Ask Your VA Claims Questions | Read Current Posts
Read VA Disability Claims Articles
Search | View All Forums | Donate | Blogs | New Users | Rules
- 0
-
Tell a friend
-
Recent Achievements
-
Our picks
-
Caluza Triangle defines what is necessary for service connection
Tbird posted a record in VA Claims and Benefits Information,
Caluza Triangle – Caluza vs Brown defined what is necessary for service connection. See COVA– CALUZA V. BROWN–TOTAL RECALL
This has to be MEDICALLY Documented in your records:
Current Diagnosis. (No diagnosis, no Service Connection.)
In-Service Event or Aggravation.
Nexus (link- cause and effect- connection) or Doctor’s Statement close to: “The Veteran’s (current diagnosis) is at least as likely due to x Event in military service”-
- 0 replies
Picked By
Tbird, -
-
Post in ICD Codes and SCT CODES?WHAT THEY MEAN?
Timothy cawthorn posted an answer to a question,
Do the sct codes help or hurt my disability ratingPicked By
yellowrose, -
-
Post in Chevron Deference overruled by Supreme Court
broncovet posted a post in a topic,
VA has gotten away with (mis) interpreting their ambigious, , vague regulations, then enforcing them willy nilly never in Veterans favor.
They justify all this to congress by calling themselves a "pro claimant Veteran friendly organization" who grants the benefit of the doubt to Veterans.
This is not true,
Proof:
About 80-90 percent of Veterans are initially denied by VA, pushing us into a massive backlog of appeals, or worse, sending impoverished Veterans "to the homeless streets" because when they cant work, they can not keep their home. I was one of those Veterans who they denied for a bogus reason: "Its been too long since military service". This is bogus because its not one of the criteria for service connection, but simply made up by VA. And, I was a homeless Vet, albeit a short time, mostly due to the kindness of strangers and friends.
Hadit would not be necessary if, indeed, VA gave Veterans the benefit of the doubt, and processed our claims efficiently and paid us promptly. The VA is broken.
A huge percentage (nearly 100 percent) of Veterans who do get 100 percent, do so only after lengthy appeals. I have answered questions for thousands of Veterans, and can only name ONE person who got their benefits correct on the first Regional Office decision. All of the rest of us pretty much had lengthy frustrating appeals, mostly having to appeal multiple multiple times like I did.
I wish I know how VA gets away with lying to congress about how "VA is a claimant friendly system, where the Veteran is given the benefit of the doubt". Then how come so many Veterans are homeless, and how come 22 Veterans take their life each day? Va likes to blame the Veterans, not their system.Picked By
Lemuel, -
-
Post in Re-embursement for non VA Medical care.
broncovet posted an answer to a question,
Welcome to hadit!
There are certain rules about community care reimbursement, and I have no idea if you met them or not. Try reading this:
https://www.va.gov/resources/getting-emergency-care-at-non-va-facilities/
However, (and I have no idea of knowing whether or not you would likely succeed) Im unsure of why you seem to be so adamant against getting an increase in disability compensation.
When I buy stuff, say at Kroger, or pay bills, I have never had anyone say, "Wait! Is this money from disability compensation, or did you earn it working at a regular job?" Not once. Thus, if you did get an increase, likely you would have no trouble paying this with the increase compensation.
However, there are many false rumors out there that suggest if you apply for an increase, the VA will reduce your benefits instead.
That rumor is false but I do hear people tell Veterans that a lot. There are strict rules VA has to reduce you and, NOT ONE of those rules have anything to do with applying for an increase.
Yes, the VA can reduce your benefits, but generally only when your condition has "actually improved" under ordinary conditions of life.
Unless you contacted the VA within 72 hours of your medical treatment, you may not be eligible for reimbursement, or at least that is how I read the link, I posted above. Here are SOME of the rules the VA must comply with in order to reduce your compensation benefits:
https://www.law.cornell.edu/cfr/text/38/3.344
Picked By
Lemuel, -
-
Post in What is the DIC timeline?
broncovet posted an answer to a question,
Good question.
