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BigRedDog

Request a Claim Decision now?

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Hello all, this my first post and question.  Trying to keep it simple for now, but I'm planning to post my more convoluted history shortly in regards to my big picture circumstances.  I've learned quite a bit here recently from the elders, mods, and last but not least, the new guys and gals asking questions such as this.  I'll try to give just enough info below, without going overboard, especially in order to help others understand their own particular situations.

Basic question(s):  On eBenefits, should I go ahead and request a claim decision?  I currently have nothing else to add .... but would it be worth it to submit a buddy statement?

Basic situation:  The claim is for IU (already eligible since 2014 at 70% combined) and an increased rating for seizures (currently 40%).  Last week, I scanned and submitted a requested statement about my self employed endeavors over the past year (type of work, hours worked, hours lost, gross & net income), for which there is a Dec 29th deadline.  FWIW, it was pretty depressing, and a net loss.  And yesterday I scanned in the 21-4192 Employment Info for my last W-2 job, which was 4.5 years ago.  Per eBenefits, this was "No longer needed," as of Oct 31, but since I finally received it in the mail from my old employer, I submitted it anyway.  C&P exam on Nov 13th by a VES doctor seemed to go as well as I could have hoped.  From judging the tea leaves and chicken innards on eBenefits, it looked like VES submitted the exam before Thanksgiving, the status moved to Prep for Decision after the holiday weekend, then back to Evidence Gathering with the request for more info about my self employment (generally a disaster trying to find work from home).  BTW, I still haven't gotten the physical letter requesting anything, so in these instances eBenefits is actually useful.  Estimated completion date is now March - June, previously being December.  My understanding of these estimated completion dates is that they are completely arbitrary, but I obviously want to get the ball rolling again ASAP.

Any insight on what to expect on this?  I'm assuming that if I don't request a claim decision, the rater won't even look at my claim again until that December 29th deadline.  The only buddy statement I could add regarding my worsening condition would be from my girlfriend, so I'm not sure if the VA can take that any more seriously than my own statements.

Thanks in advance.

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Have you applied for or if so you now receive SSDI?

If you get SSDI solely for the SCs, that award letter from SSA is good evidence for TDIU.

Also did VA Voc Rehab ever turn you down for rhab solely due to your SCs? If so that also is good evidence for TDIU.

.  "C&P exam on Nov 13th by a VES doctor seemed to go as well as I could have hoped."

I hope the VES doc made a statement that you are unemployable  solely due to your SCs.

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Berta, thanks for responding. 

I have not taken the SSDI route yet.  Probably going to start that journey next week.  Like a lot of other vets, it's taken me awhile to come to grips with the fact that I'm actually pretty messed up now, and none of us ever wanted to be "that guy" on disability.

I went through Voc Rehab for school after the Marines, but I haven't tried that route since I started having seizures.  It's only from reading here over the past couple of weeks that I realized having a denial letter from Voc Rehab would help me out.  I'll give them a shout and see what they have to say.  I'm going to start a separate thread about how they screwed me twenty years ago.

Just trying to see a VA neurologist has proven impossible so far (I'm learning now to get my requests documented, instead of making pointless phone calls).  Lucky for me I had a great civilian neurologist when I still had insurance, and his work was enough to get me service connected with my new claim in 2014.

The VES doc that did my recent C&P started his career as an army doctor in Vietnam, and now he gets sent all over the world doing C&P's.  He didn't break any rules by telling me what he was typing up.  But I quizzed him enough to make sure that he had read my file and he went out of his way to document some extra physical observations on my older injuries.  We had a good conversation about brain trauma and all of the things he had seen in his career, and I didn't have to prompt him much before he started talking on his own about the difficulty of getting or keeping a job for someone with seizures.

I plan to provide much more info to you and everyone else here in another post about my background situation.  I've learned much here just from reading everyone's unique cases.  I just posted this to start in the eBenefits forum because I'm getting impatient and I want to hit that link and get them to decide on my claim ASAP.  As we all know, eBenefits isn't very self explanatory.

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I'll keep updating this thread for future reference for anyone else trying to gauge how their claim is progressing in eBenefits, and what the different tea leaves may indicate.  I still have some questions myself about the process.  Yes I know I shouldn't drive myself crazy with this.

