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How long does the authorization process take?


smithmary614

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I have had an appeal in for over four years now. In January I was put on financial hardship to expedite my file. I was sent an SOC April 10th detailing why they couldn't fully grant my appeal. I did get two things increased but three other things denied. Also in the SOC they said that they newly granted me service connection for fibromyalgia, mental disorder and sciatica. But they had no rating in the SOC just a note saying "an award letter would come under a separate cover". The 1-800 number says that there has been a rating assigned to the new service connected conditions but they can't tell me what they are because they haven't been finalized yet. They are being reviewed and authorized. So my question is how long will that take to finish usually? And why did they do them separately? 

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We would have to see the letter to see what is going on but it sounds like you don’t have one?  Have you checked ebenefits?  Or va.gov?  

Are you at the BVA?  

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@smithmary614

your post is titled How long does the authorization process take?

sadly the answer is no one can really say.

As @shrekthetank1 asked do you have access to Ebenefits? and are you at the BVA or RO ? I suspect BVA but please verify.

The reason for Ebenefits access is that under the Disabilities section your changes will show up long before the BBE. Under the Letters section if you receive a 100% rating (TDIU or Schedular) a Commissary Letter will be generated and a ChampVA letter.

The Commissary letter has no financial information so it generates very quickly. In it will be authorization for a 100% SC vet to use a base commissary and to do that you need a base ID. A vet who is 100% P&T will have no expiration / renewal date on that ID in the letter. A TDIU vet will have a date that corresponds to their next review C&P.

As for authorizations and time, there are many factors. Is there an Earlier Effective Date (EDD) involved? Back Pay? if so then depending on the amount of pay more signatures are required. I think the number 25K is the trigger for more signatures.

Are there SMC's involved like Aid and Attendance? that needs other authorizations.

Did you get an increase on your May 1 check? any deposits your were not expecting? those often happen before the BBE arrives and with very little math you can identify your rating level increase, but not the specifics or reasoning, only the BBE will tell you that.

Since you know you were denied a couple things, order your C-file now. by the time it processes these documents will be at the imaging center. I am supposing you will want to know what evidence was used and what the Codesheet and DBQ say so you can form your appeal of the denials.

I wish there were more definite answers but at this point everything is just speculation.

Good luck and let us know what happens.

 

 

Edited by GeekySquid (see edit history)
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@shrekthetank1 and @GeekySquid sorry it took so long to respond. I had to scan cooies of my SOC to post here and show you both. On page 1 of my SOC the issues section outlines five of the seven issues I was appealing. And then below it is has a note that states that I was granted service connection for the other two issues I was appealing plus a third that I didn't claim but I'm told comes with having back issues. But they don't have a rating assigned to them. The 1-800 number and my VA appeals coordinator said that they are rated but they can't tell me what they are because they haven't been finalized yet. Then on page 34 is the decision. I was granted increased rating for my back and my knee. My sleep apnea stayed the same and then they denied the other two. The increase on my back and my knee alone will increase my overall rating and give me a back pay. I was told by one VA rep that I wouldn't have to wait until the new service connected issues were finalized to get my back pay for the increases. But then I was told by another VA rep that I would have to wait until the newly service connected issues were finalized before I would get any back pay so it's done all together. So if that's the case how long should it take for the new service connected issues to finalize? Its been over a month now. 

Also, I appealed the effective dates of my back and knee that was in the SOC and I was told that wouldn't affect the back pay from that but then I had another VA rep tell me that since I appealed those effective dates that I could potentially have to wait until that goes to the BVA before I get back pay. So I'm just really confused. Why did they not finalize everything together in the first place? 

SOC.pdf

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40 minutes ago, smithmary614 said:

The 1-800 number and my VA appeals coordinator said that they are rated but they can't tell me what they are because they haven't been finalized yet.

