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]

"I was informed today, that my backpay and CRDP will go back to March 11, 2020.  Reason?  According to the group 'There was never a disagreement submitted on the description of the disability or the granted 0 percentage from the December 2009 decision'.  Had I been made aware of that, I would have argued it.  Whole-heartedly."

Also you said:

"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 was regarding your much  older thread here.

What is the status of that appeal? Was it denied?If so by who- BVA or the VARO?

Can this "group" provide you with a copy of something from the VA that they are interpreting?

Also there is the December 31, 2013 factor-As I understand this from VBM (NVLSP)***

CRDP unlike CRSC became law  on December 31, 2013- so prior to that no retiree was getting any CRDP., thus no retro based on their SC rating.

CRSC is a little different.

I do not comprehend the significance of   March 11, 2020.

Is that the date of the formal claim they awarded recently?

Who is the "group"?

If you don't want to answer that's OK but  what did they advise you to do next? They will know what and who VBM and NVLSP is.

Did you have to pay them any money??

 

 

[Scottish_Knight]

@Berta, I am most like using the wrong phrases and terms and perhaps mix-matching them.  Apologies.

Not sure what this is called.  An appeal or new claim?  I wanted the matter looked at again as I felt the 0% rating was fully not correct and the injury had become worse over the years.  I had surgery in 2017 as the pain from two broken screws became unbearable.  The 'group' is the DAV.  Seems they overlooked the information I provided and zeroed in on 'worsened' and reported that to the VA.  In the end, it seems this was not done as an appeal and an appeal is what I wanted.

The DAV have no documents for me.  I'll just have to wait until the originals arrive.

The 11 March 2020 date is the date I asked the DAV to assist me.  I do find this an odd date for the VA to use.  How do using the DAV have any effect on my injury?  Makes little to no sense.
I wasn't required to pay them, as they expressed to me.  But in the end I have; 20 Euros per month for a year.  Fine.  They have assisted and I feel it's worth the assistance.

Now, after my recent email back to them expressing my dissatisfaction with 'no disagreement filed', here is their response:

In order to have the VA or the Board of Veterans’ Appeals review your decision you need to select one of the below options.
1. Supplemental Claim: This option allows for a decision to be made in about 3-4 months but requires New and Relevant evidence to be submitted.
a. New Evidence: Evidence which has never been submitted to the VA before
b. Relevant Evidence: Information which may prove or disprove a matter at issue in a claim. Relevant evidence includes evidence that raises a theory of entitlement that was not previously addressed (i.e. secondary service connection) 

2. Higher Level Review: This option allows for a decision to be made by a more senior rating specialist; however no additional evidence may be submitted. The VA will only review the evidence available at the time of the decision. Under this option there is the opportunity to schedule an informal conference with a decision maker to discuss errors found in your case.

3. Appeal to the Board of Veterans’ Appeals: This option allows you to choose from three different lanes
a. Direct Review – fastest decision, however no hearing or new evidence is allowed
b. Evidence Submission – you may submit new and relevant evidence (see above), however no hearing is afforded
c. Hearing – slowest option, but you will have the opportunity to discuss your case with a Veteran Law Judge. Evidence may only be submitted after the hearing has been conducted. Any evidence submitted between the decision and the date of the hearing will not be reviewed by the Judge. 

If it is for any other disability you need to:

To file a claim a claim for service connection you will need to complete the below listed form. All forms can be retrieved by going to https://www.va.gov/find-forms/. If you are unable to locate a form or need assistance with completing the form, please let us know. In general, compensation claims average 6-8 months for a decision

§ VA Form 21-526EZ – Application for Compensation

In general, the VA requires the following three things for service connection to be granted:
1. Evidence of a current chronic condition
2. Evidence of an in-service injury or illness
3. A medical link between the current chronic condition and the in-service injury or illness.

Below is a list of evidence to consider gathering to support your claims:
§ Personal statement explaining: Why do you believe your injury or illness is related to military service – provide specific details. If your injury is related combat, please be specific about this as the VA views statements regarding combat injuries as holding more value.
§ Copies of Service Treatment Records
§ Copies of relevant private treatment records
§ Statements from fellow service members who can attest to your injuries in service
§ Statements from friends and family who can attest to you dealing with a chronic condition

Regarding VARO, BVA, VBM.... no idea what those mean / are.

Thoughts?

Thank you again.
 

 

Edited January 21, 2021 by Scottish_Knight

[Berta]

"The 11 March 2020 date is the date I asked the DAV to assist me.  I do find this an odd date for the VA to use."

That means -the date DAV filed the claim for you.

A filing date is usually the retro date. Except for Nehmer claims.

Still there might be some potential on the claim they denied  in the past.

If we can read the 2009 decision to include the evidence list, maybe we can help more.

There is an Abbreviation and acronym list here-I will post it if I can find it.

Sorry for all the abbreviations etc-VA lingo is my second language.

When my daughter was home on leave from USAF she heard me talking to our hadit Radio show podcast producer and she said most of what I said was all acronyms  or abbreviations.

 

[Berta]

https://hadit.com/va-claims-glossary-definitions-abbreviations-terms/

It certainly pays to go over this list to understand VA -speak.

[Scottish_Knight]

@Berta, Good morning,

thank you for the link with the acronyms.  That is truly helpful.

I've attached the 2009 VA Decision.  Just reading it again gets me blood boiling.  The exam, specific to my leg injury was a joke, at best.  There is a portion that describes my mobility.  No mobility tests were conducted, so I've no clue how that was justified.  With the doctor in Augsburg, this past October, we did numerous mobility tests, to which he concluded I am severely limited.  I'll need to wait and read exactly what he wrote, but he expressed as much to me.

Looking forward to your input.
 

 

Edited January 26, 2021 by Scottish_Knight

[Berta]

Sorry I forgot to ask- can you scan their rating sheet-

That would give me the codes they used in that 2009 decision for the gunshot wound residuals.

I can compare them with the codes in place at the time.