Missing claim AGAIN

[Rhodesia]

Ok I have a problem again, I filed a claim for a service connected injury for a Total knee replacement on 4/15/2018 all necessary paperwork including VA forms were submitted, that claim somewhat disappeared 4 months later, so I submitted a second total knee replacement claim on 08/01/2018 they have labeled it as a secondary condition claim because I had to have it done all over again to replace the total knee again I had in the first place so in another words I had two total knee replacements on the same knee., I submitted all necessary VA forms and documentations as before, this morning on 09/14/2018 I was notified that I need to submit evidence all over again and I have until 10/10/2018 and the claim was move back to 05/15/2020 (What the Hell) what I uploaded all disappeared again, plus they are asking for Tri West billing statements this time because it was paid through the choice care program and approved by the VA. that's a first. They did not ask for that the last time so I resubmitted all documentation all over again and the new VSO I went with she is about as useless as pigs with wings. So am I missing something here or is the VA trying to NOT pay the 100% temp for the second knee replacement and making it a secondary condition. I have not found anything that makes a second total knee replacement a secondary condition unless someone out that has gone through this before? 

Edited September 15, 2018 by Rhodesia

[broncovet]

Key evidence disappearance has been around a very long time at VA.   Many/most experienced Vets advocates mail stuff certified mail, return receipt requested, and send it to Janesville, where 3rd parties scan it into the computer.  Better yet, submit it electronically via ebenefits.  

Like yourself, I would not have beleived VA would do this to Vets 15 years ago, when I was still wet behind the ears.  I actually thought the problem was mostly solved with documents being scanned into janesville.  VA employees have figured out a way to lose it electronically.  

I will estimate half of all appeals involve "loss of" or VA not reading the evidence, but that estimate could be low.  

In 2008, the VA had "the October incident" where a half dozen VARO's were caught red handed with Vets evidence in the shred bin by the VAOIG.  The VA "fixed" the problem by no longer doing shred bin inspections, and by "allowing" Veterans to submit a "Special Handling request due to mishandled evidence" but for only an 18 month period beginning in 2007.  The VA wasnt required to adjuticate the Special Handling Request, however, so the VA can just say, "Ok, we gave you special handling, and we denied you anyway".  
"

[Rhodesia]

2 hours ago, vetquest said:

Why did you need to refile.  Any VSO worth their salt keeps copies of everything submitted scanned into their computer server.  If this VSO did not you need a new VSO.  I will bet the VA is trying not to pay the 100% temp.  Once my records disappeared from the San Diego VA.  They wrote to my senator that I had never been treated at their hospital.  they agreed to add any copies of their records that I had.  I had copies of some of them.  I then tried to get an appointment and they said I could not because their records said I had missed three appointments.

No I did most of my filing on my own with success because some of the organizations that help me from the start were not in the best interest but for them self's, I only looked for a VSO this time because my claims were missing and then they took the 20% reduction rating away for scars and gave me a 0% which I found out I have to file a new claim just for the scars, after the knee replacement which is kind of dumb because My scars have not disappeared and the VA knows I have them otherwise I would not have been getting a 20% rating for service connected. I finally retained an attorney for my Malaria claim since I was denied twice he says I have a case because my records shows I contracted it in 1995 and the VA recognized it while on active duty, but the VA makes it look like I contracted Malaria in Portland, Oregon anyway that's another story.

[broncovet]

You posted:

 

Quote

So just to understand this, are you saying that it is ok for the VA to charge my private insurance (Correct, its ok for VA to charge my private insurance).  for my combat related injury's and it's ok for me to pay my own deductible (No.  The Veteran should not be responsible for the deductable) in order for the VA to help pay health insurance for a fellow veterans care that has no insurance?

The whole idea of having "multiple Insurance policies" is so that the insured's "out of pocket" costs are reduced or, hopefully zero.  It does not always work, but this is the idea.  Im not advocating you should have to pay a copay or deductable when VA bills your insurance, but I have not seen that happening, tho nothing suprises me with VA anymore.  

As far as Im concerned, I dont care who pays for my care..VA or an insurance company, as long as I dont have to pay.  

