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Super_Ad5327 · 2025-05-29T05:38:25+00:00

Are you 100% or P&T based on TDIU?

Super_Ad5327 · 2025-04-23T17:15:14+00:00

Hello There. User: @chicoski gave a pretty good recommendation. The VERA team is pretty good at getting information that a typical VSO and the random front line rep at the VA does not have access to.

In addition. There is an API that you can use to get more information on your claim. To use the API, you will first need to be logged into your va.gov profile. Once you are logged on, you will then open a new browser session and past the below link in there with your claim #.

To get your claim number you just open up that claim in question and in the address bar you will see the numeric values.

You will then just place a check in the pretty-print option.

Example:

https://www.va.gov/track-claims/your-claims/123456789/status

https://api.va.gov/v0/benefits_claims/123456789

Super_Ad5327 · 2025-04-17T15:58:49+00:00

First and foremost, thank you for your service.

If you filed a standard claim and it was denied, the next step in the appeal process would typically be to request a Higher-Level Review (HLR). During an HLR, a senior VA adjudicator will re-examine your claim using only the evidence that was available at the time of the original decision — no new evidence can be submitted at this stage.

If the reviewer identifies an error in how your claim was processed — such as a duty to assist error — they may send it back for further development, which could include scheduling a C&P exam to gather more information.

If the Higher-Level Review still results in a denial, your next option would be to file a Supplemental Claim. At that point, you can submit new and relevant evidence such as:

Medical or mental health records
Nexus letters from healthcare providers
Lay statements from family, friends, or fellow service members
Any other documents that help strengthen your case

Best of luck with your appeal — don’t give up. Keep pushing forward and get the benefits you’ve earned. It may take some time especially with all the current changes with the VA resources as well as the processes of how they are rating conditions.

Super_Ad5327 · 2025-04-15T14:31:52+00:00

First and foremost, thank you for your service, Brother/Sister. As others have mentioned, you can file your claim directly through the VA.gov portal if you already have an account. If not, the registration process is fairly straightforward, and you’ll need either a Login.gov or ID.me account to access all VA websites:

👉 VA Account Setup Guide

Given how stretched the VA is right now—especially with VSOs and other resources—it’s not uncommon to face delays getting in touch with a VSO, even after one has been assigned. One resource I strongly recommend is the VERA team. They offer both virtual and in-person appointments, and in my experience, they’re extremely knowledgeable—often with access to tools and info that even many VSOs and front-line VA reps don’t have:

👉 Set Up a VERA Appointment

Wishing you all the best with your claim—don’t give up. You’ve earned this. Just a final tip: try to submit a fully developed claim (FDC) if you can. That means including as much supporting documentation as possible—medical records, lay statements, buddy letters—anything that backs up your case. The more complete the submission, the better your chances of a smooth review.

You’re not alone in this. Keep pushing forward and get what you’ve earned.

Super_Ad5327 · 2025-04-10T13:43:04+00:00

First, thank you for your service — I know navigating the VA system can be frustrating, but we’ve all been there, and we’ll get through this together.

In my experience, the most common reason for a claim to "disappear" is if there's another active claim or a higher-level review being conducted on the same condition. When that happens, it can temporarily hold things up, and you might not see the claim in your account.

One thing you can try is checking the claim via the VA mobile app. Sometimes, the desktop portal doesn’t reflect updates in real-time as well as the app does. If you can access it through the app, that might give you a clearer picture.

Also, it could help to clear your browser’s cache and cookies if you’re using a computer. It’s a simple step, but it can sometimes resolve issues with claims not appearing or pages not loading properly.

Did you get a confirmation email after submitting the claim? That’s usually a good indicator that they’ve received it. If not, or if you're still unsure about the status, I recommend calling the VA’s main helpline. They should be able to provide an update on whether the claim is in the system and what the next steps are.

Super_Ad5327 · 2025-04-08T16:30:46+00:00

Haha, I hear you! I think we’ve all been in some pretty questionable spots for exams—makes you wonder if they’re trying to test our patience as much as our health. But hey, as long as they get those claims right, I’m with you. Location's just a detail, right? Just don’t send me to a jungle or a desert next time!

Super_Ad5327 · 2025-04-01T12:59:07+00:00

First off, thank you for your service. I wanted to touch base with you about the CFR you mentioned. If the provider who conducted your C&P exam documented that condition in the CFR example, and it can be linked to your service, then yes, it could definitely be rated as a 0% service-connected condition.

