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

[ToddG]

10 minutes ago, Buck52 said:

ToddG

Hopefully the BBE will have exactly what you want in it.

Just have a Plan B ready in case it don't , but it sounds favorable to me.

 

Buck52, for anyone similarly situated and following the thread - what about this strikes you as favorable? Is it the details of the claim?

Of course, the money would be nice - but I'm not in an emergency situation. So, no plan B needed.

THANKS!

[Buck52]

Favorable that a decision is on its way.

As long as it take the VA to render a correct decision  I would say that's emergency enough.

[ToddG]

I called Peggy today to find out how to get a copy of my C-file and asked about this claim while I had her on the phone. As expected, she couldn't/wouldn't tell me much, except that on her end the claim closed today (3/25) - which is strange because ebennies said it closed on 3/22. She said the BBE goes out tomorrow, and in my experience, that means I should have it by Saturday. I'll update when I know more. 

[ToddG]

It's exactly a year since I posted here, and things are finally moving again.

There was a delay caused by the USPS. My local PO is notorious for misdelivering and losing mail, and this time it really bit me.

In any case, here's what my claim looks like now:

 

Pending Disabilities

 

Disability                                                        Submitted        Type    Actions

 

Attorney Fee Memo                                       03/19/2020      NEW   View Pending Claim         Gathering of Evidence

Attorney Fee Eligibility                                   03/19/2020      NEW   View Pending Claim         Preparation for Notification

Bilateral Hip Condition                                   10/02/2019      NEW   View Pending Claim        Preparation for Notification

Degenerative Arthritis Cervical Spine         10/01/2019      INC     View Pending Claim         Preparation for Notification

Diabetes Mellitus Type 2                              10/01/2019      SEC     View Pending Claim         Preparation for Notification

Headaches                                                      10/01/2019      SEC     View Pending Claim        Preparation for Notification

Radiculopathy Left Upper Extremity           10/01/2019      SEC     View Pending Claim        Preparation for Notification

 

It was stuck in Gathering of Evidence for months, then Review of Evidence for weeks. Then, last week it moved rapidly to Preparation for Notification on 3/19. The Attorney memos also appeared on 3/19 – and I have no experience with them, so I have no idea what they mean except what I found in other peoples posts.

I lost my initial TDIU claim, and I now know why – I have the C-file and the C&P examiner wrote that I was unable to function in a “physical work environment.” But I’m not pissed, because I didn’t have the strongest evidence on three of my four initial physical claims, and he gave me service connection – which will help me forever. The TDIU is currently in appeal (secondary consideration) with an attorney, and he now appears on all of my claims, even though he’s only covering the TDIU appeal going back to May 2017. I’m hoping I don’t have to fight to keep him from getting the fees for the newer claim – which he never touched. I will happily pay the fees for the entire time if the claim he’s handling gets approved first – and it may, because it’s also in Preparation for Notification.

 

These things appear in the claim, but I won’t speculate as to what they mean:

There is a “Secondary Approval Required,” now closed out in the “needed” section.

All the dates for the new physical claims were 10/02/2019, but they’ve changed four of the five to 10/01/2019.

I went to two C&P exams, and I think the first examiner was a dud (the reports are very poorly written), but no one ever examined my hips. Fingers crossed that they just gave me a “bye” on them because I submitted a crap-ton of medical evidence, including xrays.

 

I’m happy to read any input or answer any questions, and I’ll check in when I know more.        

 

[Berta]

" I’m hoping I don’t have to fight to keep him from getting the fees for the newer claim – which he never touched. I will happily pay the fees for the entire time if the claim he’s handling gets approved first – and it may, because it’s also in Preparation for Notification."

Years ago I contacted a lawyer if I needed representation- because that claim was going on when I returned to college to finish my degree. It was just a brief email and I mentioned the evidence I had.

I thought it would save me time to get a lawyer.

He called me right away and was quite willing to help, even sent me a contract to sign.

I had 2 CUES pending that had nothing to do with the claim I contacted him about-and mentioned them because- we had quite a talk about VAOLA and he would see them in my C file anyhow if he ever repped me.

The contract however included ALL issues I had, and I refused to sign it-then he said he would eliminate the CUEs from the contract but by then I knew I would have to support my claim myself.....after all I had already done all of the medical legwork and had very favorable 2 IMOs.

I won that claim at the BVA.

Be careful of those contracts.

Also I helped a vet get SC after 10 years, 2 CAVC trips etc etc and he had a law firm who VA was going to pay. I sent the VA a letter stating who I was and how I had helped him myself ( this happened during my above claim too and I spent hours a day for over 3 weeks, going through his SMRS etc.) and I pointed out how his lawyers violated the 5 conditions of fee payment and had obviously never even read his BVA decision.

The vet had begun to call me by the hour, email me a lot, and pressure me relentlessly to get his claim awarded as fast as possible.

Once he got the award he was happy and never called me again. I assume the VA never paid his lawyers.Otherwise he would have pressured me on appealing that fee situation.

I only helped him because my former POA asked me too. (Meantime my former POA was messing up my claim.)

I filed a OGC complaint against them, the POA outfit ,with great results and then emailed their lawyer ( state vet org) after I won the BVA case , that my former  state POA said would Never succeed. 

I filed a complaint with their boss too- the Governor of NY.

Incompetence does not just infect the ROs, it happens within our vet orgs as well.I believe  we are all smart enough to handle our claims ourselves.Because everything we need to know is at hadit.

If it involves needing an IMO/IME however, that is a chance we all need to take, to make sure the IMO/IME will actually garner what we want.

It took me over 3 weeks of daily work and research to help the CAVC vet above, and his private  doctor even got mad at me because I also included his Health grade report  as evidence, in the lay medical opinion I prepared for him to consider for this vet.

He was pissed because he is the best Endocrinologist in NY, and thought I was questioning his expertise.

I pointed out to the doc that the healthgrade report shows he has far more expertise than the main VA Endo at Buffalo whose lousy C & P exams, I rebutted myself on my own DMII claim and my IMO doctor supported those medical errors. I said the VA doesn't know who he is -they have to be told. 

He then calmed down and prepared an excellent free IMO for the vet ,who he had treated for many years, referring to the SMR evidence I had found, that VARO Buffalo  AND his 2 lawyers at CAVC ,had completely overlooked .

 

 

 

 

 

 

 

 

 

 

 

 

 

[ToddG]

Thank you for the heads up, Berta. I'll be prepared to fight.

Do you have any idea what the "Attorney Fee Eligibility," "Attorney Fee Memo," or “Secondary Approval Required” mean? Or why I wasn't sent for a C&P on my hips?

THANKS!