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Old closed claim injuries added to current claim and I didn't add them. Also what does appeal substitution review mean on claim status?


ZBS

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So we are curious...

Have been at 80% since 2011 but things have progressed with mental status and being able to keep a job and function like normal. I decided to apply for an increase in PTSD on Jan. 9, 2019. I had a very weird C&P exam where it lasted literally 20min  and nothing was really asked much about anything. My previous exam for this was very traumatizing and it disrupted my life for weeks after. Every trigger they could hit, they did. This time was very different. I was very thrown off by it as I was so worked up thinking about the last one I didn't sleep for 2 weeks prior to this one. This time the doctor said "I will suggest you are put in for an increase, God Bless you, and thank you for your service". Less than a month later they moved my PTSD from 50% TO 70% which brought me to 90%. I saw this in my bank account before I saw it in Ebenefits and way before I got the notice in the mail. When the notice came in the mail it said "at 90% pending return of TDIU form". The VA then sent me a form for TDIU. I have never heard of them actually sending/requesting to fill out this form, have you? I figured maybe they wouldn't send it if they didn't plan on considering it? So I filled it out and sent it back in.

At about the same time i submitted the TDIU papers I saw on my claim that 5 of my old physical injuries that were previously rated were added to my claim (both knees, both legs, and back) and in parenthesis after the description it said "(INCREASE)". I didn't add these to this claim, they were previously rated and closed claims. What does this mean? Has anyone had this happen before? A week or so later they also sent a request to disclose medical records from outside providers. In the same letter it said they will wait 30 days to process my claim unless I am done submitting evidence. If I was done submitting please check box (or do it online) that you are ready for a claim decision and that I have submitted all evidence I have.

Because they added the extra things on my claim, and my physical pain has been increasing as I have gotten older, I went ahead and sent in records from my physical therapist and such that were all done outside the VA since 2011. Because I had nothing left to send in, I then clicked on the button "decide my claim, I have no additional evidence to submit" and after that, this is what showed up in my claim status "File: ClaimDecisionRequest.pdf Type: Appeal Substitution Review". What does Appeal Substitution Review mean? It seems kind of confusing. I don't want to assume anything!

I also just got an email that 2 days ago from VES where I got my C&P notifying me that the VA claims requested clairification from my medical records from them. Looking at my claim it shows "Exam Request - Request for Clarification No longer needed"  I've also never had this happen. Maybe this is all positive things?

It is all really odd to me, as all my other experiences in the past years have not been like this. In the past it was a horrible process to deal with and very long and drawn out. It currently seems to  be moving very fast this time around, which is a load off. I am hoping its all positive as I am currently not doing well and not able to work. It would be helpful to get my 100% to help support my family right now. I have been out of work since February. Just curious what your thoughts are on this and if anyone has had anything similar happen as described above?

There is nothing left to do but wait. Thanks in advance, I appreciate the input!

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On 5/8/2019 at 12:15 PM, ZBS said:

"at 90% pending return of TDIU form

In general it looks like the VA rate builder triggered and they want to bump you to 100% under TDIU, which is good for you based on your description.

The VA pay rate table shows  this

70% - 100% Without Children

Dependent Status 70% 80% 90% 100%
Veteran Alone $1,403.71 $1,631.69 $1,833.62 $3,057.13
Veteran with Spouse Only $1,522.71 $1,767.69 $1,986.62 $3,227.58
Veteran with Spouse and One Parent $1,617.71 $1,876.69 $2,109.62 $3,364.37
Veteran with Spouse and Two Parents $1,712.71 $1,985.69 $2,232.62 $3,501.16
Veteran with One Parent $1,498.71 $1,740.69 $1,956.62 $3,193.92
Veteran with Two Parents $1,593.71 $1,849.69 $2,079.62 $3,330.71
Additional for A/A spouse (see footnote b) $109.00 $125.00 $141.00 $156.32

80 to 90 is a couple hundred a month, 80 to100 (even tdiu) is about 1400 a month for a single vet.

you can see it here

https://www.benefits.va.gov/COMPENSATION/resources_comp01.asp

 

AS for that Appeal Substitution Review language it looks like they are trying to help you get to 100 Schedular instead of TDIU. VA has to maximize your award and Schedular, if possible, is better than TDIU as TDIU has limitations on future income just like SSDI does and requires annual verification and reporting from you. With Schedular those things are eliminated.

