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Effective date on recent appeal


firedog974

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Hi all,

            I recently won a RAMP appeal that originally started Jan 2016 when I put in a claim for PTSD.  I received my decision letter today, and the effective date is March 5, 2019.  Just wondering if anyone has any advice on where to go from here, as I feel the VA (as usual) screwed this one up.  In my decision letter it states the reasoning for the effective date as follows-"You were diagnosed with just alcohol use disorder on Aug 24, 2016 VA initial PTSD exam. Alcohol use disorder by itself is not a disability for VA purposes.  You now have a diagnosis of PTSD, therefore alcohol use disorder was included with it. We have assigned an effective date of March 5, 2019 which is the day the facts found show that you had a diagnosis of PTSD. An evaluation of 50% is assigned March 5, 2019"   So a little back story, when I initially filed, at the C&P exam, the shrink told me they could not find evidence of the stressor event, so he stated he could not diagnose me with PTSD (couldn't just take my word for it).  I filed an appeal when I received my denial letter, and submitted a report from my doctor with a diagnosis of PTSD, and began doing my own research to verify my stressor (The VA advised much of my personnel record was missing).  I submitted a lot of evidence during my appeal, and was finally granted it.  So is the VA essentially saying we know you filed for a PTSD rating over 3 years ago, but despite what your doctor said, the effective date is only when our doctor diagnosis you?   Is this correct, or is the VA wrong?  Any input for my next step (if there is one) would be appreciated.  

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I think you have a good shot at fighting this. I am sure there is someone here who has faought this issue. 

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What you are looking at is an appeal for EED.  If your case was before BVA there is not much chance of winning.  If your case was at the RO I would appeal to the BVA.  I will go out on a limb and say what the VA is stating is that your disability could not be verified until the date of your last C&P.  They did this to me on a claim for PTSD and I won on appeal to the BVA.

They can and do use this to avoid paying backpay when a claim has taken a considerable amount of time for them to get their act together.  It should not be right that they use the date of your last C&P and they can get away with this if you let them.

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20 minutes ago, vetquest said:

What you are looking at is an appeal for EED.  If your case was before BVA there is not much chance of winning.  If your case was at the RO I would appeal to the BVA.  I will go out on a limb and say what the VA is stating is that your disability could not be verified until the date of your last C&P.  They did this to me on a claim for PTSD and I won on appeal to the BVA.

They can and do use this to avoid paying backpay when a claim has taken a considerable amount of time for them to get their act together.  It should not be right that they use the date of your last C&P and they can get away with this if you let them.

Thanks vet quest.  Not sure what an EED appeal is, can you elaborate?  How long does something like that take?  This claim has been going on for over 3 years...

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5 minutes ago, firedog974 said:

Thanks vet quest.  Not sure what an EED appeal is, can you elaborate?  How long does something like that take?  This claim has been going on for over 3 years...

Earlier effective date.  And who knows. I have been 5 years+. 

Your brown envelope should have your next step to appeal to the BVA. 

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An EED (earlier effective date) appeal will usually go before the BVA.  You need to provide evidence to show that the EED is valid.  Usually the BVA provides much more weight to your case and evidence than the RO.  My appeal took five years but that is quick now a days.  A lot of veterans hire an attorney for their appeals, I did.  They get twenty percent of your award but that is better than 100% of nothing.

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You posted:

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We have assigned an effective date of March 5, 2019 which is the day the facts found show that you had a diagnosis of PTSD.

When you appeal effective dates, understand the general rule is that your effective date is the later of the date of claim or "facts found".  

To appeal, you have to refute the statment I quoted.  Here is why this statement is wrong.  

Refer again to the caluza elements.  It says you have to have a "CURRENT" diagnosis.  You did not have to have a PTSD diagnosis in service...and, if you read the effective date rules, they do not say, your effective date is the date of your first diagnosis.  

The VA pays you for SYMPTOMS, not a diagnosis only.  If I were diagnosed with PTSD with no symptoms, then my rating would be zero percent if not denied.  

