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    • The 5, 10, 20 year rules...



      Five Year Rule) If you have had the same rating for five or more years, the VA cannot reduce your rating unless your condition has improved on a sustained basis. All the medical evidence, not just the reexamination report, must support the conclusion that your improvement is more than temporary.



      Ten Year Rule) The 10 year rule is after 10 years, the service connection is protected from being dropped.



      Twenty Year Rule) If your disability has been continuously rated at or above a certain rating level for 20 or more years, the VA cannot reduce your rating unless it finds the rating was based on fraud. This is a very high standard and it's unlikely the rating would get reduced.



      If you are 100% for 20 years (Either 100% schedular or 100% TDIU - Total Disability based on Individual Unemployability or IU), you are automatically Permanent & Total (P&T). And, that after 20 years the total disability (100% or IU) is protected from reduction for the remainder of the person's life. "M-21-1-IX.ii.2.1.j. When a P&T Disability Exists"



      At 55, P&T (Permanent & Total) or a few other reasons the VBA will not initiate a review. Here is the graphic below for that. However if the Veteran files a new compensation claim or files for an increase, then it is YOU that initiated to possible review.



      NOTE: Until a percentage is in place for 10 years, the service connection can be removed. After that, the service connection is protected.



      ------



      Example for 2020 using the same disability rating



      1998 - Initially Service Connected @ 10%



      RESULT: Service Connection Protected in 2008



      RESULT: 10% Protected from reduction in 2018 (20 years)



      2020 - Service Connection Increased @ 30%



      RESULT: 30% is Protected from reduction in 2040 (20 years)
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    • https://community.hadit.com/searching-for-va-claims-information-on-hadit.com/

       

      Your question has probably been asked before so the fastest way to find the information you need is to search for it.
      • 3 replies
    • How to get your questions answered...


      All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

      Tips on posting on the forums.

      Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.


      Knowledgable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title. I don’t read all posts every login and will gravitate towards those I have more info on.


      Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.


      Leading to:

      Post clear questions and then give background info on them.

      Examples:

      A. I was previously denied for apnea – Should I refile a claim?


      I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?



      B. I may have PTSD- how can I be sure?

      I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?



      This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.

      Note:

      Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview.

      This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
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christiane41

Skin Cancer

Question

Hello there.

 

My primary doctor is concerned about a spot on my face that looks to him very suspicious. He wants to send me to a dermatologist who deals with skin cancer. Is that visit and or any skin cancer treatment covered by ChampVa? 

 

Also my other concern, on my last Dr check up the office coded the visit as an annual physical/exam. ChampVa completely denied the claim. My Dr office is not changing the coding. How can this even be right? We are always talking about preventative care. An annual physical would fall into that category I would think. I am just shocked they will not pay the office visit. 

 

Thank you for any and all answers. 

 

Christiane Bayes

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Did you call Champva and ask them?  Its been my experience that Champva is the best insurance you cant buy. (You have to earn it by having a 100 percent disabled Vet as a spouse.) 

Like other stuff at VA, tho, I usually use the "teenager" method.  If mom says no, ask Dad.  If Mom and Dad say no, ask your teacher.  Essentially, you take advantage of the fact that "mom, dad, and teacher" dont communicate all that well.  This is true among VA employees, times 8.  You are not really "taking advantage" but are getting what you deserve.  It works well when you use it that way, but if you use this in a malicious way, pressuring benefits you dont deserve, then it can backfire.  

In other words call at a different time and ask a new employee, and you are likely to get a Veteran friendly employee this time.   This works because VA is not a "unified body", and, there are few policies that work VA wide that each employee enforces the same.  

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Good advice.

I juts realized I did not get my 2020 CHAMPVA handbook, but it is on line ,if you don't have one:

https://www.benefits.gov/benefit/318

You have a right to know why they denied.Did they send you a letter as to the denial?

The Handbook has some contact info in it. 

I only had one problem in decades , and I called a phone number in the section about Pharmacy stuff.

The problem was not with CHAMPVA but with my pharmacist.He told me ,without even checking, that a med my doc advised would not be paid by CHAMPVA. I paid the bill myself. When I got home I looked up the med- he was wrong.The CHAMPVA woman called him immediately and then he called me to tell me that my 53.00 payment was waiting for me. Hve you called CHAMPVA?

There is something about CHAMPVA that CHAMPVA recipients know.

At age 65 a CHAMPVA recipient must apply for Part A and Part B of Medicare.

At that point, Medicare is their prime payer, and CHAMPVA kicks in for the rest of the coverage.

