Als Claim

[mom24]

Hello,

I posted a question before I believe in wrong place because I didn't get any response. So, I'll post here and try to be brief. I filed claim for ALS on 9/24/08. Had to get a VSO with PVA to get ball rolling for me. He did. I was scheduled for a C&P exam on 2/23/09. The dr who did the exam had me scheduled for an EMG to confirm the diagnosis. I wasn't happy with how exam went and let my VSO know about. On 2/27/09 I received an award letter being rated 60% for ALS for a combined 70% with my knee disability from before. I immediately called my VSO because the rating decision was made on 2/23/09, the day I had my C&P exam, which wasn't even concluded. AFter a couple of days, he got back with me to let me know the rater told him she rated me just so I could start getting some compensation because it would be 20-30 days before she got results from exam back, and when she got the results from C&P exam, she would rate me again. Fast forward to last week. On Tuesday, I emailed my VSO for an update. Didn't hear back from him by Thursday, so I called the 800# and was told my claim was closed with no further action pending unless I appealed. I then left another email for my VSO and and a voice mail message. On monday morning I got email from VSO saying he would pull my file and see what was going on. I then, that same day, went to VAMC to request a copy of C&P exam and was told it wasn't done! The lady at release of information office could only pull off a progress note dated 3/13/09 from the Dr. who did my exam stating that a C&P exam was scheduled by VARO on 2/3/09, but then cancelled before the date I had it which was 2/23/09. Nobody notified me or the VAMC of this since I had my exam as scheduled. The dr's note from 3/13/09 also gave results of EMG. The lady at release of information called down to C&P office to see what was going on. I was able to go down there and actually speak to the Dr. who did my exam. I had my award letter with him and explained to him how I was rated based on medical records from my dr that I submitted and why they were not sufficient for VA rating purposes. I asked him if he still had notes from my claim and he did. He said that after he got results from EMG and went to enter his findings in the computer, the screen for him to enter it wasn't there. HE then saw where the exam had been cancelled citing adequate medical evidence already received as the reason. He read over my notes again and actually examined me again. We talked some more and then he called the rater while I was in his office and let her know that he still had his notes from my C&P exam and he could type them up if they would be of some use to her. He told her that medical records I submitted from my dr. contained more diagnostic information about my condition than functional. I know the exam would have either brought me to 100% or the claim I filed for IU at same time I submitted back in Sept would have been approved based on his notes. Rater had also denied my claim for IU because I homeschool my children. Now, on Friday, I also submitted a IRIS inquiry and they answered me on Monday to say that they reviewed my file but needed clarification from the Regional Office before they could give me a status. I was able to update them with the information I got from the Dr. who did my exam on Monday. So, now it is Wednesday, and I still have not heard back from my VSO and still waiting to hear back from IRIS inquiry. Right now, I'm just giving my VSO and IRIS time to respond before I do anything else like a Congressional Inquiry or something. Any advice?

[ZenArcher]

mom24, I would recommend that you attend a MDA sponsored ALS clinic if you are able. They have been a great help in numerous ways. Each visit you will speak with any and all specialties needed as well as a social worker with experience in ALS and the VA. I can't say enough about the help they've been to my family and I.

[mom24]

Good news, I hope. I got word from VA through the IRIS Inquiry that my claim has been reopened and that they will use results from my C&P exam. After the doctor types them up, it will go back to the rating board. I double checked this out by calling the 800# and they verified it has been reopened awaiting results from C&P exam.

[mom24]

Good news, I hope. I got word from VA through the IRIS Inquiry that my claim has been reopened and that they will use results from my C&P exam. After the doctor types them up, it will go back to the rating board. I double checked this out by calling the 800# and they verified it has been reopened awaiting results from C&P exam.

