First claim questions

[XIbodybag]

So back story, i spent 6 years in the guard including several combat deployments to iraq.  I got out in 2013 and neglected filing a claim.  In november of 2019 i filed my first claim for PTSD, TBI, Tinnitus, knee pain, back pain and secondary to PTSD i claimed anxiety, depression and sleep disturbance.  I filed a FDC.  In hindsight now i know the secondary claims should have come later. 

 

Long story short in January they changed it to a standard claim and set me up for a C&P for PTSD only....C&P was through VES and went well.  I have a CIB and arcom w v device so my stressor is confirmed automatically from what ive been reading?  Ive been calling the 1000 number since january asking about the status and they give me the same answer.  "You're in the development stage of blah blah blah" and that they are waiting on paperwork from the national guard.  When i ask them what paperwork to see if i can produce it they tell me its internal to the VA and they cant see what it is? Lol.  They've requested 4 times apparently over the past 5 months.  Anyways i finally get it out of them 3 days ago that they need some type of personnel records but no specifics.  Luckily i find hrc.army.mil and login with my premium login account and every personnel record from my enlistment, to my seperation from service is in there. 

 

The thing is why are they playing dumb and not telling me specifically what was needed?  Also why only a C&P for ptsd?  My knee complaints have been documented through active duty dr visits and va dr visits.  Also no C&P for tinnitus? Isnt that a given for infantry combat veterans?  Im so disillusioned with this whole process so far.  Going on 210 days and counting....

Edited June 11, 2020 by XIbodybag

[brokensoldier244th]

C an Ps are giving in person always (or telehealth right now, but that is a temporary directive) for specialty issues, generally anything above the neck needs to have a C and P for sure, and usually in person- tinnitus and hearing being one of them. Your CIB is just fine for a conceded stressor. The phone people aren't playing dumb, they have no access to your C file because they aren't cleared for it. If vsr's had to request records from the NG it will be a request for your whole file- medical and personnel just like what is requested for active duty. If you have stuff, label it clearly as what it is that you are uploading and send it- it will ping your claim file as 'newly uploaded' and then your claim in waiting status is flagged and sent to a VSR as part of their daily workload to review what was uploaded to the file.

 

Your knees and whatnot, if well documented with inservice event, evidence of current problem, and a connection opinion from someone between the two can be examined by looking at the evidence on record without a C and P in person- it may show up on your end as an exam, but it will be one that you don't report to. The doctor just goes through your medical evidence and renders an opinion on that if its recent enough. If VA is requesting something and they haven't been able to get it, they usually send you a letter telling you what and why. I can tell you right now that requests for records to NPRC (National personnel records center) and Guard/Reserve units, is backed up to hell and gone because those places in many cases don't have people reporting to daily duty yet, and you can't do records searches and reviews for a lot of things like personnel and medical remotely because its not all digitized yet. 

You are correct- generally its easier to file for secondary issues separately after you already have a rating for the primary condition. You can file both together but your claim then bounces back and forth between waiting for evidence and review because the primary condition may not be rated yet and the secondary is tied to it. Any secondary aggravation claim requires a rater to look at it first with the medical evidence on hand to decide if VSR's can set up exams or not for it, or, sometimes, the rater can take that part of the claim from the VSR and rate it right there based on the evidence on file. If your primary condition is already rated then all VSRs have to do is make sure you have all three Caluza elements (inservice event, current problem, link between the two) and then then can schedule an exam or send for decision. 

Edited June 11, 2020 by brokensoldier244th

[XIbodybag]

4 minutes ago, brokensoldier244th said:

C an Ps are giving in person always (or telehealth right now, but that is a temporary directive) for specialty issues, generally anything above the neck needs to have a C and P for sure, and usually in person- tinnitus and hearing being one of them. Your CIB is just fine for a conceded stressor. The phone people aren't playing dumb, they have no access to your C file because they aren't cleared for it. If vsr's had to request records from the NG it will be a request for your whole file- medical and personnel just like what is requested for active duty. If you have stuff, label it clearly as what it is that you are uploading and send it- it will ping your claim file as 'newly uploaded' and then your claim in waiting status is flagged and sent to a VSR as part of their daily workload to review what was uploaded to the file.

