New Veteran Worried My Claim Isn't Being Done Correctly

[iroberts]

Hello everyone,

I've been lurking here for a while but decided to finally post. I was medically retired from the USAF with a SC of 10% (10% for the VA and 60% for the DOD retirement) in 2010. My disability is an eye disease (retinitis pigmentosa) and I have noticed it has gotten worse over the last few years.

I contacted the Blinded Veterans Association to see if they could help me navigate the VA and see about getting an increase. Despite a few hiccups (not receiving phone calls or emails back for weeks at a time) they have been generally helpful.

However after reading these forums I'm not sure if everything was done correctly. The BVA had me start the claims process (I think the online 526 form) in November 2013 (starting it but not submitting it). Shortly after that the claim was submitted on December 3rd 2013. Later on that month I was scheduled for some eye exams at the VA hospital here (December 29th). Everyone there (the techs, ophthalmologist, VIST coordinator, etc.) said I should definitely be much higher than 10% since much of my vision is missing as shown by my field of vision tests.

I have since learned that the supposedly this medical data is in the system and that it would be part of my claim. However I can find no evidence of this.

When I go to view my "submitted applications" all I can see is the original 526 that was submitted on December 3rd. There's even a box checked on the form that says "I DO NOT want my claim considered for rapid processing under the FDC Program because I plan to submit further evidence in

support of my claim." This makes sense since it's from December 3rd, which is 23 days before I had my eye exams. But it still seems strange.

I asked the BVA and they seem to think that everything is fine and dandy but I can't tell if they're just placating me or perhaps they know things I don't know. After numerous emails asking whether or not the most recent eye exams were in my claim I was told "I just talked to Joseph in Atlanta. He said all the ophthalmology records needed were in your health care records from Bay Pines and that is stated on the claim." But I personally can't find any actual evidence of this.

The most recent email back from the BVA stated the following: "I am hoping they process your claim as fully developed and use those records [the December 29th eye exams]. In that case the claim should be completed in the next couple weeks. If we submit anything else the VA will pull the claim out of the fully developed claim process and then it will take a lot longer."

I honestly can't tell what is going on with my claim. It seems like everyone wants me to just sit back, relax, and hope for the best but I wanted to get everyone else's opinion here first since you guys are the experts!

Phew... sorry for the long post. Thank you!

[Berta]

I've been lurking here for a while but decided to finally post. I was medically retired from the USAF with a SC of 10% (10% for the VA and 60% for the DOD retirement) in 2010. My disability is an eye disease (retinitis pigmentosa) and I have noticed it has gotten worse over the last few years.

10% from VA but 60% from DFAS? That doesn't make sense. Do you still have copy of your PEB/MEB stuff?

"The VA advises DFAS - Cleveland Center of all changes in VA compensation amounts. However, if the amount of your VA compensation does not match the amount deducted from your retired paycheck, you should immediately notify the DFAS - Cleveland Center and the VA to resolve the discrepancy. "
http://usmilitary.about.com/cs/generalpay/a/retirementpay_3.htm

This above site as well as Mililiary.com and other retirees here could provide more help with that.
Also we have a link to PEB MEB forums.

Has the BVA ( Blind Veterans Assoc) commented on the disparity from VA and DFAS at all????

"I have since learned that the supposedly this medical data is in the system and that it would be part of my claim. However I can find no evidence of this.

I was told "I just talked to Joseph in Atlanta. He said all the ophthalmology records needed were in your health care records from Bay Pines and that is stated on the claim." But I personally can't find any actual evidence of this."
You need to write to the Records Access Officer (sometimes called the FOIA officer) at this VAMC for a copy of your VA medical records.

The most recent email back from the BVA stated the following: "I am hoping they process your claim as fully developed and use those records [the December 29th eye exams]. In that case the claim should be completed in the next couple weeks. If we submit anything else the VA will pull the claim out of the fully developed claim process and then it will take a lot longer."

That is basically correct but I thought FDC had a specific form they (BVA) should have used.

Someone else will chime in on that.....

"I honestly can't tell what is going on with my claim. It seems like everyone wants me to just sit back, relax, and hope for the best but I wanted to get everyone else's opinion here first since you guys are the experts!"

Since 'Joseph of Atlanta" whoever that is ,did confirm the med recs were there at Bay Pines, that is good
but us hardcore claimants will tell you it will be even MUCH better to get copies of all of your VA (and private ) records yourself and also get copies of any C & P exams they have done. Those copies can be obtained from the VAMC where the exams occurred.

This way, if "Joseph' was wrong ,or the VA misses using the proper med recs in the decision, you have a strong argument for getting them to fix their error right away.
I can help you if that happens.

BVA stated the following: "I am hoping they process your claim as fully developed and use those records [the December 29th eye exams]. In that case the claim should be completed in the next couple weeks."

I suggest you ask the BVA if they in fact sent the claim in as fully developed and used the specific form for that.....

"Hoping" does not guarantee that the VA will do the claim right.

From what you told us, not only does it appear that they need to match the DFAS comp amount (I assume it is solely for the same disability)
but ,if the medical evidence warrants a higher rating, the claim should not become too boggled down as it appears fairly easy to resolve.

You can check what your medical evidence warrants as a rating at our VA SRD (Schedule of Ratings) here in a topic below.

