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Help! Need Answer Fast


jessie0054

Question

Help!!

Son just got off the phone with the folks on the 1-800 line.

They are telling him that because he summited new material with his letter of reconsideration it is now a re-opened claim.

When we sent the Letter of Reconsideration on the rating decision i sent copies of material that was already in the file and highlighted the areas i wanted them to pay attention too along with a article of the Blood Journal that gives the guidelines for the treatment of his diease to get them to understand that when his Blood HCT levels are above 45 he is to have a phlebotomy. [ he had been denied a phlebotomies by the VA because they said his HCT wasn't high at 52 and was within their norm.]

They now want to schedule another C&P exam!!! What's the point!! All the evidence is in the file and just needs to be given the correct rate for the condition!!!

His SO is out of his office and will be out for a long period of time due to his own health.

So what do we do to get this thing moving again???

Anyone!!

Thanks

Jessie

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  • Moderator

Jesse, what stage is the claim, Was it denied at first. If so are you in the 1 year period after the denial?

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Jesse, what stage is the claim, Was it denied at first. If so are you in the 1 year period after the denial?

Hello jbasser

And thank you for your reply.

His claim according to his SO 3 -4 weeks ago was surposed to have gone to the rating board to see that it was ready to rate.!!

They[ the raters] were trying to determine at that time if he needed another C&P.

The SO pulled his file and took it to the raters and told them that another C&P was not needed as he has all the evidence in the file to show that he has the condition and is receiving phlobotomies and that another C&P was a waste of time.

The SO reported to me that if the rating Spec agreed then he would have it rated. [ that was then]

No: it wasn't a denied claim he was service connected for the condition [ in April 07] but was given a 0% rate and he should have been given a 40% rate because he is receiving phlebotomies now every 3 weeks.

He received the rating decision on this claim in April 07 and we ask for the reconsideration in May 07.

So now what do we do!!!

Jessie

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Hello jbasser

And thank you for your reply.

His claim according to his SO 3 -4 weeks ago was surposed to have gone to the rating board to see that it was ready to rate.!!

They[ the raters] were trying to determine at that time if he needed another C&P.

The SO pulled his file and took it to the raters and told them that another C&P was not needed as he has all the evidence in the file to show that he has the condition and is receiving phlobotomies and that another C&P was a waste of time.

The SO reported to me that if the rating Spec agreed then he would have it rated. [ that was then]

No: it wasn't a denied claim he was service connected for the condition [ in April 07] but was given a 0% rate and he should have been given a 40% rate because he is receiving phlebotomies now every 3 weeks.

He received the rating decision on this claim in April 07 and we ask for the reconsideration in May 07.

So now what do we do!!!

Jessie

jbasser I forgot to add that the claim was filed in Feb 06 it that make a difference.

Jessie

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jessie, your son doesn't need to do anything. if he is confident that the board has all the evidence it needs to increase his evaluation, he can simply not report for the exam, and the claim will be rated on the evidence of record.

at this point the claim is considered a reopened claim for processing purposes, just a category that the regional office can keep track of. if the additional evidence has been submitted within the one year appellate period, that will be taken into account when the effective date is determined.

as for your SO telling you he "pulled the claim" and took it to the rater to show him it was ready to rate... highly unusual. but if your son wants to find out if the claim is considered ready to rate, the folks at the 800 number can tell him.

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I agree with entropent in part and disagree in part. I agree that he doesnt need to do anything now, but I am not sure it is ever a good idea to skip a scheduled C&P exam. Reason: I recall reading somewhere about an "abandoned" claim..that is, it sounds like the Vet abandoned his claim by skipping a C&P exam virtually guarnteeing the claim be denied.

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I agree with entropent in part and disagree in part. I agree that he doesnt need to do anything now, but I am not sure it is ever a good idea to skip a scheduled C&P exam. Reason: I recall reading somewhere about an "abandoned" claim..that is, it sounds like the Vet abandoned his claim by skipping a C&P exam virtually guarnteeing the claim be denied.

I've read the same regarding the abandonment of a claim (i.e., not showing up for a c&p exam).

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I've read the same regarding the abandonment of a claim (i.e., not showing up for a c&p exam).

Thank you for your replies:

I agree that he should not miss another C&P if one is ordered. I had read that somewhere too!

So if he does nothing and lets the claim go forward as a RE-Opened claim. does that mean that he will lose any retro back to the opening of the claim back to Feb. 06??