Maybe I can clear it up.
The spouse is eligible for DIC if you die of a SC condition OR any condition if you are P and T for 10 years or more. (my paraphrase).
More here:
Source:
https://www.va.gov/disability/dependency-indemnity-compensation/
NOTE: TO PROVE CAUSE OF DEATH WILL LIKELY REQUIRE AN AUTOPSY. This means if you die of a SC condtion, your spouse would need to do an autopsy to prove cause of death to be from a SC condtiond. If you were P and T for 10 full years, then the cause of death may not matter so much.Picked By
Lemuel, -
-
Question
harleyman
Screen examples-
These are not the actual screens, as I cannot provide them without getting into a fix at work. I am sorry you will have to scroll up and down but hopefully this will help some.
Contention screen
ClaimedContention body description Type of Claim Date received Claim Type Claim status
Hearing loss Hearing loss Core 1/25/2013 new pending
Shoulder injury Shoulder,right 5/20/2013 reopened pending
Right elbow fracture Elbow, right 5/20/2013 secondary pending
Right knee injury Knee, right 5/20/2013 new pending
Pension Misc new new closed
This will give you an idea of what the tracking screens look like, that track your claims. Please understand there are more boxes than I am showing here, but this gives you an idea of what the telephone call center people are looking at when they are on the phone with you. Since they DON’T work claims, they really don’t know what this means as far as where your claim is in the development stage.
The contention screen lists all your claimed conditions. New, reopened, secondary, this is the list of issues that we are currently working on. (we have other screens that show what you are service connected for what you have been denied for , how much your monthly payment, how many dependents on the award, etc. screens for everything, But this is one of the screens the call center sees.
Tracking screen
Tracked items Date requested Date received Not received Tracked item Closed requested in error 1st request 2nd request
Audio exam 6/2/13 8/15/13
MES request
5103 request for 5/20/13 9/15/2013
medical records
from claimant
5103 Notice 5/20/13 8/25/13
response
VAMC Reno 5/20/2013 9/15/2013
progress notes
Veteran 5/20/2013 5/20/13
submitted
STRS copies
Radiology report 5/20/13 5/20/13
Dr. Green from
Veteran
Right elbow
opinion MES exam 6/20/2013 8/25/13
request
Gen Med exam 06/20/13 7/2/13
for pension
STRs requested 06/20/13 8/25/13 9/10/13
National Guard
New and material 5/20/13 9/10/2013
evidence for
shoulder, right
This is an example of the tracked item screen this screen tells us what has been requested, by whom, and what has been received. You will note the issues involved are the same issues as those in the example contention screen. This tracked item screen is another screen the 800 call center people can look at to see what is going on with your case. These screens can be updated changed or modified as needed depending on what is going on with your claim.
When a file has all the requested information completed, (this does not mean we got the information), it means we have done the requests we are required to do, and we have fulfilled our part to get the records or order exams and the file is ready to rate.
THE VSR WILL GO IN AND CLOSE ALL THE TRACK ITEMS AND SELECT A SUSPENSE REASON CODE.
When the tracked items are closed because there are many ,many tracked items, and the file is ready for a decision, closing the tracked items allows the file to be move to the next step. VSRs do not always enter the dates the evidence was obtained, especially if the records are current treatment records that are available for our review at any time through another program. The VSR just closes the tracked items and moves the claim to the Rating Board, as the rating board knows where to find that evidence in the file or in the computer. When this happens the computer shows it as NOT RECEIVED.
Tracked items are to aid a VSR in managing the case. When we set up and send the Veteran a 5103 letter, the computer sets up tracked items we may not need to track, but the computer program for whatever reason needs to set these up. This is an internal thing the system does, and we cannot kept it from listing these auto generated items. So we closed them out when we move the file to the Ready for Decision phase, and eBenefits shows the items as closed without receipt. So what happens, the Veteran thinks we didn't get the necessary information in support of the claim.
