Financial Hardship and claim advice

[joerohling]

Question: Does anyone know the typical time frame for the following situation and is there anything additional I can do on my behalf?

Background: Have  a claim I filed a FULLY DEVELOPED CLAIM in January with intent to file going back to last July with 90+ pages of evidence in organized chronological order and most items claimed are already service connected from September of last year with total of 90%. I did ask for permanent status if scheduler percentage is 100% or asked for TDIU consideration if for some crazy reason not able to obtain the final 10% needed. Have completed 6 C&P exams with one addressing 5 different claimed issues and the last of these being at the beginning of March. Claim went to preparation of decision Mid-March only to go back to gathering of evidence and has been sitting there since, but waiting for a follow up opinion from a doctor that seems to have it on the back burner because it's been since April 10th that the original clarification request was submitted. The clarification is about alcohol use disorder that has already been determined to not be a factor in my claims from last year. I have also been documented many times to be sober for over 4 years now. My exams already completed were favorable for sleep apnea with device and one physicians opinion Total Occupational and Social Impairment as well as favorable on a few other issues. Part of my claim is for temporary total disability due to service-connected surgery March 3 and continued need for walking boot and crutches after complications and unable to work due to all issues combined. Per 38 CFR regs, I qualify without a doubt and everything is in my VA record. I am in a bad spot financially with cut off notices and on verge of eviction possible next month. My claim should come with an increase to scheduler 100% and SMC-S based on all evidence, favorable exams, and current percentage, but in the meantime I'm gasping for air to survive.  I submitted another 40 pages this past Thursday with the following statement for a financial hardship and VA Form 21-8049:    

I request the Veterans Administration to expedite the above referenced claim due to financial hardship that was refereed to in my original claim statement I submitted along with my claim in January. I have been unemployed due to my service connected conditions since January and my wife is unable to work due to having to take care of our 3 children, ages 11, 7, and 9 months old, and taking me to my appointments as well as ensuring that I remember to take my medication daily and remember my doctor appointments. I have exhausted all avenues of income, savings and credit with negative balance in my bank account and am currently in arrears on almost all my bills including cancellation notices for utilities and have been given notice to either pay or face eviction by the end of this month for our living situation.

I am currently receiving what little assistance that is available and am submitting proof of that along with this letter. I also and submitting the cut off notices from my utility companies and letter from my landlord.

I understand that there is a process of adjudication of claims and that I am not the only veteran who has a claim waiting. I ask that at the very least the Temporary Total Disability claim be adjudicated as I have had surgery on a service connected disability with continued immobilization of a major joint -right foot/ankle- immobilized with removable walking cast/ cam boot since February 17, 2017 with surgery March 03, 2017. I am submitting the evidence documenting this and due to complications, the physician is suggesting a second surgical procedure on the same foot prior to moving on to my left foot.

I ask that consideration be made to the outstanding medical opinion request as to the establishment of alcohol use disorder being a separate condition from my mental health issues that was determined by claims examiner Dr. Rudra Prakash 0n 06/02/2016 which was a factor in adjudication of claim filed last year. The opinion on record of Dr. Prakash is as follows:

Alcohol Use Disorder is a stand alone disorder - not secondary to another

disease.

Adjustment Disorder in this case is at least as likely as not proximately due to

or a result of Vet's service connected ORIF of Frontal Sinus Fracture/TBI.

RATIONALE: Vet sustained Frontal Sinus Fracture in service and that was a major

stressor. He underwent ORIF and has service connected disability due to it. Vet

continues to have depressive and anxiety symptoms stemming from the stressor and

its medical sequelae (pain).

/es/ RUDRA PRAKASH

Psychiatrist

Signed: 06/02/2016 14:09

I have been abstinent from alcohol for four years and have a diagnosis from my mental health provider, Dr. Michael Franklin, whom I see regularly as follows:

Diagnosis

alcohol use dx in full sustained remission

chronic adjustment dx with mixed mood

adhd (diagnosed in military after head injury)

mdd moderate

I would appreciate immediate consideration to this request as my financial situation is dire and my family is in desperate need of financial stability as we face the very real risk of homelessness in the very near future.

[Gastone]

What does your VSR say about requesting a "Financial Hardship" bump to the front of the Decision Line?

There are (3) Vet situations that the VA will usually consider in regards to an "Expedited Decision, If You're Dying (short life expectancy), or are/about to become Homeless, or are about to File Bankruptcy. Just being out of work since 01/17 doesn't necessarily support an IU Award.

How did your 2015 and 2016 Earned Income compare to the VA SGI for under 65 ($12,400)?    Can't say I've ever seen a Direct SC for Alcoholism. At best, it's usually considered an underlying symptom attached to an MH issue such as PTSD.                                                                         You may want to review the BVA Decisions for 14-15 and 16 with regards to Direct SC for Alcoholism. I've never seen one but I haven't been looking. Can't recall ever seeing a Hadit post regarding a Direct or Secondary SC of Alcoholism claim, your's is the 1st.                         Semper Fi

[joerohling]

8 hours ago, Gastone said:

What does your VSR say about requesting a "Financial Hardship" bump to the front of the Decision Line?  