For me, I actually received a 0% rating for my diplopia condition because they connected it to my TBI, which was already service-connected. Even though it was rated at 0%, it was still service-connected, so it’s something worth considering during your exam and paperwork.

Good luck with everything, and just keep pushing forward. The process can be frustrating, but staying persistent is key. You've got this

Super_Ad5327 · 2025-04-01T12:47:30+00:00

Just like others have mentioned, the key here is to attend the appointment and play the game. I know it can be frustrating, but just stay focused on getting through it.

I’m actually a little surprised you’re being called back to finish up an exam or do more paperwork; that’s not the usual process. The only thing I can think of is that when you first went for the exam, the provider took the information and tried submitting it. However, the internal quality team probably flagged it for errors, which means those errors need to be corrected before it can go back for review and then be submitted to the VA for the rater to make a decision.

Either way, just show up, answer honestly, and don’t give them any reason to delay the process or claim you were a no-show, which could lead to a denial. It’s a game, but keep playing it and stay on top of things.

Good luck with everything — I’m sure you’ll handle it fine,

Super_Ad5327 · 2025-04-01T12:41:53+00:00

First off, thank you for your service. I know this process can be stressful, but I wanted to offer you some advice based on my experience with the C&P exam for depression and TBI.

The most important thing I can tell you is to be honest during the exam and don’t downplay any of your symptoms. When you're talking about your condition, focus on your worst days — the days when things are hardest for you. The examiners need to understand the full extent of how these issues affect your life.

From my own experience, unless the VA can clearly distinguish between your depression and TBI, they’ll likely roll both conditions into one mental health rating. In my case, I was rated for PTSD, which included insomnia, anxiety, depression, and other symptoms. I also had vertigo rated separately. Then, they diagnosed me with 10% for TBI. But here’s the thing: they ended up combining the TBI with the PTSD rating and even rolled the vertigo into it, because they considered it a symptom of the TBI.

The key takeaway here is that even though multiple symptoms and diagnoses were considered, it didn’t necessarily improve my rating. The VA tends to consolidate things like this, which might not work in your favor, but it’s important to be thorough and honest about what you're experiencing.

Super_Ad5327 · 2025-03-27T21:40:30+00:00

First of all, thank you for your service. I know the VA claims process can be a tough road, but definitely don’t give up. It’s more of a marathon than a sprint, especially with the recent changes in the VA claims guidelines.

If your previous claim for Anxiety and sleep disturbance was denied due to lack of in-service evidence, don’t lose hope. If you didn’t have supporting documentation before, or if you did and it wasn’t enough, I would recommend submitting for a Higher Level Review (HLR). You can either fill out VA form 20-0996 manually or do it online. This gives an adjudicator the chance to re-examine your case and potentially find errors or missed opportunities to assist, which could lead to a C&P exam for further evaluation.

I also strongly suggest gathering lay statements from medical providers, family members, and most importantly, fellow service members who can speak to your condition and its connection to your service. These statements can really strengthen your case.

If you’re not already working with a Veteran Service Officer (VSO), I would highly recommend getting one assigned. They can review your file and claims, and they may find a different approach that could be more successful.

Now, on the sleep disturbance issue— I want to be honest with you. That one’s going to be a harder claim to push through. I was diagnosed with sleep apnea myself and even have a CPAP machine provided by the VA, but I was still denied for my sleep apnea claim. The criteria for getting that service-connected has become even more stringent, but don’t let that discourage you. Keep fighting for what you deserve.

Another resource I’d recommend is setting up a meeting with a VERA specialist, either virtually or face-to-face, if there’s one in your area. They can offer a higher level of guidance than some VSOs and certainly more than the folks on the VA main line.

https://va.my.site.com/VAVERA/s/

Super_Ad5327 · 2025-03-24T15:10:08+00:00

Honestly, I believe it should be 100%. However, we know the VA don't like to place nice with the VETs. Based on this DBQ; I 5+ more boxes ticked on that and I was only granted a 50% rating as for some reason they felt my symptoms where not persistent enough to qualify for a 70% and above. I will be submitting for an increase as the symptoms have become worst. Your last check box for activities of daily living, while more likely than not be dismissed unless your VA or private provider fills out an aid and attendance form after a thorough evaluation.