 

 

 

 

 

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I almost forgot- years ago my PCP doctor wanted me to get an opinion  on a cyst I had.

A skin specialist examined it and said right away it was nothing to worry about.It was a very common type of cyst.

It was on my back and I had noticed that spring, during yard work that, it was being irritated by a back support I wear for yardwork. I made another Appt with the skin doctor and asked him if he would remove it and check it for cancer.

He did, in his office, and a  test result on it ruled out cancer.

I thought maybe CHAMPVA would consider this as unnecessary cosmetic surgery and maybe not pay for the removal. But they did.

 

 

 

 

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Another point these places normally make a mistake and if someone before them did not do their job correctly they just keep pushing something which should be resolved.  My wife get 3-4 a year she has to call in on because it was covered and they try to not cover it.  She is also the one who will call them prior and make sure it is covered.  it is possible they made a mistake.  

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27 minutes ago, Berta said:

I almost forgot- years ago my PCP doctor wanted me to get an opinion  on a cyst I had.

A skin specialist examined it and said right away it was nothing to worry about.It was a very common type of cyst.

It was on my back and I had noticed that spring, during yard work that, it was being irritated by a back support I wear for yardwork. I made another Appt with the skin doctor and asked him if he would remove it and check it for cancer.

He did, in his office, and a  test result on it ruled out cancer.

I thought maybe CHAMPVA would consider this as unnecessary cosmetic surgery and maybe not pay for the removal. But they did.

 

 

 

 

I have had over 150 removed now and any time you tell them it is painful or uncomfortable it is covered.  I know I don't pay for them anymore, but when I saw a private doctor the nurse told me about this once they code it this way the insurance has to cover the cost.  As for cancer if the doctor has given you a referral because they think something is wrong then 99% of the time this is covered.  Someone could have coded it incorrectly.  

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    • The 5, 10, 20 year rules...



      Five Year Rule) If you have had the same rating for five or more years, the VA cannot reduce your rating unless your condition has improved on a sustained basis. All the medical evidence, not just the reexamination report, must support the conclusion that your improvement is more than temporary.



      Ten Year Rule) The 10 year rule is after 10 years, the service connection is protected from being dropped.



      Twenty Year Rule) If your disability has been continuously rated at or above a certain rating level for 20 or more years, the VA cannot reduce your rating unless it finds the rating was based on fraud. This is a very high standard and it's unlikely the rating would get reduced.



      If you are 100% for 20 years (Either 100% schedular or 100% TDIU - Total Disability based on Individual Unemployability or IU), you are automatically Permanent & Total (P&T). And, that after 20 years the total disability (100% or IU) is protected from reduction for the remainder of the person's life. "M-21-1-IX.ii.2.1.j. When a P&T Disability Exists"



      At 55, P&T (Permanent & Total) or a few other reasons the VBA will not initiate a review. Here is the graphic below for that. However if the Veteran files a new compensation claim or files for an increase, then it is YOU that initiated to possible review.



      NOTE: Until a percentage is in place for 10 years, the service connection can be removed. After that, the service connection is protected.



      ------



      Example for 2020 using the same disability rating



      1998 - Initially Service Connected @ 10%



      RESULT: Service Connection Protected in 2008



      RESULT: 10% Protected from reduction in 2018 (20 years)



      2020 - Service Connection Increased @ 30%



      RESULT: 30% is Protected from reduction in 2040 (20 years)
      • 4 replies
    • Wonderful news way to hang in. I hope this gives you some well deserved peace. 
    • If HadIt.com has helped you or you believe in it’s mission then please donate even $1 helps. I hope HadIt.com has provided $1’s worth of help to you. Imagine waking up and there is no HadIt.com it could happen and that is why I’m asking for your help now.



       



      Our traffic is going up and so are our expenses, however revenues have gone down and so I am reaching out to you to see if you can help me keep Hadit.com up and running.
      • 4 replies
    • https://community.hadit.com/searching-for-va-claims-information-on-hadit.com/

       

      Your question has probably been asked before so the fastest way to find the information you need is to search for it.
      • 3 replies
    • How to get your questions answered...


      All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

      Tips on posting on the forums.

      Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.


      Knowledgable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title. I don’t read all posts every login and will gravitate towards those I have more info on.


      Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.


      Leading to:

      Post clear questions and then give background info on them.

      Examples:

      A. I was previously denied for apnea – Should I refile a claim?


      I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?



      B. I may have PTSD- how can I be sure?

      I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?



      This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.

      Note:

      Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview.

      This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
      • 2 replies
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