New Claim Appeared Automatically

[MarineLCpl]

I logged into my VA.gov account today and noticed it said there was a claim for compensation started. I never filed a claim on my end. I’m not sure if it’s just coincidence, but there’s a few things that strike me. 
 

The claim is dated for today(June 30th, 2020). My last claim was July 1st, 2015 which was a re-evaluation. I was called for a C&P exam back then, can’t remember if it was before or after this date. 
 

So it’s been almost 5 years exactly, do you think this was automatically triggered by the VA to do a re-evaluation of my current status? I honestly can’t think of anything else it could be. 
 

One last thing, I submitted my taxes this morning also. I’m currently rated at 80%, but getting paid for TDIU. On my taxes, the only income there was to report was around 2k in hobby income, in which my expenses almost matched(few hundred dollars shy, I believe). 
 

I know I shouldn’t be as worried as I am, but the paranoia in me says that they saw this tiny bit of earned income and requested a re-eval. I can’t say for sure, the status of my generated claim says they’re still adding details and to check back. 
 

Any ideas or info on the matter is appreciated  

[GBArmy]

Buck Yes I sent it to Janesville and before the virus hit they turned those requests over usually in a few weeks. But, like I said, with the limited admin support, some of this stuff just is put on the back burner. I guess I will try an IRIS inquiry and see what kind of response I get. You're right though; 3 months is too long. I'll post what they say, as others are in the same boat I'm sure.

[brokensoldier244th]

2 hours ago, Buck52 said:

GB

Did you send in a request with the FOIA to the BVA?  (For your LHI C&P Exam? Although they do send the report back to the VA but obviously it don't get placed in the VAMC  M.R. System.

I also heard through the grapevine  LHI is not Veteran Friendly.

You may need to contact LHI and ask if there is a problem getting you a copy of your exam?  you had with them on date?

After 3 months you should have had some results.

*''Due to the covid -19'' * this is just an excuse not to help the veteran, as long has this is a ''no physical contact I can't see why they lay the blame on the covid-19

At 3 months you should have heard something by now and no excuses.

I also got word that the C&P EXAMS are preparing to to be conducted at the VAMC and outside contractors locations.  within 2 weeks.  but this could change if the covid-19 has another high deadly wave come through?

 

We've been split scheduling for about a month. Depends on the location of the vamc, though, and who they have available for what exam types. 

We've also been breaking up some exams that have been languishing at a contractor or vamc and rescheduling them as resources open up in some places.

 

Traditionally we'd prefer they all be done at one location for simplicity and so we aren't waiting for records from multiple places. It does speed things up even if it doesn't seem like it from your end. Butt with covid that's been changed. Can't say/dont know if that will continue after.

Edited July 17, 2020 by brokensoldier244th

[deedub75]

15 minutes ago, GBArmy said:

Buck Yes I sent it to Janesville and before the virus hit they turned those requests over usually in a few weeks. But, like I said, with the limited admin support, some of this stuff just is put on the back burner. I guess I will try an IRIS inquiry and see what kind of response I get. You're right though; 3 months is too long. I'll post what they say, as others are in the same boat I'm sure.

So, you've already had the exams with LHI but you're waiting for VBA to send you a copy of it.  Is that correct?

I had exams with LHI in March and I just submitted a FOIA request for them about 3 weeks ago after the ROI office at the VAMC told me they no longer receive copies of them.  

Currently, I am waiting for exams to be conducted by LHI for some new claims I sent in on April 30.  Even after the VA said that in person exams can resume, LHI keeps telling me they can't find an examiner to conduct the exams.  I called to request that my exams be pulled away from LHI since they can't get them done but I know they get a certain amount of days to get them done before the request will be pulled away from them.  

[GBArmy]

deedub75 That's correct. They won't give you a copy of your exam, but tell you you have to get them from the VA. Now, actually I have a problem with that. I have a lot of problems with some of the VA claims process, but in this case,  it seems they are depriving me of my personal info. Constitutional issues? Anyway, it is what it is. My suggestion on the new exam is to ask them what is their specific process in "trying" to get it scheduled. Ask to speak to the manager that will schedule and see what can be done. You must have some recourse of pulling it back after a reasonable wait, so see if that can move the needle. But you have a possible dilema. If you force the VA, or even the contractor to assign the C&P to someone "less-qualified" to conduct the exam, and then you get an inadequate exam, it's going to be difficult for you to demand a new exam because it's going to sound like you're just trying to get a favorable exam. Just things to consider. In any case, be polite and tread lightly so that adverse notes aren't put in your file as being a complainer. It sucks, but it's hurry up and wait, all over again isn't it.

