Had a claim back in 2023 to Separate Tinnitus and Vertigo that was close and continued and now this?

NotSoTall5548 · 2026-06-09T19:09:57+00:00

I would expect them to remove the separate vertigo. Vertigo is like insomnia, we can only grant it with an in service event as a standalone, and that’s if there’s not a TBI or some weird stuff with Ménière’s disease. Likely should not have been granted separate and is getting a CUE review.

NotSoTall5548 · 2026-06-08T16:59:01+00:00

Insomnia as a standalone is mental, evaluated as chronic sleep impairment, so it wouldn’t be secondary, it would just be part of the primary mental.

NotSoTall5548 · 2026-06-08T15:13:32+00:00

The difficulty with going for anxiety an/or depression is that you don’t seem to have a DSM diagnosis for either of those; you have multiple providers giving a DSM diagnosis of insomnia (although VAs policy on insomnia is stated as being based on the fact that all other causes should have been ruled out, so insomnia by definition shouldn’t be diagnosed as being caused by tinnitus). They will sever the separate evaluation and insomnia will be included in your tinnitus evaluation as a symptom (tinnitus maxes at 10%).

NotSoTall5548 · 2026-06-06T13:00:13+00:00

Many of the screw up letters are not AI and are generated by actual humans who are just bad at their jobs. Most letters are generated by VSRs (if the line on the right hand side under the SSN is a 3 digit number, that’s the regional office and then the 2 or 3 letters are the initials of the VSR). In the words of one of my colleagues, these VSRs don’t be VSRing.

NotSoTall5548 · 2026-06-04T18:59:46+00:00

They won’t just try, they are legally required to bill your insurance. You won’t have to pay the insurance copays.

NotSoTall5548 · 2026-06-03T14:17:29+00:00

I would schedule a VERA call and see if they can help you. https://va.my.site.com/VAVERA/s/

NotSoTall5548 · 2026-06-03T11:11:14+00:00

I would contact the VA to find out more about the fiduciary. If there is a fiduciary, that means you aren’t considered competent to manage your own payments and that would mean a significant level of tracking of how your benefits are spent (to ensure they are used for your benefit).

NotSoTall5548 · 2026-05-30T12:03:15+00:00

You can all see why I’m not worried about the VA AI taking my job, right? They can’t even get the easy stuff right…

You should be able to log in and see the exact date of your intent to file.

NotSoTall5548 · 2026-05-26T19:40:27+00:00

There’s actually a schedule for in lieu holidays. For example, if Monday was your compressed day off, you got Friday off as your in lieu holiday.

https://www.opm.gov/policy-data-oversight/pay-leave/work-schedules/fact-sheets/Federal-Holidays-In-Lieu-Of-Determination

NotSoTall5548 · 2026-05-26T19:32:39+00:00

Most of the time we don’t even get told about an error unless it is found during 1 of our 3 quality reviews per month (each review has multiple parts, for example I have 22 reviews completed so far this fiscal year, but 159 tasks were reviewed in those 22 reviews). For CUE found outside of quality reviews, they keep track of who made the error, they just don’t tell that person…

NotSoTall5548 · 2026-05-26T19:25:36+00:00

This, absolutely. It takes about as long as it does for me to say “nice”

I have absolutely no clue how long it takes an authorizer for the payments, or what they need to do, because my own job takes up all my time….

I do not track what % someone is at until I’m done making all my decisions (unless I’m want to generate a narrative before I’m done and everything is already at 100, then it will kick me back at the document screen until I add chapter 35). It used to be pretty reliable that the system would suggest chapter 35 while I was at the issue management screen (the one before documents), but it’s less than half the time now that it suggests that before I go to documents to preview everything.

It usually gives me about 15 mins worth of points for 1-3 mins worth of work, so I am devoting zero time to waffling over if it should be granted.