Personally I am stunned that you get a 60% Mil comp amount but VA gave you only 10%.


Did you take any steps, at time of the 10% decision, to appeal it?

We have FDC info here under a search and our advocate Meg here, knows the whole 9 yards on the FDC process.

I admire the fact that you are being proactive on this.I am sure the Blind Veterans Assoc is OK, but you see the BEST vet rep you will ever have, every time you look into a mirror.

Edited March 10, 2014 by Berta

[Berta]

BTW Welcome aboard here!

and to add:

This Board of Veterans Appeals case shows some rating info for the disability you have:

http://www.index.va.gov/search/va/view.jsp?FV=http://www.va.gov/vetapp10/Files2/1012592.txt

This is why I asked if you still have the PEB /MEB info.

In part:
"THE ISSUES

1. Entitlement to a rating in excess of 90 percent for
retinitis pigmentosa for the period from December 16, 1970,
to December 29, 1988.

2. Entitlement to a higher level of special monthly
compensation (SMC) prior to December 29, 1988."


"The RO sought an opinion from the Director of the VA
Compensation and Pension Service regarding an extraschedular
rating based on visual efficiency. The Director determined
that an extraschedular rating was warranted.

On the basis of loss of visual efficiency, the Veteran was
entitled to an evaluation of 90 percent for visual
impairment for the service-connected retinitis pigmentosa
with decreased visual acuity and diminished visual fields
based on the November 12, 1970, Physical Evaluation Board
proceedings.

In a January 2001 rating decision, the RO assigned the 90
percent rating, effective December 16, 1970, under
Diagnostic Code 6006-6080. The Veteran seeks a higher
rating for the assigned period."

and
"ORDER

For the period of December 16, 1970, to December 29, 1988, a
rating in excess of 90 percent for retinitis pigmentosis is
denied.

For the period of December 16, 1970, to December 29, 1988,
special monthly compensation at the "k" rate is granted,
subject to the controlling regulations applicable to the
payment of monetary benefits."

This decision takes into account the potential SMC factor and the potential Allen Act factor.I dont know if these factors would come into play with your claim.

Do you have a copy of the actual claim the BVA filed?

This link to VA explains the FDC process but if you use the headit search feature many discussions here will pop up:

http://www.benefits.va.gov/fdc/

[iroberts]

Thank you so much Berta! I have to admit that after lurking for a while, I had hoped you'd respond.

I do not understand the discrepency between the original 60%(DFAS)/10%(VA) ratings. It didn't seem strange to me at the time since it was all so fast/new to me (so I did not appeal or even question it at the time). I was pushed out much more quickly than I was pushed in! However one thing I would be concerned about when investigating the discrepency is losing my 60% DFAS rating. Regardless, I would think that it would be better to investigate that issue after I get my new claim processed. Wouldn't that be the best course of action?

As for the most recent evidence (my eye exams from December 2013, I just sent an email to my VSO representitive to find out more about it. Like I said, I was told that it was submitted. I just don't know where it is.

[JMFG]

iroberts,

I apologize that I really don't have anything of value to add to your question. However, after reading your post I thought I should respond. I was medically retired from the AF in Oct. of 2011, after 8 years of active duty. My medical retirement was also because of retinitis pigmentosa. The AF granted me retirement at 30% based on my reduced visual fields, then a year later I received a 10% rating from the VA. I currently have an appeal in with the VA.

I couldn't agree with you more in regard to the BVA. I am sure I could reach out to them more and ask for specific help, however so far the only communication I have with them is the statement I get each month of them asking me to pay my remaining lifetime dues.

I hope you claim gets resolved quickly!

[iroberts]

Berta, thanks for the info.

JMFG, the BVA hasn't hit me up for dues yet, so we'll cross that bridge when it comes. They have been an interesting organization overall. Very responsive anc aring some months, completely quiet and apathetic other months.

Unfortunately my claim is still in the "Under Review" stage so I can't really gage what's wrong (if anything) with my claim. I guess at this point I just have to wait it out. I submitted and IRIS inquiry yesterday so we'll see if that changes anything...

[Berta]

"Regardless, I would think that it would be better to investigate that issue after I get my new claim processed. Wouldn't that be the best course of action?"

I would think VA needs to be aware of the 60% from DFAS, now, because if that rating has not changed and is obviously for the claimed disability you still have,

it is evidence they should consider for the higher rating of the 10% VA gives you.

That might put you out of the FDC process, however if you inform VA of the discrepancy and as the link I posted says, DFAS should be informed as well.

I am surprised the BVA didn't advise you on this major discrepancy.

It sounded to me here as if the BVA didnt know if this was filed as a FDC claim or not.

Personally I would raise the DFAS issue now...because I know that will add time to the claim, but it will add time anyhow and I seem to feel VA never considered the DFAS 60% comp award in the first place and this evidence could impact on the currrent claim.

( I am assuming however that the 60% was solely for the same eye condition)

Maybe the VA itself will pick up on the disparity.....

Are you registered with ebenefits? It is one way of knowing what the VA is doing with the claim.

The VA IRIS system is another way too:

http://www.va.gov/

Just click on the "Contact Us" button and then on Ask a question.

Hopefully they can tell you of receipt of the C & P exam and whether the claim is being processed a FDC.

I suggest asking for email replies from IRIS instead of a phone call. That way you have documented proof of what they say.