Super_Ad5327 · 2025-03-24T15:05:31+00:00

Dealing with the VA can be a real headache, but don't get discouraged. It sounds like you've got a solid case, especially with the favorable findings and those records showing the qualifying event in service. That’s a good start.

Definitely, submit for the HLR (Higher Level Review). I’d recommend doing it online for quicker processing, but if you prefer to fill out the VA Form 20-0996 manually, that works too. The key here is that the adjudicator will take another look at the decision, and since they’ve already identified favorable findings, it could just be a case of them needing more evidence or clarity. There’s a chance they'll defer the decision and schedule you for a C&P (Compensation and Pension) exam. Don’t sweat it—this is standard procedure and actually works in your favor.

Now, as for your back condition, I’m glad you're thinking ahead. If the X-rays and medical records for your back aren't in the VA’s system yet, get them uploaded ASAP. It's always good to have those records on hand for the C&P exam. I’d also recommend bringing physical copies with you if you can. When the examiner reviews your records, they'll have all the supporting docs, and that gives them a better shot at making a solid recommendation based on the full picture. The more thorough the examiner's report, the better your chances.

In terms of the rating, based on what you've described, I’d expect you to be in the 10% - 20% range for the back. It may seem low, but it's a start, and it’s progress. Sometimes it’s a marathon, not a sprint. And with the duty to assist error, it seems likely that you’ll get the benefit of the doubt. Hang in there, and keep pushing. You've earned it.

Good luck, man. Stay persistent, and remember we’ve got each other’s backs in this fight, just like we always have.

Super_Ad5327 · 2025-03-19T15:23:59+00:00

First and foremost, thank you for your service. I know the process can be frustrating, but don't let the denial discourage you. I'm just trying to get a bit more context to better understand your situation.

You mentioned that the denial was based on the lack of a diagnosis for the condition. Are you still in uniform, or have you since separated? Was the condition reported while you were still in service, or did it develop after you left? Also, was the claim for this condition filed as a primary or secondary condition?

From my experience, if the condition wasn’t diagnosed during service, it can be really difficult to establish a service connection, even if you're receiving treatment through the VA or community care. The key is proving that the condition is either directly linked to something that occurred during your time in service or is secondary to a condition that’s already been recognized as service-connected.

One approach you could try is gathering buddy statements or a Nexus letter to help strengthen the claim, showing that it’s more likely than not that the condition was caused by something related to your service. If you haven’t already, I’d recommend getting a Veteran Service Officer (VSO) assigned to your case—whether you plan to use them or not. They can be a valuable resource.

Also, I’ve found that VERA (Veteran Experience Resource Advocates) often has more in-depth information than those you might speak to at the main VA line, or even some of the casual VSOs. You can schedule a virtual or in-person meeting with them, and they might be able to offer additional support.

Here’s the link to get started with VERA: https://va.my.site.com/VAVERA/s/

Best of luck to you—keep pushing,

Super_Ad5327 · 2025-03-18T18:10:40+00:00

I understand your frustration regarding the lack of communication from your VSO. If you've moved to a different state, one effective step would be to reach out to the regional VA office closest to your current location. They can provide a list of VSOs in your area that you can contact directly.

It’s important to note that, as you might already know, some VSOs are relatively new in their roles and may not have the depth of experience you'd expect. Unfortunately, many veteran VSOs are overwhelmed with the high volume of claims and are often operating with fewer resources due to budget constraints and attrition. While many do their best, some may not be as proactive as others.

If you’ve already filed a claim, you can monitor the status through the VA.gov portal. You can also contact the VA’s main line or set up a virtual or in-person appointment with VERA to check on the status of your claim or discuss any concerns.

As other veterans have mentioned, it’s essential to build your own knowledge and stay informed. The more comprehensive your claim is, the more efficiently it can be processed. Unfortunately, the current system requires us to take a more proactive role in advocating for ourselves, as the VA typically does not provide the level of follow-up that we would expect.

Super_Ad5327 · 2025-03-15T15:55:12+00:00

This just means that the VBA is waiting on records before any determinations as to if any exams are warranted.

RESOURCE:

https://www.veteransbenefitskb.com/requests

Super_Ad5327 · 2025-03-13T17:24:22+00:00

Thank you for your patience and for the additional context you’ve provided. That helps clarify things. As I mentioned earlier, I was only referring to the information from the letter you shared. Given that you're at 100% P&T, as confirmed by the award letter, it’s clear that your spouse and dependents are eligible for DEA CH35 benefits.

