Refile a claim

[drago]

Hi All,

I'm back again... still working on claims that started last July, and I apologize if this is a little scrambled. In a nutshell, I'm currently rated 90%, 70 PTSD/TBI/alcohol, 20 bladder, 60 kidneys, 10 tinnitus, 0 headaches, 0 hearing loss. "0" for headaches was because first evaluator would not listen to my comments about them. I also have degenerative disc disease which is related to a training accident but has been denied because when I went to civilian dr. I made a statement I hurt it doing construction. My current PT said (unsolicited) that the injury would not have been from lifting, but from trauma years earlier aka the training accident. Also been diagnosed with hypersomnia that the civilian dr. says is definitely from training accident. More on that in a moment. So hypersomnia is pending claim, high blood pressure is pending, and heart disease is pending.

So, filed hypersomnia, heart disease and blood pressure in July via my VSO. The back had been denied, and was asking for review after submitting a buddy letter from PT. At least I thought it was pending review. At some point in August, the VA "combined claims", and put everything into one claim. The hypersomnia apparently is related to PTSD, so VA asked for re-evals for PTSD, TBI, as well as a "general physical" presumably for blood pressure and heart disease. It took forever to get those appointments via QTC, but they are complete now. PTSD as 1 Oct, TBI was 6 Oct, and general physical was early Nov. Then QTC called to schedule an echo-cardiogram of heart, which was 24 Nov. QTC has now called to schedule a re-eval of headaches,PTSD and TBI, and audiology (which I pushed hard for headaches in PTSD and TBI appointments because first dr didn't accurately reflect them). Anyway, QTC said they were calling to schedule ONE appointment for all those, and I said I just had PTSD, TBI, and general physical appointments. QTC rep became defensive and said she could note I was refusing to go. I said I wasn't refusing to go, I'll go where they send me, but PTSD and TBI were done less than 60 days ago, and the appointments are difficult. She said she would call provider to get them scheduled, would I hold. Sure.  She came back after 5 minutes or so, said the whole thing needs referred back to the VA because the file/request is not processed correctly, the PTSD, TBI, audiology, and headaches all have to be separate appointments. I asked if she was sure they wanted all those or if they wanted an appointment for headaches that is RELATED to PTSD/TBI/Alcohol Use Disorder and the alcohol use disorder is abbreviated AUD that LOOKS LIKE audiology. Back to "I can note you do not want to attend..."

Now waiting on QTC to call back with the reprocessed VA request...

In the meantime, I've been checking the VA.gov website, and the one claim has changed to "claim closed" as of 7 Dec (Pearl Harbor Day, how ironic), and nothing further shows. In fact, even less shows than when it was an open claim. My VSO changed jobs and is kind of MIA, so I have no way to "see behind the curtain" and see what is going on. The disc disease claim/review seems to also be missing from all the claim information that is visible on va.gov.

Sorry to be so lengthy, but I know detail is helpful. This all leads to several questions:

1. Any insight from anyone about might be going on with the request to have all new appointments 66 days after just having them? Paperwork SNAFU?
2. What happens with the back claim since it appears the additional review may not have been uploaded, and not within 30 days of the decision if it was? The decision was in June. Is that just dead and gone then, or can it be refiled? EDIT**Looks like I may have misread the dates on the website. It appears there is actually a year from the decision to request further review?
3. VSO-the guy I was working with was great, said when he changed jobs to a similar organization he would keep my case, but now I simply get in touch with him. The people in the office now are all kind of new, and have said my case is complicated and I should stick with the original guy. Is there a way to get access to "a file" somewhere, and work on my own claim(s)? or at least be able to get a hint at what's going on?

Thanks everyone for listening and any help you can provide...

Edited December 9, 2021 by drago

[drago]

I'm going to answer my own question #1...

I logged into the QTC portal, and it now says that there is an "acceptable clinical evidence" exam next week.