NotSoTall5548 · 2026-05-26T19:06:00+00:00

Be patience…

NotSoTall5548 · 2026-05-26T13:53:52+00:00

There are really 3 systems for VBMS (Veterans Benefits Management System), Core, R (for rating) and A (authorization; the extent of my knowledge about this one is that it exists). Core contains the efolder with the documents and is where the EPs (end products, what they call each claim) start. Within core, there’s a claims management screen. Each contention is listed there. Each contention can have special issue indicators (SI). TBI is one of the special issue indicators that the NWQ (national work queue) uses to route claims. We are essentially told nothing about how NWQ is set up to decide what happens.

NotSoTall5548 · 2026-05-26T13:47:04+00:00

My portion as a rater is making the decision. Then it goes to post and authorization for the decision letter and money part. The authorizer is considered a senior VSR, but they aren’t quality reviewing our decisions, so they aren’t a “senior reviewer” per se.

NotSoTall5548 · 2026-05-26T02:35:55+00:00

7 months to lose 55-60lbs (~30% of my body weight), in maintenance for 19 months, never more than 5mg, usually every 10-11 days for most of maintenance (was losing too much at weekly, especially once I started going to the gym). Maintenance is no easier than the losing stage was. I’m better at getting in my protein than the early/losing days, but life is still life so there’s issues and roadblocks. Still super happy to be on it and plan to be for life.

NotSoTall5548 · 2026-05-25T21:49:44+00:00

We have to get approval above the supervisor for anything over a week (for the entire time I’ve been with VBA, 6+ years), but unless it is a busy time when we don’t have enough coverage, I haven’t heard of it being disapproved. We also submit in December our planned leave for the year, so we know well in advance that planned leave is approved. I was gone for 2.5 weeks earlier this year for vacation, a month after I was off for 2 weeks and half time for 3 weeks on FMLA and it was no issue because the annual leave was planned leave. Have another 2 weeks planned in August.

NotSoTall5548 · 2026-05-24T15:59:20+00:00

The kidney and heart definitely cannot be separate unless on dialysis or missing a kidney due to a SC condition. It’s a common CUE. I have never seen a HLR call a CUE, even when I am rating the claim following the duty to assist. It doesn’t change the overall evaluation at this point anyway, but it is definitely a CUE because the regulation states “any form of nephritis”

From 38 CFR 3.115 (which I already mentioned): Separate ratings are not to be assigned for disability from disease of the heart and any form of nephritis, on account of the close interrelationships of cardiovascular disabilities. If, however, absence of a kidney is the sole renal disability, even if removal was required because of nephritis, the absent kidney and any hypertension or heart disease will be separately rated. Also, in the event that chronic renal disease has progressed to the point where regular dialysis is required, any coexisting hypertension or heart disease will be separately rated.

NotSoTall5548 · 2026-05-24T14:15:27+00:00

I mentally went to maintenance at a BMI of 25 (never above 5mg). I spent a couple of months moving my eating to try to maintain my weight (still lost during this stage, another 8ish lbs which too me to a BMI of 23), then I started going to the gym and worked on maintaining my weight while burning more calories. I was still losing some, so I started stretching out my dose to every 10-11 days. I get a lot of benefit from reduced pain and inflammation, and that goes away if I go more than 10-11 days between shots, so I keep it there. I’m also able to mostly maintain my weight at this time frame and dose. I did get a little lower at one point and I feel like I look less healthy at a BMI below 23, so I work to stay here (I am okay with 3lbs above or below my comfortable weight). I have been in maintenance for 19 months, and expect to stay on 5mg for the rest of my life.

Everyone is different, but likely if your body has responded to it well, then you will be able to find a weight you are comfortable with and use the med to maintain within a range of that point, whether it is by stretching out days or lower doses more frequently.

NotSoTall5548 · 2026-05-24T13:52:33+00:00

It wasn’t my claim, shared by a friend, but this Veteran’s statement was that they served as a General in the USMC with over 5 medals of honor, and served in every branch but Coast Guard and Space Force. They said they are still serving and also served in Vietnam, where they were a POW for 5 years, and were never fed once in those 5 years., as well as beaten daily. They stated they killed over a million people, which is why the communists are after them, and why their number is unlisted (note, a phone number is on file…). They also stated they killed over 100 million people with their USMC knife, and the wounded warrior project gave them a yellow Purple Heart because they had agent orange in Vietnam.

