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Anyone have an idea what the following means? notification letter starts off like this: VA completed your request for Higher-Level Review received on May 4, 2020 and identified an error in assisting you in gathering evidence to support your claim in each of your claimed conditions. VA will provide you notification of the evidence we will obtain to address these errors under a separate cover.
Need your all's opinion on this.
Just had my HLR closed for 2 claims.
- Originally Submitted on April 16th as an HLR. (not gonna back track the whole story with NODS/Supp claims for last 3 years).
- Closed on September 3rd (Thursday before Labor day weekend).
- Says VA "HAS MADE A NEW DECISION"
- On details tab is says "Compensation Issue" for both Claims.
- Nothing has been updated on EBennies and VA.gov sucks at giving any more details.
- What do you all think?
I was checking va.gov after receiving the mostly favorable results of an HLR for an earlier effective date claim for migraines where VA called CUE on themselves.
I say mostly favorable because the effective date claim went back to 2006. The CUE was instead awarded exactly one year back from the date of the intent to file in March 2019 back to March 2018.
That's when I noticed a new claim for increase on va.gov for TBI that I did not submit.
That's where it says under evidence gathering "Request 1- 930 rating not addressed see claim notes"
I spoke to a VA rep who says that it's an internal review and was about pyramiding TBI and PTSD. I've been mislead by the phone reps before though...
Can anyone make sense of this?
Edit- in the HLR rating decision code sheet it says "REVIEWER NOTE: pyramiding under DC 8045 is outside the scope of the current HLR for earlier effective date for migraine." Could be a clue...
Updated as of 2020-08-27 (at the bottom of my original post)
How long does a higher level review/CUE take? I initially called the 1-800 number and they said supplemental reviews are supposed to take less than 125 days, but they were not certain about higher level reviews. The agent speculated they could take a year or longer.
This post was changed to track my claim as it made it's way through the VA system. This may help other veterans understand some of the inner workings of what goes on behind the scenes.
Why am I calling this HLR/CUE and not just CUE or HLR?
At the time the claims were submitted, other members have indicated filing their CUE claims as regular letters. With the overhaul to the VA claims and appeals process in early 2019, they have became sticklers for filing on certain forms. Unfortunately, there is no mandatory form for a CUE claim. With HLR and CUE being mostly similar, aside from the restrictions of CUE, I wanted to cover my bases and not cause any delays with them having to come back and ask me to use a specific form.
2019-09-20 Mailed to VA certified mail w/return receipt
2019-09-23 Claim received
2019-10-08 Not yet posted to va.gov. Called 1-800-827-1000. ETA March 2020.
2019-10-17 Moved you evidence gathering, review, and decision as of 2019-10-15. ETA November 4, 2019
2019-10-22 Moved to initial review as of 2019-10-03. ETA March 30, 2020
2019-10-24 Requested records
2019-10-29 va.gov status unchanged. Development letter sent. Called 1-800-827-1000. Claim is in the national work queue and being worked by Houston VARO. The development letter was the typical "we got your claim and are working on it". They sent a request to the Birmingham VAMC for medical treatment records from 1995-1999. Called the VAMC's Release of Information Office and they have 20 business days to complete the request.
2019-11-25 Called 1-800-827-1000. Status still unchanged, but the suspense date of the medical treatment records request has expired. VA agent sent IRIS request. Called the VAMC's Release of Information Office. Paper copies were mailed via USPS certified mail to the Evidence Intake Center in Janesville, WI. They were nice enough to provide the USPS tracking number.
2019-11-29 Certified mail tracking shows package was received by the Evidence Intake Center in Janesville, WI.
2019-12-11 Called 1-800-827-1000. Paper copies have been scanned in to PDF. Waiting to be picked up by a VARO.
2019-12-12 Called 1-800-827-1000. The call center agent (Donald) sent an IRIS request to inform the VARO that the claims are ready to proceed.
2019-12-20 Moved you evidence gathering, review, and decision as of 2019-12-19. ETA January 23, 2020.
2019-12-27 No change to va.gov status. Only change is ETA of May 27, 2020, which is five months out. Called 1-800-827-1000 and was given a strange status. First, they said they were waiting on more medical records from the VAMC from December 20, 2019 through January 20, 2020, which doesn't make much sense. I called back later in the day and was told something different. Called my POA VSO. They said the VA sent me a letter asking if I had any additional evidence to add. The VSO said the ETA is probably out so far because they are waiting for a response from someone outside of the VA system (i.e. me).
