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Confused Not100% but get ChampVA

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Poopsy Woopsy

Question

I am at my witts end with confusion!! I have been denied "Accrued benefits" which should have come AFTER getting 100%. because

of IU or TDIU.

If I get ChampVA (I just read you have to be at 100% to receive it) why then wouldnt I have been awarded "Accrued benefits for ALL the 

time we were waiting on these claims to be done.

How am I not getting 100% for allotment amount and accrued benefits for back pay on pending claims.. 

They said 1: they went off an old SSI claim which was way before all his medical trouble..which Should and could also be connected to his 70% PTSD. 

I dont know how to make the Old SSI irrelevant or not count towards his claims.

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Others will help you- they need to see that letter if you can scan and attach it here.

Cover your C file, name, prior to scanning it.

The past posts here under Poopsy Wootsy, and your Tidlywink post ,contain conflicting information.

Also I wonder if you took any of my past advice as to the AO ships list etc etc etc.

This started out with what seemed to be an 1151 DIC claim, because you said the VA 'killed your husband'..

1151 DIC awards do not award CHAMPVA or DEA benefits.

You said today

"How am I not getting 100% for allotment amount and accrued benefits for back pay on pending claims.. 

They said 1: they went off an old SSI claim which was way before all his medical trouble..which Should and could also be connected to his 70% PTSD. 

I dont know how to make the Old SSI irrelevant or not count towards his claims."

I have no idea what a 100% allotment is, and back pay (retro) only comes with successful accrued awards.

Others will help.They will need to see the letter from VA as to the "old SSI claim."

And they will need to see youtr past posts undfer Poopsy Wootsy and Tidlywink.

You might have made some under "Jody" as well-

 

 

Edited by Berta
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I agree with Berta.  It confuses us when we try to answer when you have posts in different handles.  

I think "accrued benefits" is pretty much the same as "backpay" (retro) for Vets.  You may heve to appeal the effective date to get backpay.  To do that, you file a NOD to a VARO decision on the applicable form if you dispute the effective date.  

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different handles? you mean different areas? Sorry for the confusion.. Not real good at this.

I know retro and accrued should be the same... my question is "How would He NOT get TDIU and the back pay owed because TDIU would make him 100% (Those were the pending claims we had in before his death) TDIU, Accrued, And A&A..In the mean time (waiting for them to process the claims pending. I get ChampVA..(I got ChampVA because our local Va hospital here was negligent and subsequently it resulted in the death of my husband...thus getting the ChampVA.) This just seems that it should be much simpler than it is turning out to be! it says you have to be 100% to receive ChampVA..???? So why isn't he?? and wouldnt "Accrue" follow getting the ChampVA because it was already "PENDING"??? We were originally trying to get him 100%TDIU (which should have been VERY easy). Instead they deny "Accrued" shouldnt you get TDIU and then they take care of the accrued from the time it was filed so thus getting accrued from the original filing date? I am also filing an NOD next week.. 

Im so sorry for the name confusion., eek!

Yes worked real hard on the "Ship List" and got some numbers of where you should be able to attain that info but to no avail.. Im hoping that once I get his C-file it will just be in there.

What the SSI letter said...the letter states "we considered the records from the Social Security Administration which show the veteran was considered disabled due to a back condition.The veteran was not service connected for a back condition. Additionally, the VA is not bound by decisions made by the Social Security Administration. "SO" I am assuming all i need to figure out is "HOW" to and what it is that would make them "NOT" take into consideration SSI.

Please don't tire of me. I am trying really hard to get all the ducks in a row so they start making sense. To me and hopefully to you all.

Thank you for your time and help.. It is still unbearable for me and can get overwhelming but I am determined to try till I come to the end of the road.. Thank you all  Poopsy Woopsy 

Edited by Poopsy Woopsy
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Different handles means posting under different names...

OK, I think I follow this much.

1. You have a claim pending (in one of the VA's different stages) for your deceased husband.

2. Your husband died at a VA hospital.

3. You are receiving ChampVA healthcare benefits.

4. The VA denied his SSI (or possibly SSDI) evidence in his VA claim.

Now, do I have that straight?

