Need Help Getting Nowhere With The Va

[foleyj]

This was the original post with the background information;

I am hoping that there is someone here that can help me with this. I am SCD 20% for DDD and had spinal fusion of L4-L5 on 7/8/2009. I was admitted to the hospital on 7/8/2009 and released on 7/12/2009. I was given a letter from the discharging surgeon that I would require 3 months of convalescence. I submitted a claim on 8/7/2009 for a convalescence rating of 100% for the 3 month period that I would be on convalescence. I received my decision on 1/25/2010, here is where it gets confusing. I will first post the decision and then I will point out the things that I think are confusing according the the regulation.

Decision:

An evaluation of 100% has been assigned effective August 7, 2009 based on surgical or other treatment necessitating convalescence. Hospital records indicate that you underwent L4-L5 laminectomy and S1 fusion, on July 8, 2009. The statement from the physician indicated that you would need a three month period of convalescence. The 20 percent is continued form November 1, 2009, first day of the month following your three month period of convalescence. The effective date of the temporary 100 percent evaluation is August 7, 2009, the date we received your claim for benefits. The effective date of reduction back to 20% is November 1, 2009 the first day of the month following your release from the convalescence period.

Points of Confusion:

1. The rating decision assigned the effective date of the convalescence as 8/7/2009 which was the date the claim was received. According the 38CFR 4.30 A total disability rating (100 percent) will be assigned without regard to other provisions of the rating schedule when it is established by report at hospital discharge (regular discharge or release to non-bed care) or outpatient release that entitlement is warranted under paragraph (a)(1), (2), or (3) of this section effective the date of hospital admission or outpatient treatment and continuing for a period of 1, 2, or 3 months from the first day of the month following such hospital discharge or outpatient release.

The effective date should be the date of hospital admission which would have been 7/8/2009, not 8/7/2009 which was the date the claim was received.

2. Even though they assigned the effective date as 8/7/2009 I was only paid for 2 months instead of the 3 months that was given by the order from the doctor. I was only paid for September and October the rating went back to 20% on November 1st.

I am not sure why I was only paid for 2 months even if they had the wrong effective date.

So what I need is, first for someone to look at this and make sure that I am not mistaken in my assumptions that the rating was not assigned correctly. Also if it is correct what is my next course of action? Do I file and NOD? A letter of Reconsideration? Or a CUE claim? Any help would be appreciated.

Thanks

Jason

So I sent in another letter requesting a re-evaluation of the the claim, and again I got another decision letter explaining that I was paid for the convalescence, which again is only 3 months. I sent the last one through my VSO, so is there something, or someone else that I can contact to help me with this? Sending the letters do not seem to help because whoever is reading them is not reading the regulation that I include with it. PLEASE HELP!!!!!!!

[Pete53]

Many think that they are shorted a month but it is the way the VA pays. On August 1st the VA pays for July or they pay a month behind.

[Berta]

I think you are right-that the day of admission is the effective date-

maybe someone got 7/8 mixed up with 8/7 dates.

I would ask them to reconsider this decision as to the Effective date.ASAP.

Send them whatever you think will help them comprehend this ( actually the reg and Hospital admission report should be all they need (and already have) as if this is not corrected ASAP it will affect this:

"The effective date of reduction back to 20% is November 1, 2009 the first day of the month following your release from the convalescence period."

I would send this with Attention to: on the envelope before saying VA Regional Office etc and then on the Reconsideration Request attention to the Initials of the rater that appear in the upper right hand corner with the numbers that designate the VARO.

What you got as the EED does not seem to comply at all with what the regs say.

It makes sense. How could someone have surgery in July but only be considered convalescing in August? DUH.

Edited July 22, 2010 by Berta