Partial award granted on appeal

[srmoore0411]

I am new to the forum, but was hoping to get some help with a question i have. I was awarded 30% for PTSD back in 2013. Within 60 days i appealed the decision, as i felt it was wrong. It took until May 2017 for them to schedule me a re examination. They bumped me from 30% to 70%, but changed my effective sate to the day of the exam. When i spoke to my VSO they said i should drop the appeal since i "got what i wanted". I decided against that and continued the appeal process. Well finally another year later i have an in person hearing. Has anyone dealt with this before?  

[broncovet]

I dont recommend dropping the appeal, unless you have more money than you know what to do with, such as you won the lottery.  

I would add, you can appeal the new decision which awarded the 70 percent and dispute the effective date.  

You need to know the rules for effective dates. 

Your effective date is the later of the "facts found" or the date you applied.  VA "often" uses the date of the exam.  

However, that is almost NEVER correct. Did you go to a c and p exam healthy and come out sick?  This is what this suggests..that prior to the exam, you had "0" issues, but the doctors exam made you sick (or in the case of an increase, made you worse).  

And, I doubt you "predicted" you would get worse later, and, sure enough that happened at the c and p exam.  

You need to order and read this exam.  Did the doctor say that he made his opinion(s) based on "your history" (medical)?  Ok, then the "facts found" were that you had a (medical history) prior to the exam, and it could/should go back the the date of the exam that the c and p doc referred to.  

Sometimes, the doctors will specifically state this:

In other words, the c and p doc can opine:   "In 2004, the medical exam demonstrated a worsening of symptoms".  

However, if the c and p exam words it like he was originating a diagnosis, then the "facts found" may be that you were just diagnosed with the malady at the c and p exam.  

That usually does not happen, either.  To make a diagnosis, there are often tests which are performed, and the c and p examiner usually opines that he agrees with Doc x's diagnosis in 2004, for example.  

You may need an IMO/IME to win this, especially if the c and p exam was unclear as to when you had a diagnosis, or when your condition worsened.  

Bottom LIne:  Continue the appeal, file a new appeal disputing the effective date, order your medical file, and consider "more professional" representation (an attorney specializing in Vets benefits):

https://vetadvocates.org/welcome/find-an-attorney/

 

[kanewnut]

6 hours ago, srmoore0411 said:

Well finally another year later i have an in person hearing. Has anyone dealt with this before?

I had an in person hearing and it was a waste of time. The RO seemed to be PO'ed the whole time. I certainly hope yours goes a lot better than mine.

 

3 hours ago, broncovet said:

However, that is almost NEVER correct. Did you go to a c and p exam healthy and come out sick?  This is what this suggests..that prior to the exam, you had "0" issues, but the doctors exam made you sick (or in the case of an increase, made you worse).  

And, I doubt you "predicted" you would get worse later, and, sure enough that happened at the c and p exam.

This is really interesting. I've never heard of this before. You've got a lot of good info broncovet.

[Buck52]

I agree with broncovet  he is right on.

[broncovet]

The person who performed the VARO hearing is almost certainly not a medical professional, and his opinon is insufficeint to award/deny benefits as far as medical evidence, he must cite a medical professional's opinion, instead.  

Effective dates are a complex area of VA law, and it often takes an attorney to win them, but its almost always worth the effort.  

VA's GS9's are rarely allowed to award six figure retros.  Instead, they just deny and it eventually takes a judge to award them.  

[srmoore0411]

Thanks for the information broncovet. The interesting thing is the Doctor who did my initial exam was also the one who performed this exam. I will try to get my paperwork together in time for the hearing, but as always with the VA im not expecting much.

[srmoore0411]

So i had my in person hearing on April 12th. The hearing lasted a total of 15 minutes. My VSO asked the Judge at 1 point about missing information from my 1st C&P, and if we could possibly remand if testimony wasn't enough to grant my appeal. He said that it would not be necessary, and that he did not want to remand, and delay this any longer. My status has gone to administrative case processing. Hopefully i hear something in the next month or 2. My docket is eligible to go straight to a judge when ready for review.