[brokensoldier244th]

6 minutes ago, GBArmy said:

deedub75 That's correct. They won't give you a copy of your exam, but tell you you have to get them from the VA. Now, actually I have a problem with that. I have a lot of problems with some of the VA claims process, but in this case,  it seems they are depriving me of my personal info. Constitutional issues? Anyway, it is what it is. My suggestion on the new exam is to ask them what is their specific process in "trying" to get it scheduled. Ask to speak to the manager that will schedule and see what can be done. You must have some recourse of pulling it back after a reasonable wait, so see if that can move the needle. But you have a possible dilema. If you force the VA, or even the contractor to assign the C&P to someone "less-qualified" to conduct the exam, and then you get an inadequate exam, it's going to be difficult for you to demand a new exam because it's going to sound like you're just trying to get a favorable exam. Just things to consider. In any case, be polite and tread lightly so that adverse notes aren't put in your file as being a complainer. It sucks, but it's hurry up and wait, all over again isn't it.

When we assign exams it goes to a location only. There is no "assigning to a less qualified or more qualified examiner" at least from the VSR exam creation part of things. Staffing for exams is handled by the location where it is assigned. We can log in after the exams are scheduled to check the status of thing (to see if they are pending, done, waiting for exam report, whatever) and we'll see the doctor's name, but we have no part in assigning the doctor. We assign the exams based on body system and whatever was claimed, and certain contentions need a specialist (sleep, ptsd, MH, dental stuff, neuro, eyes, hearing-basically anything above the shoulders) but again, no idea what doctor will be assigned to it. 

[brokensoldier244th]

On 7/15/2020 at 2:48 PM, MarineLCpl said:

Oh, gotcha. It appears so, but I have no way of knowing for sure if both mental conditions are or if it’s just PTSD...the only thing I’m not sure of is what’s actually being counted towards my scheduler status. This most recent claim was labeled PTSD w/ major depressive. But I’m not sure if that’s two separate things, or if they have it all lumped into one. On eBenefits, it shows both major depressive and ptsd as separate conditions. They are in different boxes, both labeled 70%. 
 

The confusing part is that in parentheses next to my PTSD, it says “previously rated as depressive disorder,” etc. The depressive disorder states that the effective date was March 2010. The PTSD(which was newly diagnosed at my C&p in 2015) has an effective date of April 2015. 

Only other SC is a bilateral knee condition, with each knee being rated at 10%. That was SC’d in 2008 and I have never been asked to come in for a re-evaluation on that...guessing they’re being considered p&t, but not entirely sure.

Means you were originally rated (at the time) as 'depressed' but later they changed the rating to reflect that its actual etiology is the PTSD, so they modified the original claim with parenthesis to show how it was originally claimed and what it is now. You can only have one MH condition as a system, so as new diagnosis come in sometimes things have to be lumped together. Your original effective date for the depression is still there, and your effective date for the PTSD is what is claimed later. There could be argument about the effective date if you didn't claim PTSD in 2010, but the effects of it as diagnosed later in 2015 actually are relating to 2010. Clear as mud? I don't do anything with EED's so I can't really opine if that's right nor not, just saying that its possible that since you can point to the effects of PTSD earlier than 2015 under the other rating you may be able to get back pay for PTSD (if it changed your rating) further back than 2015. 

 

Back to parenthesis. I see this a lot with claims that come in with 5 variations of wording for 'low back' condition or something. Its all only 1 condition, and can only be rated that way, so I condense the contentions before I schedule exams because they aren't claiming 5 different things (generates 5 different exam forms for the doctor) they are claiming 1 systemic issue. I still contact a rater first before I do it- I don't just willy-nilly go off the reservation. All changes are tracked anyway, so If I was doing it and wasn't supposed to be I would be audited and probably counseled and eventually fired. 

 

That, in a nutshell, is why you'll sometimes send in X,Y, Z on your -0995, or 526ez with 10 contentions but only get rated on 5 of them. If the ones that weren't rated were part of the same body part/system, they were put together because in essence they were the same thing. Again, this isn't something VSRs can just 'do', and even if I missed it, a rater might do it later when they get the claim. 

Edited July 18, 2020 by brokensoldier244th