25 Year Long Service Connected Disability Denied After C/p Exam.

[ardodd]

This epic battle began 25 years ago when I was Discharged from USMC with a Medical Discharge for Bilateral Patello Femoral Syndrome in both knees. I filed when I got out in 1990, or so I thought I filed, according to the VA. I am not getting any help from VA on it at all. But I will move on and let that be my battle to prove.

All of this supposedly began in 1990, but it was not until 1999 when the VA said I filed a Claim. So I will just go from there, I supposedly submitted a Claim then. But in 1999 I was Denied my Claim for Disability and supposedly they sent me a letter telling me I was Denied. This was after signing the private hospital and doctor release forms. Of which to the knowledge of all these places they were never contacted.

So forward to 2010 when I Appealed that decision in 1990 stating they never Reviewed my Medical Records from the Military and from private hospitals and doctor's. Plus I signed the Release of Medical Records form again. And yet I was sent a Denial of Claim stating I had not provided any new material evidence. So in 2011 I Appealed that again and was told that after Review I had not provided new material evidence supporting my Claim. I was frustrated so I just dropped it and did my best to work until 2014 when I was struggling to keep employment and unable to perform daily task. And after being involved in automobile accident I tried in 2015 to go back and try to resolve this 25 year problem.

You may ask why are you know deciding to finally set down and try to resolve it?

Until now I did not understand all the laws and complications this process has. So after filing an Apeal for all the years I had been Denied and taking this matter to some Senior Board members in Washington,D.C for help and and guidance from the VBA. I was unclear of any of it. But my biggest Question has always been to the VA. First why was I not processed when I got out and was paid Severance for my Disbility. Second why have I been denied a C/P exam if they say I had no new material evidence if I signed the Forms for them to get the Medical Records. And the biggest clue for me was during this year when I filed an Appeal and was told that it would take between 2weeks to a,month for them to have my Service Medical Records scanned into the System.

Hello that is like handing me a Loaded Gun. Why would they need to send off to St. Louis for my Service Medical Records after Denying my Claim for over 25 years. I have been told by every VSO,RO and every VA rep that they have access to that file and it was used to Decide my Claim. Ok, if they had it then why did they need, more Importantly why did I send by email a scanned Certified copy of my Service Medical Records for them to use in my Claim this year. It was not until I sent them my certified copy did they let me have a C/P exam. And after 25 years do you honestly think that I would have the exact same symptoms and disabilities as I did 25 years ago. Why of course not, after all human,bodies and disabilities change.

But according to the C/P examiner in his Nurse Practioner wanting to play doctor said that my condition now was not what I was Discharged from the USMC for. And that what he diagnosed me for is not debilitating. Honestly where do they get these people from. He did not do a full exam,and his Non-Board Certified Orthopedic opinion is what 25 years of frustration has turned into. But I am Appealing this poponderous and unethical wisdom.

Sorry this so long but I felt it needed a merit of background, I have left out a lot of details to make it shorter. But my question is two things.

1) Did or does the VA have to grant or give a Veteran a C/P exam if they were Medically Discharged? This was in 1990

2) If the VA did not have to grant me exam even back in 1999,2010,2011 and it would of proved my Claim why would they still not give one and state I did not provide new material evidence even if I showed them records of not one but two arthroscopic knee surgeries as proof?

3) The biggest Question I have is how can the VA Board make any Decission without using my Service COnnected Medical Records and why would they not even acknowledge that I was Discharged from the Service with the Disability?

I would like to say that 2weeks ago I witnessed some VSO's shredding old folders from a filing cabinet. I asked what they were and they told me they were just old folders or files over 7 years old and they had to go. So I am,asking how is it that if someone like me wants to Appeal and old Denialxand might need the proof of the doctor's notes or something from it that was missing or not included. Why would they not scan and record all the information onto a CD or external type hard drive for cataloging. I am just asking has anyone known of this to happen and later the VA says,they never received anything. Kind of makes me wonder why the VA says they never got my 1990 Claim and says I did not try for Disability Compensation until 1999. What your thoughts on it?

[Andyman73]

ardodd,

I feel your pain, I went 15 years between claims due to believing that I did deserve, but was not worthy of receiving. I never had a chance to become a combat Vet, not that my MOS would have gotten me that(wouldn't have). I fell down a flight of stairs in the barracks at MCRD San Diego, on my 5th day of boot camp.

I currently have half a dozen NODs filed, one for EED(earlier effective date) to Feb, '06. I was told not to rock the boat, and so on, back in 2000 or so.

And if you have a C&P exam for depression secondary to chronic pain, don't be too surprised if the examiner ignores 99% of your evidence and downplays your injury. Mine wrote that one minor leg injury couldn't possibly lead to depression.  This is out right denial of the truth, that minor leg injury has me rated combined 30% for my knees and 40% for my back.  These are both SCd to my EAS of 11/98. So if the VA gives me that, how can the examiner feel these can't lead to depression? Then the RO also ignored the mountain of evidence and rated against me. 

Anyway, rock the boat, file those NODs, and so on. Even if you don't feel you deserve it, you really do.  We all do.

Semper Fi

[Fat]

Great News............

[ardodd]

I have not been this far down that road to disability with the VA before. So I must ask a couple of questions about it for those that know. I am getting all my medications through the VA right since I was only getting $263.23 a month income.

And with a disability rating of 60% now will I have to pay for my prescriptions?

And with a disability rating of 60% will I lose the travel pay to appointments?

