Payment Error?

[AimHigh1986]

I had heart bypass surgery on 2 Jul 09; I filed a new claim which was rec'd by the VA on 3 Aug 09. The ratings schedule says that veterans received 3 months of temporary 100% after heart bypass surgery. I received my decision letter the other day and they granted temporary 100% with an effective date of 1 Sep 09, ending 1 Nov 09. That's only 2 months. The check I received today confirmed that fact. August is missing. Should I file a NOD to tell them I disagree or can an obvious error like this be solved over the phone or through IRIS?

Thanks,

A.H.86

[Pete53]

It seems like that but VA pays one month behind

[Berta]

If it seems the VA did make an error-write to them and tell them to explain their decision on the money.

They can handle a letter like that faster than filing a NOD or any other type of request.

I had responses in 3 weeks or less when they made math errors in some of my money.(and I got the money)

If your medical evidence warranted the 3 months of temp-then they owe you the 3 months but they word things in such a way that as Pete said- they pay a month behind- and maybe they just stated the benefit wrong.

You have every right to question them as to what amount of temp they are paying.

I wouldnt depend on IRIS but maybe that too could resolve this.Worth a try and if that doesnt work, send them a letter and use the RE: initials that appear on the upper right hand side of the decision and in Attention to on the envelope and then within the letter.(get proof of mailing and keep a copy of it)

[AimHigh1986]

If it seems the VA did make an error-write to them and tell them to explain their decision on the money.

They can handle a letter like that faster than filing a NOD or any other type of request.

I had responses in 3 weeks or less when they made math errors in some of my money.(and I got the money)

If your medical evidence warranted the 3 months of temp-then they owe you the 3 months but they word things in such a way that as Pete said- they pay a month behind- and maybe they just stated the benefit wrong.

You have every right to question them as to what amount of temp they are paying.

I wouldnt depend on IRIS but maybe that too could resolve this.Worth a try and if that doesnt work, send them a letter and use the RE: initials that appear on the upper right hand side of the decision and in Attention to on the envelope and then within the letter.(get proof of mailing and keep a copy of it)

Thanks for all of your help Berta.

[JamesBreckenridge]

I had heart bypass surgery on 2 Jul 09; I filed a new claim which was rec'd by the VA on 3 Aug 09. The ratings schedule says that veterans received 3 months of temporary 100% after heart bypass surgery. I received my decision letter the other day and they granted temporary 100% with an effective date of 1 Sep 09, ending 1 Nov 09. That's only 2 months. The check I received today confirmed that fact. August is missing. Should I file a NOD to tell them I disagree or can an obvious error like this be solved over the phone or through IRIS?

Thanks,

A.H.86

Boy that's wrong. Your effective date should have been July 2, 2009, the date of your surgery. On the code sheet, the rater should have input 100 percent from July 2, 2009 to October 31, 2009 (the end of the third month), and scheduled an exam in November to determine what your current level of functioning is for your heart. Otherwise, how do they know what to lower you back down to. If you have not already been scheduled for an exam, put in for one.

Do you have any other disabilities beside the heart condition? If they add up to 60 percent, you would also be eligible for Special Monthly Compensation due to Housebound Status, since you would have a 100% for those 3 months plus a separate 60%.

Sounds like a VERY green rater.

[AimHigh1986]

Boy that's wrong. Your effective date should have been July 2, 2009, the date of your surgery. On the code sheet, the rater should have input 100 percent from July 2, 2009 to October 31, 2009 (the end of the third month), and scheduled an exam in November to determine what your current level of functioning is for your heart. Otherwise, how do they know what to lower you back down to. If you have not already been scheduled for an exam, put in for one.

Do you have any other disabilities beside the heart condition? If they add up to 60 percent, you would also be eligible for Special Monthly Compensation due to Housebound Status, since you would have a 100% for those 3 months plus a separate 60%.

Sounds like a VERY green rater.

Thanks for the info James. I did have several C&P exams for my heart, and they rated me at 10% for heart disease effective 1 Nov 09. They also increased my SC hypertension from zero to 10%. I can live with that, but like you stated I should have had the temp 100% from 2 Jul 09 to 31 Oct 09. Do you think I can use IRIS to correct this or write a letter?

As for my other disabilities, I was 70% for sleep apnea, migraines and a bad hip. How would I apply for Special Monthly Compensation due to Housebound Status?

Thanks again,

A.H.86

[JamesBreckenridge]

Thanks for the info James. I did have several C&P exams for my heart, and they rated me at 10% for heart disease effective 1 Nov 09. They also increased my SC hypertension from zero to 10%. I can live with that, but like you stated I should have had the temp 100% from 2 Jul 09 to 31 Oct 09. Do you think I can use IRIS to correct this or write a letter?

As for my other disabilities, I was 70% for sleep apnea, migraines and a bad hip. How would I apply for Special Monthly Compensation due to Housebound Status?

Thanks again,

A.H.86

Well, it's probably going to have to take an actual claim, rather than something that can be fixed with a phone call. Sorry.

Fill out a Form 21-4138, and say something along these lines:

"Per the rating schedule for heart bypass surgery, I am entitled to three months of a temporary 100 percent rating. I only received 2 months. The effective date should have been from July 2, 2009 (date of surgery) to October 31, 2009 (last day of the third month). I have been shorted one month of temporary 100 percent evaluation.

Also, as an inferred issue, I should have been granted Special Montly Compensation due to being "Statutory Housebound," because I was in receipt of 100 percent for my heart condition, and had other disabilities (sleep apnea, migraines, and hip) which combined to 60 percent or more."

That should do it.