2019-12-30 Checked va.gov and noticed it says they sent me a development letter and items need attention. Called 1-800-827-1000 and they said a letter was not sent out and they are not waiting on anything from me. My claim is still at the VARO and assigned to a VSR. They found a note indicating that the recent second request for VAMC medical records was in error. They said they have seen this happen before where it triggers the ETA date to be pushed out automatically. In this case, it cost me about six to seven weeks of unnecessary delay.
2020-01-03 Checked va.gov and no change. Called 1-800-827-1000. The call center rep said it was confusing and transferred me to someone else who could help tell me what is going on. Talked with a friendly lady who said that on 2020-01-02, the person developing the claim sent a message to the quality department asking if the claim should have been submitted on 21-526EZ or 20-0995 (supplemental claim form). Fortunately, earlier today, @Dustoff 11 posted the exact information from M21-1 indicating that no specific form is required. I provided that to the lady and she sent a message to the VARO to let them know exactly where it is. No clue if they have actually processed my request and were just double-checking or if they still need to do it. At least I was able to help them to help me, I hope.
2020-01-07 Well how about this. I received a letter in the mail from the VA yesterday which was dated 2019-12-20 requesting additional evidence (treatment records). Called 1-800-827-1000 and let them know this is for CUE and no new evidence could be added. They did say the request to revise is assigned to a rater, so that's promising.
M21-1, Part III, Subpart iv, Chapter 2, Section B - Revision of Decisions
III.iv.2.B.4.d. Considering Requests for Revision Based on CUE
2020-01-09 One week has passed since VARO asked about how to proceed regarding filing using a specific form. Called 1-800-827-1000. They said it is now awaiting a decision. Estimated completion date was moved from May 2020 to February 12, 2020, which is an improvement.
2020-01-17 No change on va.gov. Called 1-800-827-1000. They said it was status 499 (National Work Queue), not assigned to an individual and waiting to be picked up. As of 1/8, it is still "Ready for decision". Estimated completion date still February 12, 2020.
2020-01-21 There was a change on va.gov, but it is a bit different than what I have seen previously. The estimated completion date is still February 12, 2020 and the last status was January 8th, but now it also includes three new lines talking about "We closed the notice for Request 1", "We closed the notice for Request 2", and "We closed the notice for Request 3", all dated Jan 8. This was not there last Friday. I'll take it as a good sign that something is happening.
I called 1-800-827-1000 to see what these three things are. They said that these indicators were normal, part of what they are doing while clearing things off their checklist. I called my VSO and they confirmed it is "ready for decision", where it has been for the past two weeks. They checked to see if a letter was generated, but one has not been created yet.
I also found the answer to my question (sort of) about the "We closed the notice for Request #". I just clicked on the "Files" header at the top.
And it showed more information about each request. It's more than what the agent on the phone provided, but it still doesn't give much transparency. For example, "Recent treatment for claimed conditions" was probably the request from the VARO to the VAMC for my medical records. However, because it was CUE, the request was probably not needed because they merely needed to check my claims file.
2020-01-23 I had to call 1-800-827-1000 to check on something unrelated, so I asked them to give me a status update. The decision was made yesterday and is presently waiting for final review (i.e. approval). Once that is done, it will move to notiification. At that point, a decision letter should be inserted into the system and become visible to my VSO so I don't have to wait for it to arrive in the mail.
2020-01-24 Friday afternoon and I checked va.gov and there was a change. Or was there? it was in step 3 yesterday and is still there today. Maybe sometimes between then and now, it was moved to step 4, but then moved back to step 3. The only visible change is the estimated completion date being pushed out by two days. No big deal. I'd rather they take a couple of extra days to get it right (I just hope they get it right). To satisfy my curiosity, I called 1-800-827-1000 to find out if that was what really happened. The first agent I spoke with was clueless and said they could not tell me anything more than what I saw on va.gov. They transferred me to a "technician", who provided a little more info, but was rather rude and made me feel like I was preventing him from leaving for the day. He said the decision was completed and they are in the process of generating the formal notification letter. He said it should be in step 4 Preparation for notification, but indicated that va.gov and ebenefits may not reflect the current status in realtime. Either way, the estimated completion date was still January 30, 2020, what I can see in va.gov.
2020-01-27 I guess someone at the VA was working over the weekend. Finally reached step 4: Preparation for notification and the estimated completion date was moved one day earlier to January 29, 2020.