Insurance is designed so that you can not make money with it.  In other words, if you have 10 car or health insurance policies, you can not collect times 10..else people would make money getting sick or wrecking their car.  Insurance is designed to "protect" you from the risk of loss.  Not for you to make money by wrecking your car.  

 

[Rhodesia]

On 9/15/2018 at 1:08 PM, broncovet said:

You posted:

 

The whole idea of having "multiple Insurance policies" is so that the insured's "out of pocket" costs are reduced or, hopefully zero.  It does not always work, but this is the idea.  Im not advocating you should have to pay a copay or deductable when VA bills your insurance, but I have not seen that happening, tho nothing suprises me with VA anymore.  

As far as Im concerned, I dont care who pays for my care..VA or an insurance company, as long as I dont have to pay.  

Insurance is designed so that you can not make money with it.  In other words, if you have 10 car or health insurance policies, you can not collect times 10..else people would make money getting sick or wrecking their car.  Insurance is designed to "protect" you from the risk of loss.  Not for you to make money by wrecking your car.  

 

That makes sense but I have seen the VA I worked for do some really stupid crap the way they pay their bill's like milking one veteran to help pay for the other veteran while reducing cost for care so monies can be utilized elsewhere in the best interest of the VA, but that's from my experience and my opinion.

[Rhodesia]

On 9/15/2018 at 1:08 PM, broncovet said:

You posted:

 

The whole idea of having "multiple Insurance policies" is so that the insured's "out of pocket" costs are reduced or, hopefully zero.  It does not always work, but this is the idea.  Im not advocating you should have to pay a copay or deductable when VA bills your insurance, but I have not seen that happening, tho nothing suprises me with VA anymore.  

As far as Im concerned, I dont care who pays for my care..VA or an insurance company, as long as I dont have to pay.  

Insurance is designed so that you can not make money with it.  In other words, if you have 10 car or health insurance policies, you can not collect times 10..else people would make money getting sick or wrecking their car.  Insurance is designed to "protect" you from the risk of loss.  Not for you to make money by wrecking your car.  

 

Also my 2nd Total Knee replacement went from Knee Replacement to Knee Replacement (Secondary) the VA claim center changed it to a Secondary condition even through it was a Total Knee Replacement 2nd time around on the same knee, so I have a feeling this (Secondary) word that was added into my claim has me thinking that it will not make the temp 100% but add an increase to the 30% I'm already receiving for the first knee replacement on the same knee I could be wrong but I have never heard of a claim for a total knee replacement  2nd time around as a "secondary condition" I could not find any reference for a claim for Secondary but the claim is being processed as like I'm going through the 100% temp claim, confusing I know. anyone have an ideal why the VA added the word Secondary? So this is what my claim says : 

 

• Disabilities Claimed: total knee arthroplasty (Secondary), knee replacement (Secondary), Temporary Total Disability (New)

Edited September 17, 2018 by Rhodesia

[broncovet]

I have a secondary rating, and its no different than primary, except the Caluza elements are a little bit relaxed.   

Instead of 3 Caluza elements, you need only 2 for secondary:

1.  Current diagnosis

2.  Nexus, or link between your current diagnosis, and a SC condition.  

     Notice the "in service event" is not needed with secondary conditions as its presumed by the primary condition.  

     You dont need to worry whether this is primary, secondary, presumptive, etc.  Once service connected, they are all treated the same.  In fact, the VA "may" be trying to help you get around (apparently) the fact you already had one temp 100 percent rating for that knee, since you need a second surgury, they are making it sail through by listing it as secondary.  

     Terms like "primary", "presumptive", "secondary", etc., are mostly for rating specialists to concern themselves with and you need not worry about it.  When you apply for benefits, the VA must assume the maximum, and you dont have to say, "I want to apply for presumptive SC for the knee", or whatever.  If you have the applicable evidence, they should award it.  

     In other words, if I applied for a condition as "primary", and it turned out the condition was actually a presumptive, (the Veteran) need not concern himself with this UNLESS, for some reason, the presumptive evidence was not present.  

     Once you meet the criteria for "presumptive", "primary", or secondary conditions, they are treated the same.  

      I was just reading a case about that..and I may have even posted something about it.