Interesting Turn Of Events

[justrluk]

Good morning crew -

Some history: filed a claim for GERD in 2009. Have all proof in my service records AND an IMO from the treating physician. Had the C&P which showed the reaction on screen during the test (had to swallow the awful thick chalky stuff -gross). Been sending emails to my VSO, using IRIS to check status and getting nowhere. I'm now approaching the one-year mark on a claim that should have been a "no-brainer", and forwarded a form 9 to my VSO in preparation for the issue going to appeal. The following email transaction happens (please be patient - it's long):

VSO: Why a form 9? You use a form 9 after a statement of a case. You have not had a statement of a case

Me: I thought I had to submit within a year of notification letter denying the claim. In reading the instructions, though, it says I have a year or 60 days from the SOC or SSOC date, whichever gives me the most time. Since I've not received a SOC I assume the 1-year from notification stands? I can only guess that since they've not responded, or consider this claim closed I will end up with another appeal. I wanted to make sure the document was ready to submit as I'm getting close to the 1 year mark from the date on the notification letter denying the claim - I don't have it with me, but my email traffic with your note re: reconsideration started mid-April 2010. Let me know if I need to go in a different direction, or if I need to submit a different form.

VSO: Has the reconsideration been denied?

Me: Don't know. They insist there's been no reconsideration, so I can only guess and follow the next step in the process.

VSO: Dr. letter we sent on the GERD reconsideration in March of 2010 and the 4142 that claim was denied?

Me: I've enclosed the latest response re: the claim: (Inserted the IRIS response here) I have nothing from the VA since the letter in April 2010, and was under the impression that reconsideration was progressing. Regardless, if this is what the VA insists is the status of this claim, I'm running out of time and don't want to lose the claim date.

VSO: I have reviewed your file and the GERD has not even been touched by the VA so I have placed it in the VA system thru the Coach and you will be hearing from them immediately. the claim will have a date of claim of 1 year as of 3/10/2010. They are a year behind on the claim already so they have to jump on the claim now. So you will be really busy getting your claim completed and the other claim which has been pending also. The appeal which is certified is on hold until these claims are completed. If they are not completed prior to the file going to DC your claims won't have a chance of completing fairly without your original claim file.

My first reaction was - this is a joke, right?? My VSO's been telling me for a year that everything was fine on their end, just be patient. NOW I see this response, and don't know what to make of it. I assume this is a good thing as the claim will finally see the light of day. Any suggestions on what to do next? They should have everything they need for the decision. HELP!!

[SonnyBurnett]

Organized Disorder! Tough call for me....leave it be or fire the rep?

[Berta]

: "I've enclosed the latest response re: the claim: (Inserted the IRIS response here) I have nothing from the VA since the letter in April 2010, and was under the impression that reconsideration was progressing. Regardless, if this is what the VA insists is the status of this claim, I'm running out of time and don't want to lose the claim date."

This concerns me from the VSO"the claim will have a date of claim of 1 year as of 3/10/2010."

What is the date of the denial that you requested reconsideration on?

The VA pissed away almost my entire NOD time frame by failing to acknowledge and respond to a reconsideration request I made regarding my CUE claim.

I was able to file the NOD at the last minute (within days) manipulating my NOD to be covered by the new Lawyer for Vets regs.

I can see the VSO seems nervous about this and I sure hope he gt them moving on te claim.

This also troubles me:

"The appeal which is certified is on hold until these claims are completed."

How the hell can they certify an appeal (I assume they mean an I-8 has been prepared for the I-9 by that) if they haven't even completed the claims yet?

In my opinion the VA is under the gun so much to reduce the backlog that they are starting to manipulate their own regulations.

Did you send them the IMO yet? Did the C & P results support the GERD claim?

[justrluk]

Ms. Berta,

Thanks for looking at this. The VSO's tone was VERY nervous in the last note. This is also more information and action than I've seen in at least a year on this or any other issue. Yes- I've sent the IMO in multiple times (to the point they asked me to stop). Also, the C&P confirmed the condition. Like I said, this should have been a no-brainer, and has now turned into this mess. I assume the Coach is someone who can take action/make a decision and move this along??

The appeal is due to the VA reducing psoriatic arthritis, rated at 40%-bilateral knees reduced to 20% due to a 'pre-existing condition' for which they have no proof. I've never had problems, didn't play sports in school, etc. They didn't even do range of motion tests.

The date of the denial is 2 April 2010. I know I have a few weeks, but don't trust them. If this 'reconsideration' that now seems to have never existed dies on the vine, I want to have the request for Appeal in place (I have already signed and sent in a form 9 with instructions to HOLD until the last week of March). Really ticks me off, since the original claim date was October 2009. I never thought something so simple could turn into this big a mess.

Sonny, thanks for the feed back. Don’t think I can fire the VSO as I have an appeal in the works. If this particular claim ends up in appeal, it will be several more years of dealing with them. At this point, I'd be better off handling things myself or whish I'd have hired a lawyer to deal with these issues. Problem is I'm not right down the hall and can't just walk into a coach’s office for action.

[Berta]

I think the VSO screwed up if he/she seemed nervous.

"The date of the denial is 2 April 2010. I know I have a few weeks, but don't trust them" I hear you there.

If they don't get their thumbs out of their butts SOON ,you MUST send them the NOD before the end of the year appeal period.

I forget everyone-is that year to file the NOD exactly 365 days in VA double talk?

"I assume the Coach is someone who can take action/make a decision and move this along" I hope so.

Are you close enough to make an appointment one to one with your VSO to see what the POA file they have on you reveals?

Did the VSO submit the reconsideration or did you send it in?

[tom91]

I've had the same scenario. Whereby, I filed claim for ptsd april 2009 and was denied nov 2009. We submitted a reconsideration oct 2010, with a NOD early nov 2010 prior to my 1 year. My C&P was done dec 2010 and claim has been w/ rating board since jan 13. By all means get that NOD in before your 1 year! I was originally advised that it was not necessary but persisted and later told otherwise. Aside from being anxious on decision, I am concerned about my retro date. Every time I call #800 they advise me that my claim is dated oct 2010 (reconsideration date) vs apr 2009 (original claim date).

[broncovet]

IMHO I have good news and bad news:

First, the bad news: Its gonna take forever to get this straightened out, and you have no choice but to wait. Rookie

Raters are going to have no clue what to do with this, and it will be handed down until it eventaully arrives at a senior rating VSR's desk, and even then it is likely to get (passed on) denied and sent to the BVA.

Now the good news: According to the VBM, the Veterans remedy when the RO fails to file the required SOC is to file a writ (and valid "writs" even tho they will be denied, are an embarrassment to the RO and it seems to motivate them to get off their duff and award benefits, IMHO)

2. When the RO refuses to issue a Statement of the Case after receiving a timely Notice of Disagreement

When the RO refuses to issue a Statement of the Case after receiving a timely Notice of Disagreement from the claimant, the veteran should, after a written demand letter fails to persuade the RO to issue a SOC, petition the CAVC for a writ under the All Writs Act to compel the RO to issue the SOC so that the appellate process may be completed. The CAVC will entertain this petition because it involves a claim over which the CAVC could eventually have jurisdiction � because once the agency acts appropriately and complies with all procedural requirements, the veteran would be able to pursue the appellate process within the VA, culminating in a final BVA decision that would then be appealable to the CAVC.123