2020-01-27 Decided to check va.gov before leaving for the day. This confirms what I was told earlier today! Tomorrow, I will ask my VSO to print a copy of the rating decision.
2020-01-28 Picked up rating decision from VSO. As expected, won one, lost one, but the one I lost will be appealed. They made the exact same mistake as in the original claim.
2020-08-27 HLR update and a recap
My HLR was received by the VA on April 10, 2020 and has been sitting idle in the national work queue. Today, I received a call from the DRO to perform the informal conference regarding the TMJ errors. He went over the details of the evidence he is allowed to consider (all evidence of record prior to when the decision was made in early 2000).
In this case, the VA did a C&P dental TMJ exam in November 1997, but they misplaced the notes and brought me back about a month later for a second exam. When the rating decision was made in early 2000, they only used the material from the second exam.
About 8 or 9 years ago, I requested a copy of my claims folder and received it a huge box. I scanned hundreds of pages, front and back, into my computer and organized them. When I had a heart attack in April 2019, I was out of work for several months to recover. I spent a good bit of that time going back over the documents looking for anything which might qualify as a CUE. As a result, I found the misplaced first C&P exam notes. I put together CUE motion and sent it to the VA in Sep 2019 for two issues. In Jan 2020, I won one, but lost the other. I took my time re-reviewing everything and filed the HLR in April 2020.
The DRO was able to see my copy of the first C&P exam notes from my packet, but needed to confirm that they were actually in VBMS already. Being handwritten, he had to go page by page and eventually found it. The document was jammed into a packet of 50+ scanned pages that were date stamped as being received by the VARO in March 1999.
He felt that when the decision was made in early 2000, the adjudicator probably was looking for transcribed findings placed on a formal C&P exam worksheet, not a handwritten progress note. However, because the first exam was so thorough, he is able to use it's contents.
He said DeLuca (4.40 and 4.45) definitely applies because numerous requirements of limitation of motion have been well documented. The first exam would indeed yield a 30% initial rating, but the second exam would only yield a 20% rating. Based on his findings, he feels that I should probably get awarded the 30% because had the material not been misplaced in error, the second exam would have never occurred.
He confirmed that CUE definitely did occur. He has to write up the rating narrative and will pass it on for review, claim approval, and any retro approval. The decision letter might be available in a couple of weeks. Due to the other CUE I won in Jan 2000, I was increased to 50% as of 1995. I should be increased to at least 60% from 1995 through 2008 or 2009.
The entire conversation lasted almost 90 minutes. I also asked him how HLR's are assigned from the National Work Queue. He said they they are assigned centrally. He saw I had my other HLR in the queue, but he is not allowed to request it. He said the HLRs are assigned to his individual work queue. For example, he may have 7 or 8 assigned to him at any given time. If he finishes up two in one day, two more are automatically assigned at the end of his individual work queue.
This news is a great relief, but as always, I will believe it when I see it. Crossing my fingers...
HLR 131 days and my informal conference was a few days ago. An error was found, as attached, and they say my new decision/% is addressed in the paper, but my vso was able to see the paperwork and it shows nothing. So my HLR worked and found there was a clear error. I hope the same outcome for others.
Ztmiller8 posted a question in Appealing Your Veterans Compensation Disability Claims NOD, DRO, BVA, USCAVC,Finally heard back that I received my 100% Overall rating and a 100% PTSD rating Following my long appeal process!
My question is this, given the fact that my appeal was on the advanced docket and is an “Expedited” appeal, what happens now and how long(ish) is the process from here on out with retro and so forth? I’ve read a million things but nothing with an expedited appeal status.
Anyone deal with this situation before? My jump is from 50 to 100 over the course of 2 years if that helps some. I only am asking because as happy as I am, I would be much happier to pay some of these bills off!
Joey Ross posted an answer to a question,I told reviewer that I had a bad C&P, and that all I wanted was a fair shake, and she even said, that was what she was all ready viewed for herself. The first C&P don't even reflect my Treatment in the VA PTSD clinic. In my new C&P I was only asked about symptoms, seeing shit, rituals, nightmares, paying bills and about childhood, but didn't ask about details of it. Just about twenty question, and nothing about stressor,
Picked ByJoey Ross,
This is the latest Compensation & Pension (C&P) Clinicians Guide dated 20180719. The only other one I've seen is dated 2002, including the one on this website and the VA website. I got this from my claims agent, who got it from the VA.
VA Compensation & Pension (C&P) Clinicians Guide 2 Final Corrected 20180719.pdf
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