Not good. Do Not pay attention to EBENEFITS reason codes. They are not correct.
AS YOU CAN SEE THERE ARE MANY MORE TRACKED ITEMS THAN THERE ARE CONTENTIONS. SO IF A VETERAN CLAIMS 30 ISSUES, WHICH IS NOT UNCOMMON, THERE COULD BE 60+ TRACKED ITEMS or more.
VSRs will CLOSE TRACKED ITEMS JUST TO CLOSE IT, TO MOVE THE FILE TO THE NEXT STEP. Ebenefits sees the item as closed (not received) and then the Veteran sees it in ebenefits the evidence was not received.
EXAMPLE:
VA sends you a 5103 letter asking for evidence and providing your Duty to Assit What the evidence must show
You sent in everything you had to submit, when your opened the claim, so you don’t have any more evidence to send.
The system did two things automatically
1, it set up a tracking for 5103 Notice response
2. it set up a tracking item for “request for evidence from the claimant”
The VSRs entered a receive date for the 5103 Notice of 8/25/13/because you sent it back to VA after you received the letter telling VA you have no more evidence to submit.
But the VSR closes the "request for evidence from the claimant" which indicated no evidence received. (we know that’s not true because you sent in your evidence wth the claim. Which we listed in the evidence screen).
Ebenefits can only tell you what box was checked in the tracking screen, it cannot tell you why it was checked and NEITHER can the 800 call center people. They do not have enough experience in the claims process or they have no experience working claims, to know or understand this system. Some of these employees think they know it all, be careful and Iwould ask them if they have ever worked in the claims departmet, as a VSR. If yes, then maybe you can trust them if not, I would not trust what they say except for minor questions.
PLEASE keep in mind we are also working in another new paperless system (VBMS). SO this information is mixed and ebenefits is pulling from multiple programs.
If you truly are anxious about your claim, and what is happening, plan a day trip to go to your Regional Office. Arrive early and plan on being there for a while. Take your wife or husband to lunch. Go in and talk to the public contact people. These employees for the most part are seasoned in claims processing, and if they don't know the answer they can walk across the isle and ask a supervisor or a senior VSR or even an RVSR what is going on with your claim.
Or call the 800# and ask the call center employee to send and email to the person who has your file, or who is working on your claim to please call you. They can enter your request into the system in the note section of your file and they can also email directly any VA employee and ask he employee to call you.
As a last resort, If you can't get to the regional office then send in a VA Form 21-4138 and ask the VSR or RVSR working your claim to PLEASE call you personally. In your note promise them you will not talk their ear off and your won't get mad, but it is reallty important that you speak with them. It might take a while for a response but when you get through the information will be more accurate.
Lastly, make friends with someone at VA. Get their number and call them at their work so the call is an official call that they can document your file appropriately. Go through the identifying protocol and they will be able to help you figure out what is happening. A lot of VA employees are members at your local VFWs, ALs, etc., they can really make a difference in helping you find out what is happeninng, however, they won't be able to move your claim or work it, but they can get information to you.
I surely hope this has helped. -Harleyman i
had to edit this as the CHARTS would not upload as charts. Sorry, this may be more difficult to look at than I thought it was going to be. But hopefully you'll get the idea.
Edited by harleymanLink to comment
Share on other sites
Top Posters For This Question
1
1
1
1
Popular Days
Sep 8
2
Sep 9
2
Top Posters For This Question
free_spirit_etc 1 post
harleyman 1 post
Notorious Kelly 1 post
manning01 1 post
Popular Days
Sep 8 2013
2 posts
Sep 9 2013
2 posts
3 answers to this question
Recommended Posts
Create an account or sign in to comment
You need to be a member in order to leave a comment
Create an account
Sign up for a new account in our community. It's easy!
Register a new accountSign in
Already have an account? Sign in here.
Sign In Now