VA asking questions on injury background. Warranted?

[Scottish_Knight]

Greetings all,

I served from 1988 to 2009, roughly 18 of those 21 years were as an Army CID Special Agent.  In 2001, I was shot in the leg, which destroy the femur.  This occurred on a US military installation, however I was taken to a civilian hospital for the surgery and was later transferred to a MEDDAC.  The bullet traveled through the femur, so a rod was inserted with two lower and two upper screws.  I lost not only length in the leg (2cm) but my hamstring atrophied.  Since then, I've encountered continued pain in my knee and hip.  All was documented in my military medical records.  Often times, the pain would have me seek medical attention about 2 times per year, which again is documented.

I underwent surgery last year to remove one of the screws (all are now broken) that was pressing against a tendon causing extreme pain.  The surgeon explained the others will need be replaced and I will also need a hip replacement in the coming years.  The pain continues.

My VA exam was in 2009 and at that time the length difference in my legs was disclosed to me for the first time and as xrays were obtained, the screws were discovered to be broken.  The VA Rating Decision gave me 0%. 

Unknown to me was the appeal process.  Last year, I found someone who is helping me with the appeal.  I live in a remote part of southern Germany, so connection to other retirees and vets is nil.

This week, through my appeal representative, the VA has contacted me.  They want all the background information on the shooting.  They require the who, what, when, where, why, and how of this incident.  I am also to supply them with records I have that they don't.  First, they have a copy of my entire medical record.  How am I to know what they don't have?  Second, the Rating Decision states that this injury was service connected and in the line of duty, so why is the background information required?  Had I been shot while in Afghanistan would they be asking the same questions?

Perhaps I simply do not know exactly how the VA adjudicates the claims.  As this is not a presumptive matter, evidence of the injury must be presented.  They have that in the form of my military medical records.  Do the circumstances behind the shooting hold weight on determining the extent of either the injury or the level and percentage of my disability?  Does the background on an injury play some part of the adjudication process and awarded disability to which I am unaware?

Thank you in advance for any insight into this.

Edited October 26, 2018 by Scottish_Knight

[Berta]

Thanks- I will read it as soon as I can-I might need to re read  all of your posts,first.

[Scottish_Knight]

Right then, last night I was playing with numbers, so to speak.  I was trying to obtain a wee estimate on the retropay, whenever it arrives.  During this, I had a thought but am unable to locate an answer.

From June 2009 through November 2020, I was listed by the VA as 20% disabled.  That increased to 60% at the end of November and now 90%.  This recent VA decision acknowledge my points to the CUE claim.  This, in essence, raises my VA disability from 2009 through 2020 as 50% (10+10+40).  Here is the rub - 20% disability was taxed and 50% is not.  Will the retropay I am to be awarded include the taxes I erroneously paid for those 11+ years?

Do any of you have insight into this?

Cheers!

[Berta]

I assessed the decision-

but first to answer your question-your retro will be based on the Historic Rate charts that are available here under a search-you will need to subtract from them any comp you have already received. You have more than one  EED ( Earliest Effective date- that too must be considered

You said:

"Here is the rub - 20% disability was taxed and 50% is not."

You mean because the 20 is under CRDP?

  "Will the retropay I am to be awarded include the taxes I erroneously paid for those 11+ years?"

That, I believe is an IRS issue but the CRDP/CRSC links I gave you in this thread before can help- DFAS phone # should be there as well.

This is my assessment of the decision:

The # 1 CUE VA awarded has an EED of June 1, 20O9, the day after your discharge.

I feel this is a proper award -and correct EED The 40% is based on the same type of GSW (gun shot wound) that a Vietnam vet friend of mine had -

Gun shot wound to thigh ( actually he has 2 Purple Hearts but did want to claim the other one, it was minor compared to the main one.) 10 years after I got him a 100% P & T award ( nothing to do with the GSW award, he took my advise and applied for PTSD- and he got 50% right away. He now get 100% P & T (1151) and SMC.(direct SC)

The rating for PTSD is correct, in my opinion. That retro can only go back to April 1, 2021, due to the April 2021 C & P exam.

VA said Feb 22, 2021 was the formal date of the claim, but VA used the C & P exam date as the first evidence they had of your PTSD.

Others here might suggest you appeal that date.

In the other CUE  award ( # 2 and #3):

In my opinion, that is a proper SC rating. ***

The proper EED for tinnitus at 10% seems to be proper  (back to date of tinnitus claim)

I also believe the additional ratings ( Hip and thigh) are  correct.

*** The internet limits the amount of information we advocates can have----it would take a good review of ALL of your medical records to determine if some of these ratings are not correct.

The DAV, as your POA, might be willing to do that-they got credit for the award- but I suggest you consider using some of that retro for an Independent Medical Opinion on some of the ratings,if you feel the established medical evidence VA had when they made these decisions, was not properly considered.

You could file more CUEs on that-

Cue, I have repeated this here MANY times,

is NOT a "one shot deal" and a CUE can be filed on any decision, I filed Cues on awards letters ( one re: my daughter-a veteran-VA reversed the decision in 3 weeks,  and others regarding a decision I got the before I got the denial ( or award) one or two awarded in 3 weeks.

I hope the DAV is aware of the regulations in M21-1MR and 38 CFR on that. I think I even posted a jpg  my card here from  President Trump thanking me for those suggestions to the VA Secretary - which have already  helped MANY.

