ptsd Awarded Smc (S) For Tdui + 60%-Retro Seems Short

[GuaymasJim]

This is a success story with a twist. My claim sat silent until February 28, 2014 when an “in-person” C&P as well as a “telephone” C&P were conducted in the next three weeks. The C&Ps were straight forward but were so incomplete that if I were not satisfied with the results I would have definitely had grounds for appeal. I got a call from the rater on April 25^th to discuss the rating. He was pleasant, polite and knowledgeable and answered all of my questions. He acknowledged the inadequate C&Ps, but felt that even if they had been accurate, the end result would be the same. I wasn’t too pleased with the effective date, as starting in August 2012, I had repeatedly asked VAMC Tucson to inform the Phoenix RO of the severe IHD diagnosis as it is a relatively new AO presumptive. VAMC Tucson failed to do so, and I am stuck with the date of the claim. Ultimately, I agreed, and I am satisfied with the end results with the following exception.

I was awarded SMC (S) for TDUI + 60% for IHD and 30% PTSD on April 25, 2014. The claim was submitted on June 10, 2013.

I received a deposit for $3,044.16 on April 30, 2014. Then on May 1, 2014, I received two deposits of $3017.60 and $341.04. The $3017. 60 is my normal monthly payment for 100% vet and spouse. The $341.06 is the normal SMC (S).

So for May 1, 2014, I received a total of $3,358.64 which is the amount stated on my award letter which stated “Your payment begins the first day of the month following your effective date.”

According to my math, I am an entitled to 6 months of SMC (S) at pre-COLA rate of $336.00 for July, August, September, October, November and December of 2013 for a total of $2016 plus 4 months of SMC(S) at post COLA rate of $341.06 for January, February, March and April 2014 for a total of $1364.24

$2016 + $1364.24 = $3380.24

$3380.24 -$3044.16 = $336.08

I am aware that the VA pays in arrears, so the months listed are the actual deposit dates as opposed to entitlement dates. I believe I have been shorted one month of retroactive SMC (S).

Can anyone find fault with my math?

[Philip Rogers]

Yup! You said it was awarded in 8/2012 and I think you meant 8/2013. If the claim date is June 10, 2013, your first check should be 8/1/2013, for July. June doesn't count for money, at all. July gets paid 8/1/13. I'm guessing the award date is 6/10/2013.

pr

[Berta]

This concerns me too Jim ( BTW CONGRATS!!!!!!!!!!!!!!!!!!!!)

"I had repeatedly asked VAMC Tucson to inform the Phoenix RO of the severe IHD diagnosis as it is a relatively new AO presumptive. "

Did you formally claim the IHD?

Do you have proof ( like IRIS email) that you informed the VA of the IHD?

In any past decision did they ever rate the IHD as a NSC, prior to Nehmer 2010?

If so you are a Footnote One Nehmer vet.

Lots of info on Nehmer and Footnote one in the AO forum.

[GuaymasJim]

Philip, the effective date was June 10, 2013. A clear reading of the award letter would seem to conflict with “June doesn't count for money, at all.” (That doesn’t necessarily mean that I disagree with you.)

The award letter:

“Your payment begins the first day of the month following your effective date. You will receive a payment covering the initial amount due under this award, minus any withholdings. Thereafter, payment will be made at the beginning of each month for the prior month. For example, benefits due for May are paid on or about June 1.”

If the award letter had stated that “Your entitlement begins the first day of the month following your effective date” with every other word in the paragraph remaining exactly the same, June would clearly be a “lost” month. However, it doesn’t. I am fairly (what a shitty word to use in a discussion about VA behavior!) sure that this has been argued ad nauseam here on hadit.com and elsewhere—and I lose. It might interest you to know that the rater who called me with the decision agreed with my math. In fact, he gave me the numbers unsolicited. (I tape and transcribe almost every single interaction I have with the VA; and then translate it into Spanish for my wife.)

Berta, thank you! I was diagnosed with severe IHD at VAMC Tucson on August 24, 2012 via angiogram along with two stent placements with the others to be staged over the following months. Due to the extreme incompetence of the med students (Fellows) who just couldn’t get the job done correctly, I still have one to go. One of the medications that I have taken for years is known to cause IHD or myocardial ischemia. In July 2012, I had two incidents after injecting the medication which dropped me to my knees feeling like some Mayan/Aztec witch doctor was ripping my heart out of my chest. I really thought the Reaper had come for me! I have suffered moderate to severe angina ever since with all but the most mild exertion. VAMC Tucson will not perform either a physical or chemical stress test for fear of provoking a MI. The rating was based on interview METS and NYHA Class III (2-5 METS) designation.

I did formally claim IHD on June 10, 2013. I have no real evidence of informing the Veterans Benefits Administration of the diagnosis other than having it entered into my (Veterans Health Administration) VAMC Tucson medical records in all CAPS and repeated and being told that Tucson RO would be informed via those records. Seem like the VBA and the VHA don’t communicate. I discussed an “inferred claim” with the rater who called, but got nowhere. “The laws won’t allow us to back farther than the date of the claim.” My original TDUI claim (34 years ago) was an “inferred claim” and was paid to the date of diagnosis because the diagnosis under VA care was the claim.

I have no prior evidence of IHD other than moderate atherosclerosis of my aorta and iliac arteries which diagnosed via CT scans in 2006 and 2007 but never reported to me, discussed, or treated in any fashion. AHA/ACC strongly recommended Plavix even back then to slow PAD progression and avoid CAD in the future.

Nehmer just doesn’t apply to me. However, I do accept, that with the wonderful exception of the heart and memories of my dear Hector, I will certainly soon be no more than a footnote!

I don’t suppose it will do any harm to NOD the effective date, and I will consider it.

Thanks again for the replies.

[Pete53]

I should have had mine go nback farther I asked for it but they used the date of My C&P.

[broncovet]

Congrats: This sounds like it is good news for both you and others. You did not mention it, but I am guessing you got SMC S "housebound" under the 100 plus 60 statue, and not housebound in fact.

This is interesting, in light that you are TDIU 100%. My mind is drawing a blank to remember the case which enabled Vets to collect SMC S by statue (without proving housebound in fact) with TDIU. However, VA definately has sought to limit this impact, and is fighting giving SMC S to TDIU'ers, in part, because VA did not say which of your conditions led to TDIU, and pyramiding prevents a condition from being considered twice. It would be great if you would post the relevant but non personal parts of the decision.