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Claim Denied


ddj6969

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I just recieved my rating decision on my claim of athletes foot. I was given a service connection but given a 0% rating.

The only evidence used was my SMR's and a examination from my Dr., I was not given a medical exam by the VA.

The VA states "We have granted a service connection for your athlete's foot because your SMR's show you were treated for and diagnosed with athlete's foot while on active duty. We have assigned a 0 percent disability evaluation based on private medical evidence that reveals you have athletes foot on your left foot. It was noted you were prescribed topical medication for control. A noncmpensable evaluation is assigned unless there is difigurement; limitation of motion or fnction due to scarring; pain on examination of scars; frequent loss of covering of skin over scars; or dermatitis or eczema affecting at least 5 percent of exposed areas or requiring systematic therapy."

The part they left out was that my Dr. stated I have over 50% of my foot covered.

I have prepared my appeal letter but am looking for any advice on how to proceed.

Thanks

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I am not one of the elders on this Hadit forum. I am pretty new to the Hadit family, myself. But, it is interesting that I was just in a conversation with a rating specialist on this same subject matter (not the foot...but the 0% SC decision).

He told me that most vets end up going years on a claim because it gets drug out through the process of NOD and appeal(s). He said there is a time to NOD and appeal; and there is a time when you simply file a new claim. In your case, I would think what he was telling me would apply.

He said anytime you file a claim for SC and it is awarded but you are not satisfied with the rating decision overall, don't appeal it. He said file a new claim for a rate increase because it gets "worked" a lot faster. He also mentioned that the new claim generally ends up with a "new" rating specialist (fresh eyes) and he has seen the "rate increase" almost given out in less than 3-4 months. I don't know if others here have heard this...but with all the things that are happening in the RO's these days...it might be worth a shot.

File a new claim for rate increase with your new info/medical evidence and let a "fresh pair of eyes" handle it. I still have a claim pending right now. If something comes back that I'm not happy with, I think I will take into consideration just filing a new claim it almost sounds more logical. Anyway, I know others will be along shortly to offer their advice and wisdom. Good luck in your endeavor, which ever way you choose to go.

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I'm a newbie to the board.....that sounds logical, but wouldn't that nullfy any chances of retro pay?

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hi ddj, you said, "my Dr. stated I have over 50% of my foot covered"

this would still be zero percent under the rating schedule, because the foot is a non-exposed area. exposed areas are the hands and face. if you had 5 to 20 percent of non-exposed areas involved, that would warrant a 10 percent. but if it only involves the one foot, no dice.

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.....He said anytime you file a claim for SC and it is awarded but you are not satisfied with the rating decision overall, don't appeal it. He said file a new claim for a rate increase because it gets "worked" a lot faster. He also mentioned that the new claim generally ends up with a "new" rating specialist (fresh eyes) and he has seen the "rate increase" almost given out in less than 3-4 months.

luv,

what the rater told you is interesting, but i do not believe it would work in all cases. raters are assigned work based on the last two digits of your claim number. if your number is 123456789, then the rater who is responsible for the 89 digit will rate the claim, and will get the reopened claim as well. so i do not believe it is a given that you will get a fresh pair of eyes on the case.

on the other hand, you definitely get a fresh pair of eyes on the case if you appeal, because the case goes to the dro. and while appeals can certainly drag on for years, generally speaking (very generally speaking!) the initial review will take about the same amount of time as a reopened claim.

but in ddj's case, a fresh pair of eyes won't really help. athlete's foot is only going to be zero percent anyway, imho.

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  • HadIt.com Elder

ddj, I have claimed for SC "rate increase" and it seems to work. The issue is already SC, so an increase is requested and for further justifcation backed up with the specific rating schedule, regulations and IMO as needed. Good luck,cg

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"He said anytime you file a claim for SC and it is awarded but you are not satisfied with the rating decision overall, don't appeal it. He said file a new claim for a rate increase because it gets "worked" a lot faster. He also mentioned that the new claim generally ends up with a "new" etc-

This is absurd advice.

Then again what better way to save money for the VA.

If the vet doesn't appeal and then files for higher rating as a new claim-

the retro money that the appeal could have awarded - is lost.

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I'm a newbie to the board.....that sounds logical, but wouldn't that nullfy any chances of retro pay?

Yes, I'm sure that it would lower the amount of retro but you would still get the retro from the date of your claim. So, it might not be years of it but a few months. That is probably why he did say "there is a time to NOD and appeal." Every situation/claim would be different, I'm sure.