@smithmary614

Did you look on Ebenefits under the Disabilities link? As a matter of policy Peggy will never tell you squat about a rating decision that is not finalized or that you have not yet received a BBE on.

Based on your SOC this was an appeal to the RO.

 

42 minutes ago, smithmary614 said:

. I was told by one VA rep that I wouldn't have to wait until the new service connected issues were finalized to get my back pay for the increases. But then I was told by another VA rep that I would have to wait until the newly service connected issues were finalized before I would get any back pay so it's done all together.

This is another area that is swampy and it should be concrete.

Depending on the claims and the reasons that issues are deferred, split off, or new ones attached to a claim, and I suspect on how bad a day the rater is having, they could do any of them.

back pay gets even trickier than just getting rating decisions. Depending on the amount there are multiple levels of approvals that have to sign off on for the VA to authorize a check to you. I think that 25k or higher in back pay triggers the next level of authorization needed, but don't hold me to that number.

In a structural sense it does flow that everything before them should be finalized and only one back pay authorization cut.

For example if you are rated 50% ptsd, 30 % lungs, 30% knees, and you appeal all three for EED and increase.

If they decide that your PTSD is really 70%, lungs 60%, and knees 40% then if they first paid you for the PTSD backpay (from 50 to 70) then figured out that you also have 60% from the same date, that means you should be paid at 80% instead of 70 and they would have to got through all the hoops for that increase. Then they find out about your knees and that 40% which would jump your 88 to 93 which is paid at 90%...more hoops. 

It gets worse, in this example you might be eligible for TDIU based on the PTSD jump to 70% alone. If that is awarded you are 100% at that time of your original claim, more backpay. Then if they later found out the 60% you are immediately eligible for SMC(s)....and all hoops start over again because that would be paid back to the ED of the original claim you were appealing....

As you can see, there is a structural reason to holding off back pay until all claims are finalized.

My best suggestion is to monitor you bank account. Check the Disabilities link in Ebenefits, and get a hobby that prevents you from obsessing over when the BBE will show up. I understand you have a financial hardship, but the stress will kill you so don't add too it. About once a week call Peggy about the BBE.

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The good news is that you have been SC'ed, the bad news is that you must now wait for the two new conditions to be rated.  It is most likely that all awards will be held until the new conditions are rated.

As far as appealing your service connection that should not affect the payment of back pay.  Will it, there seem to be no hard and fast rules with the payment of back pay.  For instance if you win a BVA appeal and another condition is remanded they are supposed to pay for the awarded condition while your other condition is being rated.  Does the VA do this, no they have been holding back pay until all actions are finalized.  They VA will do as the VA has always done, delay, delay, delay.

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I also understand that if you are in financial hardship, you can apply for an expedited payment, on at least any new s-c condition that was found and awarded while the other(s) are being worked on.

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3 hours ago, GBArmy said:

ou can apply for an expedited payment

 

I had heard this but I never knew how you did that. Any idea @GBArmy

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I am sure if your Congressman has a GOOD veteran rep working for him/her, they should be able to advise on the process because many of their constituents  experience financial hardships. Obviously, you will have to submit on some form in writing.

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13 hours ago, vetquest said:

The good news is that you have been SC'ed, the bad news is that you must now wait for the two new conditions to be rated.  

How long do you think that may take? I know that you never know with VA but maybe someone has a general idea?

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Assuming that you are a hardship case I would guess about three months.  In my case on remand requiring two new ratings a writ of mandamus was filed and that is the time it took.

That is a wag but that is my guess.

Edited by vetquest (see edit history)
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51 minutes ago, vetquest said:

Assuming that you are a hardship case I would guess about three months.  In my case on remand requiring two new ratings a writ of mandamus was filed and that is the time it took.

That is a wag but that is my guess.

