Effective date

[SPO]

I said it in another thread, but I won my appeal at the board and was rated @ 100% p&t.  But I have an issue with effective dates.

1. I started the process in Nov 2018 with 14 issues. Got denied on all issues for no diagnosis.

2. Filed an HLR within a month of the first decision and got denied again on all 14 issues

3. file a supplemental claim a few months later.   I was awarded 2 out of 14 issues with an effective date of 11/2018 based on a C&P in 7/2020

4. I appealed the other 12 to the board about a month later.  I was just granted service connection for all 12 in 11/2021.

5. The RO rated me at 100% 12/1/2021.   A few items were 0% and effective 11/2018. Anything with 10% or higher was given An effective date of 7/2020(the c&p).

in my mind this is a continuously perused claim. Nothing went over the 1 year appeal timeline. Also based on the fact that the supplemental claim ratings, based on the same c&p as the appeal were effective 11/2018. It seems all items should be effective on 11/2018.   Thoughts?  

[SPO]

In the board’s decision letter (the one only granting service connection) it says I can’t appeal to the board again, only supplemental or CAVC.  This seems outrageous to fix what is more or less an administrative error.   Is the rating portion issued by the RO still considered the “board’s decision”.  Again this appeal was done under AMA.

Edited December 2, 2021 by SPO

[JKWilliamsSr]

2 hours ago, Mr cue said:

I thought he said it was a bva decision.

If it's a regional office decision granting this yes he can nod.

But if it's a board decision he has 120 to appeal to court.

Under legacy now I am not up on the new ama system.

My understanding is that once the BVA grants service connection it will go back to the RO for percentages and effective date.  Since it is the RO that is making the percentage determination and effective date that can be appealed to the BVA.

[pwrslm]

What medical record on the conditions they rated from 7/20 at the C&P? If there were not enough medical evidence that would support a rating prior to the 7/20 C&P, then they would not award you benefits prior to the date that medical evidence showed a ratable condition existed. 

Example would be the RO could ID a 0% ratable condition in 11/18, but the severity could not be documented prior to 7/20. They would not award the 11/18 because the info they have does not justify it. Check the reasons and basis for this in your decision letter. The RO should explain why they did this.

 

Look at the medical records in the C-File from the original date of submission in 2018, and track if the records show any changes or progression of the condition up to the C&P in 07/20. If the conditions all show they were the same and ratable from 11/18, then you will likely prevail in this. Document the records for a HLR or appeal on this issue.  If you have any other medical evidence showing a ratable condition existed in 11/18 then a supplemental should work. A few lay statements from family/friends/employers may also do the trick for new evidence to avoid the HLR. The point you have to get across is that the conditions they dated 07/20 were ratable in 11/18.

 

Same thing goes with the conditions they awarded 0% for. Check the records to see what they based their decision on, and if they missed anything, or you find anything else wrong, post back on that issue.

0

Edited December 2, 2021 by pwrslm

[SPO]

The problem I have is that the supplemental claim previous to this gave me an effective date back to 11/2018, and that decision says it’s because it was continuously pursued.  It’s all based off the same medical information, including the fact that the final ratings came from the same c&p. The evidence I added in the appeal was a medical opinion and didn’t address severity. 

Edited December 2, 2021 by SPO

[pwrslm]

you still want to check the validity of the ratings on your own then

 

If the awarded 0%, validate that this is not a lowballed rating. This happens all to often. Same goes with the ratings that you did get, verify that you think the symptoms you have are what you see in the rating sheets. 

I was given 20% for my left lower extremity radiculopathy. The C&P exam noted atrophy, which called for a 40% rating. After documenting this with a HLR, they corrected it to 40%. 

[broncovet]

You have been given some good advice.  I will put in my 2 cents worth.  (Which is a nickel, now, due to inflation and supply chain issues).  

Your effective date is "The later" of the date of claim or facts found.  "Facts found" means the date the doc said you were disabled.  

    Many docs "dont mention a date", so VA often uses the date of the c and p exam.  

   The date of the c and p exam is "virtually NEVER correct".  Why?  Think about it.  

    You go to a c and p exam for xx condition.  You are healthy and have no problems (according to the VARO).  Then, you exit the examiners office and "poof" you are totally disabled.  Horse pucky.  You were already disabled before you went to the exam.  The C and P examiner did not do something to you to cause you to be disabled.  You were already disabled and he should have looked in your records and said, "The Veterans symptoms first began Jan 8 2003, according to his medical history".  

     But, if the doc does not say when your symptoms began, VA often uses the date of the c and p exam.  

    My advice:

    Check your medical records.  When does a doctor say your symptoms began.  It does NOT have to be a c and p exam..any doc exam?

     Then appeal citing that the "exam dated Jan 8, 2003 shows symptoms began on that date, Not 2018."  *Dr. J, examiner..

     You should win this appeal.  Now, if you do not have evidence "in your file" that your symptoms began (prior to 2018 when you filed), you may need an IMO.  

     But, for example.  Lets say you hire a doc he examines you and your records, and opines your symptoms began in 2003, based on an exam at that time.  You could get an additional 3 years of retro.  If this is 100 percent that is about 100k retro.  

    So, a thousand or so for an IMO is worth 100 times your money.  Get one if you need it to get that eed retro.  We can help.