Won my CUE Claim for Skin Condition

[saxman]

Congratulation on your win!  Never give up!!!!

[Vync]

Congratulations!

[JustGettingStarted]

Thanks everyone.  I couldn't give up because I knew I was correct on this.  However, VA put me through the ringer.  I am so glad RAMP opened up and I was able to get this straightened out. 

Now it has been 6 weeks, and I am still waiting for the back pay.  I am sure it will come - I got the letter that says what I was paid, and what was actually owed. 

A lot has happened since I made the announcement on Sep 13th.  We got stuck in Canada when our truck broke down and had to wait for parts.  While camping in the Nissan parking lot for two weeks, Hurricane Michael struck my home.  Our home took moderate damage and of course utilities have been out.  Today is the first day I have been able to go online and catch up on bills and other paperwork.  

Now I just need to find the DFAS number to contact to make sure the back pay is in the works.  It will come in handy paying for a few "upgrades" to our house as it is repaired.

No longer,

JustGettingStarted

[JustGettingStarted]

Here are some of the curve balls VA threw at me when I did my CUE claim.

This should have been simple.  In 2009 I claimed "eczema" and I was on constant oral medications.  VA service connected me for eczema, noted I was on daily medications, and then gave me a 0% rating.  I did not have a VSO and I did not know my skin condition should have been rated the same as eczema, so I did not appeal.  

In 2002, Title 38 was changed so that anyone with a skin condition rated the same as eczema or dermatitis, would get rated on the area of coverage, or how often the veteran had to take "systemic" medications.  The regulations said like "immunosuppressants or corticosteroids" and this caused a lot of confusion in the ratings.  Many raters did not include other types of systemics like anti-viral, anti-fungal, or antibiotic drugs in the skin ratings when they should have.  That is what happened in my decision in 2009.

Fast forward to 2016, the VA illegally calls me in for re-evaluations on 2 of my conditions.  I was over 55, and I had the conditions for more than 5 years.  Under Title 38 they are not supposed to do a re-eval without "unusual circumstances".  When I questioned why - they said it was because they were backlogged.  Like many vets, I was afraid of a reduction so I decided to get smart on my disability benefits.

I went back and looked at all the conditions I had claimed, and compared them to Title 38 and a website called Military Disabilities Made Easy.  That is when I found the error on my skin condition.  I should have been rated 60% in 2009 instead of 0.  I thought my only choice was to claim it and move forward, but someone on a FB page told me about CUE.  My research on CUE led me to HADIT.  I learned what was and wasn't CUE and also checked my case against the BVA claims - I knew I had a rock solid claim.  It was all in the my records and in the claim I did in 2009.

I thought it was going to be easy.  I did my claim and was scheduled for a C&P exam.  Since my claim revolved around the use of systemic medications, I provided a list of my medications I had been taking back to 2004 with my systemic medication highlighted.  Unfortunately, I got a bad examiner that left my medications off because he didn't see my skin disease listed by the VA and he didn't think my medications were important (I saw the same idiot for a knee exam later and confronted him).  And although the VA had the same list of medications in my claim file and mentioned in my Statement, they did not "consider all my evidence" and denied my claim because I wasn't on constant use of systemic medication.

I requested my claim be reopened for reconsideration because the doctor left my medications out.  The VA reopened it and then they said I missed an exam that was never scheduled and denied my claim again. 

I challenged the VA to prove the exam was ever scheduled and requested my claim be reopened for reconsideration again.  It was, and the VA scheduled another skin exam.  However, the exam and claim ended up being for my chronic wart condition rated at 0 percent instead of the eczema condition.  I was denied again.

I was tired of this VA BS.  I had an upcoming appointment with my dermatologist, who had never treated me for my "eczema".  I was seeing him every 6 months for pre-cancerous lesions.  But that didn't stop me from filling out a DBQ, attaching all supporting documentation, and asking him if he would sign the DBQ.  He did, and I submitted it asking for my claim to be reopened again.  This time my skin condition was increased to 60%, but there was no mention of back-dating it to 2009.  At least I had one a battle, but the war wasn't over yet.

So now I submit a CUE claim again for the back date.  I was denied because the VA said there was a "policy change" in 2016 (it was actually in 2015 but they don't know their own policies), that allowed for my drug to be systemic in 2016 but it was not considered systemic in 2017.    Anyone familiar with CUE knows it has to be based on the LAW at the time the mistake was made, and not policy.  When I was going through this, Title 38, which is the law, had not changed since 2002.  VA was trying to say "no" based on MR 21-1.  The policy change in 2015 was an update in MR 21-1 which helped to clarify what "systemic" drugs were because a lot of veterans were getting rated incorrectly.  

So, I requested my case be reopened for reconsideration again, and explained to the VA that CUE has to be based on law, pointed out a VA case they had lost in 2004 for the same condition I had, and also a recent US Veterans Court Case that also explained the law as it applied in my case.  What does the VA do?  The send me to another exam, and then they say they were denying my "increase" because I was already receiving the highest rating possible for my skin condition.  They completely ignored my request for an earlier effective date.  Aaargh!

About this time, RAMP, had just opened up to all veterans.  You did not have to have an invitation letter.  Glory be - I would no longer have to deal with regional offices.

I watched a video on one of the VA official sites that said if you wanted to skip DRO Review, fill out a NOD, fill out a RAMP opt-in, and submit them together.  I did just this and requested Higher Review with an informal telephone conference.  This was on 21 May 2018.

Then I get a letter saying I cannot opt into RAMP because there was already a decision on my BVA case.  ???? There never was a BVA case, so I know this was impossible.  I called VA and was told to wait until my NOD was in the system, and to call back.  About a week later I called, explained the situation, and was told my original RAMP opt-in letter dated 21 May would be used.  Things looked squirrely in eBenefits, but I kept calling and checking and everything finally fell into place.  Around the first week of Sept, I got a phone call from RAMP.  They wanted to know if I was ready to talk or if they should call back.  I was 8 hours from my home but I had brought my files with me because I knew I was getting close to the RAMP 125-day goal.  I went out to my car and had my telephone conference.  They brought up the "policy change" and I said yes, but that wasn't the law and explained the law hadn't changed since 2002 and that CUE could not be based on MR21-1.  I pointed out all the vital evidence - the 2009 decision letter that said I had the skin disease and I was on a daily medication that was systemic, the pharmacy records that showed I continued to take the medication since 2009, MTF record that showed I was put on the medication in 1998.  

On 13 Sep 2018, I got a call from my VSO.  Exactly 120 days from when I had done my RAMP claim, I was given an earlier effective date of May 2009 for my skin condition.  

It was a long, frustrating road, but every time I could see the obvious errors made by the VA.  I do not know how much of it was intentional and how much of it was people that didn't know how to read or do their jobs properly, or even someone trying to protect their bonus.  

Now it has been 6 weeks since I won my CUE and I am waiting for my back pay.  However, I know the first time I received back pay on a claim, it took 4 months.  The second time it took 6 weeks.  This is a larger amount, around $40K, so I expect it may have to go through additional audits.

No Longer,

JustGettingStarted

[paulstrgn]

Congratulations on your win!!!

[jefmil50]

Congratulations!