Sometimes docs change your diagnosis...medical science changes.  As an example, Alex has pointed out there was no such thing as a hep c diagnosis in the 1970's..That does not mean you could not have been infected, and it does not mean you had not symptoms, either.  YOU need a CURRENT diagnosis.  

Dont let VA pull that crapola.  Appeal.  You suffered with symptoms of PTSD, long before that doc diagnosed it.  Equally important, read your file to see if a doc previously diagnosed your ptsd.  Or, if he prescribed medications normally for PTSD.  Your doctor CAN prescribe PTSD meds for something else...say a hangnail...but he should state that he is prescribing this drug "off label"..in other words he is prescribing this med when you dont have ptsd, but he is prescribing it off label.  Off label means that its for a purpose other than what the drug company says its for.  

If you were prescribed a mental health drug..say prozac...and the doc did not say that was "off label" to treat your stomach issues, then its presumed you have a mental health disorder.  

"The date of diagnosis of PTSD" does not control here.  The date of the onset of your symptoms is controlling.  As I said, the Caluza element requires a "current" diagnosis.  You could well have been receiving treatment for this malady PRIOR to this doc finally documenting you have PTSD. 

If you break your leg, you still have symptoms of a broken leg BEFORE . you go to the doc and he tells you its broken.  (gives a diagnosis of a fractured leg).  

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3 hours ago, broncovet said:

 

If you break your leg, you still have symptoms of a broken leg BEFORE . you go to the doc and he tells you its broken.  (gives a diagnosis of a fractured leg).  

Makes sense.  I appreciate the info, I knew it didn't seem right. I guess this will be my next fight with them....

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15 hours ago, vetquest said:

An EED (earlier effective date) appeal will usually go before the BVA.  You need to provide evidence to show that the EED is valid.  Usually the BVA provides much more weight to your case and evidence than the RO.  My appeal took five years but that is quick now a days.  A lot of veterans hire an attorney for their appeals, I did.  They get twenty percent of your award but that is better than 100% of nothing.

I used a medical consulting company with my appeal, but am kind of regretting it at this point.  Wish I would have gone with a lawyer. Hopefully the company I am with will give me some direction, as they won't get paid any retro either....

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@firedog974, what company are you using?  It sounds like something to tell other veterans to watch out for.

Edited by vetquest (see edit history)
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A "medical consulting" company may be a good choice "If" you need an IMO/IME.  To find out, I suggest you order a copy of your cfile and read to see if you had a diagnosis of PTSD earlier, by another doctor.  

A doctor could opine, for example, that he read your file, and his opinion is that you had symptoms of PTSD (earlier), even tho it was not officially diagnosed until (the effective date of your exam).  

Such an IMO, could be used to "reopen the claim" due to new and relevant evidence under 38 cfr 3.156 b, and could result in an earlier effective date.  This evidence would need to be submitted BEFORE 1 year from the date of decision.  38 cfr 3.156 b applies to "pending claims", and a claim would still be pending within a year of a VARO decision because its still in the appeal period.  

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3 hours ago, vetquest said:

@firedog974, what company are you using?  It sounds like something to tell other veterans to watch out for.

I am using Vet Comp and Pen.  Yes, I won my appeal, but I did almost all of the legwork for it. I did not read the fine print, and I thought they were a VA rep, and they are not.  Many times I had questions, I would call them, and they would tell me to call the VA. Now I have to pay them 4x my increase and 10% of any retro I get.  I don't think they were worth the money, but many vets had a lot of good things to say about them, so I went with them.  I will hire an attorney next time. Learning experience.....

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1 hour ago, broncovet said:

A "medical consulting" company may be a good choice "If" you need an IMO/IME.  To find out, I suggest you order a copy of your cfile and read to see if you had a diagnosis of PTSD earlier, by another doctor.  

