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Need you opinion on this outcome. Should I be worried?

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boomerps2

Question

VA lawyer opened High Level Review for backpay I should have gotten for years of denials without my permission. I was angry but decided to let it ride. Originally was denied from 2019 to 2022 then got 100% P&T on those denied claims with enough rating to qualify for SMC-S (170%) but didn't get it for some unknown reason. I decided not to "Poke the Bear" because I was more than happy where I was at.

Fast forward to a couple days ago and noticed decision was made. Turns out they noticed their error and bumped me to SMC-S with $8000 in backpay.

Then looked again and it changed to "Duty to Assist"

"We failed to get federal records. We will develop for VAMC records (EHRM)". What does that mean after I have gotten a decision on my rating?

Says "VA will make a new decision" even though I already have the decision letter.

VA website doesn't have anything under the "issues" tab but the VA app under the "issues" tab says "Currently on appeal."

Is more money owed? What does this mean and would they lower my rating after raising my rating for some unforeseen issue? Should I be worried?

Thank you for your help

 

https://preview.redd.it/should-i-be-worried-need-your-opinion-w-outcome-v0-p7pw3xjddzoc1.png?width=736&format=png&auto=webp&s=b489e51eae23f489d42139e755e2573bd4f3fa31

 

                                       REASONS FOR DECISION

1. Entitlement to special monthly compensation based on housebound.
Entitlement to special monthly compensation is warranted in this case because criteria regarding
housebound have been met from July 27, 2022. (38 CFR 3.350)

2. Higher Level Review for mild neurocognitive disorder and traumatic brain injury.
The issue of mild neurocognitive disorder and traumatic brain injury was returned for correction
of a duty to assist error in the prior decision. We failed to get federal records. We will develop
for VAMC records (EHRM).

3. Higher Level Review for post concussive headaches.
The issue of post concussive headaches was returned for correction of a duty to assist error in the
prior decision. We failed to get federal records. We will develop for VAMC records (EHRM).

 

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Stop worrying.  It wont help.  It sounds like you already have an attorney who is looking out for you.  Generally, once you give the law firm POA, they dont call you or even inform you each time they file a document, to include a HLR.  It sounds like you "not only" have retro coming, but you also may have still more Retro, with the DTA (duty to assist), because, it sounds like there is "something" in those federal records the VA failed to get that will help you. 

Under 38 CFR 3.156 C, New Service records, when VA finds service records related to your claim that were not previously available (for whatever reasons, it sounds like the previous reason was laziness) then you get an effective date back to when you first applied, if awarded benefits.  While I have not reviewed your file, and your attorney has, this could well mean more retro for you.  

Instead of worrying, you can start thinking of what you will do with your retro.  I recommend you do that.  

When I knew mine was coming, but I did not know how much, I did a "3 tiered plan".  I knew the retro could be up to about 100kplus.  I also knew it could be less.  

So, I built a financial plan that went something like this:

A.  Retro 5000 to 25,000 

     Tithe to my church.  Pay off bills. From that left over,  Save 50 percent.  Enjoy spending 20 percent of wants, such as take my wife on a trip (short). 

 

B.  Retro.  25000 to 50,000.  Tithe.  Pay off bills.  From that left over.  Save 50 percent.  Invest in dividend stocks.  Take wife on longer trip. 

 

C.  Retro 100k or more.  

     Tithe.  Pay bills.  From the left over.  Invest.  Go on a longer trip.  Consider new car.  

     Sure enough, the retro was (C).  

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6 hours ago, boomerps2 said:

VA lawyer opened High Level Review for backpay I should have gotten for years of denials without my permission. I was angry but decided to let it ride. Originally was denied from 2019 to 2022 then got 100% P&T on those denied claims with enough rating to qualify for SMC-S (170%) but didn't get it for some unknown reason.

You never know what the VA will or will not do until you get your notification letter in hand. With that said, it is not likely they will try to reduce or even collect any benefits that you just received.

Take a deep breath, based on your own post it may very well be that you are owed even more retroactive pay. You posted that your claims were denied between 2019 and 2022 but your most recent letter states your last award went back to 2022. That means the VA may still be working on if you are owed benefits back to 2019. Don’t quote me, unfortunately you will have to wait for your new decision letter.  

Your VAMC Medical Records may show an even earlier effective date of when you were diagnosed and treated for your conditions that may go back to 2019 and could shed light on additional pay that was not considered and owed.

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