Thank you. I was considering filing a writ of mandamus before I got my SOC as I had been waiting over four years. I brought it up to the 1-800 number rep and she gave me the number to the CAVC who gave me information on a writ. While talking to an attorney about possibly filing one, I got my SOC. But I've thought about still filing one for the rest of it to finish. A VA rep put in an inquiry request for me to my regional office to have them send me my notification letter because she said everything was decided but they hadn't sent the letter yet. What does that mean?

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@shrekthetank1 @GBArmy @vetquest @GeekySquid

So I just got a call back from my inquiry. My ratings have all been decided. My fibromyalgia was rated at 40% effective to my original claim date 6/1/2013. My mental disorder was rated at 70% effective back to original claim date. The third condition that was newly connected was lower bilateral radiculopothy rated at 20% right and 20% left as of 2/26/2015. So my total combined rating is 100% as of 2/26/2015. And while she didn't say specifically, I gathered from the newly SC conditions and their rating and their ED that before I got 100% as of 2/26/15 I should have been 90% from 6/1/13 to 2/26/15 when I should have been 100%. So she said that my award amount is just being figured and authorized I guess but she is putting me at the front of the line so I can get paid. And then I will get a notification letter breaking down all the ratings and ED. So now I just check my bank account? Hopefully it won't be too long. 

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1 minute ago, smithmary614 said:

So now I just check my bank account? Hopefully it won't be too long. 

@smithmary614

WooHoo! Good for you!

with those back dates the pay should be a good chunk.

once you get all the paperwork , consider asking that they should reconsider your numbers from 2013 and make you TDIU for all the period that you were not 100% schedular.

Check Ebenefits under the Disabilities link to see when they post the new results and check under the Letters section. A 100% rating gives you Commissary access and that letter and the ChampVA letter process through quicker as they don't have a dollar amount in them.

Once those are there then the clock begins on the back pay in earnest. anything over 25k requires another level of approvals so that adds more time.

Congrats!

Keep us informed.

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Congrats Mary! That is great news, long time coming. You might want to contact Alex/Asknod and see if there are some potential smc action you should follow up on. On something like this, that has been anxiously awaiting for such a long time, a little word of advise. When the back pay starts coming in don't go off getting a big expensive item you have been dreaming about. Sure, pay off bills that are past due, but sit on the rest for a while and let the dust settle. And, unfortunately, the VA makes mistakes on back pay (as well as just about anything in the benefit claims process). If they mess up and overpay you, they will start taking a chunk out of your disability check until it balances out. If you have most of it you can cover that situation if it did come up. Again, congrats!

 

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That's great.  Take GBArmy's advice to heart about spending.

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18 hours ago, GeekySquid said:

@smithmary614

once you get all the paperwork , consider asking that they should reconsider your numbers from 2013 and make you TDIU for all the period that you were not 100% schedular.

 

The VA rep that called said I can send in the form for the IU because even though I'm 100% now, I could potentially get more back pay if I could get IU back to June 1, 2013. But while I haven't really worked since 2013, I have had small jobs that lasted no more than a month just to make ends meet over the years. But I never discussed my disabilities with my employers so I doubt they would or could fill out their part of the form. 

So how would I fill out that form to get IU back to June 2013? Or should I just not worry about it and be happy with the 100 I have now? 

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2 minutes ago, smithmary614 said:

Or should I just not worry about it and be happy with the 100 I have now? 

@smitthmary614

In my opinion the answer to that is HELL NO! you probably are entitled to the TDIU, don't leave money on the table!!!!!!!

3 minutes ago, smithmary614 said:

The VA rep

what VA rep? do you mean 1-800-Peggy? do you mean your VSO (american legion, dav, etc)?

 

4 minutes ago, smithmary614 said:

. But while I haven't really worked since 2013, I have had small jobs that lasted no more than a month just to make ends meet over the years. But I never discussed my disabilities with my employers so I doubt they would or could fill out their part of the form. 

Their failure or unwillingness to complete the forms is a complication but it is one that can be overcome. I don't have TDIU, but to be honest I am considering trying for it for the 6 years I was 70% and not working.