I checked earlier today, and it indicated that the statement I uploaded last week was marked "Initial Review Complete."  Took 'em a week, but it's nice to know someone looked at it.

This evening I checked again, and it is showing a new request.  Although it appears under the "Needed from You" tab, it appears that it is a notation for info from Social Security.  The notation is "SSA Coordinator request," but it's also marked as No Longer Needed.

Since I don't remember anyone else bringing this up before, I'll go ahead and mention how non-intuitive (stupid) it is that information requests aren't numbered sequentially in eBenefits.  New requests are always at the top, as Request #1, etc.  But in this case, the SSA Coordinator request came in at Request #4, the bottom of the "Needed from You" tab, knocking the employer request on the next tab down to #5.  Anyway, my take on this was that there must have been a prior reach out to SSA at some point, but for whatever reason, it just didn't show up before.

To make it more interesting, I went to look at the "new" version of claim status, which as some of you know, actually shows the dates that requests are made and closed.  The SSA Coordinator request didn't show up there, although the previous requests were all renumbered.

Anyway, it looks like things are happening.  I'm optimistically inclined to believe that this means they don't need more evidence in order to make a decision, at least for IU, and I'll soon see this move back to a pending status.  And then not back to gathering evidence, geez.

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Just updating for future reference.

As of today, eBenefits says my claim is back to Preparation for Decision.  Estimated completion date range has been moved up to 12JAN2019 - 23FEB2019.  That's a lot better than the last date range which extended from March to June 2019, which was given last time my claim moved from Prep for Decision back to Gathering Evidence (requested info on my self employment).  My original date range was from mid December to late January.  For anyone who hasn't dealt with the online claims process yet, this just goes to show you that these time frames are completely arbitrary and subject to wild swings.  Try not to worry about it too much.

However, I do recommend checking eBenefits on a regular basis when your claim is at this stage.  It took at least 10 days to receive the letter from VA which asked for more info about my self employment.  Since I was watching eBenefits, I saw the notation for the request right away, and I submitted the info online several days before I got the letter in the mail.  I'll continue to check online, in case they want more info from me, or anyone else.

On another note, primarily due to recent info posted by Asknod, after reading the pertinent parts of the M21 and those other internal process manuals, I have a better understanding of the workflow and decision making process that the claims people try to undertake.  For example, they are always supposed to get more info from people who have been self employed, when those claimants are filing for IU.  I wish that had been something that was done early in my claim, instead of the reviewer or rater sitting on it for two months, and then deciding that the VA needed it, after my C&P exam results were documented.  Also per these manuals, one can see and understand the circumstances which will generate a request to Social Security or Voc Rehab for more info. 

In my case, they should also technically be taking a look at my old Voc Rehab docs, since my file should indicate my completion of a Voc Rehab program several years ago.  This is probably why it's best to already have a letter from Voc Rehab stating that more training is not feasibly going to help.  In my case, this should already be evident, just like it was evident from my statements that I'm not receiving SSDI.  But there is no note in eBenefits for a Voc Rehab request, as there is for SSA.  So I'm left to wonder .... is the reviewer sending this up to the rater in order to finalize a decision, only to have it sent back down again because no Voc Rehab info was requested?  It seems like that's what happened when my claim was previously pending decision and then moved back down to gathering evidence; the reviewer had yet to request info from me about self employment.

Anyway, I'm feeling fairly positive that this will finally move forward now.  But there are several things for the rater to determine (IU, possible increase to 100% schedular, possible SMC S), and eBenefits certainly doesn't help much when it comes to figuring out what point they're at in deciding a claim.  I'll keep updating, as eBenefits changes.  I was planning on hitting the button to "Request a Claim Decision" today if there had been no updates, but I guess I'll go back to waiting again.  I'm not sure if clicking that button would do much at this point anyway. 

 

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Checked eBenefits tonight.  Claim status is now "Pending Decision Approval."  Doesn't mean it can't move back to "Gathering Evidence" with more hoops to jump through.

Estimated completion date range moved up again, 01JAN2019 - 26JAN2019.

I'm sure by this Friday, they will do something to crush my growing sense of optimism.

 

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