5103 Waiver Review

Delao

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#1
Filed for adding sleep apnea on March, 13, 2013 thru Ebenefit and my claim sent to Seatlle, WA. I had my proposal rating on March 2013 with defered sleep apnea since they didn't have evidence and it is not finalized yet. I sent all evidence such as sleep study CPAP machine prescription,.... whwn I applied as mentioned.
My claim was at "UNDER REVIEW" since then, but suddenly today it went to "GATHERING EVIDENCE". Ebennies lists a "5103 Waiver Review" being required and due on July 10, 2013. Can anybody help me with info on the 5103 Waiver Review?
 

moneyblind

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#2
U.S.C. Section 5103, entitled "Notice to claimants of required information and evidence," provides:
46
(a) Required information and evidence. — Upon receipt of a complete or substantially complete application, the Secretary shall notify the claimant and the claimant's representative, if any, of any information, and any medical or lay evidence, not previously provided to the Secretary that is necessary to substantiate the claim. As part of that notice, the Secretary shall indicate which portion of that information and evidence, if any is to be provided by the claimant and which portion, if any, the Secretary, in accordance with section 5103A of this title and any other applicable provisions of law, will attempt to obtain on behalf of the claimant.

47
(b) Time limitation. — (1) In the case of information or evidence that the claimant is notified under subsection (a) is to be provided by the claimant, if such information or evidence is not received by the Secretary within one year from the date of such notification, no benefit may be paid or furnished by reason of the claimant's application.

48
(2) This subsection shall not apply to any application or claim for Government life insurance benefits.

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38 U.S.C. § 5103 (emphasis added). Under 38 U.S.C. § 5103(a), when the VA receives a complete or substantially complete application for benefits, it must notify the claimant of any information, and any medical or lay evidence, not previously provided to the Secretary that is necessary to substantiate the claim. In the case of information or evidence that the VA tells the claimant he or she must provide, § 5103(b)(1) provides that, if such information or evidence is not received by the VA within one year from the date of the notification, no benefit may be paid or furnished by reason of the claimant's application.
I grabbed that from a google search,

My interpretation of it is that a 5103 is the form for completion of the package, listing additional documentation needed to finish a claim. So MAYBE, a 5103 WAIVER is a procedure to waive the requirements of the 5103 because all the documents are there?

This is just my interpretation, I would really like to see MAPARKER or JASON's interpretation.

 

Delao

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I grabbed that from a google search,

My interpretation of it is that a 5103 is the form for completion of the package, listing additional documentation needed to finish a claim. So MAYBE, a 5103 WAIVER is a procedure to waive the requirements of the 5103 because all the documents are there?

This is just my interpretation, I would really like to see MAPARKER or JASON's interpretation.
To day also on update column "Development Letter Sent" added.
 

Delao

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#4
Date of ClaimEstimated Claim Completion Date
StatusClaim TypeUpdatesActions

03/16/2013 At this time, your Regional Office is unable to provide an estimated completion date for this type of claim GATHERING OF EVIDENCE Compensation
Development Letter Sent
Upload Documen
 

Warrior644

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#5
To day also on update column "Development Letter Sent" added.
Date of ClaimEstimated Claim Completion Date
StatusClaim TypeUpdatesActions

03/16/2013 At this time, your Regional Office is unable to provide an estimated completion date for this type of claim GATHERING OF EVIDENCE Compensation
Development Letter Sent
Upload Documen
From my experiences within the DoD IDES MEB/PEB process via eBenefits web-based application, your current status reflects a pre-generated response from the information currently available by the DoVA D-RAS.

Moreover, in my opinion, the "Development Letter Sent" pre-generated response was yielded after the DoVA forwarded a hard-copy letter by USPS first-class mail stating that my original claim was received, but they were backlogged with disability compensation claims and completion will be undeterminably extended.

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
 

gsfowler

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#6
Contact your PEBLO for your MSC's information if you do not already have it. Then contact your MSC and see if they need anything additional from you.
 

Delao

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#7
Contact your PEBLO for your MSC's information if you do not already have it. Then contact your MSC and see if they need anything additional from you.
I called my MSC, he doesn't have any information.:(
 

THE POST 9-11 HOUSE

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#8
Ok, this sounds worse then it really is, the VA should have sent you a packet a very small packeot asking you if you have anything other then the VA records to add to your claim... this is the VA 5103 Waiver Review paperwork. if you did not have anything to send in then just sign and send back so they can move on with your claim. You can now skip this step when you file new claims starting two months ago... they call them fully developed claims now at the time you file your claim you can already sign this paperwork and dont have to add 60 extra days to your claim waiting for this paperwork just to sign and say no.... i hope this helps.
 

THE POST 9-11 HOUSE

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#9
Also feel free to hit me up on any other questions about MEB and SO on i do this for a living now and have some much infomation, about CRSC and so on ... if you guys know people wondering what their CRSC payments are going to be i have a new updated payment Calculator to pass on it is Accurate to the nearest dollar.
Ollie out-
 

Delao

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#10
Also feel free to hit me up on any other questions about MEB and SO on i do this for a living now and have some much infomation, about CRSC and so on ... if you guys know people wondering what their CRSC payments are going to be i have a new updated payment Calculator to pass on it is Accurate to the nearest dollar.
Ollie out-
Thanks for your help. I got call from another MSC today-My MSC is in San Diego my claim is in Seattle and that guy called me from LA) and he asked me about sleep study and I was told by him "DRAS states in VTA that sleep study is not of record". After our conversation, he sent email to my PEBLO, my MSC in San Diego, VBASEAT and VBASDGO.