A doctor could opine, for example, that he read your file, and his opinion is that you had symptoms of PTSD (earlier), even tho it was not officially diagnosed until (the effective date of your exam).  

Such an IMO, could be used to "reopen the claim" due to new and relevant evidence under 38 cfr 3.156 b, and could result in an earlier effective date.  This evidence would need to be submitted BEFORE 1 year from the date of decision.  38 cfr 3.156 b applies to "pending claims", and a claim would still be pending within a year of a VARO decision because its still in the appeal period.  

I agree.  This is a case of me not knowing any better, and being tired of fighting the VA on my own.  I had IMO that confirmed my diagnosis (which the reason I submitted my claim) but the biggest hurdle for me was getting it service connected due to missing service records.  I did that on my own.  As I said, I didn't know any better at the time, but I would have been much better off using a lawyer. Medical consulting was not the right venue for my particular situation. Either way, I am just happy I was successful, but I think this next step (retro pay) is where a lawyer would be ideal....but I'm stuck with what I have for now. 

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On 3/19/2019 at 5:10 PM, firedog974 said:

I am using Vet Comp and Pen.  Yes, I won my appeal, but I did almost all of the legwork for it. I did not read the fine print, and I thought they were a VA rep, and they are not.  Many times I had questions, I would call them, and they would tell me to call the VA. Now I have to pay them 4x my increase and 10% of any retro I get.  I don't think they were worth the money, but many vets had a lot of good things to say about them, so I went with them.  I will hire an attorney next time. Learning experience.....

Just found out I don't have to pay them any retro, because I was awarded none (even if I get some in the future) and they advised me to use an attorney.  Any advice on a good one?

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If you look up veterans benefits attorneys you can find them by state or locality.  I worked with a law firm out of Virginia that had several attorneys and many paralegals working for them.  I was not able to meet with the attorney but I was given a phone consultation and told that they would accept my case.  Find one willing to work with you, not someone who wants you to look pretty and be quiet.  My attorney did not want to handle my appeal for neuropathy but relented after I did a write up on it.  I won SMC out of that. 

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I agree with Vetquest and broncovet

Good Advise.

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Hi Everyone I've learned so much from this site over the past 5 years.  I was granted service connection for PTSD (02/28/2019) and I am in the same boat.  My effective date is the date of my last C&P (01/31/2019) even though I had a diagnosis from a private doc from and never let my claim close.  I just filed an appeal using the higher level review lane (03/28/2019) so I will try and post my  timeline and eventual outcome.

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On 3/18/2019 at 7:42 PM, vetquest said:

What you are looking at is an appeal for EED.  If your case was before BVA there is not much chance of winning.  If your case was at the RO I would appeal to the BVA.  I will go out on a limb and say what the VA is stating is that your disability could not be verified until the date of your last C&P.  They did this to me on a claim for PTSD and I won on appeal to the BVA.

They can and do use this to avoid paying backpay when a claim has taken a considerable amount of time for them to get their act together.  It should not be right that they use the date of your last C&P and they can get away with this if you let them.

I am going through the same thing as well. I was diagnosed in 2016 with my Pyshc who forced me to file a claim. During the C&P she said I had alcohol dependency in 2017 and was denied. I have appealed in time every time. In March 2020 I reappealed to HLR and was bumped to 70% but they put my effective date as 9/2020. My rep put in the Appeal for effective date last week and was just loaded today with BVA. I figured minimum they would have given me from the last March 2020 appeal date but they screwed me again. 

 

How long is the process with BVA for just an effective date issue? 

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On 4/3/2019 at 7:36 PM, Scatback said:

Hi Everyone I've learned so much from this site over the past 5 years.  I was granted service connection for PTSD (02/28/2019) and I am in the same boat.  My effective date is the date of my last C&P (01/31/2019) even though I had a diagnosis from a private doc from and never let my claim close.  I just filed an appeal using the higher level review lane (03/28/2019) so I will try and post my  timeline and eventual outcome.

How did your appeal go?

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