HLR or Appeal? Self/Lawyer? (CUE for VA didn’t review my evidence and denied my claim)

[cherry picker]

I submitted an increase for OSA (2nd to PTSD) and SMC-R1 (AA) (currently at Housebound, SMC - S) in the early month of 2024.

Just a few days ago my wife gave me a yellow envelope with the Rating Decision Letters for the aforementioned increase claims. 

The verdict appeared as: 

•  OSA (2nd to PTSD) granted 60%. - approved. (All reelevate medical documentation was reviewed and noted under the "Evidence"  paragraph. 
•  But, SMC (R1) Aid & Attendance increase was Denied! (reason(s) why it appears intentional denial explained below)

 After meticulous review of this Rating Letter, I came across some areas of clear disregard of Private Treatments documentation, Medical Records, 2680 VA Form completed by examining doctor medically annotating the importance of AA due to my inability to perform ADLs, as well as additional private and VA treatments stating the essential need for being approved for AA. 

Reasons for (possible) cue:

1. It seems very strange that the VA rater(s) ONLY INCLUDED ALL THE DOCUMENTATION EVIDENCE RELATING to the claim of OSA (2ND TO PTSD) .
2. But, OMITTED ALL THE MEDICAL DOCUMENTATIONS, VA FORM 2680,  ADLs LAY LETTER (WIFE & SON), EMERGENCY MEDICAL TREATMENTS (unexpected falls causing head trauma), as well as other medical files evidence I submitted as evidence of support for the need of AA. (a plethora of medical documentation was provided to prove beyond a reasonable doubt. 
3. The only reason provided (within the Rating Letter) is "You are housebound on account of your post traumatic disorder (PTSD) rated 100 percent and additional service-connected disabilities independently ratable at 60 percent or more (date #####)."
4. Above all, my denial for AA was given before my physical scheduled QTC (C&P) exam!

I have a very gut feeling that this SMC- R1 medical documentation (ADLs) omitting and stating my SMC (housebound) was intentionally aimed at denying my SMC (R1). 

For those who have had similar experience and/or knowledgeable as to how to proceed, I am reaching out for some advice as to the steps I need to take in order to make the VA Raters aware the mistake they did by denying my request for AA increase. 

1. Proceed on my own? or
2. Seek VA Lawyer?
3. HLR? or
4. Supplemental? or
5. Appeal?

Thank so much for the help ahead of time. 

 

Cheers!

[pacmanx1]

IN MY HUMBLE OPINION (IMHO) always keep in mind that the veteran loses his/her benefit of doubt when filing a CUE Claim. With that said, if you are not familiar with the CUE criteria, then you should seek assistance.

Since you just received your decision. It might be simpler just to file an appeal. Most supplementals and HLRs are denied and a waste of time (Yes, some are granted but not many). You will have a longer wait but a better chance of the BVA remanding or granting your benefits and you keep the benefit of doubt. As always, your decision your claim.

eCFR :: 38 CFR 20.1403 -- Rule 1403. What constitutes clear and unmistakable error; what does not.

[broncovet]

Make no mistake.  Money talks.  R1 is big money.  Hire a professional such as CCK law if you want R1.  You may well need medical opinions.  Oh, you can represent yourself, sure.  And, you can dig through the criteria and see how your's lines up.  But do you know where to get a favorable medical opinion on R1?  I promise VA knows where/how to get an unfavorable opinion, they probably already did that. (But IDK as I have not read your file).  

Rookie raters with  2 weeks of rating experience pretty much are "not allowed" to grant R1, regardless of what VA tells you.  This would wave a red flag for fraud about YOU, and the rater.  When experienced judges make that decision, it will stick.  

Think about it.  You just began with VA, and you are excited about your first cases.  You come across a file seeking R1 or R2, which means thousands and thousands of dollars every month, with big retro, probably into 6 figures or more.  Do you think your boss wants you to sign a document that gives a Veteran this kind of money?  Think again.  Yea, they will let you do zero percent hearing loss.  Maybe tinnitus.  But your boss knows HIS bosses will wonder why he allowed a 250,000 retro on the first get go.  

 

If you mopped the floors at McDonalds, do you think the owner or managers will have you decide where to spend $250,000?  Yea, they may not care if you give a customer a drink who spilled there's slipping on the floor,, that cost them 10 cents or less.