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.

[JKWilliamsSr]

2 hours ago, Vync said:

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.

One of the issues with supplemental claims is that you cannot actually identify them as FDC's like you would a new claim.  You have to rely on the VA inferring it. With a new claim you get the option to decided if it is an FDC and on top of that even if it is a normal claim you get the option to request a decision because you do not have any additional evidence to submit.  We cannot do that for supplemental claims. 

My claim had all the necessary evidence to make a decision. 

1.  I submitted a separate personal lay statement for each disability claimed.  I submitted this on the VA Form 21-4138
2.  My wife wrote a statement for me in support of my claim also on a 21-4138 we have been together since 2009
3. My ex-wife who is a BSN wrote a statement in support of claim also on a 21-4138.  This statement along with my own statement shows symptomology going all the way back to the year 2000
4. A nexus was provided for each disability claimed with diagnosis.  In the necessary wording that the VA looks for.  I expected C&P exams because while I provided a nexus I did not have DBQ's
5. My outside doctor provided measurements using a goniometer for all of my claims that dealt with range of motion
6. With my claim I submitted copies from my SMR's.  I did not trust the VA to properly go through my records since they previously denied to claims saying they were not in my SMR's
7. I submitted current medical records that showed all current diagnosis.  Especially for those disabilities I was claiming secondary to an already existing SCD.
8. I submitted the curriculum vitae of my Independent Medical Examiner. 
9. I submitted a record from my pharmacy that shows all the medication that I was on.  This was in conjunction with my private records that shows diagnosis and prescriptions

Now with my Independent Medical Examination Report submitted I still expected C&P exams because that is something the VA loves to use even though is it clear it is not required of outside doctors.  The C&P examiners was supposed to look at all the medical evidence and make a determination but in the C&P exams I received none of the doctors commented on my medical evidence. 

So in reality there is really no reason my supplemental claim should still be sitting in gathering evidence given all the evidence I submitted and I had my C&P exams 75 days ago. 

Edited January 23, 2020 by JKWilliamsSr

[Vync]

I thought I would file for my heart attack like you would a new claim. Wrong. Because I filed previously for something else heart related, I was told I needed to file it as a supplemental. The VA screwed up by not always treating FDC's separately.

You are correct. Don't trust the VA to be thorough or correct. That's why I recommend spoon-feeding them exactly what they need. Sounds like you did that.

Hopefully the VA will get to your claim soon. You might want to call and ask when the last time any activity was. It might be more recent than what you can see online. I equate activity with someone doing something on it. Just have to hope it is not something stupid.

[vetquest]

JKWilliamsSr, I do not want to seem that I am putting you off but I believe your claim is not excessive yet.  I filed an NOD one year ago and am still sitting in a holding pattern.  Now I know that NOD's are taking longer since they are trying to get the AMA stuff done.  I would call the 1800 number and see if they will give you a status.

[JKWilliamsSr]

3 minutes ago, vetquest said:

JKWilliamsSr, I do not want to seem that I am putting you off but I believe your claim is not excessive yet.  I filed an NOD one year ago and am still sitting in a holding pattern.  Now I know that NOD's are taking longer since they are trying to get the AMA stuff done.  I would call the 1800 number and see if they will give you a status.

I understand what you are saying but my supplemental claim is not an appeal but reopened claims.   Since the changed the system you cannot reopen claims like you did a year ago.  Now I would not have a problem with the wait if I had not had my C&P exams.  The fact that I had them and it has been 75 days ago and it is still in the "gathering evidence" phase I think I may have been lost in the shuffle somehow.   Here is the thing.  I submitted the supplement claim on Sept 22 and they don't touch it until it has been scanned in. Once that is done things happen.  My claim was scanned in on October 22 and 3 days after that I am getting called for C&P exams.  

[broncovet]

Dont expect a reopend claim to be done faster than an appeal, in fact, much of the time VA simply ignores reopened claims.  Why?  Because they can!!!  There is no accountability.  

I dont recommend you "stir up a hornets nest" because your claim was not done within 75 days of c and p exam and, regardless of what ebenefits says.  

Yes, I know VA "says" they get claims done in 75 days or less but they also say they are "pro claimant non adversarial" too.  My advice is to wait a couple more months...pressuring VA to a quick decision rarely works out well for the Veteran.  I know.  This is part of the reason I applied in 2002, and 17 years later, I am still IN appeals.  

If you upset someone, they can simply "press delete" on some of your critical evidence, and it will take you 5 years or more to run that down.  

 

[Miken2c74]

On 1/6/2020 at 12:22 AM, JKWilliamsSr said:

This is the exam where I had the bad C&P exam but there still should have been some kind of movement.

Did you challenge this exam ? My examination was done by a German Contract PR and my medical opinion was done by someone else at VES. It is virtually unrealistic to perform a medical opinion if you are not the administering  the exam. You can fight it. You should write a letter.