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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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What Does "case Review" Mean?


SemperAye

Question

I filed an FDC Jan 2015 in Winston-Salem NC, shortly after I received a letter that it was converted into a normal claim for some reason. I was surprised by this since I had given them everything they needed, and I just had a C&P for another claim a few months ago that was finalized. The estimated completion date for my new claim was September 2015, all was fine.

7 months later....... for two days out of this week, my claim made it to preparation for decision, but it has since gone back to gathering of evidence. I chatted with Peggy and was told "It shows it is a case review, which means that team needed to look at or correct something." Now the estimated completion date is November 2016 LOL!

I'm guessing that since the preparation for decision phase it when a rater recommends a decision, that if it went back to gathering evidence, maybe the person who signs off on it saw an error or something? What does "case review" mean?

Thanx.

Thank you for your service!

Edited by SemperAye
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Yes. I spoke with them this morning. My claim (I posted a long detailed layout on this forum earlier today) was in Pending Decision, but then went to Gathering of Evidence when another claim was combined with it. However, ebene. says they need no further information, and "Initial Review Complete". So, I have not seen this before, so I called Peggy. The gentleman informed me my claim is in the Decision phase, and the rater is undergoing a "Complex Exam Review" with the physician at this time. I am guessing this means it was sent for a Decision, but the higher ups had a question and are getting with the physicians to figure it out? I thought I was in the first phase since ebene. shows "Gathering of Evidence", but Peggy said I'm in the decision phase, and even said I should hear something soon. Fingers crossed.

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A lot of time, the claim will stay at each lever for quite a while and then right before the decision, it will bounce all around a couple days (weeks). I have had prep for decision go back to the beginning and then closed in as little as two weeks after spending many months at gathering evidence.

I think they need a clarification on one issue before they pull the trigger.

You are probably closer than you think, however, remember its on a VA timeline...

Hamslice

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SemperAye:

Many of the same things happened (as all of those above) to my FDC claim as it bounced back and for a couple of times among the stages, but in the end it turned out fine. I know it's frustrating but you just need to hang in there? My claim went from a year to 3 years then back down to a year and did the same thing again in the span of 6 months and drove me crazy but was ultimately completed in 11 months? I personally have very little patience and something like this is really hard on me and all Vets. But I'll tell you as the 9 month mark came, I called the 1800 number again and the rep said, "Sir, it's completed and was signed off 2 months ago?"...but then I waited, waited and then waited some more and at the 11th month, it showed up in ebenefits at 80%. Later I found out that the retro payment was over 25K, so they have to get another "big wig's" signature to make it official? At least for me, things always moved right after CP's were completed? I also, would call the Exam Contractors QTC or VES and asked them If anyone owed anything on my claim because that's the main reason that a claim gets held up. So, If you can provide the missing documentation, MRI & X-Ray reports or other smrs, you can upload them to ebenefits and the rater will see it and probably act on it? Then I would send a follow-up email to IRIS just to make sure the Regional Office knew it was on the radar for action....anyway... goodluck and godspeed on your claim...! Rootbeer22

Edited by rootbeer22
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