I bring that up because in 1998 a vet rep told me I had no CUE basis in a 1998 award letter. Like a dope I believed him but it still bothered me. In 2003 I filed multiple CUEs on the award letter- they were all won... by 2010.

My daughter's CUE was with a NOD , I prepared for her tocopysign and send to them, VA Edu, on a award of DEA. The VA Educational Department is an oxymoron sometimes because they failed along with receipt of her DD 214 and their own regulations, in the decision,to properly award her 7 years of DEA. They gave her one month of DEA and the NOD/CUE I wrote was Scathing.

Fixed in 3 weeks by VA Edu. 

I repeat this crap VA pulls from time to time because they get away with this stuff if we dont fight back.

VA EDU did pay for half of my degree at AMU so , at that point, someone there knew how to read.

 

 

 

 

 

[Scottish_Knight]

Berta, thank you for taking the time to not only re-read everything but in offering your insight.  Very much appreciated.  There is quite a bit here for me to digest.  I'll have a long read on the weekend and will most like return with comments and questions.  But from this point, it would seem there is more work (claim date, for example) to be done.  The VA do not make things easy.

I've attached a part (1 page) of the recent notification letter from the VA.  I rang the VA earlier today as I am confused on something.  This most recent claim was adjudicated on 12 August.  On 13 August, the VA paid me $1458.00  I've no clue what that is so I rang the VA.  I presented my most friendly voice, as I do each time.  The woman explained this, but I am honestly lost as to what she was attempting to clarify.  I do not understand this payment and she continued to refer me to this page of the notification letter.

1 June 2009, I retired.
September 2009, I had my first C&P.
December 2009, the VA provided the Decision Rating.
April 2010, I received the Decision Rating.
Jan or Feb 2010, I received the retropay from June 2009 through December 2009.
March of 2020, I started a claim for the gunshot wound.
Sept 2020, C&P
November 2020, C&P Xrays
November 2020, Decision Rating and increase to 60%.
January 2021, retropay from March 2020 through November 2020.
February 2021, new claim - Mental Health, Hearing Loss and Tinnitus.
March 2021, C&P mental health
May 2021, CUE claim for gunshot wound submitted
July 2021, hearing and tinnitus C&P
August 2021, adjudication for claim(s) this year:
    Mental Health and Tinnitus award 70% and 10%
    CUE claim founded - retropay pending?

The woman from the VA attempted to clarify this payment of $1458.  She told me it was a Cost of Living Adjustment.  As I increased from 60% to 90% (increase of $740.00 monthly) for March - July, where is that $3700?  I'm fairly good with maths, but I am just not seeing this $1458.  I am also unsure how to calculate the retropay (136 months of 30% (20% -> 50%) for June 2009 through November 2020.  I simply cannot get my head around all this payment rubbish. 

Is there somewhere I can ring that can speak to me as if I am a complete idiot to better understand all this?  I have to clarify it with my German taxes, so I need to understand it all.

I don't receive CRDP/CRSC

Advise?

Thank you!

Notification letter Page 3.pdf

Edited September 1, 2021 by Scottish_Knight

[Berta]

"I don't receive CRDP/CRSC" I thOught you did- in any event

"I served from 1988 to 2009, roughly 18 of those 21 years were as an Army CID Special Agent.  In 2001, I was shot in the leg, which destroy the femur.  "

You probably will NOW! ( unless you waived any CRDP/CRSC to receive VA comp instead.)

CRDP is automatic, and the VA contacts DFAS for you.  CRSC has to be applied for.

It looks to me that the third column on the retro audit will tell you how much to expect.

VA used to send the entire retro all at once , but now they stage it sometimes-in separate deposit.

This might help you on the initial deposit....it might be a partial payment however

 

https://militarybenefits.info/va-disability-rates/

You said:

"The VA do not make things easy." Us hardcore claimants here would sure agree. We have all been overwhelmed by it, when first starting out with a claim.

But the hadit Motto here is " Knowledge is Power." S0 TRUE!!!!!!

[Scottish_Knight]

Thank you Berta.  You are correct in that I am setup for the CRDP.  The CRSC...this is complicated.  Being shot outside of a 'combat zone'...  The VA do not see the work done by CID agents as combat.  Technically correct.  CID command will not advocate for us.  We simply 'suck it up', so to say.

I looked at your link above, but am still clueless.

I also looked at the VA History Payment page.  The page indicates the $1458 was retropay.  Retropay for what exactly?  The numbers make no sense.  Is this for the 70% mental health and 10% for Tinnitus for March through July?  Is it all I am to expect for the CUE claim?  Again, the lass I spoke with yesterday at the VA did a poor job of explaining.

To my thinking and please correct me if I am wrong on these:

1.  Mental Health & Tinnitus.  This increased my disability from 60% to 90%, which is an additional $740, monthly.  March through July is 5 months times 740 equaling $3,700.00.  

2.  The CUE claim.  For 136 months, I was recognised as 20% disabled.  I was paid roughly $250.  The CUE was acknowledged.  So I should have been recognised as 50% disabled.  This should have been roughly $800 for those 136 months.  A difference of $550 per month.  It would therefore seem to me that the VA owes me roughly $75,000.00 ($550 x 136).

What is this $1,458.00 and are my retropay figures correct or not?  Seems I may need to ring the VA again today.

Cheers!