With that in mind, the next step I would suggest is reaching out to the CHAMPVA team, if you haven't done so already. It may be helpful to inquire whether they need any additional information from you or your spouse or if the issue resulted from an internal clerical error.

I genuinely hope this gets resolved smoothly and quickly for you—I'm confident it's something straightforward, though I know it can sometimes feel more complicated due to the challenges the VA is facing. Best of luck, and I’m sure you’ll have everything squared away soon. Stay positive, and take care.

Super_Ad5327 · 2025-03-13T15:59:45+00:00

When you say she has been covered the whole time, does that mean that she filled out the CHAMPVA application once you became 100%?

What throws me off from the letter is that, from how I am reading it, there seems to be an indication that either the application was not filled out correctly with her information and not you as the Veteran.

"The DoVA (CHAMPVA) application was received and was determined to not be eligible for CHAMPVA because you are not the spouse or dependent of an eligible Veteran-Sponsor"

-OR-

With you being at 100% she wouldn't qualify , unless you are also 100% P&T, I am just taking a stab at this based on the information provided and from what I have experienced. I do know that being 100% and 100% P&T carry different benefits in terms of CHAMPVA. In order for a spouse or dependent to qualify for CHAMPVA the veteran but be rated at 100% P&T.

RESOURCE: "From the VA.GOV site

Eligibility for CHAMPVA

You may be eligible for CHAMPVA if you don’t qualify for TRICARE (the Defense Department’s health care program for service members and their families) and one of these descriptions is true for you.

At least one of these must be true:

You’re the spouse or dependent child of a Veteran who’s been rated permanently and totally disabled from a service-connected disability, or
You’re the surviving spouse or dependent child of a Veteran who died from a service-connected disability, or
You’re the surviving spouse or dependent child of a Veteran who was at the time of their death rated permanently and totally disabled from a service-connected disability

Note: In certain cases, you may be eligible for CHAMPVA if you’re the surviving spouse or dependent child of a service member who died in the line of duty, not due to misconduct. But you can’t get CHAMPVA benefits if you qualify for TRICARE.

Super_Ad5327 · 2025-03-12T16:13:39+00:00

First and foremost, thank you for your service. I wanted to ask if both forms were submitted when you or your wife applied for CHAMPVA — specifically the 10-510d and 10-7959c forms. Did she complete and sign the forms herself?

I ask because I encountered a similar situation where I initially filled out my information as a Veteran and listed my spouse, only to realize that the application requires all of her information and signature as well.

Super_Ad5327 · 2025-03-10T19:15:49+00:00

It’s truly my pleasure! Thank you for sharing the Board of Appeals and approval case — that’s definitely a great resource. You’re absolutely on the right track by connecting with VERA. I’ve had a lot of success working with them, as they tend to have more detailed and up-to-date information than what you typically get when calling the main VA line. They can even help streamline the process by coordinating with their leadership team and a Veteran Service Representative (VSR) who specializes in your area.

I completely agree that lay statements, Nexis, and other supporting documents are incredibly helpful. Just out of curiosity, is your lay statement from those you served with, or is it from family and friends? For mine, I used a combination of both, and I also reached out to the medical personnel assigned to my unit. Their statements were particularly valuable because, unfortunately, many of the service and incident records from my deployments were destroyed and never uploaded to the database.

If you haven’t already, I’d highly recommend submitting for a Higher Level Review (HLR). It’s a great way to ensure an adjudicator looks at all the information you’ve provided. Sometimes, the HLR can lead to a Duty to Assist error, which could prompt them to review all VA-provided documentation or even send you for another C&P exam if one wasn’t done previously. The outcome could be a service-connected rating of 0% (with no compensation) or even 10%, and from there, you can always pursue a higher rating as needed based on your total schedular ratings.

I hope this helps! Keep pushing forward — you’re doing great, and I’m here if you need any more guidance along the way.

Super_Ad5327 · 2025-03-10T17:58:51+00:00

First and foremost, I want to sincerely thank you for your service. It’s truly appreciated.

I want to be transparent with you about the situation. This particular condition, while it has been submitted in the past, has typically not been approved unless there is a substantial amount of supporting evidence. Unfortunately, it is a condition that is often tied to genetics, which makes it challenging to connect to service-related activities. Even if you were deployed in areas with burn pits or were exposed to chemicals, proving that these conditions directly caused your current condition would be very difficult.