 

Your knees and whatnot, if well documented with inservice event, evidence of current problem, and a connection opinion from someone between the two can be examined by looking at the evidence on record without a C and P in person- it may show up on your end as an exam, but it will be one that you don't report to. The doctor just goes through your medical evidence and renders an opinion on that if its recent enough. If VA is requesting something and they haven't been able to get it, they usually send you a letter telling you what and why. I can tell you right now that requests for records to NPRC (National personnel records center) and Guard/Reserve units, is backed up to hell and gone because those places in many cases don't have people reporting to daily duty yet, and you can't do records searches and reviews for a lot of things like personnel and medical remotely because its not all digitized yet. 

Hey thanks! I was hoping for a response from you.  Its been a pain in the ass trying to get clarification about what was needed.  Any idea how long after i uploaded my personnel records and medical records before they review the newly uploaded documents (in general of course).

[brokensoldier244th]

The suspense is automatically set for 30 days for most 'waiting for veteran' stuff. 10-15 for records requests from NPRC (except for now, it has to keep being pushed out), and some things can be gotten electronically within a few hours- depending on when you discharged and whether or not it Active or Guard/Reserve. NG/Reserve usually has to be requested (statutorily) from the unit, if for no other reason than because the statute says that Duty to Assist says so.  'New Mail' (as it shows up on claim files) is assigned by a national computerized queue based on overall workload- not my monkeys, I have no idea how that stuff is assigned, it just shows up. Sorry I can't be more help there. Usually, though, based on what I see come across my 'desk' (at home, aint it great right now) is claims with newly uploaded stuff within a few days of when it was uploaded or scanned in by the mailroom somewhere. 

[XIbodybag]

7 minutes ago, brokensoldier244th said:

The suspense is automatically set for 30 days for most 'waiting for veteran' stuff. 10-15 for records requests from NPRC (except for now, it has to keep being pushed out), and some things can be gotten electronically within a few hours- depending on when you discharged and whether or not it Active or Guard/Reserve. NG/Reserve usually has to be requested (statutorily) from the unit, if for no other reason than because the statute says that Duty to Assist says so.  'New Mail' (as it shows up on claim files) is assigned by a national computerized queue based on overall workload- not my monkeys, I have no idea how that stuff is assigned, it just shows up. Sorry I can't be more help there. Usually, though, based on what I see come across my 'desk' (at home, aint it great right now) is claims with newly uploaded stuff within a few days of when it was uploaded or scanned in by the mailroom somewhere. 

Okay thanks for the info!  I just called the 1000 number again and the representative said that even though i uploaded the whole personnel file and medical records that the va will continue to request it until the government agency they are requesting it from provides an adequate response.  Does that make sense?  Does that hold true even if i upload it on my own? I should add the va has requested 4 times now with the first request being in january.

Edited June 11, 2020 by XIbodybag

[GBArmy]

Broken We appreciate your inputs on the inner-workings of the VA. Just a little info from knowledgeable people such as yourself provides a little easing of the mystery if you know what I mean. Thanks.

[brokensoldier244th]

Just remember that I can't do anything like look up people, etc, and somethings I don't know- outside my paygrade. Things like appeals? WTFK- I rarely see them and have to punt those if they are inadvertently assigned to me. Other than that, no problem, thank you. I don't want VA to be the enemy, at least in my very tiny slice of the world. I routinely get called out because, if nothing else, I spend too much time on a claim and it affects my overall numbers. We do have quotas, of a sort, but its its like 8-10 claims touched/researched a day. However, that 1 claim could have 8-10 uploads of treatment records (mil and private), C and P info, etc, that spans hundreds or thousands of pages. CTRL-F doesn't always work on scanned documents, so its eyeballing it and scrolling through it. Im also pretty new at things, so I have no insight on how things 'used to be done' for good or ill. I can only work with the information as I was shown based on current directives/M21, etc. 

 

NOTE to ALL- routinely check the M21 before quoting it. It changes CONSTANTLY. I get 3-4 update emails a week just about those. https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000075494/M21-1 Changes By Date#June    Thats a public link on their website. Its currently going to June but there is a table at the top for the rest of the months.