Pending HLR, Pending Supp Claim, Closed Supp Claim. Should I call or file IRIS

[JKWilliamsSr]

I am trying to decide if I should call the white house line of file an IRIS claim myself.   I am leaning towards filing the IRIS claim because my understanding is that is what happens when you call the white house line anyway.  So here are where my claims stand.

1.  In September my supplemental for Sleep Apnea and 1 other was closed.   I still have not received a letter or any other type of notification about this other than it is what shows on va.gov.   I am certain they are required to send me notification and by not doing so is a clear violation of 38 CFR 3.103

2. The remaining claims on that supplemental claim are still pending.  I have called them twice already on this for the status.  This is the exam where I had the bad C&P exam but there still should have been some kind of movement.  I had the C&P exam on November 5th and 30 days later I called to request the status and was told they were waiting for exam results.  Called them out on that and they said it was because of backlog.  I called a couple weeks later and they were not gave me any additional information.  Just stated it was still pending.    I personally believe this exam should be in the hands of a rater because it is not an appeal but reopened claims with new evidence.  Unlike new claims or increases I cannot request a decision because I do not have additional evidence like you can on ebenefits.

3. I also have an HLR pending for denials I received an October.   Right now the status is "A senior rater is taking a new look at your case".  It has been sitting in that phase for the last 3 weeks and since no evidence  can be submitted it should not take a rater this long to be looking at this.  I could be wrong but I have seen way too many HLR's being completed within a week or so of a senior rater looking at it.   Maybe it is a good sign maybe not.

Here is what I think is happening.  I have several different types of claims going and I think it is just being swept away.   The last time I called I asked about both my HLR and Supplemental claim and the person I spoke to was clueless and could not give me any information because in my opinion they did not know what the hell they were doing.  I think with an IRIS complaint I can detail all of my concerns and have it listed where it cannot be ignored.  Sure it may not make a difference but it will be on record and can be used in my appeal.

[vetquest]

I would file an IRIS complaint on item 1, the case being closed without notification.

As to the second, I believe that sometimes it takes thirty days for the C&P to get to the VA when it is done by an outside contractor.

Item 3 is not to worry too much, Legacy NOD's are taking up to two years and I have read that some HLR's are taking up to a year.

As for the 1-800 number not helping much that is the normal route for them.  If you are really nice they sometimes will look at VBMS and tell you how things are going but that is not all of the operators.

[broncovet]

Well, you should try to get to the bottom of the claim which was "closed", but the rest of the stuff?  Probably not.  Yea, sometimes HLR's get done quickly but if your is not just wait a few months.  

Back to the "closed" claim.  Ramp, aka AmA, "closes" the claim when it is transfered from legacy to ama.  

My advice is to ask IRIS the "status" of you OSA and any other claims which were closed.  You get more flies with honey than vinegar, so keep it light.  You can always get mad and complain later.  

[JKWilliamsSr]

Update:

I filed an IRIS request on Jan 6th to get an answer for the closed claims without notification.  The automatic email says we normally can expect a response in 5 business days.  I did not get a response so on Jan 14th (6th business day) I replied to the email they sent per the instructions and requested an update.  No response.  So on Jan 22nd (12th business day) I sent another reply to the request for an update.  Still no response there.   I am getting the feeling they are just ignoring it. 

My HLR is still pending and which is fine because it was submitted Dec 4th and today is only day 50 and as we all know the VA says their goal is 125 days so I will just wait and see what happens there. 

I am concerned about my supplemental claim though.  I submitted it on September 22nd and had my C&P exam on November 5th.  It was done at a VA facility and the results were uploaded that day.  My first post on this thread has a brief outline of the situation.  With all the information just sitting there I am baffled about this because on my normal claim it was completed 8 days after my C&P exam and that exam was with a contractor.  So we are looking at 122 days and the it has been 75 days since the C&P Exam.  I am going to call for an update about this one.  Probably the white house line. 

Edited January 23, 2020 by JKWilliamsSr
had wrong dates entered

[Vync]

That is odd. Back when I had a bunch of claims going, they granted/denied some and deferred others. I received a letter about it in the mail. 

Your supplemental is close to the 125 day limit, but keep in mind they base that on when they receive it - not when you send it.

