diabetes Oooooops! Va Paying Too Much?

[Lorraine]

Hope this is the correct forum for this, if not, hope you moderators catch this and put it in the correct forum.

My Vet has had numerous changes in his compensation dollar amount since his initial claim. We got his first check Dec.2011 and the retro. He got 60% for AO/IHD, then the VA suggested he file an additional claim for diabetes type2 and PAD (they'd found these dx's in his medical records)So, after C & P and filing the paperwork, then he got rated at 70%. Because he's 20 yr retired AF, he'd also filed for CRSC for the 60%, then had to file again for the increase to 70%,, then there was the COLA raise, so you can see why the reimbursement was frequently changing. I thought it was finally all done so went to the new 2012 table to make sure he was getting the correct amount and it appears he is receiving $99 too much for a 70% rating and having a spouse. That looks like the amount awarded for AA, but he/we don't qualify for that.

So, my question is - how do we rectify this? Write to them (where??--Regional office?)and send it certified mail and keep a copy for our files? I assume we'll have to pay them back? I don't have a clue how long this has gone on because it all got so confusing with the frequent changes so I guess I'll have to leave it up to them to figure it all out!(that doesn't make me very comfortable!)

I guess I should be thankful that I looked this up today and didn't end up getting dinged for it 5 yrs from now!

Thought this was all done and that I could quit leaning on you folks at Hadit to walk me through all of this, but here I go again asking for some advice. Sure glad we were financially in a position to follow Carlie's advice to not just BLOW the retro and be cautious, we've been nervous that something would happen and they'd end up saying they made a mistake or something. Talk about creating your own reality!!

Lorraine

[johnjjr]

Has he been awarded SMC K for ED. That would explain the extra $99.

[Chuck75]

The combination of DMII, IHD, and PAD can easily result in ED, as well as PN. SMC K is likely. I'd wonder if the vet was properly considered for TDIU. 70% may be low.

[johnjjr]

I was wondering the same, Chuck. I'm schedular, P&T, for IHD, DMII, and PN w/SMC K. He has all that plus PAD. Sure sounds like a lowball to me. IMHO, I would file for TDIU and ask for P&T.

[Philip Rogers]

I agree, it may be a "k" award but it should be explained in the award letter. That being said, I don't believe it's your responsibility to audit the amount the VA is paying. You can advise them or you can wait until they realize there's an overpayment(if there really is) and when they request repayment, request a waiver cuz it wasn't your fault. You could also hold it in a separate bank account, accruing interest, and pay it back, when they request it, less the interest, of course. jmo

pr

[Berta]

I know the feeling.

When I went over my AO award, I thought they paid me too much and was horrified I could be potentially "dinged" somewhere in the future.

But, the part of the award I became concerned about was based on some regulations most vets and widows never even need to consider.I had never read those regs before and should have.

They regard when the disability is both Section 1151 and also direct SC. I copied out the entire M21-1MR stuff on all that, and the actual regs, and after I read it many times , I realised the award was correct and I had learned stuff I never even considered before on 1151 awards.Ron Abrams, NVLSP, discussed this stuff with me in 1995 ,as I had some questions in general abut the 1994 VBM but I had forgotten what he said.

I posted the links to what I learned here:

.NVLSP then read the award about a week later and called me up and said they (VA) might owe me a little more more ( we await the VA response on something I requested from the C file on that )

and the lawyer agreed that I appear have a new basis for another CUE claim.

But if I owed them, I wanted to pay them back right away. I do think in many cases, as Philip said, they can waive overpayments in some situations.

If you got a Rating sheet I agree with others here that this does sound like the SMC K award.

I sure wish they would prepare those audit statements better.

It is almost impossible to understand them.

Edited March 26, 2012 by Berta

[Lorraine]

BINGO!!!! You hit the nail on the head once again. I dug out the last award when they upped him to 70% and there's a statement saying "entitlement to special monthly compensation based on loss of a creative organ is granted", but it never indicated any dollar amount. There is mention of erectile dysfunction along with DM type2, bilat PN, bilat PAD - three separate listings for 10% each and with VA math, that brought him up to 70%.

I've gotta tell ya that no where in my RN training or Anatomy and Physiology classes did I ever learn anything about a "creative organ"!! Somebody got rather "creative" with their terminology.

Berta had mentioned looking into TDIU when he got rated at 70% so I read everything I could find about that, but didn't see where it applied to him. He quit his job when he was 60yrs old because they were doing lots of layoffs of the younger guys, it was literally making him sick because we could get along with his AF pension and these young kids were hurting with mortgages and little kids. I told him his health was worth more than a paycheck so to turn in his papers and he did.(it was a good decision - he's still here!) He did not claim it as being for his health, so no records to back that up. He started drawing Soc Sec at 62(no disability - didn't put in for it) He's 71 now, certainly couldn't work now. If he makes a trip to the commisary or Costco with me, he comes home and sleeps for a couple of hours to recuperate. Doesn't age factor into whether or not you are able to work for TDIU?

I'd appreciate any further input from you guys on the TDIU and P & T. We're certainly not out to get anymore than he should be awarded, have been so grateful to finally get something from VA if only to offset all that we've put out of pocket for medical expenses over the years.

Thanks so much for your replies...I surely missed the part on his award about the entitlement to special monthly compensation. I can always count on someone at Hadit to set me straight.

Lorraine