Claims examiner may have made a mistake...

[ToddG]

Greetings! I've been lurking here for a bit and have been the beneficiary of quite a bit of good information. Now I have a question specific to my claim that I don't see answered anywhere else.

Here's a quick synopsis of my claim:

SSDI approved; 13 DEC 16

Intent to file VAD; 22 MAY 17

Completed filing; 14 MAY 18 claiming four disabilities (cervical spine arthritis / left hip arthritis / L&R shoulder bursitis and tendonitis) and IU   

Received first rating decision; 31 OCT 18 - left hip denied / left shoulder approved @ 20% / right shoulder and neck deferred / IU denied, but VA acknowledges I am unemployable but due to NSC disabilities

Received second rating decision; 27 NOV 18 - cervical spine approved @ 30% / right shoulder approved @ 20% / C&P examiner added right upper extremity radiculopathy @ 40% (surprise!) so, VA math - 40+30+20+20 = 80%, and all back pay received

But my IU claim was left in the dust, and I'm thinking it should have been re-opened.

Called today and spoke to Peggy - she filed for a reconsideration of IU based on new rating decision and agreed it should have been held open till deferred items were decided. She said it should reappear on ebenefits within 30 days, and call back if it doesn't

 

My question is: Should I do anything else right now, or just wait the 30 days and see what happens? Plenty of time for a NOD later.

How does this all look? Complete claim as far as anyone can tell?

 

Edited December 17, 2018 by ToddG

[broncovet]

So, the IU was denied Oct, 2018?  It will be "ok" to see if the IU claim was reopened, but what were the "reasons and bases" for IU denial?  You indicated they said your IU was "NSC".  This is a classic ploy used by VA..the same one they used for me.  I was eventually awarded TDIU, but not until fighting with VA for 15 more years.  

What "disabilities" did SSDI say you were disabled for?  Look it up on the decision and see if you are service connected for those conditions.  You can use the Social security letter for evidence also, as I explained, if SS said you were disabled from conditions that the VA says are SC.  

My advice is to wait, but in no circustances should you NOT file a NOD before Oct. 2019 UNLESS you have already received TDIU or 100 percent schedular.  

[ToddG]

2 minutes ago, broncovet said:

So, the IU was denied Oct, 2018?  It will be "ok" to see if the IU claim was reopened, but what were the "reasons and bases" for IU denial?  You indicated they said your IU was "NSC".  This is a classic ploy used by VA..the same one they used for me.  I was eventually awarded TDIU, but not until fighting with VA for 15 more years.  

What "disabilities" did SSDI say you were disabled for?  Look it up on the decision and see if you are service connected for those conditions.  You can use the Social security letter for evidence also, as I explained, if SS said you were disabled from conditions that the VA says are SC.  

My advice is to wait, but in no circustances should you NOT file a NOD before Oct. 2019 UNLESS you have already received TDIU or 100 percent schedular.  

 

Thanks for the fast response, broncovet.

It looks like they considered the SSA decision in determining that I was non-SC IU, but they don't say which disabilities, so I have to assume it's the disabilities that were deferred and later approved as SC.                             

My major beef is that they decided against service connection while there were still deferred disabilities, and then didn't reopen the IU claim when ALL the deferred items were later approved, PLUS the C&P examiner added another one.

Peggy even agreed with me, FWIW. 

[vetquest]

I would say file the nod and note that you were denied IU for non SC disabilities but they were not specified.  If they deny you they have to state the reason.

[Dot09]

Congrats on the new awards Tod. I agree with Bronco on how the va does things. Your post made me think of a old article I read about combining a shoulder injury with Neuropathy.

https://www.hillandponton.com/nerve-conditions-part-1/

 

[broncovet]

Todd:

I agree that TDIU should "not" be denied UNTIL/unless all the underlying claims are decided.  How do they know TDIU is NSC if they havent completed your claims.  For legal followers, most Vets advocates understand that there is no such thing as a "TDIU" stand alone claim.  Instead, TDIU is part of a claim for increase to include TDIU.  

[ToddG]

Here's a quick follow up for anyone following this thread.

Claim showed as reopened on 01/11/2019 and went straight to "Preparation for Decision" the next day with a completion date of 02/02/2019 - 02/28/2019. 

I've called every other week to make sure everything looks right, and that they don't need any further information from me. One of the Peggys even said it looks like a simple case of reopening and correcting an error, FWIW.

I have an attorney on standby and will go to NOD if this doesn't work out.

I'll check in again when I know more.