Have you called 1-800-827-1000 or had your VSO (if you have one) to give you a bit more detail of what's going on behind the scenes?  It's worth it to explore every avenue to get them moving on it. Calling their call center, your VSO, IRIS, and WH hotline are good options to try. The good thing about WH hotline is the VA is required to respond within a certain number of days depending on the issue. That doesn't mean they will respond, but you can always call them back to check on things later.

Here's a link to my HLR/CUE topic which has an HLR/CUE Timeline I keep current in the initial post. I have kept track of what I have done and learned every time I checked the status of the request. It might give you some ideas. For a while, mine was stuck in the national work queue waiting to be picked up. I called and they said that they could not do anything until it had 30 days of inactivity. Once that happened, they sent an IRIS request over and the next week things started happening.

 

[JKWilliamsSr]

1 hour ago, Vync said:

Have you called 1-800-827-1000 or had your VSO (if you have one) to give you a bit more detail of what's going on behind the scenes?  It's worth it to explore every avenue to get them moving on it. Calling their call center, your VSO, IRIS, and WH hotline are good options to try. The good thing about WH hotline is the VA is required to respond within a certain number of days depending on the issue. That doesn't mean they will respond, but you can always call them back to check on things later.

I have called the 1-800-827-1000 a few times about my claims.   It always seems the people I am talking to have a hard time finding anything. 

1.  Supplemental claim filed on Sept 22nd via fax with confirmation - VA website show receipt of September 25th

2. Supplemental Claim scanned in on October 22nd - Called the White House hotline on October 15th to ask for an update and was told it would be scanned in soon. 

3.  C&P exam was scheduled on October 23rd for November 5th. 

4. C&P exam completed and uploaded into the system on November 5th

5. November 25th I called the 800 number and requested an updated.  They said they were waiting for the C&P exam results.   I told them that made no sense because Blue Button shows the results already uploaded.  They changed their story and said it was because of the backlog

6. . On December 5th I was able to view my C&P Exam results via Blue Button.  The C&P examiner flat out lied in the DBQ  claimed he did things that he did not.  I called the 800-827-1000 number and filed a complaint about it.  They told that within a couple weeks I should hear something. Well I never did and I never expected to. So with my lack of trust with the VA a few days after I called  I faxed in a letter about my concerns with the C&P exam and requested a new one.  This was faxed in on December 9th and I have confirmation it was received. 

7. I called 1-800-827-1000 on December 16th to get an update and was told it was in gathering evidence phase.  The problem I have with this is the submitted a FDC with plenty of evidence and the exam results were already uploaded.  During this call I was attempting to get updates on my HLR as well as the Supplemental claim.  I was able to confirm they did receive the letter about the bad C&P exam.  The person I talked had a hard time just finding the C&P exam results.  

I have not reached out to the VA since the last call with the exception of the IRIS request I filed on Jan 6h concerning my closed exam without notification 

Edited January 23, 2020 by JKWilliamsSr

[Vync]

My experience with the call center was the same. Some are better than others, but it's a shame that the skill/knowledge level of each agent is not adequate. 

On #5, that's not surprising. They are just trying to help within the scope of their knowlege or level of access. Many of them try to come up with a reason/excuse for what is happening downstream.

On #6, it reminds me of some posts I read recently. The C&P examiner can write whatever they want, but are presumed to be correct. We don't have any true due process rights where we are privy to the exam results and can raise a red flag when the examiner blatantly screws up. A good example of this is like when watching court TV shows and the lawyers can object. We have to wait for final adjudication of the claim and then enter the appeals lane.

On #7, did your FDC include a nexus? Sometimes it may be missing and the VA sends you for an exam. Other times, it could be present, but the VA either needs clarification, or it may be dated and the VA needs a current assessment, thus they send you for an exam.

I don't place much hopes in IRIS requests that I submitted because I did not get a timely response. I placed several. Some never received a response. A couple did get a response, but it took six or more months. By that time the claims were already closed. The IRIS requests sent by the WH hotline did tend to yield better results, but still not every case resulted in someone from the VA doing what was requested or even contacting me. I hope you get a reasonable response from your IRIS request.