TKR & 100% temp disability

[mtmorical]

We are new to the site and hoping for some help.

My husband left service in 2002 honorably and medically. After he got home and received treatment they determined him at 0%. We went about life although his R knee has always been an issue. In 2013 it finally became to much for him so in the spring he started going back to the VA, they tried to clean it out with a scope, then they tried cortisone injections, but the doc said that his knee was too far gone and that he needed a TKR so at 38 years old he put as long as he could and it was scheduled for Dec 2015.

Unknown to us the VA was doing something with his discharge and one day we got a check in the mail for over $8k, and two days later a letter explaining that his R knee has now been rated at 10% do to degenerative joint disease, arthritis and would be receiving compensation at the 10% rate. Great!

Now my questions:

Will the approve the temp disability for his TKR since he has been determined 10% for arthritis?

Is there anything that they could deny it for? Like not getting medical care (we couldnt afford it and didnt know he was VA covered)

We filed a FDC only to get paper in the mail that he needed to sign saying his had no additional information, so we signed it and sent it back, then we got flag on ebenefits stating requested information past due. So we contact a VSO, he called us back and told us that they never should of sent that letter since we submitted a FDC, that he was working with a manager and was going to request an informal expedite since its caused his claim to be suspended due to the paper that should never of been sent, the flag about requested information past due has since been removed.

Has anyone had experience with this? Will they now drop us to a standard claim because we submitted those additional documents? Has anyone had luck with an financial hardship expedite request?

 

Thank you in advance for your help!

mtmorical

Edited March 28, 2016 by mtmorical
more info

[broncovet]

It would be nice if it happened this way, but VA thinks its their job to make as many new homeless Vets as possible by making us wait as long for our benefits as possible.  You likely wont get your temp100% until well past needing it.  That is why you need to file a NOD and file for an increase now.  Im not a rocket scientist, but it sounds like the suregeon has already determined you need a new knee by agreeing to the surgery.  Most doctors dont replace good knees with plastic and metal ones.  

This said, it IS election year and people dont exactly want to run out and vote for the guy who was responsible for their homelessness, so you may get your temp 100% sooner than most of the rest of us got our benefits.  I did not get my benefits in time, until 4 years after I applied and lost my home as a result, so Im not making this stuff up about VA wanting more homeless Vets.  I looked in my records, too, and I told several docs I would be homeless...VA did not care and did not listen.  They awarded me 0 percent, even after an appeal.  Im just telling you to "hunker down" save your money and prepare for a long wait, tho I agree I just posted it in black and white, above, that you are to get 100% for a TKR when the knee is SC for a year, then 30 percent after TKR "as a minimum".  

You could try telling VA that not getting your benefits timely would be a hardship and likely result in homelessness...maybe someone will listen to you, even tho they did not listen to me.  Yours is a little more cut and dry as you have already been awarded SC for your knees, so their is no debate as to whether or not you deserve temp. 100%.  

I have never figured out why VA is so fast at getting VA employees their paychecks.   They seemed to have figured out that if they dont, the VA employees will get mad and quit.  However, even with all this 'end Veteran homelessness"  stuff going on, they still manage to find glitches to hold up our benefits until we become homeless.  Im not trying to scare you, Im trying to PREPARE you.  Hopefully, those "glitches" that have haunted so many of our claims wont also haunt yours.  

Sometimes it IS the VEts fault..because he did not do one or more things required by VA to get his benefits.  You dont want that to be the case, so file for an increase NOW as well as file a NOD to get back pay.  

[mtmorical]

Ok, a couple more questions!

We were able to work with VSO and they got the extra info backed out of the system so the claim is still FDC, they said that "Angie" took the file to "Drew" the rater.

How long will this sit with a rater?

it was mentioned to file NOD and go for back pay because since he needed a TKR SC should of been higher then 10%. He has since had the TKR (Dec 2015)

can we still do this?

How would I do that and what evidence would I need?

thanks in advance

 

[mtmorical]

Also eben did update from Gathering of evidence to Prep for decision today as well!

[broncovet]

I know people want answers to the "how long" question, but there are none, only guesses.  The only real answer is, "VA will take as long as they like".  

There have been Vets who got their benefits in a matter of a few weeks, while some of the rest of us is much longer.  I have waited 14 years.  I applied in 2002...no decision until 2008...denied.  Appealed, got remanded in 2012.  Remand finally implemented in 2015...denied again.  Now, Im appealing to the CAVC, and that is expected to take from 3 to six months if its a single judge decision, longer if its a panel or en banc.  Then, its back to the BVA, and then back to the RO again for implementation, again.  For me, I will be lucky to get it done in 20 years.  Maybe 18, or even 16 if I am lucky and everything goes my way.  

[mtmorical]

I'm sorry to ask so many questions!!

when separated received seperation pay, then rated at 20% for 6months then 0% for years until they reviewed and redetermined at 10%, (they did the review and increase without us requesting it) then had TKR and applied for 100% temp.

currently receive the 10% of 133 a month, 

wouldnt they have recouped that prior to beginning that 10% payment if indeed they recoup?

will the recoup the seperation pay I received?

will they take all of the back from me or just a portion?

is there arrangements that can be made so it's repaid more affordable?

thanks in advance

Edited March 30, 2016 by mtmorical

[broncovet]

If they are sending you $133 per month, then if there had been adjustment for seperation pay, they likely would have already taken it.  

If you get increased, to say, temp 100%, then any money they already paid you will be deducted from your retro.  

Hypothetical example:

You applied for temp total in Jan. 2016.  Lets further assume you get  100 percent is approved from Jan. 2016 through Jan 2017.  (12 months.) and further assume   You get the award letter (for temp total) 100% in July, exactly 6 months after you applied.  

So, in July you should get 6 months retro MINUS the six months you already got paid $133 per month times 6 months.  (Remember this is hypothetical...your pay does not begin until the first day of the month AFTER your effective date, so you would have to have 7 months to get 6 months retro.)

If you are a single Vet, in the above example 6 months times 2906 = 17346  MINUS the 133 per month already received(133 times 6) =798.  So your retro would be (for six months) would be 17436 minus 798 or 16,638.  

No.  Im not promising this will happen in 6 months.  I have no idea how long it will take.  Maybe more, maybe less.  But IF it did take six months after you applied then that would be your retro if you are single.  More if you have dependents.  

As I posted the "criteria" above, I note that 30% is considered the "minimum rating" for TKR, so your comp should be increased to at least 30 percent when VA gets you rated and your TKR is accomplished.  No, you wont get 100 temp plus 30 percent.  You get the 100 percent, then, after a year it would go down to a minimum of 30 percent.  (It could be 60 percent if you meet the criteria above).  If you are married or have dependents your comp is increased by the number of dependents.

http://www.benefits.va.gov/COMPENSATION/resources_comp01.asp