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Clarification


rightstrivinsissy

Question

Hello Hadit Helpers, 

I feel like I am stumbling around blind. I hope someone can help me see.

I was service connected in 2011 severe anxiety due to mst and a bladder condition.

I have not had gainful employment since ETSing in 2004. I was re-evaluated for an increase and received an overall 70 - 40 -10 but started being payed at 80% in 2016. 

In June of 2019 I applied for TDIU. I hit the make a decision now button on ebenefits, which was like shooting my own foot for lack of patience, not realizing that this meant the VA could not request any further info from me.

In August I was denied, and obtained an attorney. 

The attorney took over and ebenefits is showing the privacy act starting on October 4th and my claim is now in the evidence gathering/decision making process. Estimated end date of April 2020, the attorney says 3 years, but I know there are new systems in place to make things move a little quicker.

I am looking for any information that you all would have about what is actually happening. I don't know if this is a NOD or what. My case manager acts like I am a major pain and won't give me any info and I fear she has no idea what she is actually doing. =(

I assume it is not an actual appeal yet, because my case manager said they would have to wait for my c-file before they would appeal on the next denial from the VA.  

I am so confused, If any of you experts could find the time to help me I would greatly appreciate it. I have always dealt with the VA on my own with no previous denials, but never fully understood what I was doing. I thought hiring an attorney would change this, but I still feel just as blind as before.

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In my opinion it is a big mistake to hire a lawyer after an initial denial.  

The VA makes a lot of mistakes with initial claims, and many denials are overturned on the initial appeal, and at the BVA, still others get denied and go on to the court.. the court may be where a lawyer can help most, but again this is my opinion, based on my 33 years dealing with the VA. With that said,  for some veterans the va claims system is too complicated  and I can understand why some veterans feel the need for a lawyer or Veteran service officer.

In your case  your representative should be doing a notice of disagreement, but under the new system it called a Higher level review, if you have no new evidence, or supplemental claim if  new evidence exist.

Your " case manage" is responsible to want to see the claims file.. but the longer they wait to appeal, the less time they  have to perfect the appeal...  Example, I have been waiting for 6 months for a copy of a C/P examination before I appeal a denial on a request for increase in my knee's.  We only have a year to appeal a decision. I don't like to be rushed to do an appeal but my time is slowly running out.  And when I do an appeal I may write it 5 or 6 times before  I am comfortable with how it reads and have made sure all bases are covered.

The  decision should state why the claim was denied and what is required to prevail.  Knowing this gives you a good start on the appeal. 

One recommendation I would make is to talk to your doctor explain what you are trying to do and ask if they would write an entry into you medical records or a letter in support of you TDIU claim.  Remember, the doctor must state that they have reviewed your medical records, and they must justify their opinion based on sound medical facts. Normally if such a letter is done correctly , the veteran will win the claim regardless of what the VA C/P examiner  many think about your claim, because the tie goes to the veteran.  Also your doctor is free to fill out the (C/P exam report )  DBQ which can be submitted along with the appeal.  ( Each medical condition has a DBQ specifically designed for each medical condition, the DBQ is what the C/P examiner fills out).   DBQ's are available  on line.

Hope this helps in some way.....

 

 

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Thanks Richard1954,

It does help. I was wondering if I was making the right decision and just did not want to make another mistake. 

I am almost positive the C&Ps I had last June and July showed deficiencies in the areas looked at for unemployablility. Although I was denied, there were favorable findings in my letter that stated I had not been working and I met the qualifications for schedular TDIU. 

I have started having snowy vision and researched this to find it could be caused by my long term severe anxiety. I don't want to do anything that will slow the process down so I have not submitted any new evidence. At this point I do not know how much I am allowed to submit on my own, without the attorney doing it for me.

I do fear the attorneys will try to make this process take as long as possible to increase their percentage of my retro pay. A quick decision in my favor benefits me, but them, not so much. =(

Is anyone familiar with the time frame of the AMA program's processing this higher review or whatever level I am at now?

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So I was way off and I feel like I am being totally screwed by my lawyer. I told them from the beginning that the VA just wanted to request something from me and couldn't.  So I really have no open claim, the va has just been pending on whether or not to send my cfile to the lawyer for over a month now. The lawyers are just waiting patiently to receive it and no one really cares what happens to me.  If I would have just submitted additional evidence after my denial in august, I would probably have my approval by now.  Who knows if I have any rights anymore. Can I do anything? 

 

 

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