I think I will still follow-up and see how I can go about having the person call me, since in the other exams I didn't go into detail about how often and the severity of headaches.

So, a revised question:

Is there a way I can submit a buddy letter for this review myself since my VSO is out of the loop?

[broncovet]

Yes, you can submit a buddy letter, with or without your VSO, but it wont hurt to keep him in the loop, if he is doing a good job for you. 

You posted:

Quote

The decision was in June. Is that just dead and gone then, or can it be refiled? EDIT**Looks like I may have misread the dates on the website. It appears there is actually a year from the decision to request further review?

Generally, you need to appeal a VARO decision within a year, beginning by filing a NOD.  I think you should explain, in your NOD, why you are appealing.  For example if you dispute the effective date or percent, then explain how you feel you deserve an eed, or you meet the criteria for a higher percentage.  Its unclear to me if you are still within a year of the decsion.  

 

[drago]

Thanks Broncovet.

The decision was in June 2021.

I think the challenge is my VSO has been handling everything to this point. We would meet, he would tell me what is happening to the claims as he could see from whatever system he was accessing, we would talk about ways to respond, and he would enter that, read it back to me, I would say sounds good or add something additional, and he would submit it. Which was all fine, except now, like I said, I have not been able to get in touch with him since he changed jobs. Not sure if I've offended him, he's sick, moved, etc. So with some of the claims/supplementals, I'm not sure exactly what we did, whether new evidence has been submitted basically as my rebuttal to a decision, whether we asked for a higher level review, etc. For example, the last rejection from VA was basically "no precipitating event in service", to which we responded something like "training accident on [date] with follow-up care for injury and pain on [date] as shown in medical report of [date]".

I *think* that rebuttal info is what is now showing in va.gov as a "decision was made on Dec. 1", but va.gov also usually says a letter has been mailed, but it does not say that this time. None of the percentages that I can see via va.gov have changed, so I'm assuming that means denied again because it has now been 11 days since the decision. The other new claims are still pending, and if I recall from earlier, when there are several things pending they wait and send everything as one big packet, but I could be mistaken on that. Either way, when something like that happened, I'd talk to my VSO, and he would look it up and we would go from there.

[broncovet]

If (your VSO is doing a good job) and it sounds like he may well be, then call his office, ask for his email.  This way, if you have time at 8 pm, you can email him, and he may respond when convient for him at 9:30 the next morning.  This can also be done with texts, if both of you have a cell phone with text service.  

This said, there is an unwritten rule that forbids VSO's from returning calls.  This COULD result in you knowing what is going on, and being awarded benefits.  Therefore, VA has banned the practice, as it costs them too much money.  

This "return calls ban" by VSO's has been going on since at least 2002.  I have had about a half dozen VSO's, and not a single one would return calls, "except" a national VSO.  

Edited December 19, 2021 by broncovet

[drago]

Thanks Broncovet. That is interesting, as even with my good VSO, he never, ever, returned a call. The most I would get was the clerk calling to schedule an appointment.

The challenge is with him moving on, we were to connect via cell, which I think was his personal cell, and then exchange emails etc. once he had his new email. Since leaving his original vso position and going to the new vso position, I haven't gotten anything back. Someone "who knows people who know him" have said his new position is more than VSO, and he is overwhelmed and unable to do much for anyone at this point. I'm more inclined to think he got a new phone or something and isn't getting word I'm trying to get in touch.

The very frustrating part is that the ebenfits site and va.gov just don't provide much detail, so on topics like "I wonder if he was able to upload this", or "did that actually get in the file?", it seems a person needs someone with that level of connectivity.

[Mr cue]

It sound like the letters are stuck in the 30 day mail bull----.

I would call 1800 ask them to  email or fax them to u any decision made

Than u can see what going on.

If he not responding to you and no one response from the office or addressing the cases he had going on

I would withdraw them and go with a vso who could help. You can change vso

You don't have to sit there and let things ride because he not responding.

Good luck