Well, I woke up early again this morning. To be honest, I wake up early every morning, but this morning was earlier than most. I was up at about 0400 (4:00 am for you nonmilitary folks), and the purpose of my early rising was to make yet another call to the Veterans Administration in regards to settlement of my disability claim. I have learned that the only way to get through to the VA is to call them early before all of the lines are busy and the VA representatives are swamped.
The quick back story for those of you who may not be familiar with the saga of my VA claim, it began in the autumn of 2011 when I was on terminal leave as I was retiring from the Marines. As a part of my transition from steely eyed killer to middle age and longer grey hair it was necessary for the Veterans Administration to examine me and determine whether or not I had incurred any service related disabilities.
Being rated for disabilities is a big deal because if you have sustained an injury which is chronic or if you have a condition that is directly attributable to your military service, then you are covered medically for that issue by the VA for life. That is a pretty great benefit these days when you consider skyrocketing medical costs.
So anyhow, I began almost two years ago and have ridden the VA claims rollercoaster ever since. I was examined and evaluated, and then my paperwork went into the mysterious void that is the VA ratings process. Some nine months later I received a partial settlement of the claim, with the notification that I needed further evaluations before all of my conditions could be adjudicated.
Six months after that I reported to the clinic for another round of examinations. At the completion of those exams I was informed that it should take a few weeks to get them into the file and evaluated.
After over two months of fruitless waiting I decided to give them another call, hence my early assault on the coffee pot this morning.
The gentleman I spoke with was very helpful and presented me the facts of my case in a professional and straightforward manner. It was a very refreshing conversation!
Here is what is up with my case:
My case had run through the initial stages of evidence gathering and evaluation, and had actually made it to the adjudication phase. It was then that the raters found that they needed more information, so my case was kicked back to gather more evidence that would come from another medical examination of yours truly.
Here is where my stock in the VA representative soared to unprecedented levels because he actually took the time to explain why a second set of exams was needed. It turns out that when you are treated for an injury or condition, the doctor records the extent of the injury and how it is treated. That is very relevant information for a health care provider, but the VA disability raters have a different set of responsibilities in terms of medical conditions. The raters need to compare the injury or condition to a set of standards in order to determine if they are indeed disabling, and if so, just how disabling they are.
The example that the representative shared with me was what is needed for a joint injury (which, after nearly three decades of walking around with heavy things on my back in unseemly places, I had several of). A doctor wants to cure the patient’s damaged cartilage and bone, and will prescribe medications, physical therapy, and perhaps surgery to alleviate the symptoms and heal the joint. The VA raters need to know the extent of the damage that the injury or condition has incurred, which is different from trying to cure it. For a joint injury, the raters need to have a documented range of motion test that the joint is capable of articulating that can be compared to the appropriate standards for a disability determination. It turns out that very specific information about the condition or injury is necessary in order to rate the disability properly.
So that is why I found myself back in the VA clinic and wearing a modesty-shattering gown and sitting on a chilly paper-covered exam table.
Once the exam was completed, the information was supposed to be sent back to the rater and re-adjudicated in a timely fashion. Certainly within a couple of months.
After assiduously checking the VA’s ebenefits website for weeks on end and seeing no progress, I decided it was time to pick up the phone and give them a call.
The VA rep was professional and told me the facts of my case as he found them. He reiterated that my case was still in the gathering evidence phase, but that the results of my most recent examinations had been scanned into my file at the end of March. The timeline for review of the case is supposed to be less than sixty days, and seeing as it is almost mid-June now that timeline has passed.
The representative offered to initiate an inquiry to the team who is reviewing my case to see what was up, and he said that they will contact me (via email this time) with their response. Although I have heard that before (from the last inquiry on my case), I will be a glass half full optimist and see if my email inbox “bings” with the sound of an arriving email from the VA.
I won’t hold my breath, but I also won’t complain too much about the VA either. They really are doing the best that they can in an overwhelming situation as they deal with me and literally millions of other veterans. I’ll continue to be patient.
I’m glad you reached someone helpful and got some meaningful answers. That makes round 2 already seem like it’s going more smoothly. Good luck!!
It seems to be going forward- thanks for reading and commenting!
Wow..those delays are really adding up! I had my claim done at 366 days total time. Of course I was working medical boards and was proactive in my case and ensured all of my initial C&P exams were inclusive of what the taters needed to adjudicate my claims.
Good for you! How did you work the medical boards?
I was helping in the medical boards office when I was separated. Of course this was before they streamlined the system so you had one VASRD for the VA and another shortened version that got the DOD in trouble and brought about the implementation of the Physical Disability Board of Review and the oversight of the PEB. So I am at least a little knowledgable about the disability system and the VA. I was awarded 60% from the VA and was eventually one of the first I know of to be retired utilizing the Physical Disability Board of Review.