C&p Report Question

[bufloguy]

All,

I got the results from my C&Pexams for TBI, Back & Neck,and noticed that the PRIORITY OF EXAM: is for an Incease. Why would Increase be the priority if these are initial exams. Any input would be appreciated.

[carlie]

http://ecfr.gpoaccess.gov/cgi/t/text/text-....69&idno=38

§ 3.160 Status of claims.

The following definitions are applicable to claims for pension, compensation, and dependency and indemnity compensation.

(a) Informal claim. See §3.155.

(b) Original claim. An initial formal application on a form prescribed by the Secretary. (See §§3.151, 3.152).

© Pending claim. An application, formal or informal, which has not been finally adjudicated.

(d) Finally adjudicated claim. An application, formal or informal, which has been allowed or disallowed by the agency of original jurisdiction, the action having become final by the expiration of 1 year after the date of notice of an award or disallowance, or by denial on appellate review, whichever is the earlier. (See §§20.1103 and 20.1104 of this chapter.)

(e) Reopened claim. Any application for a benefit received after final disallowance of an earlier claim, or any application based on additional evidence or a request for a personal hearing submitted more than 90 days following notification to the appellant of the certification of an appeal and transfer of applicable records to the Board of Veterans Appeals which was not considered by the Board in its decision and was referred to the agency of original jurisdiction for consideration as provided in §20.1304(b)(1) of this chapter.

(Authority: 38 U.S.C. 501)

(f) Claim for increase. Any application for an increase in rate of a benefit being paid under a current award, or for resumption of payments previously discontinued.

[darkhorse]

Don't worry bugloguy...Remember, examiners are human too and this was probably just a mistake.

Are you already SC for these conditions?

dh

All,

I got the results from my C&Pexams for TBI, Back & Neck,and noticed that the PRIORITY OF EXAM: is for an Incease. Why would Increase be the priority if these are initial exams. Any input would be appreciated.

[bufloguy]

Now thats the rub, I am not SC for any of the conditions,

Here is my history:

- In 1989, while on active duty I was involved in 2 separate car accidents, both involving injuries to my back, neck & head.

- The second accident was considered poly-traumatic; I was unconscious for several hours, lost 3 days of memories, sever whip-lash, broken rib, clavicle, fractured shoulder blades ect.

- The accident and all my injuries were well documented in my SMR's, including 2 years of pt for my back and neck.

- Unknowingly I was suffering from TBI & PTSD, and did not re-enlist after 6 years.

- I was granted 10% in 1991 for week foot condition, and during the VA examination - I brought up the car accident to the examiners attention, and was advised that since it didn’t happen during work it was not covered.

- Within a year of separation I started seeing a chiropractor for back & neck pain.

- In 1995, I filed an unassisted claim for back, neck, poor memory, and sever fatigue.

(I do not even remember filing this claim until I got my C-file)

- The claim was denied without a C& P being performed; they had the evidence of the accidents in my claim file& documentation from my chiropractor. What they didn’t have in my file was a nexus letter sent by my chiro to the RO. I happened to find a copy of the letter in my records.

So could the exam for an Increase be due the claim being "reopened" or bacause the RO made a mistake when they denied me 10 years ago?

[jbasser]

Your 10 year old claim was final. What was the claim for?

It will be treated as a claim to re-open.

Did the denial show the Nexus letter you had from the Chiropractor?

If they did not do a C&P exam and there was only 1 medical opinion then I dont see how they could deny your claim.

Can you scan the decision and cross out all of your personal information.

I would like to see it.

Hang in there.

J

[JamesBreckenridge]

When a VSR fills out the computerized exam request form, there is a drop down for "priority of exam" Unless it's your very first claim ever, we just use "increase" instead of "original". There are some other options like "Terminal" but fortunately I've never had to deal with a case like that one. Given the length of time involved in the claims process, I really don't think the "priority of exam" box means much of anything. I doubt it makes the hospital move any faster unless it's "Terminal" and you put in the exam request something like "VETERAN IS DYING PLEASE EXPEDITE!!!"

Edited October 6, 2009 by JamesBreckenridge

[bufloguy]

J

I've attached the info you requested (It's a pdf):

page 1 is the claim

page 2 is the chiro's nexus letter

page 3 & 4 is the first denial

page 5 & 6 are the second denial.

Thanks for taking the time to look at this. Thanks!

1995_Claim.pdf