I hope those with TDIU will chime in on this to share their experience related to yours.

In general what happens is you fill out a claim for TDIU and all the associated forms. You list your former employers and length of work at each. The VA will call up your Social Security records to verify that you were paying into SS during those times as every employee is supposed to be doing.

Depending on claimed conditions, I suspect the VA will be looking for employers to respond with things like "was let go and cannot be rehired", maybe if there was a serious conflict the employers HR will use coded language to say "they are troublemaker".

By law an employer cannot do anything more than say "XXX worked here from y to z dates. They are (or are not) eligible for rehire". it would take a court subpoena and a deposition or testimony to compel them past the limits of the law. Each state is a little different but all are in that same set of limitations.  Be clear though, an employer who is a friend (or just willing to) can put in a buddy letter to say that you were a good worker but it was observably difficult to do xxx job. As long as they don't say you were fired for XXX they should be within the law as they are making a personal observation not a statement that is covered under employment law.

Your statement and buddy letters will provide the reasoning behind being fired and or quitting.

you will want to thoroughly read

https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000014564/M21-1-Part-IV-Subpart-ii-Chapter-2-Section-F-Compensation-Based-on-Individual-Unemployability-IU?query=tdiu#2e

particularly

IV.ii.2.F.2.k.  Identifying Reasonably Raised Claims of IU

 

Reasonably raised claims of IU may arise
  • during the processing of a(n)
    • claim
    • decision review request under 38 CFR 3.2500, or
    • legacy appeal, or
  • as a result of a routine future examination.
 VA must consider a claim for IU if
  • the Veteran’s SC rating meets the minimum schedular criteria found in 38 CFR 4.16(a), and
  • there is current evidence of unemployability due to SC disability(ies) in the Veteran’s claims folder or under VA control.  
Reference:  For more information on reasonably raised claims for IU, see

 

but you will want to also search the above MR21 link for all TDIU related information to make sure you put your papers together properly.

--------

If work was seasonal, say so for each job. Mark any temporary job. Any income that was marginal identify that as marginal.

For example you took a christmas job for 10 bucks an hour for 3 weeks part time and you only earned 1100 bucks. Then you did not work for another 2 months. That is marginal income. Even if you actually end up going over the Poverty Level income by a few bucks. Now if you made 20K in 3 weeks you will not be able to claim marginal.

The conditions I see  that you are newly rated for in the original post are likely justification for saying I tried but failed at each of these jobs. The pain was too much, my MDD kicked in and I had to quit before I was fired, etc etc etc.

Any employees on those jobs or people who drove you to work etc can supply a buddy letter saying things like '" at work when they had to stock things on a high/low shelf the groaned in pain and had to have me/others do their work" or maybe "had to constantly take breaks because moving/standing was obviously painful for them" or maybe "I had to pick up the slack as they just could not keep up due to obvious pain/slow movement"..

lay evidence is competent if it speaks to a fact a reasonably intelligent adult could observe. It cannot be a direct medical type statement like "her sciatica prevented her from doing...." because it could be construed by a court as the lay person trying to give medical testimony. Competent Lay Evidence could be "I saw he struggled to move around and winced in pain when he walked. At one point we talked about sciatica because my mother has it". struggling to walk, wincing/crying from pain, asking for help to complete a task due to your pain, are all competent as lay evidence from a coworker.

a friend might say "we would go grocery shopping so I could help. not all stores have those disable motor carts and my friend has problems walking up too many aisles, bending/stretching and picking up heavy things." Things like that are observable to a lay person and are competent evidence to related SC harms like fibro or sciatica.

Hope that gives you a clearer idea of how to write your statements and please don't let the VA get away with NOT paying another vet what they are entitled to by law.

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On 5/15/2019 at 1:42 PM, GeekySquid said:

In general what happens is you fill out a claim for TDIU and all the associated forms. You list your former employers and length of work at each. The VA will call up your Social Security records to verify that you were paying into SS during those times as every employee is supposed to be doing.

