Effective date on recent appeal

[firedog974]

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.  

[firedog974]

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....

[firedog974]

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....

[vetquest]

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

Edited March 19, 2019 by vetquest

[broncovet]

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.  

[firedog974]

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.....

[firedog974]

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.