Re-embursement for non VA Medical care.

[Hawks and Doves]

I was traveling in Australia and had to go the a local emergency room at a local hospital for treatment. This is illness is unrelated to any already compensated for service related disability. I am not trying to get my disability increased. All I want to do is to be re-embursed for the bills caused by this emergency room visit.  I sent the appropriate form and attached documentation, (VA Form 10-583 Claim For Payment of Costs Unauthorised Medical Services), to my local VA Medical Center. When I followed up in person they could not find any information related to my inquiry. I could not seem to be able to get it across is that I do not want increased compensation, just re-embursement for an emergency room visit. I was directed to re-sent (VA Form 10-583 Claim For Payment of Costs Unauthorised Medical Services), and all documentation to  this address, Department Of Veterans Affairs Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444, which I did.

I got a letter back saying the the information that I received was placed in VA records and that I submit a, (VA Form 21-526EZ, Application for Disability Compensation and related Compensation Benefits). Once again it seems I was misunderstood, I not want increased compensation, just re-embursement for an emergency room visit Any assistance in this matter is appreciated.

Thanks

 

 

 

 

[relatively happy camper]

15 hours ago, Lemuel said:

Thanks bronco.  I qualify for SMC-S from mid 2009 I think.  TDIU 100% from 09/1985, TBI 40%, 2009, Mixed organic personality syndrome 30%,  Hearing deficit 20%, 1984, Tinnitus 10% 1989 for combined 70% from 7/10/2009.

Is my assessment correct and will CCK be able to get the back payment for SMC-S until my SMC-T starts?

Lemuel - you probably qualified for SMC-S from 09/1985.  At that time the VA was required to evaluate and discuss in your decision the "S" criteria and if they failed to mention (approve or deny) it, at that time, that claim remains open until the decision is made.  You may want to pursue that as a retro award of 14yrs+/- would be worthwhile/substantial.  

[Lemuel]

1 hour ago, relatively happy camper said:

Lemuel - you probably qualified for SMC-S from 09/1985.  At that time the VA was required to evaluate and discuss in your decision the "S" criteria and if they failed to mention (approve or deny) it, at that time, that claim remains open until the decision is made.  You may want to pursue that as a retro award of 14yrs+/- would be worthwhile/substantial.  

Sent an email to that affect to CCK who has my case at the BVA.  Lead attorney said he was at regional with SMC-T last week.  Read into what he said as he is a Scalia denier of the 9th Amendment.  He had not read my brief and motions and did not seem to care about anything else because the firm had to cover expenses.  Much of my appeal to the BVA was for additional ratings that would not have made any difference for me.  

Made a "next of friend" claim for veterans with organic brain syndromes like mine in 1994 and alleged it should have gone to the Director, Compensation Services then for TBI and Cerebral Malaria Victims because the "complete injury examinations" were not done on veterans' first claims.  

Not expecting much from my lead attorney.  Hope the attorney that presented the Haskel case to the 3 judge CAVC panel gets a look at my case file.  Not expecting much of the attorney that has my case now.  Think I will write CCK a letter asking them to change lead attorneys.  Or may just wait and send a 38 CFR 20.1000 appeal to the BVA to reopen the items he did not address that are in remand from the 2017 BVA decision and from the 2023 CAVC remand. (no legacy appeal hearing and consideration of brief and motions filed to the BVA through slamming into AMA)

[Lemuel]

The "separate and distinct" to TDIU is probably a problem if I am hearing you correctly.  TBI is the cause of my TDIU.  Epilepsy confirmed, mistreated with Tegretol, a pending 1151 claim that it appears the CCK attorney does not want to go forward with is actually the cause of unemployability.  It is one of the claimed "residuals of the head injury".  Seems to me that the attorney needs to fight for that confirmation leading to compensation for more than 55 years before my epilepsy was treated with a medication that worked. Meaning a payment of 80% from 1974 to 1985, the TDIU EED.

I do not know how late "confirmation of epilepsy" works.  Mine was confirmed in September of 1990 as a cause of an MVA and I could not drive until my epilepsy was treated correctly in 2015. 

The epilepsy was actually the thing that made me unemployable. 

Clear in the CAVES report from Social Security and the back injury caused by the MVA in 1990.  The neck spinal disc disease has been SC as a residual of the 1969 TBI by a BVA judge in a 2017 remand based on my description and assessment of what I saw in the MRI radiographs that were shown to me quoting cases that allowed medical opinions from medically trained appellants before the BVA.  13 years as a Navy corpsman with independent duty experience was the basis for recognition of my ability to claim the left lateral blowout of a cervical disc was related to the head being hyper extended to the right as opposed to the whiplash to the left in the 1990 MVA which would have caused a right lateral blowout. 

Other physiology involved was the change of the spinal fluid from the lower back ruptured disc fragment dissolvement.  Something explained by the back specialist but not charted because of the VA's policy of not letting treating physicians record etiology.  That etiology is left to be determined by the rating and service connection process  in VABA. 

There is a lot wrong with the medical recording of medical reports in VAHA.  The etiology left out of a physicians reporting leaves the question of accuracy of the physicians assessment by others.  Leaves the patient to explain the etiology to the next physician attending.  And if the patient has no medical training, how is that going to go?

Edited Friday at 07:46 PM by Lemuel
correct error

[Vync]

@Lemuel The separate/distinct phrase makes absolutely zero sense. A veteran either has a disability causing them to be unemployable or they don't. Feels like this was added by the bean counters as a mechanism to seriously limit those who would be able to qualify for TDIU.

[Lemuel]

1 hour ago, Vync said:

@Lemuel The separate/distinct phrase makes absolutely zero sense. A veteran either has a disability causing them to be unemployable or they don't. Feels like this was added by the bean counters as a mechanism to seriously limit those who would be able to qualify for TDIU.

That is like how do you separate spinal disc disease of the lower back from the neck?  Only a rater under pressure to reduce payout would do that under pressure from his superior trying to get his bonus or increase his bonus by reducing the overall budget.

[relatively happy camper]

Lemuel - I was not impressed w/CCK or for that matter most lawyers claiming to work for vets.  I had CCK about 10yrs+/- ago and they latched on to the first thing they could win a remand on.  They won the remand, got the EAJA money and they dropped me.  Actually, that was good b/c I got another atty and he helped me win another remand which got me to a good BVA judge who actually read the complete file and finally awarded me the SMC-S retro to '89, 30 yrs.  Most attys latch onto the first thing, they can win a remand on and never look deeper. (jmo)