Vike 17- What Exactly Is The Process?

[Guest jangrin]

Vike 17,

It is fairly apparent that you have had or currently have exposure and experience in the VA claims process. It would be really nice if you would take a few minutes and explain the claim process (ideally the process) the typical claim takes through the VA maze and the steps it takes to be processed and granted. Start to Finiah.

I understand that their are many problems and things don't go smoothly, but having an idea of what happens and typically how long it should take and how many different people are assigned to each file and who makes the detrmination.

You know what I mean, the flow chart of a typical claim. It would be most helpful. And please who are those people who answer the 800# and the IRIS inquiries. Why so many different answers to questions that contradict each other? Help us out here maybe with some addtional knowledge we can be more productuive and help unclog the VA claims systems by doing our part more completely or something.

Thank you

Jangrin

[Pete53]

Vike17

I appreciate your extensive help on Hadit but in my experience the lack of a C&P usually means a denial. Nothing good happens without a C&P.

[Tbird]

i've met at least one person who didn't get a c & p and still received a favorable rating, though it seems as i remember that his disability and the start of that disability was undeniable

[Guest jangrin]

Vike 17,

There are many veterans on this site that are RVN era. There are many AO related claims. DM and DMII are very debilitating conditions with many secondary body systems being affected and research is showing even MORE conditions than those we currently know about.

In my husbands case, every condition he listed on his initial claim was first diagnosed by his VA PCP. He had no other medical records other than VA. He was awarded his SSD first time based on VA records and SSD doctors examination findings and reports, mental and physical.

This being the case, VA diagnosed everything and listed all in his VA medical records. When my husband finally was told he should file an AO claim the service office said to list everything. So he listed everything the VA doc had told him was going on. DMII,peripheral neuropathy, CAD, arterial sclerosis, HBP, ED, gostrointentenial, depression, PTSD, cataracts, hearing, tennitis (sp),. Probably more but I can't remember everything right now.

VA did a hearing test, they did the psychological work-up, they did they eye test, they did all they diagnoses of the DMII, heart, neuropathy, they did it all.

The only C&P exam they have sent him to was performed by the NP who also does the AO registry exams and she did the original AO exam. When she did my husbands C&P she covered evrything except hearing, eyes, and PTSD, during the exam. The VA called the exam a disability C&P exam.

WE SENT IN THE NO OTHER EVIDENSE VCAA LETTERS AND SIGNED ALL THREE.

We were told by someone at 800# the VA felt the case was ready to be rated. We moved our family to Texas and now the case is at the WACO VARO.

The SO at WACO talked with the local TVC where we live and they agreed together over the phone that the claim was ready to be rated. iT'S BEEN THERE ABOUT 6 WEEKS.

My question is- where do you think we are in this process and do you think my husband will need to have more C&P exams? Do you think the VA will SC the secondarys if all we did was list them under the conditions sections of the claim. Or do we have to file a claim and list every single condition as SECONDARY to the DMII. Or can the VA figure out what is secondary?

Thanks,

Jangrin

Edited January 7, 2007 by jangrin

[Vike17]

Jangrin,

It appears that there isn't any more C&P exams that would be needed for your husband. From the looks of it, your husband appears to be in the 'final' stages of the claims process. I say this because, once the C-file is with the rating activity and all of the C&P exam have been completed, the only thing left to do is actually decide the claim. The only thing that could possibily hold up a claim at this stage is if there is something in the C-file that pops up and needs to be further developed, such as maybe a difference of opinion ect...

Further, the VA must address every disability claimed by the claimant on their VA Form 21-526. Keep in mind that some veterans will claim conditions that will actually be rated together with another disability due to pyriamiding, but don't understand this and come back later and say the got "screwed." For example, a veteran will claim a lower back condition and then claim scoliosis as secondary to the lower back. But when the VA decides and rates the claim, they won't receive a seperate rating/decision on the issue of scoiliosis because that condition would be considered together with the lower back. I hope this makes sense. Another example of this is lots of time veterans will claim PTSD and make a seperate claim for Depression, and when the VA comes back and decides the claim they will combine the two into one rating.

The VA can 'infer' a claim if they see it in the records. Some regional offices do it more than others. Generally, if the condition jumps out at the RVSR, they'll go and infer the claim. But like I said, some RO's and ulimately some RVSR's do it and some don't. Your best bet is to file the claim yourself and not count on VA to do it for you.

Vike 17

Edited January 7, 2007 by Vike17

[Guest jangrin]

Jangrin,

It appears that there isn't any more C&P exams that would be needed for your husband. From the looks of it, your husband appears to be in the 'final' stages of the claims process. I say this because, once the C-file is with the rating activity and all of the C&P exam have been completed, the only thing left to do is actually decide the claim. The only thing that could possibily hold up a claim at this stage is if there is something in the C-file that pops up and needs to be further developed, such as maybe a difference of opinion ect...

Further, the VA must address every disability claimed by the claimant on their VA Form 21-526. Keep in mind that some veterans will claim conditions that will actually be rated together with another disability due to pyriamiding, but don't understand this and come back later and say the got "screwed." For example, a veteran will claim a lower back condition and then claim scoliosis as secondary to the lower back. But when the VA decides and rates the claim, they won't receive a seperate rating/decision on the issue of scoiliosis because that condition would be considered together with the lower back. I hope this makes sense. Another example of this is lots of time veterans will claim PTSD and make a seperate claim for Depression, and when the VA comes back and decides the claim they will combine the two into one rating.

The VA can 'infer' a claim if they see it in the records. Some regional offices do it more than others. Generally, if the condition jumps out at the RVSR, they'll go and infer the claim. But like I said, some RO's and ulimately some RVSR's do it and some don't. Your best bet is to file the claim yourself and not count on VA to do it for you.

Vike 17

Thanks Vike,

Filing the claim ourselves is probably a little late for that.lol But I know that when my husband filed the claim he did not list things as secondary to other illnesses. His just listed everything the doctor told him was going on. After all was said and done and file maybe six months went by. The VA doctor asked my husband if he was a Vietnam Vet, you should have seen his face when he realized that my husband was.

I think he may not have done things they way he did if he had known. For some reason he just didn't realize it.

Oh well,

I hope the wait is not too long as this does get stressful. We would just like him t oget the DMII SCd so he will have some priority in appts. He has had to wait for 4 months to get a Dr. Appt.

Jangrin

[Guest jangrin]

Hey everybody, Just an Update on the Claim,

Well. just when you think that you have all your ducks in a row and everything is moving along something gets you. Today my husband got two letters from the VA for 2 more C&P exams.

One is for the 7th of February in Temple, Tx and the Vet center there. It doesn't even say what the exam is for.???? Why wouldn't they say what it is for. The other one is in March for PSYCH. exam in AUstin. This really is unbelievable, he had what they called a disability C&P exam back in September. This is so unorganized , why didn't they schedule them back when they scheduled the other one???

After being told for the past 3 months that the claim is at the rating board and now having more C&Ps scheduled months apart we are just flat disapointed and very tired. My husband told me today that he will die from his heart condition before the VA even gets his Diabetes II service connected.

I (we) are so sick of this waiting I think we are going to take a break from the board for a while. It has been a really rough couple of years trying to even get an initial rating for even his DMII.

Thanks everyone for your past help, just wanted you to have an update, of the VA stringing things out for as long as they can.

Jangrin