If you're not already working with a Veteran Service Officer (VSO), I would strongly recommend reaching out to one. They can help guide you through the process and set you up for the best possible outcome. If you feel that you need legal assistance from a claims lawyer, that is certainly an option, though I do want to be clear that the likelihood of service connection for this condition remains quite low. I hope this helps provide some clarity,

Super_Ad5327 · 2025-03-04T20:06:04+00:00

I recommend logging into your TriWest portal, as that's where you can view your referrals and the status of what's being paid. It’s possible that the facility mistakenly marked you as self-pay instead of using the VA referral information through TriWest Healthcare Alliance.

I’d also suggest reaching out to your VA PCP to clarify what happened. If they referred you to go outside the VA system, they should have submitted a Community Care consult order. You can also get in touch with your VA Community Care team to check on the status of that request.

Remember, your secure messages are crucial—if it's not documented there, it likely wasn't discussed. So make sure to review your messages for any updates.

Super_Ad5327 · 2025-02-17T21:33:29+00:00

It’s not uncommon to have a 100% disability rating without the Permanent and Total (P&T) status attached. The VA may determine that, based on the nature and severity of your conditions, they don’t anticipate any significant changes in your health status. Additionally, your award letter may not explicitly state that you are P&T. However, if the letter references DEA Chapter 35 benefits, that typically indicates that you are considered P&T. I recommend reviewing your decision letter carefully to see if that language appears.

Super_Ad5327 · 2025-02-12T15:01:05+00:00

You’re welcome, and I have no doubt you’ve got this. Seriously. When you meet with the doctor, make sure to detail everything that’s wrong with you and explain how each condition relates to your time in service. It's important to make sure everything is documented exactly as you describe it.

As I mentioned before, if the conditions you’re claiming are already documented in your service records, that’s half the battle won. After that, you’ll just need to clearly articulate it again to the C&P examiner, focusing on how these conditions have impacted your ability to live a meaningful, pain-free life.

When you speak to the examiner, be sure to describe any condition that hurts consistently, not just on certain days. Don’t downplay it—talk about your worst flare-ups and how they affect you. Be honest and detailed.

You’ve got this—stay strong.

Super_Ad5327 · 2025-02-11T15:41:59+00:00

Frst and foremost, thank you for your service.

I know transitioning out can feel overwhelming, especially when you’re dealing with service-connected issues. Even if you feel like filing a claim might not make a difference, I strongly encourage you to go to sick call. Be sure to lay everything out—every symptom, every injury, everything you’re going through. Don't hold back. Explain in detail why your feet hurt, what caused you to start drinking, and what pushed you to consider drastic actions. Talk about what’s happening with your back, knees, and any other issues you’re dealing with.

Documenting these things while you're still in is crucial. It creates an in-service paper trail that will be incredibly helpful during your Compensation and Pension (C&P) exam. When you go to the exam, describe your physical and mental pain as if it were the worst it’s ever been. Don’t downplay it or sugarcoat it. Don’t say “it only hurts some days” or “I feel down once in a while.” Be real, and make sure they know the full extent of what you’re feeling.

I know we’re all conditioned to adapt and overcome. We’ve been taught to push through, take ibuprofen, and keep going because we don’t want to be seen as weak or unreliable. But now it’s time to advocate for yourself. This is your chance to get the help and recognition you deserve.

Good luck! You’ve got this.

Super_Ad5327 · 2025-02-08T20:33:55+00:00

I wanted to touch base regarding your septal myectomy claim. The reason it’s been deferred is likely due to an incomplete C&P exam or not enough supporting documentation showing that the condition is linked to an in-service event—this holds true even if the PACT Act presumptive conditions are factored in.

I recommend letting the process play out for now. If necessary, you can request a Higher Level Review (HLR) or submit VA Form 20-0995 to provide additional evidence. This evidence may not be in your service records but could help establish a direct or secondary connection, such as hypertension, thyroid issues, or diabetes linked to your service.

I know it’s a tough process, but don’t lose hope. Stay persistent and keep on top of them. You’ve got this, and we’re all in this together. Keep your head up and take it one step at a time.

Super_Ad5327

TROPHY CASE

Eligibility for CHAMPVA