Well, not so good news, as it turns out, but I believe it is typical after all I've read. I got the new decision today. They did use as evidence the results of the C&P exam I had. First, let me say, the C&P exam was a joke. I thought it would be after the way the exam went. The dr. forgot to mention things he told me he had written down. I'm not surprised by this, though. What I am surprised by is the fact that the things he did mention that would have increased my rating, the rater totally ignored. My reopened claim was treated as a reconsideration of what they had already rated me on and the percentages stayed the same. I didn't expect any increase on what I was already rated for. I did, however, expect to be rated on the different things mentioned in the C&P which were not in my private medical records. Like I said before, the C&P dr didn't put in there all the notes he took and read back to me, but he did put in there about my hands. After looking over my c&p exam, I knew the only thing they would be able to rate me for would be for my hands. They didn't and didn't even reference any of the dr's notes about them. They just ignored it. Only thing they mentioned was his notes about my arms and legs. Of course, they denied the IU claim again, because there was nothing in the C&P exam except me stating I stopped working because of the weakness in my hands and wrist and that I had little use of my left hand. This is not why I told him I stopped working, btw. Ok. I'm not mad about any this and really I am not very surprised. I'm only concerned with how to proceed.

I did apply for SSDI on 5/06/09 and claim was approved in 30 days on 6/5/09 (Thanks for urging me to do that Pete and Berta!). They reopened a claim I filed back in Jan 08. Apparently I missed the 4 year window for one I did in Jan 05. That's fine. But then claim was selected for quality review and caseworker said they have until 8/4/09 to be done with it. So after getting claim approved in 30 days be cause it was a compassionate allowance (CAL) case, I have to wait 2 extra months. Then I check around on the internet and find out they can deny you after you've been approved. My caseworker said my claim would be ok, so I'm going to trust her on that.

So, I have already talked to my ALS dr whom I saw today and she will write va a letter stating that my condition prevents me from working and that it is permanent. I'm hoping with a letter from my dr and the award letter(when it comes) from ssa, the va would have a hard time denying me IU. I still will need to claim IU because, I just may not make it to schedular 100% because of my slower progression. I'm going to try, but I'm not real sure about that now. I do have an appt scheduled with the VA clinic where I live next week. This will be my first visit and I will make sure to tell them everything and am hoping that will help me get evidence for all the problems I have because of this disease. I think the VA doctor may be better than my private dr for the purposes of my claim. I can kinda start fresh, by telling the va dr everything that is affected and hopefully, they will appropriately assess each condition. From their I can build my claim with stuff the VA just ignored and stuff even my dr at the als clinic doesn't mention. Bless her heart, she just compares me with other ALS patients and if you do that, then I'm doing pretty good. She was surprised that va only gave me 70% though. Anway, I'm planning to file a new claim with new medical evidence(once I get some) my ssdi award letter and letter from als clinic for IU. I can easily see me getting to 90% and being stuck there for a while. I really don't expect any new progression other than where I am now for a long time. At least not enough for any increases. It took me years to get to this point. That is just how slow my progession is. IU is a must have for me. Not to mention, healthcare for rest of family, college for 4 kids(not for a long long while yet and I'm sure by then I would be 100%) and just paying the bills, you know.

Any advice about my plan if you could understand it. I'm a rambler, sorry.

[sharon]

You seems to have a plan already. When you get the information from SSDI ask for reconsideration on this claim. That way it will go back to the rating board.

[ZenArcher]

I filed for an increase after every clinic visit. I was initially connected at 70% in 9/08 and immediately filed for an increase because the information they used was over 3 months old. On that run I was granted 100% with SMC L retroactive to 12/23. In May I went to Advocacy Days in DC and had the pleasure of meeting Bo Rollins the director of field services for PVA. He called my local service officer and effective May 18 I was granted SMC R1.

My advise is that following each clinic visit that shows progression you submit for an increase. Ask the clinic if you can have copies of your visit report and make sure the doc, OT/PT and the rest note any new issues specifically. My clinic has been very accommodating in this respect. Ensure that everything goes through the PVA. The majority of issues we see on the ALS Veterans Issue Team are from individuals who opt to do it themselves. PVA and ALSA have worked very closely together and in most cases things have gone smoothly.

[Berta]

Did you formally apply for TDIU with the VA form 21-8940?

If the SSA is solely for the same VA SC condition, they must consider it and award TDIU.

Make sure you send them an authorization form (they should send one to you but these forms are at the VA web site- to get the SSA records.

The doctor's statement you have should help considerably too-

did you get copy of the actual C & P results?

They parse and manipulate these C & P reports in the SOCs.

And they can leave out critical info the doctor stated in the actual report.