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Denied: Reopened Claim Still in Appeal?

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lawrencebe

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Back in October 2012 when I separated I filed my original claim and was fully denied (missed appointments). Before the denial I tried to reschedule but was given the run around and pretty much was at a loss. In August of 2013 I filed, with help from my local VA office, for an appeal and for over 5 years I heard nothing from the VA. In early 2018 my VSO filed for another appeal because it seemed as if the VA never got my original appeal and was denied due to it being outside of the “one year time frame”. In April this year my VSO  filed an NOD stating, with evidence, I filed an appeal within the year time frame and was susquently denied again and my original claim in 2012 was “closed”. So in April 2018 I refiled and my claim was “reopened”, and in October I restarted this process and made it to all of my QTC appointments. My claim made it all the way to “Pending Decision” and had a estimated completion of 1/14/2019-2/7/2019 and all seemed well!

Today the hammer dropped...

I went on ebenifits to do my weekly claim status check and my claim was gone. I called the VA and was told I will be getting a letter soon stating “my claim was being forwarded to the appropriate reviewers because I cannot claim disablities that are in an appeal”. At this point I am just trying to see what is my next step in this process because it appears as though I’m in gridlock/checkmate with the VA.

Any help or advice would be great! 

Edited by lawrencebe
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That's not a hammer, its a dove!  Your claim is in appeals, so, if awarded, you should get backpay.  Otherwise, if you file a "new" claim, you wont get retro earlier than the date you filed for the new claim.  (There are exceptions, tho).  

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51 minutes ago, broncovet said:

That's not a hammer, its a dove!  Your claim is in appeals, so, if awarded, you should get backpay.  Otherwise, if you file a "new" claim, you wont get retro earlier than the date you filed for the new claim.  (There are exceptions, tho).  

So do my recent QTC appointments go towards anything? Do I need to file something else to expedite the appeals? Or am I just in a waiting game for this appeal process? Because according to ebenefits I don’t have any historical appeals. DB607539-BEB5-438A-81BA-EEEC700286C8.png

Edited by lawrencebe
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You asked:

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So do my recent QTC appointments go towards anything? Do I need to file something else to expedite the appeals? Or am I just in a waiting game for this appeal process? Because according to ebenefits I don’t have any historical appeals. 

Your QTC appointments, if not considered as evidence, could form a basis for appeal, or, a reopening due to 38 cfr 3.156 b.  

If you think you qualify for an "advance on the docket", then you should do so.  You probably qualify if 1.  You are over 75 years old, 2.  You are terminally ill, or, 3.  You have documentation of a financial hardship such as a foreclosure.  

Everyone has to play the "waiting game", welcome to VA Club Delay and deny.  

Lastly, you are relying on unreliable ebenefits for your information.  That is like asking a known liar for advice.  Ebenefits can be useful, but fretting over it is unlikely to be productive.  

Instead, this is what I recommend:

1Contact your VSO.  If he is like many who "dont return calls", show up at his office and ask your questions.  He has (or should have) access to your VBMS, while we do not, so he should be able to provide an update.  

2At this stage, your patience sounds like a winner.  Recent C and P exams demonstrate someone is at least trying to get evidence to award, UNLESS you already had it and VA is "developing to deny", a good way for you to appeal.  

3.  If you want to micromanage your claim, or, at least know what is going on, then you need to get your hands on a copy of your cfile.  Check it to see if you have all 3 Caluza elements, if not, do your best to get them.  Getting all 3 Caluza elements is the best thing you can do to win benefits.  Make sure they are documented.  If you dont know what the Caluza elements are, I would be very interested in knowing your VSO's response to your question, "What are the Caluza elements?"  

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10 hours ago, broncovet said:

You asked:

Your QTC appointments, if not considered as evidence, could form a basis for appeal, or, a reopening due to 38 cfr 3.156 b.  

If you think you qualify for an "advance on the docket", then you should do so.  You probably qualify if 1.  You are over 75 years old, 2.  You are terminally ill, or, 3.  You have documentation of a financial hardship such as a foreclosure.  

Everyone has to play the "waiting game", welcome to VA Club Delay and deny.  

Lastly, you are relying on unreliable ebenefits for your information.  That is like asking a known liar for advice.  Ebenefits can be useful, but fretting over it is unlikely to be productive.  

Instead, this is what I recommend:

1Contact your VSO.  If he is like many who "dont return calls", show up at his office and ask your questions.  He has (or should have) access to your VBMS, while we do not, so he should be able to provide an update.  

2At this stage, your patience sounds like a winner.  Recent C and P exams demonstrate someone is at least trying to get evidence to award, UNLESS you already had it and VA is "developing to deny", a good way for you to appeal.  

3.  If you want to micromanage your claim, or, at least know what is going on, then you need to get your hands on a copy of your cfile.  Check it to see if you have all 3 Caluza elements, if not, do your best to get them.  Getting all 3 Caluza elements is the best thing you can do to win benefits.  Make sure they are documented.  If you dont know what the Caluza elements are, I would be very interested in knowing your VSO's response to your question, "What are the Caluza elements?"  

Thanks for your detailed response @broncovet!

After looking over my paper work I can see where my VSO back in August 2013 filed an NOD and requested a DRO review after my original decision (denial) came in February 2013. I’m assuming that’s what is holding all of this up.

The interesting part about all of this is I never heard anything back from tha VA after the first NOD but the second NOD in April 2018 triggered a denial response that I received in May 2018. Obviously filing a NOD year outside of the 1 year time frame of my original decision would do that but at that point I’d assume I would’ve been told I already had an appeal in place—he also attached the original NOD to the 2nd NOD and  I was still denied.

Even my VSO couldn’t see where the VA ever sent anything to me after the first NOD was sent in August 2013. I never received a SOC for the 2013 NOD, hell I never received confirmation of the VA getting my original NOD. So my VSO filed for a new claim, just in case my original was closed as it seemed it was at the same time as the 2nd NOD in April 2018. 

Now all of a sudden I cannot refile for things that are in appeal but there is no record of the VA telling me about this appeal over the last 5+ years. I know I’m getting screwed but at this point I can’t tell where the screw is coming from to at least fight back. 

Mind blowing but I’ll chdck back with my VSO tomorrow and see what they say and update some more then.

Edited by lawrencebe
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