So the VA will call the social security to at least verify when I worked? The reason I asked is because I had a couple of places I worked that weren't reported and I thought about using them because I could get a buddy letter from them. And then not using the other places but if they will look anyway then I should put them. 

And the VA rep that called: I think she said she was from the Atlanta regional office. But she could have said that she was from the Georgia Department of Veteran Services. The number that showed up on my phone was not the 1-800 number but it was the number to the GA dept of veteran services. And I can't remember if she said she was an appeals coordinator, a VA rep or what. But she was able to tell me all my new ratings while everyone else kept telling me they couldn't tell me. And its still not changed in ebenefits. 

So now that its decided, how long until the money comes? It going to be about 100K. 

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I would go with the IU.  If one of your disabilities is declared to be your IU sustaining disability you might be in line for SMC if you have another disability that is 60%. 

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6 hours ago, smithmary614 said:

So the VA will call the social security to at least verify when I worked?

@smithmary614

 

everyone who is rated under TDIU has to fill out annual reports of what income they made.

By regulation and law VA contacts SS when a claim is made, directly or inferred, for TDIU to get that report

or at least that is the path they are supposed to take. Many folks who don't get TDIU but should have been considered for it, see no evidence that SS was contacted at all.

6 hours ago, smithmary614 said:

So now that its decided, how long until the money comes? It going to be about 100K. 

WOOHOO for you! Congrats.

Now you have to twiddle your thumbs for a while. large amounts take more signatures to approve.

I don't want to get into your business but most people have never had 100K handed to them and people can get a little silly when that happens.

I would suggest you find a financial advisor or at least talk to your regular bank about how that money is to be handled immediately.

I suggest you consider taking an amount like 1 or 2 k to just blow. Keep your hands off the rest. Don't be buying gifts for friends and family. DO NOT LOAN ANYONE ANYTHING!!

in fact don't tell anybody that you are getting anything, much less that amount!

I would suggest if you need things like a new car, clothes, computer, that you make a list  and figure out how much you want to spend. DO NOT PAY CASH FOR A BRAND NEW CAR!!!

I would suggest you look at your debts if any, find out which can be paid off completely without taking up that whole amount.

Keep in mind there are some good debts and bad debts. Having some debts can help your credit rating and are worth keeping, or at least not paying off.

For example if you have student loans in an amount, say 30K, and you have been paying on them regularly. Don't pay them off if your interest rates are what the govt set for sub and unsub loans. AT most pay off half of them and choose the unsub loans to pay off first. Fed Govt Unsub Student loans are at like 6 percent subs at about 3.8%. That 3.8% is a much better interest rate than almost any Credit Card debt (even the unsub rate is better than 99% of credit card interest rates) interest. Additionally the nature of Student loans as a long term debt, when paid as agreed, gives you a score boost. Further, any paid long term debt in good standing when paid off, gives you 10 years of "good" credit power after it is paid off.

Car loans are in this same category. Leverage the length of your loan to increase/support your credit rating for an additional 10 years after pay by paying off only half the loan and keeping the term where possible.

it is too complicated for a simple post, but a banker, who does not get a fee from you, can help you decide what are the best choices for you.

I would suggest that at least 50% of that money needs to be put away in safe, long term investment for your future, 75% would be better for you. Put them in instruments that cannot be legally attacked, say something owned by a trust fund instead of under your own name. The reason is if you ever got sued for a say traffic accident that back pay is potentially vulnerable even though it came from the Fed Govt as a compensation. Compensation is generally protected, but once it leaves the account it was deposited in it becomes vulnerable to a debt collection action or lawsuit.

Please just protect yourself from any potential debt collection or lawsuit, and most importantly protect that money from any possible habits you have in term of spending. That chunk of change can enhance any bad spending habit.

Congrats!

Let us know what the ratings are

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