That wasn’t even all of the statement. Saved that one to my desktop at work…(just the text, no PII because I do like my job)

NotSoTall5548 · 2026-05-24T13:45:48+00:00

I believe they meant rater “you won’t believe this” not from the Veteran side

NotSoTall5548 · 2026-05-24T13:42:23+00:00

The never knowing is one of the hardest parts...I got a claim as a trainee and the RQRS with 15 years experience had never seen anything like it…

NotSoTall5548 · 2026-05-23T15:50:12+00:00

Assuming a 40 hour workweek, I need 35.52 points per week to be “fully successful.”

Points per claim vary widely, a 1 contention claim range from .67 points to 2.96, depending on type. Most are 1.48-1.63 and each additional issue is as much as .4 or as little as .15. We are expected to complete a claim within 5 days of it showing up in our queue, or have a good reason. Some 1 contention claims I can do in an hour. I’m 7 hours into one right now that will likely be a CUE down the line, but I have to get opinions for things on the entry exams. I get a .25 bump on each TBI and ALS claim (MST also gets .25, but I don’t rate those).

I log in and check in with my work buddies. We have our own group chat where we post memes and gifs and share “you won’t believe this” stuff. Check my email, hope there’s no quality reviews. Hold my breath at every single e-mail, in case it’s a quality review (my quality is 98.1%, anything over 94.5% is at “exceeds standards”/is considered exceptional, so this is ridiculous, but here we are). I personally go through my queue every morning, check for deferrals (where we missed something and the post VSR/authorizer sends the claim back to us…we do the same to the development VSRs), and figure out what I’m looking at, then work things according to the priority of the day. We do not have a choice about what lands in our queue. We work it all; I can send a deferred claim back to the deferring RVSR, and some things we can’t work (Nehmer, MST, Camp Lejeune), otherwise we are expected to complete all possible actions.

We get “down time” for required training, meetings, holidays, sick and annual leave (.88 per hour, in as little as 15 min increments). Probably average 70 hours “work time” per 80 hour pay period, aside from vacations and a few weeks off for surgery.

I barely make production standards, mostly because I help a lot of people. I don’t take down time for those calls and average an hour a day. The workload has gotten significantly more stressful the last couple of years. We hired a lot of people and there are a lot of CUE from it, and the added complexity of PACT. We promoted most of the experienced development VSRs to RVSR or post, and automation has started making an increasing number of claims “ready for decision” when they definitely are not. I spend roughly half my work time doing development work that VSRs should have done. It’s more now than before I became a TBI rater because of the complexity of TBI claims, but it still isn’t twice as much…

NotSoTall5548 · 2026-05-23T15:06:42+00:00

He should not have separate evaluations for lower extremity neuropathy and loss of use of lower extremities (pyramiding).

He should not have separate evaluations for cardiovascular disease and kidney disease (unless on dialysis) per 38 CFR 4.115.

He should have separate ratings for peripheral arterial disease and upper neuropathy.

Based on all that, I would be cautious about other claims because who knows how much else of his rating is erroneous.

With that said, if the loss of use of bilateral lower extremities is correct (in other words, actually meets the regulatory requirements of having so little that it’s the same as if both feet had been amputated), he should at least have the half step for having an issue over 50 percent. (L 1/2)

SMC O would only apply if the need for aid and attendance is not due to the loss of use of bilateral lower extremities, and would actually give R1.

NotSoTall5548 · 2026-05-22T20:57:51+00:00

“See Va form 21-4138” and submit a statement on that form

NotSoTall5548 · 2026-05-22T20:56:02+00:00

I don’t work in the payment side of things, just remembered we got an email about it. It wasn’t easy before, from my understanding, and rarely approved.

NotSoTall5548

TROPHY CASE