Others may have a different reading on that language.

 

this language is common in files

Exam Request - Request for Clarification No longer needed

VES notification to you is lagging behind the VA decision process.

It all looks favorable to you. Hopefully you will update us so we can congratulate you!

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20 hours ago, GeekySquid said:

In general it looks like the VA rate builder triggered and they want to bump you to 100% under TDIU, which is good for you based on your description.

The VA pay rate table shows  this

70% - 100% Without Children

Dependent Status 70% 80% 90% 100%
Veteran Alone $1,403.71 $1,631.69 $1,833.62 $3,057.13
Veteran with Spouse Only $1,522.71 $1,767.69 $1,986.62 $3,227.58
Veteran with Spouse and One Parent $1,617.71 $1,876.69 $2,109.62 $3,364.37
Veteran with Spouse and Two Parents $1,712.71 $1,985.69 $2,232.62 $3,501.16
Veteran with One Parent $1,498.71 $1,740.69 $1,956.62 $3,193.92
Veteran with Two Parents $1,593.71 $1,849.69 $2,079.62 $3,330.71
Additional for A/A spouse (see footnote b) $109.00 $125.00 $141.00 $156.32

80 to 90 is a couple hundred a month, 80 to100 (even tdiu) is about 1400 a month for a single vet.

you can see it here

https://www.benefits.va.gov/COMPENSATION/resources_comp01.asp

 

AS for that Appeal Substitution Review language it looks like they are trying to help you get to 100 Schedular instead of TDIU. VA has to maximize your award and Schedular, if possible, is better than TDIU as TDIU has limitations on future income just like SSDI does and requires annual verification and reporting from you. With Schedular those things are eliminated.

Others may have a different reading on that language.

 

this language is common in files

Exam Request - Request for Clarification No longer needed

VES notification to you is lagging behind the VA decision process.

It all looks favorable to you. Hopefully you will update us so we can congratulate you!

Thanks for the info and input Squid! Yes this "File: ClaimDecisionRequest.pdf
Type: Appeal Substitution Review" didn't show up on my claim until the instant I hit the "Claim Decision Request" button after all evidence had been submitted. So maybe that is just standard on what comes up when that button is pushed?

 

I also had evidence of a letter from Unemployment denying me all unemployment benefits (this just floors me) and their reasoning was "me, my last job, or someone else told them my illness was preventing me from looking for a job or becoming employed" Go figure....so I sent that in with my TDIU form they asked me to fill out.

 

Yes they also retropaid me for the extra $200month for the increase of 50-70% which brought me to 90% overall. So that is positive. So far the process has moved pretty quickly. I have been impressed with it this go around. Is there different benefits of 100% and 100%TDIU for my family? I have a wife and two children. I will keep you updated on my end! THANK YOU!

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7 hours ago, ZBS said:

Yes they also retropaid me for the extra $200month for the increase of 50-70% which brought me to 90% overall. So that is positive. So far the process has moved pretty quickly. I have been impressed with it this go around. Is there different benefits of 100% and 100%TDIU for my family? I have a wife and two children. I will keep you updated on my end! THANK YOU!

@ZBS

I am not sure I see all the details in your posts to track you from 50-70-90 but for this thread it doesn't matter.

The big problem with TDIU is that by law, you cannot earn more than the annual poverty wage over and above your TDIU payment. This is the wage a SINGLE person it does not matter how many dependents you have for this purpose. It tracks with SSDI>

You must also submit annual wage statements.

VA will pull your SSA records fairly regularly to see if you getting paid a wage above about $13,000 (this year) and they get ticked off if you earn more.

TDIU, even on a P&T rating, is very easy to have yanked out from under you compared to a Schedular rating.

if you can get there Schedular is always better. If you can't TDIU is the next best thing. You can still get SMC's on TDIU. Champva, commissary and Chapt 35 bennies for wife and kids. but you must stay on it until they use those bennies unless you convert to schedular.

Asking for increases on TDIU can lead to problems, you are legally allowed increases, but if one of your docs or a c&p is not spot on in your favor. any hint of improvement and the can of worms opens up.

I always hate to say this, but you have to wait for the BBE. Scan it and start a new thread. just pm me when you do so I know to look for it.

good luck

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