HLR since pandemic

[flynsolo2]

******UPDATE---4-13-2021*******

 

I received my decision letter for my duty to assist (although I never did receive a full explanation on why a duty to assist was flagged or what basis and I think I never will)...they note that from my C&P exam, my symptoms are:  pyrosis (heatburn and/or reflux), regurgitation, substernal pain and vomiting, and the decision is to continue my GERD rating at 10%. I don't know what else to do here. Shouldn't I be rated at least 30%, if not 60%? I mean, there are times, (as I told the C&P examiner), that I have had to come home from work to take medicine or reschedule a meeting during a flare-up because, ya know, belching etc., isn't professional. My examiner wanted to hear none of it. Did not even look at my file when I tried to show him all the documentation that this has been going on for such a long time. Now, a week later, I get a decision letter that it is to be continued at 10%....Any suggestions? Should I do a CUE at this point?.... 

 

 

***NEW UPDATE-April 3, 2021

Okay, so I received a letter about the duty to assist for my GERD claim, and scheduled a C&P. My file online for disability claims also updated to show the GERD claim. I went to my C&P exam this past Wednesday, where the claims guy went over the whole sheet about my symptoms and whatever for my GERD. Then, on Thursday, it updated on my disabilities page-except now it says PTSD claim? Same thing yesterday, it says, "what you've claimed-PSTD, claim received March 31st (when I had my C&P exam". Who do I contact about this error? OR do I wait for them to catch it? It still says it today (obviously, since the VA is closed). But, all the way up to this point, it HAD said GERD. It also has listed my GERD files stuff under the files section of the claim.......

 

 

 

*****NEW EDIT AS OF FEB. 14th....

 

Okay, it says that the HLR review was completed on Jan. 28th. I STILL have not received a letter, and on Monday, the 15th, it will be three weeks. The rating looks to be the same on my e-file, but, when I called the VSO on Friday to see if he could see anything on his end of what the VA said about the HLR, he said that my file showed nothing-not the claim or my disability percent(s), or the HLR. Anyone else run into issues with HLR decisions and taking longer than the 10 days to receive your decision letter? I would like to know why I was denied (I am assuming I was, since the percent is the same)...

Thanks everyone!!

 

 

Good Afternoon,

 

I know the time frame for a HLR is normally about 4 months (they state on their website 125 days), however, I am wondering if anyone has filed a HLR since they opened up the VA more in August? Just wondering if there is a huge backlog now. I have mine just sitting there since September, and no status change, even though I was thinking it would be until January, but, as most others have said, still checking often to see if there has been any updates!

Thanks!!!

Edited April 13, 2021 by flynsolo2

[pacmanx1]

8 minutes ago, Hucast21 said:

I hope you get it Pac!

My claim is based on 38 CFR 3.156

OK I had to find where I read it but here it goes: Once a claim is reopened, a claimant is “entitled to have his claim re-adjudicated on the basis of all the evidence of record, both old and new.” Bernard v, Brown, 4 Vet. App. 384, 390 (1993)

Part (B) states:

Pending legacy claims not under the modernized review system. New and material evidence received prior to the expiration of the appeal period, or prior to the appellate decision if a timely appeal has been filed (including evidence received prior to an appellate decision and referred to the agency of original jurisdiction by the Board of Veterans Appeals without consideration in that decision in accordance with the provisions of § 20.1304(b)(1) of this chapter), will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period.

Part (4) states:

A retroactive evaluation of disability resulting from disease or injury subsequently service connected on the basis of the new evidence from the service department must be supported adequately by medical evidence. Where such records clearly support the assignment of a specific rating over a part or the entire period of time involved, a retroactive evaluation will be assigned accordingly, except as it may be affected by the filing date of the original claim.

 

[Foxhound6]

8 hours ago, flynsolo2 said:

@pacmanx1 I hope not. That is irritating and the exam for GERD would be another endoscopy, which isn't an easy C&P exam. Also, the original decision was based off of an endoscopy that I had done. I received the endoscopy and they rated my GERD two weeks after the results. I am hoping I would NOT have to go for another endoscopy. Plus, my medical file and all the issues related to GERD are all documented all the way back to 2006, including an endoscopy even then showing the severity even then! I wish they would just review all my medical files (with the VA doctor's notes as well stating severity) that I sent them when I originally appealed this decision. I have been fighting this rating decision since they first assigned it 2 years ago. This is so frustrating.........

I hate to say it but I agree with Pac. Looks like they identified a DTA in your claim.via that HLR and it was sent back St Petersburg RO for processing. That RO put in request for another GERD C&P. I am in same boat with my HLR for exam on lower thoracic. Been waiting months for QTC to get me an exam. Hang in there. 

[flynsolo2]

@Foxhound6Yea, just looked on my file, they have me scheduled for a C&P exam for the 31st......but, I am going to do what someone else suggested and bring all my files, in chronological order, with all my tests and results and doctor's notes/assessments so that the examiner has everything available at this appointment. I am not really sure what a C&P exam for GERD would "look like" , since it's not like my other C&P exams, where they look for range of motion/pain. Guess we will see.......so now I wait until the 31st....and for the letter to come in the mail. 

[El Train]

2 hours ago, flynsolo2 said:

@Foxhound6. I am not really sure what a C&P exam for GERD would "look like" , since it's not like my other C&P exams, where they look for range of motion/pain. Guess we will see.......so now I wait until the 31st....and for the letter to come in the mail. 

I had Dr. Ellis do an IME on GERD.  He gave his rationale and stated it should be at the 40% level. He did IBS at 30% (had 2 other DR's diagnosis of IBS too). VA did their own, and gave me a big ol 0% for GERD/IBS.  I'm on meds for both.  Sure they low balled me.  But I'm rated for it at least.  Also, I'm 100% P&T with SMC-S.  Otherwise I'd file an appeal.

They're just going to ask questions and see if you have a diagnosis, tests, labs, etc.  They're not going to stick a scope down your throat or anything.

[flynsolo2]

@El Train I see that they have my appointment at Bay Pines, which is about two hours away from me. UGH. I just want to get this over with. That stinks that they rated you at 0. I am rated at 10% but I have evidence from 2006 showing from VA doctor's diagnosis, tests and endoscopy results that (according to the VA's own ratings) I should have been rated at 30%. But, even if they do not go back to 2006 and only do 30% as of the most recent rating of 2019, I would be happy. It still probably will not get me to 100, but gets me closer. I am at 90% now, but, I am pretty sure that is rounded up to 90. If I calculate it right, this still only gets me to 93%. But, I am going to see if I can get both my knees from 0% to at least 10%, and hopefully that will get me to 95%, so rounded up to 100%....fingers crossed. I am so sick of this YEARS LONG battle of trying to get to 100..... 

[Foxhound6]

On 3/3/2021 at 12:06 PM, flynsolo2 said:

@Foxhound6Yea, just looked on my file, they have me scheduled for a C&P exam for the 31st......but, I am going to do what someone else suggested and bring all my files, in chronological order, with all my tests and results and doctor's notes/assessments so that the examiner has everything available at this appointment. I am not really sure what a C&P exam for GERD would "look like" , since it's not like my other C&P exams, where they look for range of motion/pain. Guess we will see.......so now I wait until the 31st....and for the letter to come in the mail. 

I would do the same. However, in my experience, it can be hit or miss whether the examiner will look or even accept them. I have had one examiner thank me for bringing certain documents because they had not seen them in the CFile and I have had an examiner outright tell me he didn't want it. But I believe it is ALWAYS a good idea to bring all pertinent information to the exam, you never know how it might help.