There are (3) Vet situations that the VA will usually consider in regards to an "Expedited Decision, If You're Dying (short life expectancy), or are/about to become Homeless, or are about to File Bankruptcy. Just being out of work since 01/17 doesn't necessarily support an IU Award.

How did your 2015 and 2016 Earned Income compare to the VA SGI for under 65 ($12,400)?    Can't say I've ever seen a Direct SC for Alcoholism. At best, it's usually considered an underlying symptom attached to an MH issue such as PTSD.                                                                         You may want to review the BVA Decisions for 14-15 and 16 with regards to Direct SC for Alcoholism. I've never seen one but I haven't been looking. Can't recall ever seeing a Hadit post regarding a Direct or Secondary SC of Alcoholism claim, your's is the 1st.                         Semper Fi

 

What does your VSR say about requesting a "Financial Hardship" bump to the front of the Decision Line?

The DAV rep I spoke with informed me that if I felt I had a financial hardship to submit a statement and proof, which I did as listed in OP.

Just being out of work since 01/17 doesn't necessarily support an IU Award.

I understand the basis of IU award and have read the regulations. I also have submitted employer form stating how SC disabilities were the reason I no longer am employed there. I also have gone to the C&P exam where the examiner stated " Total occupational and social impairment" and "I think the evidence, when viewed in totality, strongly suggests that the veteran has difficulties of a breadth and severity that meaningfully prevent him from successful employment and it is more likely the case than not that these problems have the potential to drastically interfere with successful vocational outcomes."

How did your 2015 and 2016 Earned Income compare to the VA SGI for under 65 ($12,400)?  

My earned income was above the SGI as I was doing all I could just to maintain employment.

Can't say I've ever seen a Direct SC for Alcoholism. At best, it's usually considered an underlying symptom attached to an MH issue such as PTSD.    You may want to review the BVA Decisions for 14-15 and 16 with regards to Direct SC for Alcoholism. I've never seen one but I haven't been looking. Can't recall ever seeing a Hadit post regarding a Direct or Secondary SC of Alcoholism claim, your's is the 1st.

I had claimed the alcohol use disorder in support of mental health claim last year based on errant advice from a fellow veteran to connect the dots over the years of self-medicating per MH provider I was seeing. The alcohol use disorder was denied, but mental health approved. I only mentioned this in my statement because the only thing thatr the rater is waiting for is a determination on how the alcohol use disorder and MH diagnosis could be related or if they are seperate. I wanted to point out in my VA notes where it has already been determined less than 12 months ago that these were seperate issues and even more important how my current MH provider. whom I see on a regular basis, has a diagnosis of Alcohol disorder in full sustained remission( been sober for over 4 years)

I may have not been very clear in my post, but I guess I am wondering how long a financial hardship expedited case takes on average if they have everything to adjudicate other claimed issues and only waiting for an addendum and what further I can do on my end to be proactive to get this claim decided. I submitted a lot of evidence with the original claim in January that was in my record all underlined and in chronological order that I figured would save the rater time based on the fact that it all has been deemed service connected for the most part, and if not, has a nexus as secondary. I have a legitamite claim with their examiners concurring and because one examiner has conflicting remarks in his exam, I am waiting over 2 months for him to get back to the rater with clarification.,

[Gastone]

Your VSR should be able to review your C-File and get a better grip on your situation.

You're SC 90% was Awarded 09/2016, so none of those Awards or Denial issues are considered Final until 09/2017 and the expiration of your NOD Filing Window. You couldn't have filed an FDC for Increase, did you file a NOD? Was the IU Denial included in the 09/15 Award/Denial Letter, had you actually filed the necessary VA IU Application before the Denial Decision was rendered?

When you received the 09/16 Award Letter, did you and your VSR discuss anything about immediately filing an "Official Request For Review" of the Award and Denials?

I believe you mentioned you've been dry for what, 4 years. When was the Alcoholism originally DX'd, pre 2012/13? I can't  ever recall seeing a reverse Secondary Issue Nexus.

 

[MikeHunt]

3.  Claims Requiring Priority Processing Because of Extreme Financial Hardship

 

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Change Date

April 6, 2015

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III.ii.1.D.3.a.  How a Claimant Establishes He/She is Experiencing Extreme Financial Hardship

If a claimant states that he/she is experiencing extreme financial hardship and submits documentation to support the assertion, accept the claimant’s statement as factual.   Documentation to support the assertion of extreme financial hardship includes, but is not limited to, an eviction notice or statement of foreclosure notices of past-due utility bills, and/or collection notices from creditors. Important:  A Veterans Service Center Manager (VSCM) or Pension Management Center Manager (PMCM) may designate that a claim requires priority processing because of extreme financial hardship even though the documentation described in this block does not exist.   Remember:  Append the Hardship corporate flash to a claimant’s record when extreme financial hardship has been adequately demonstrated.   Reference:  For more information on appending the Hardship flash, see the Share User Guide.