My PEBLO send my sleep study and CPAP machine prescription. I called him again questioning about when do I get my finalize rating.He checked claim and told me my rating is almost finalized and 100% P&T and with chance of getting SMC even if they deffer sleep apnea and I should receive it around 1st of August since my IDES claim is 16 months old.

My question since I retired on 06/10 and they got my DD 214 and claim start at 02/2012. Do you think he is right about time frame?
Also can you send me your CRSC calculator?

Thanks
 

THE POST 9-11 HOUSE

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#11
question when did you retire from the Military? ( i see 6/10 but is that JUNE 2010 or june 10 2013?) Also the rep you talked to was he you're VA rep? the reason why i'm a little confused is you state you are talking to you're PEBLO? If you have any questions about you're VA claim you would want to talk to your VA rep who is deciding on your claim.. But never take anything said over the phone as solid information on look and trust what is in writing.
 

THE POST 9-11 HOUSE

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#12
now as far as VA claims and MED boards go, if you retired on JUNE 10 2013, then the VA will start to process your claim on the day after you retire now here is where the BAD NEWS comes in if any, you only get paid for whole months from the military and the VA as far as payments they will not start you pay begin date till JULY 1 2013 (going by if you retired june 10 2013) so your first payment from the Military won't be until 1 AUG 2013 and at that time (if all the dates are correct) you're VA Claim should be complete on 1 AUG 2013 and you won't receive your first payment until SEP 1 2013 (so if someone was looking out for you they should have told you to retire on the 26-29th of the month so that way there is a less gap in payment to you) Please i hope this makes since, also please e-mail me if at anytime you have any issues paying bills and so on i can direct you to ORG, and can help get you to the right place while you wait for your payments to be received
OLLIE OUT-
 

Jason Perry

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#13
Filed for adding sleep apnea on March, 13, 2013 thru Ebenefit and my claim sent to Seatlle, WA. I had my proposal rating on March 2013 with defered sleep apnea since they didn't have evidence and it is not finalized yet. I sent all evidence such as sleep study CPAP machine prescription,.... whwn I applied as mentioned.
My claim was at "UNDER REVIEW" since then, but suddenly today it went to "GATHERING EVIDENCE". Ebennies lists a "5103 Waiver Review" being required and due on July 10, 2013. Can anybody help me with info on the 5103 Waiver Review?

I will post a separate thread on this...but, I have recently come across this issue of a request for a "Waiver" of claims in IDES cases.

I can't say for sure what is going on. I can only share my reaction and suspicions.

In the cases I have seen, the VA did not complete the necessary exams to rate the claimed condition. So, I suspect that these letters for "Waiver" requests are being sent in order to speed processing of cases. In the most relevant recent case that I had where this request for waiver was made, we responded with a statement that my client would not waive the claim and requested a complete examination to address the claimed condition. The response was a request for referral for exam from either a military provider or TriCare referred civilian provider.

I have a great deal of concern about this tack in requesting "Waivers." One of the main points of the IDES process is to provide a complete examination and award of full VA benefits upon release from active duty/retirement/or separation. The only time I could see it making sense to agree to a waiver would be if a member wants to be out sooner and the rating will not matter to their ultimate outcome (or they are satisfied with pursuing their claims after they are retired/separated). I think this whole scheme is bogus.
 

Delao

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#14
now as far as VA claims and MED boards go, if you retired on JUNE 10 2013, then the VA will start to process your claim on the day after you retire now here is where the BAD NEWS comes in if any, you only get paid for whole months from the military and the VA as far as payments they will not start you pay begin date till JULY 1 2013 (going by if you retired june 10 2013) so your first payment from the Military won't be until 1 AUG 2013 and at that time (if all the dates are correct) you're VA Claim should be complete on 1 AUG 2013 and you won't receive your first payment until SEP 1 2013 (so if someone was looking out for you they should have told you to retire on the 26-29th of the month so that way there is a less gap in payment to you) Please i hope this makes since, also please e-mail me if at anytime you have any issues paying bills and so on i can direct you to ORG, and can help get you to the right place while you wait for your payments to be received
OLLIE OUT-
I start my Claim on 02/16/2012
Narsum sent to PEB on 08/02/2012
Unfit Memo done on 01/17/2013
Propsal rating done on 02/09/2013 (100% PDRL Army, 100% VA P&T)
199 Signed on 03/01/2013
DD 214 sent to VA on 05/29/2013
Last Day In Army 06/10/2013
VA sent me development letter with 5103 waiver review on 06/14/2013 and I did not receive it yet
I got call from SMC and he asked abou my sleep apnea Document on 06/18/2013
He got sleep apnea doc on 06/18/2013
Today I checked eBenefits and shows my claim completed on 06/25/2013

can not believe that. As I read on forum it takes between 2 to 4 months to get finalize rating. How I can find finalized rating done and what was awarded?
 

THE POST 9-11 HOUSE

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#15
The trick to get the rating is to look in your documents folder in EBENEFITS they uplod the rating before you even get it in the mail. (as far as rating , i mean how much money you will be getting.
 

MILES_armorer

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#16
Also feel free to hit me up on any other questions about MEB and SO on i do this for a living now and have some much infomation, about CRSC and so on ... if you guys know people wondering what their CRSC payments are going to be i have a new updated payment Calculator to pass on it is Accurate to the nearest dollar.
Ollie out-
I would like the calculator and some info . I am going through the process now. EB say Developement Letter sent.
Thanks so much for the information
 

Warrior644

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#17
I would like the calculator and some info . I am going through the process now. EB say Developement Letter sent.
Thanks so much for the information
Indeed, welcome to the PEB Forum! :)

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!