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I went to the VA Medical Center today to talk to the Veterans Benefits Adviser about my claims and to get a copy of two of my denied C&P exams. The first question I asked was why my secondary "intermediate-step" claims that I submitted were denied at the initial level. He looked at me an said "what's that?" After I explained to him what an intermediate-step claim was, he told me that he had never heard of that before. I asked if the raters at the Higher Level Review (HLR) would know. He said he had no idea. So, am I missing something here? They're supposed to be the experts. Last week I spoke to another advisor in the same office who told me that I wasn't eligible for TDIU because I didn't have the required percentage. He then (incorrectly) quoted me the requirements. I told him he was incorrect, but he was steadfast. I wonder how many veterans have been affected by their misinformation? Am I wrong in thinking that the VA purposely doesn't inform, or properly educate, their representatives about everything so that they don't pass the information on to veterans? Plausible deniability?

MY OPINION: if a veteran is not self-educated about their claims, and relies solely on the "expertise" of VA representatives, they're screwed. In my humble opinion.

Am I wrong?  🤔  Has anyone else ever run across this? 

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11 minutes ago, harry59 said:

Am I wrong? 

It seems that representatives will say just about anything to get you out their office or off the phone.

(b) It is the established policy of the Department of Veterans Affairs that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Therefore, rating boards should submit to the Director, Compensation Service, for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in paragraph (a) of this section. The rating board will include a full statement as to the veteran's service-connected disabilities, employment history, educational and vocational attainment and all other factors having a bearing on the issue.

 38 CFR § 4.16 - Total disability ratings for compensation based on unemployability of the individual. | CFR | US Law | LII / Legal Information Institute (cornell.edu)

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The person you talked to was not a rater and would not know more than you know from your decision letter.  You need to get a VSO with VBMS access as they are not part of the VA system and only exist to serve the veteran.

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Posted (edited)

I agree with ASDF.  The question you asked was probably "above that employee's pay grade".  

Its pretty much unrealistic to expect every employee you speak to at VA Medical center, to know every detail about the benefits claim process.  Be glad they understand their job.  

This employee likely should have referred you to, probably, your VSO..who probably cant answer your question either.  

The question of "why was your claim denied" should be officially found in your VARO/BVA decision.  What did the decision say the reason it was denied?  

If this employee could find out "why" the VA did something, then they need to buy lotto tickets with numbers that the employee suggested.  

VASEC has no idea "why" VA does stuff, VSO's have no idea, and neither do VA medical center employees know.  

Most of the time the reason for denials can be found with a thorough review of your cfile, comparing it with the decision.  Since most of the time the decision is wrong, then you can dispute the "reasons and bases" from the decision in your appeal.  

Whenever I appeal, that is what I do..refute their reasoning, if possible.  Most of the time the REAL reason for a denial is something like:

"Well, I need to pick up my kids at the dentist at 3:00, so I only had 2 minutes to work this claim, because I have a quota and IM behind.  So, denial was the fastest way.  With denials, the rating specialist need not calculate a disability percentage, nor does he need to review your file for an effective date."  

Its just faster to deny.  

Edited by broncovet
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I wonder how many veterans have been affected by their misinformation?"

I would guess THOUSANDS AND THOUSANDS_

I have been around the VA 'block' since 1981-I can make an educated guess.

You would not believe how they treat some of us widows-

If any of you have a spouse get them up to speed on your VA issues, and make sure they can use a PC and also make sure they have your hadit password-or can register her themselves, as a member ifyou die.

My neighbor 's husband 70% SC died the day after he was disharged from a hospital, that VA sent him too- she does not have a single clue what to do-

I have another matter that needs all of my time, but she  is going to the County Vets service Agency tomorrow- I know their VSO and he can contact me if he needs my help.Dr. B already told me he will help her too-she hs very little money- but he still will help her....as he hs helped MANY who cannot afford an IMO fee.

GOOD successful doctors have to provide Pro Bono services and keep an accounting of them.

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Unless you talk to an experienced and "motivated" VSO such as DAV, VFW, AMVET, Amer Legion, PVA paid representative then you are wasting your time asking VA medical personnel at VA medical facilities about your disability claim ratings and requirements for a claim. It is not their job to know this stuff and they should tell you so and not give out misinformation.

Some VSOs do have offices at some VA medical facilities but not all.

Edited by Dustoff 11
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17 hours ago, harry59 said:

the Veterans Benefits Adviser

I agree with @broncovet on this. Just because someone works in a VSO's office does not mean they are the best and most knowledgeable. I have received assistance through my state agents, DAV, and American Legion. Over time, I learned there was wide variety of quality amongst the employees. Some did as little as possible to flip visitors (i.e. get them out of the office) and others were very accommodating so long as I had an appointment. One rep I had was fantastic, but retired and replaced by someone who was so new, I probably was more qualified than them. Others told me to trust the VA and not to rock the boat by filing anything else. It wasn't until I was in front of the BVA that I was told that I should have received a C&P exam and needed the Caluza elements. Years later, I learned that I could have filed for secondary conditions. In the end, I learned the ultimate responsibility for claims belongs to the veteran.

 

 

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