If so, can you answer this,

1. Do  you now receive DIC.?

2. Have you received or have signed any legal documents regards your husband's death while at the VA hospital and or after his death.?

What you need to know.

The VA does not use the SS (I or DI) for a link to service for service connection.  So, their statement as you state can be correct.  Now, I have read that SSDI will and does use VA records for their determinations for disability and have a expedited process for that.

In general,

From what I am reading, you, I think, are suggesting that the VA (either from SS, or with SS) determined that your husbands illnesses had occurred at an earlier date and therefore they, the VA, should use the date SS used.  The VA is only going to use what the evidence says the earliest date is, notwithstanding what Social Security says.  The disability evidence has to stand on its own, not what someone (in this case, SS) says.

My thoughts,

Hamslice 

 

Edited by Hamslice
cause I screwed up
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Thank you guys for a speedy response!

Ok. 1. We HAD 3 claims pending "Before" my husband was killed by the negligence at the VA where they immediately conceded their wrong-doing and thats how I got DIC, AND ChampVA. SO The SSI I keep talking about is quite a few years back my husband (by the way his name is Don, so I will refer to him as Don) Don was on SS disability for his back. He had surgery and things were fixed, but the pain continued! so a lot of his VA records indicate pain and meds for the pain, but nothing else regarding his back. this was so far back I can't remember the dates. BUT This is the reason they keep "Denying" his claim for TDIU.          

(I am going to write straight from denial letter)  

Reason for Decision

For accrued purposes, entitlement to induvidual unemployability

The claim for individual unemployability is considered reopened. Entitlement to individual unemployability remains denied because the evidence does not show that the Veteran was unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities.   ( this is not a typeO ) " considered reopened then says remains denied"????

Is "Entitlement" the operative word here?

Continuing on right from the "Ratings" paper.       They go on to say in the next sentence. We considered the records from the social security  Administration which show the Veteran was considered disabled due to a "Back condition ". Additionally, the VA is not bound by decisions made by the social security  Administration. They go on to say Entitlement to individual unemployability remains denied because the claimant has not been found unable to secure or follow a substantially gainful occupation..??? 

Did they just ignore the fact we put in for A&A?? Twice, denied the first time.. He was also deemed by the VA after a stint in the hospital to be put in a care facility (for good) instead of going home!!! (Over my dead body!!)  Sheer HELL, then they KILLED HIM!!

I am assuming all I have to do is get them to disregard the previous SSD I just don't know how to do that??

The other thing is, I have been trying to figure out is, "You can't get DIC Or ChampVA unless you are "100%". So why am I not "Just receiving TDIU.. There is all kinds of evidence that he was unable to work. His medical records, previous PTSD records.The VA's own volition. (Previously stated above paragraph..I did all the work for his PTSD claim and he was awarded the first time around and in a timely manner!) He got 70% PTSD with a 50% GAF. thats pretty obvious and by all I've been reading, Not easy to get!!  ARE they just playing "DUMB"? hoping I cave or miss something so they can just dismiss the case.. It should have been automatic..... What am I ignoring or missing?? 

 

 

 

 

 

 

 

 

 

 

Edited by Poopsy Woopsy
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You do not have to be 100% to get DIC.  As a surviving spouse, you can (should) get DIC if your Veteran spouse dies of a service connected medical condition irregardless of the conditions rating.  In other words, if a Veteran died of a heart attack, and had a 30% rating for heart disease, then the spouse would get DIC.  There are different DIC rules regards 100% and time and non-service connected death. 

You are getting DIC and ChampVA because your husband died from a service connected condition is what I suspect.  In 2003, the changed the law and surviving spouses and children under age 18 (unless college, then 23) can get ChampVA, healthcare.

As I said before, SSDI and VA are not related.  The Va in your letter mentions the SSDI determination, but that means nothing regards your husbands service connection.  They are just agreeing to your reading of same.

Now, from what I am reading, you seem to be looking for back pay of some sorts,

Is this correct, or what exactly are you looking for from the VA.?  And from what date, etc.?  

And, where  you on ChampVA before your husband passed, or did you get that at the same time you got your DIC.?

Trying to help,

Hamslice

 

 

 

 

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