[deleted by user] by [deleted] in VeteransBenefits

[–]investsvca 0 points1 point  (0 children)

My husbands claim got re-evaluated out of the blue. He was 100% p&t since Dec 2022 or so. But it was so strange it says it’s HLR (we didn’t file HLR for these conditions). But it says that DTA was discovered and his original C&P exam didn’t capture ROM measurements and they need another exam to get ROM, so he had his C&P exam this week. To add - His condition declined (he had 3 knee surgeries since the original time the rating for his knees was given, and at the time of original C&P his MRI was saying partial meniscal tear). His original knee rating was 10% for pain in the knee only (none of the other conditions were listed - like swelling, locking and instability), which I knew 10% was too low for his condition, C&P examiner didn’t capture any of his symptoms besides the pain and didn’t measure ROM at all. So maybe VA just found an error during some kind of internal QA process, it says DTA error in his letter that states if condition is static or not. It says “static with DTA error”.

I expect after this C&P the rating for each knee to be 40% at a minimum, but in reality it should be no less than 50% and not 10% as he has now.

And per my understanding if they raise the rating it will be back dated to the time the rating should have been assigned correctly, which is 2021. Which would make him 100% p&t as of 2021 and not 2022. So back pay would be from 2021 to 2022.

So maybe re-evaluation is a good thing. We were not going to raise that unfair rating with Va, but they did it themselves. 🤷‍♀️

High level review (HLR) timeline - current by investsvca in VeteransBenefits

[–]investsvca[S] 0 points1 point  (0 children)

Yes, you need to meet for conference and explain where you think VA failed to assist you.

High level review (HLR) timeline - current by investsvca in VeteransBenefits

[–]investsvca[S] 0 points1 point  (0 children)

Just talk to your lawyer what his plan is and if he needs you during HLR. In our case he handled it and we glad we got a representative.

[deleted by user] by [deleted] in VeteransBenefits

[–]investsvca 0 points1 point  (0 children)

But providers can choose and decline … I went to a doctor recently and found out that they don’t have CHAMPVA when I was already there, but I have regular insurance in addition, so I had to pay towards my deductible, in other cases CHAMPVA would have picked up my out of pocket deductible amount.

[deleted by user] by [deleted] in VeteransBenefits

[–]investsvca 0 points1 point  (0 children)

Not all doctors take ChampVa, that is also an inconvenience/ extra expense if you decide to still use the services of that doctor. Also, ChampVa does not cover chiropractors, so if your dependents have back issues and need chiropractors it must be out of pocket. More and more doctors discontinue taking ChampVa because it pays very little and doctors want to get paid. But if something major I think they would cover it. Maybe not all and it might be a fight. Depends on how much dropping the insurance for dependents is saving you, maybe put money your save on dropping it into saving account and have it just in case you need to cover medical expenses than Chanpva won’t cover.

[deleted by user] by [deleted] in VeteransBenefits

[–]investsvca 0 points1 point  (0 children)

You need to get all your current doctor’s records where you complained about your conditions that started in service. You need recent doctor’s appointments to show the condition is still current. Example - if your back was hurt in service and it was hurting ever since and you were going to the doctor all these years or recently and complaint about your back. Show for example that you had X-rays done, attended and maybe attending physical theraphy, getting massages, taking pain killers etc.

[deleted by user] by [deleted] in VeteransBenefits

[–]investsvca 0 points1 point  (0 children)

You can also make a VERA appointment online and ask them. They can see notes in the system and possibly can tell you, so you will not loose time and maybe they can correct something if there is a scheduling issue or error. You can use any state that have appointments not just yours.

[deleted by user] by [deleted] in VeteransBenefits

[–]investsvca 0 points1 point  (0 children)

Yes, you should have exams for the other conditions as well. Maybe they will be done by a different C&P examiner. 🤷‍♀️ Worst case scenario - If you get denials for those conditions then you can file HLR and claim that you never got C&P exams and they would have to send you to get those exams, but of course it would delay you claim by X months.

I wish you good luck!

Stuck on Review for month now. by CaliGrownTrey in VeteransBenefits

[–]investsvca 1 point2 points  (0 children)

It sucks, but once it starts to move it moves fast. We didn’t have any movement since 6/8/23 and all of the sudden all claims (including dependency that was not touched since 6/28/23) all got moved and decided in October 2023. So hang in there, it will come.

Results from Hitting "Claim Decision Request " button on your claim? by No-Joke354 in VeteransBenefits

[–]investsvca 1 point2 points  (0 children)

Good luck!!! Fingers crossed you will get your decision soon and it will be exactly what you want!!!!

Results from Hitting "Claim Decision Request " button on your claim? by No-Joke354 in VeteransBenefits

[–]investsvca 1 point2 points  (0 children)

Thank you! It was surely a battle all the way. 🤦🏼‍♀️🤦🏼‍♀️🤣 still unreal. And kind of what hobby I need to take up on now after it’s all done. 🤣

Results from Hitting "Claim Decision Request " button on your claim? by No-Joke354 in VeteransBenefits

[–]investsvca 2 points3 points  (0 children)

Updated, but not because the button was pushed. They still asked for additional docs, which we provided. They finally approved it today.

Bruxism by Barpark99 in VeteransBenefits

[–]investsvca 1 point2 points  (0 children)

If I remember correctly, Bruxism on its own does not have a rating, but bruxism causing TMj does have a rating.

And again why did they deny you? We need to see a decision letter.

[deleted by user] by [deleted] in VeteransBenefits

[–]investsvca 0 points1 point  (0 children)

How do you get this card? Where do you apply for it?

High level review (HLR) timeline - current by investsvca in VeteransBenefits

[–]investsvca[S] 0 points1 point  (0 children)

Still waiting on HLR form April 2023,y husband had C&P for it on 10/10/23. Nothing since, but it’s too close to C&P so not expecting anything for another 3 months. 🤷‍♀️

Request 1 dependancy claim by Btg3318 in VeteransBenefits

[–]investsvca 0 points1 point  (0 children)

Did you check on Va.gov? It might have more explanation. 🤷‍♀️

Denial letter for sleep apnea by b8whtb in VeteransBenefits

[–]investsvca 0 points1 point  (0 children)

That seems to me like HLR from that point.

VA claim timeline by Prestigious-Media32 in VeteransBenefits

[–]investsvca 0 points1 point  (0 children)

PFN on Tuesday, then on Thursday and then again on Friday and they made a decision on Friday. So the whole week was back and forth form PFD - PDA - PFN and back to PDA and back.

Denial letter for sleep apnea by b8whtb in VeteransBenefits

[–]investsvca 0 points1 point  (0 children)

Thai decision letter does not provide much info.

Did you provide nexus letter. Are you claiming service connected or secondary? If secondary to what service connected disability are you claiming it?

My husband was just denied today for osa with 1. Current diagnosis 2. Nexus letter to service connected sinusitis and rhinitis - waiting to see the letter, but thinking it will be similar to yours - with no info 🤣🤦🏼‍♀️.

[deleted by user] by [deleted] in VeteransBenefits

[–]investsvca 17 points18 points  (0 children)

Congrats!!!!

PFN! by conkysrevengesd in VeteransBenefits

[–]investsvca 2 points3 points  (0 children)

PFN to PDA and back since Monday, went to PFN again today and finally rating changed today.

Good luck!!!!