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"He said anytime you file a claim for SC and it is awarded but you are not satisfied with the rating decision overall, don't appeal it. He said file a new claim for a rate increase because it gets "worked" a lot faster. He also mentioned that the new claim generally ends up with a "new" etc-

This is absurd advice.

Then again what better way to save money for the VA.

If the vet doesn't appeal and then files for higher rating as a new claim-

the retro money that the appeal could have awarded - is lost.

Berta, it may be "absurd" advice to the veteran who doesn't mind waiting years for his/her appeal. I have a new claim being worked but my claim dated 2003 is STILL on appeal. I think it is a personal thing and really depends on the individual veteran situation. But it is just FYI/INFO not me saying someone should do this or not. Frankly, I like the idea of "fresh eyes" looking at my claim, especially when I have seen in another thread that a rating specialist stated that he "...decides a claim depending on what side of the bed he got up on."

I, personally, have been receiving SSD since 2005 and I'm not interested in a mega retro check. My life has not stopped, which means my bills still need to be paid. So, hey, it may not work for you or others. But if my new claim is favorably decided within the next 60 days, I will definitely be okay with that, big retro or not.

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"I'm a newbie to the board.....that sounds logical, but wouldn't that nullfy any chances of retro pay?"

I think you are right on the button Sidney-

Say vet gets award for 30 % PTSD in 2002 and does not appeal or NOD the award.Lets say the claim had been at the VARO for 1-2 years already.and disabilities can get worse from the time the initial claim is filed- lets say -The medical evidence warranted a higher rating then 30% but the vet didnt appeal that rating.Or the vet also got SSA award for PTSD during or after time of the 30% grant.

The vet waits until 2005 to file a "new claim" - a TDIU claim -with a 21-8940.

The vet is awarded TDIU back to the date in 2005 that he filed the TDIU claim.

The vet NODs and sends them the SSA award. The VA grants one additional year of retro due to the SSA award (back to

2004).

Yet still if the 30% should have been higher in 2002-

at 50%, 70% or even TDIU - the vet has lost all of that potential retro by not appealing the original decision and rating.

My husband was a good example:

30 % from 1983 to 1988

he got into voc reb and I already bored everyone with what happened.

One semester and the VA proposed to reduce him to 10%. 1988

I filed a NOD for him. 7-8 months later they dropped that idea and restored him to 30%. 1989.

In 1992 a VA doctor told him the 30% was way too low and he filed for higher rating.

I dont even remember him filing formally for TDIU.

In 1993 SSA awarded him SSA solely for PTSD.

In 1997- 3 years after his death

VA awarded him 100% SC P & T for PTSD back to 1991.

Say VA had denied his claim for higher rating he filed in 1992-and he never appealled it.

Then lets say he lived long enough to apply for TDIU in 2003.

Maybe the VA would have granted an additional year retro to the 2003 claim- due to his SSA award but he forfeited 9 years of retro by not pursuing the 1992 denial.

One doesnt go from 30% to 100% overnight either-he had to have been 50 and then 70 and then 100% but

the VA never accounted for that at all.

They aren't going to give staged ratings unless the vet makes a point of asking for it and NODs and continues their appeal until they get what they want-and this way they preserve their EED for the proper retro.

Edited by Berta
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Thanks for the great replies everyone!

I have filed my appeals and am wondering what to expect next?

I really have no clue so if someone could give me the step by step I would appreciate it.

Thanks

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  • HadIt.com Elder

Berta pretty much says it all. Filing a new claim changes the effective date and you also are required to bring new and material evidence up to get back in the door. Latley the VA has taken these refiled claims if there was exposure for many back years.

Even though it appears that nothing is happening as a claimant you can take some steps to shorten the process. I recommend that you notify the VARO that you are ready to proceed and rate your claim and that you want them to use the evidence that they have.

If you are early in the claim you can go to your VAMC and get all the progress notes and take them to your VSO to send to the VA. Don't forget to notarize any statements you send including buddy letters. See if you can get your Medical Records I ran around Dallas and got some myself.

Call them and see what status ask you VSO to call and ask how the claim is doing. Its a free call and yes they talk to each other.

My Last Claim for HB benefits was done in under 4 months and my Dro Hearing was today in under 6 months. When I took my C&P I signed a STatement that I was ready for them to rate with the evidence that they have.

Good Luck

I would never refile I think it is a mistake keep the claim working.

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  • HadIt.com Elder

If you file a new claim as opposed to an appeal you lose the earlier effective date of the original claim. That is why you appeal to keep the effective date. If you file a new claim the ED will be the date you filed for increase. How long did it take to get the original rating?

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ddj,

I agree with entropent concerning,the rating will stay at 0 percent (with your current evidence).

jmho,

carlie

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