Jessie

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the "reopened claim" that he was told about on the 800 line is what is known as an "020." it is merely a tracking method. when the rater gets the claim, he will assign an effective date in accordance with applicable law. meaning that, if an increase is warranted, it can go back to the date he submitted his original claim for increase. provided that his condition met the criteria for increased evaluation on that date.

the "abandonded claims" provision does not apply here. if your vet is concerned about this, he can call the 800 number and explain that he cannot make the exam, and to please send his claim to the rating board on the evidence of record in the file. they will gladly do so. again, this is only if he is quite confident that he has submitted evidence sufficient to warrant increased evaluation. chances are pretty good that if he has had a va examination within the last year, the rater will not schedule him for another one, anyway.

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the "reopened claim" that he was told about on the 800 line is what is known as an "020." it is merely a tracking method. when the rater gets the claim, he will assign an effective date in accordance with applicable law. meaning that, if an increase is warranted, it can go back to the date he submitted his original claim for increase. provided that his condition met the criteria for increased evaluation on that date.

the "abandonded claims" provision does not apply here. if your vet is concerned about this, he can call the 800 number and explain that he cannot make the exam, and to please send his claim to the rating board on the evidence of record in the file. they will gladly do so. again, this is only if he is quite confident that he has submitted evidence sufficient to warrant increased evaluation. chances are pretty good that if he has had a va examination within the last year, the rater will not schedule him for another one, anyway.

entropent:

Thanks, I think i get it now!! Sorry so slow, My mind is working in overtime trying to work with My son, My husband, My brother and Brother in law's Claims.

We are very confident that there is enough evidence submitted already to rate the claim that warrants the increased rating.

It that's not enought evidence i still have 6 months of recent phlebotomy report. I just haven't sent them as i didn't want to slow down the decision.

Jessie

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  • Moderator

Jesse, have him write a 21-4138 and put these words on it.

Previous information submitted. ( Attach a Copy) was an official request for reconsideration, Not an appeal or a request to reopen the claim.

Explain that you are well within your NOD period of April 07.

You can also ask for a DRO review of this decison (0) percent.

They are missing the point on this one. Maybe just a delay tatic being used.

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Jesse, have him write a 21-4138 and put these words on it.

Previous information submitted. ( Attach a Copy) was an official request for reconsideration, Not an appeal or a request to reopen the claim.

Explain that you are well within your NOD period of April 07.

You can also ask for a DRO review of this decison (0) percent.

They are missing the point on this one. Maybe just a delay tatic being used.

jabasser:

Thank You:

This is what i was looking for!!

jessie

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jabasser:

Thank You:

This is what i was looking for!!

jessie

jbasser, one more question!!

When we send in the 21-4138 do we go ahead and send the last 6 months of Phlebotomy records and the results of the recent blood studies that confirm his diagnosis of Polycythemia Vera which was the diagnosis and was Service Connected that gave the 0% rate in the first place that we were asking for the reconsideration for to bring the rating up to the 40% rate which it should have be awarded in the first place.

Or would this further complicate the issue??

Thanks,

jessie

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  • Moderator

Yes, but on each page. ( Information per VA record. not new) If you have a POA,, let them do the leg work. Send the certified copy to the Ro and send a copy by fax to the VSO. The VSO should be able to run interference if they are any good. Of course al lot of them are just claim sponges. (sit back and write claim after claim with no follow up whatever)

J

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Yes, but on each page. ( Information per VA record. not new) If you have a POA,, let them do the leg work. Send the certified copy to the Ro and send a copy by fax to the VSO. The VSO should be able to run interference if they are any good. Of course al lot of them are just claim sponges. (sit back and write claim after claim with no follow up whatever)

J

jbasser:

Thanks for your guidence!!

The Phlebotomy reports i was referring to are NEW since we wrote the Letter of Reconsideration back in May 07.

So i'm not to submit any new records? Just a copy of those already in the file with the " information per Va record, Not New" on each page? I don't want to confuse them anymore than they are already!!

Jessie

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jbasser:

Thanks for your guidence!!

The Phlebotomy reports i was referring to are NEW since we wrote the Letter of Reconsideration back in May 07.

So i'm not to submit any new records? Just a copy of those already in the file with the " information per Va record, Not New" on each page? I don't want to confuse them anymore than they are already!!

Jessie

Attn: jbasser!!!

I have the form 21-4138 ready to send in.

Do i send any new records in with this as i am trying to get them to respond to the Letter of reconsideration sent in May 07. That they are calling a reopened claim!!

Jessie

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