And with a disability rating of 60% will I be charged for my medical care now?

For me it is 120 miles to the closest VA hospital for treatment, and the clinic is 40 miles from me. If I need medical attention that the clinic can not handle am I eligible to ask for Veterans Choice Program?  

At 60% is other programs or benefits that I am eligible for?

I ask this because I am not able to work not only from the VA side of things but also from the private sector side. As I have had 2 back surgeries and 1 elbow surgery. I have disc in my neck and down my whole back that are protruding on to my nerves. Along with my problems from the service connected disabilities. I have not filed for unemployability as some of the conditions are not related to service. but contribute to the overall health.

To be eligible for unemployability does my overall health condition have to be related to service connection?   

[Andyman73]

ardodd,

The opposite will be, the higher your rating, the less you have to cover.  Not sure where the tip off point is, but 60% is past it.  Not only that, VA comp is a tax free, non reportable source of income, as it's disability compensation.

So...no, still get travel pay, prescriptions should be free, completely. No charge for med care. You already paid for all of that through your FICA when you were working, and then you earned it by serving our great country and getting injured while serving.

Some states have property tax relief equal to your disability rating, some only do so for 100%(like my fair state of PA).

If you're not able to work, you should file for IU, individual unemployabilty, I think it's called.

Some others will weigh in with better info than mine.

Andy,

Semper Fi

[Guest]

http://www.va.gov/HEALTHBENEFITS/resources/priority_groups.asp

Priority Groups

Today’s Veterans have a comprehensive medical benefits package, which VA administers through an annual patient enrollment system. The enrollment system is based on priority groups to ensure health care benefits are readily available to all enrolled Veterans. Complementing the expansion of benefits and improved access is our ongoing commitment to providing the very best in quality health care service to our patients when they are needed during that enrollment period regardless of the treatment program or the location.

Priority Group 1

• Veterans with VA-rated service-connected disabilities 50% or more disabling
• Veterans determined by VA to be unemployable due to service-connected conditions

Priority Group 2

• Veterans with VA-rated service-connected disabilities 30% or 40% disabling

Priority Group 3

• Veterans who are Former Prisoners of War (POWs)
• Veterans awarded a Purple Heart medal
• Veterans whose discharge was for a disability that was incurred or aggravated in the line of duty
• Veterans with VA-rated service-connected disabilities 10% or 20% disabling
• Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151, "benefits for individuals disabled by treatment or vocational rehabilitation"
• Veterans awarded the Medal Of Honor (MOH)

Priority Group 4

• Veterans who are receiving aid and attendance or housebound benefits from VA
• Veterans who have been determined by VA to be catastrophically disabled

Priority Group 5

• Nonservice-connected Veterans and noncompensable service-connected Veterans rated 0% disabled by VA with annual income below the VA’s and geographically (based on your resident zip code) adjusted income limits
• Veterans receiving VA pension benefits
• Veterans eligible for Medicaid programs

Priority Group 6

• Compensable 0% service-connected Veterans
• Veterans exposed to Ionizing Radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki
• Project 112/SHAD participants
• Veterans who served in the Republic of Vietnam between January 9,1962 and May 7,1975
• Veterans of the Persian Gulf War who served between August 2, 1990 and November 11, 1998
• *Veterans who served on active duty at Camp Lejeune for at least 30 days between August 1, 1953 and December 31, 1987
• Veterans who served in a theater of combat operations after November 11, 1998 as follows:
  • Currently enrolled Veterans and new enrollees who were discharged from active duty on or after January 28, 2003, are eligible for the enhanced benefits for five years post discharge.
  • **Combat Veterans who were discharged between January 2009 and January 2011, and did not enroll in the VA health care during their five-year period of eligibility have an additional one year to enroll and receive care. The additional one-year eligibility period began February 12, 2015 with the signing of the Clay Hunt Suicide Prevention for America Veterans Act.

Note: At the end of this enhanced enrollment priority group placement time period Veterans will be assigned to the highest Priority Group (PG) their unique eligibility status at that time qualifies for.

*Note: While eligible for PG 6; until system changes are implemented you would be assigned to PG 7 or 8 depending on your income.

*Note: While eligible for PG 6; due to system limitations, Veterans will be manually assigned to Priority Group 8c, yet eligible for the enhance benefits

Priority Group 7

• Veterans with gross household income below the geographically-adjusted income limits (GMT) for their resident location and who agree to pay copays

Priority Group 8

• Veterans with gross household income above the VA and the geographically-adjusted income limits for their resident location and who agrees to pay copays

Veterans eligible for enrollment:

Noncompensable 0% service-connected:

• Subpriority a:  Enrolled as of January 16, 2003, and who have remained enrolled since that date and/or placed in this sub priority due to changed eligibility status
• Subpriority b:  Enrolled on or after June 15, 2009 whose income exceeds the current VA or geographic income limits by 10% or less

Nonservice-connected and:

• Subpriority c:  Enrolled as of January 16, 2003, and who have remained enrolled since that date and/or placed in this sub priority due to changed eligibility status
• Subpriority d:  Enrolled on or after June 15, 2009, whose income exceeds the current VA or geographic income limits by 10% or less

Veterans not eligible for enrollment:

Veterans not meeting the criteria above:

• Subpriority e: Noncompensable 0% service-connected (eligible for care of their SC condition only)
• Subpriority g: Nonservice-connected

[ardodd]

Wow that is alot to read and try to understand. Thanks for posting this information as I will have to read more on it since some of it does not make sense to me.