Denied VA care until rating recieved, waiting more than a year

spinal

spinal

PEB Forum Regular Member
Hi, I was medically retired May 2013 @50%.My Jag said I could fight for more, but I just wanted to be done. My PEB took 2 years. I got sent back home for my wife and kids to care for me on convalescent leave for 10 months, as my command knew I was disabled, but my file just sat there. After discharge with 50% PDRL I applied for VA benefits may, 2013. I have tricare prime. I am using the DAV. But the bastard representing me just quit one day. The VA said they would NOT see me until I get a rating from them. Also, the VA just accepted and reviewed my civilian doc files, and I am now going to QTC appointments. Last QTC this month. Yet, my rating is expected to be completed by Feb 2015 to July 2015. Am I the only one in LIMBO like this, and do I have the right to go to the VA hospital for my monthly procedures and treatment, rather than paying $12 & $25 co-pay and $200+ in monthly meds? Also I requested a speedy case based on financial hardship on me my wife and kids, but because I'm not behind on my bills they can't help me. WTF? I am in up to my eyeballs in debt and family loans. Sorry just needed to vent.
 
Go to the patient advocate. I took in my proposed ratings, dd214, and they put me in the system while I was on terminal leave with my first appointments scheduled for the day I hit the PDRL list. They should see you - I know of no reasons why they can't. Play hard. Bob
 
spinal said:
Hi, I was medically retired May 2013 @50%.My Jag said I could fight for more, but I just wanted to be done. My PEB took 2 years. I got sent back home for my wife and kids to care for me on convalescent leave for 10 months, as my command knew I was disabled, but my file just sat there. After discharge with 50% PDRL I applied for VA benefits may, 2013. I have tricare prime. I am using the DAV. But the bastard representing me just quit one day. The VA said they would NOT see me until I get a rating from them. Also, the VA just accepted and reviewed my civilian doc files, and I am now going to QTC appointments. Last QTC this month. Yet, my rating is expected to be completed by Feb 2015 to July 2015. Am I the only one in LIMBO like this, and do I have the right to go to the VA hospital for my monthly procedures and treatment, rather than paying $12 & $25 co-pay and $200+ in monthly meds? Also I requested a speedy case based on financial hardship on me my wife and kids, but because I'm not behind on my bills they can't help me. WTF? I am in up to my eyeballs in debt and family loans. Sorry just needed to vent.
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Spinal, were you retired under Legacy? If so, that explains why you wouldn't have a VA rating.

As for the VA, do you have an Ebenefits account? If so, what is Ebenefits stating as to the status of your claim? Is the date of your current claim May 2013? The VA Office of Communications and Case Management might be of some assistance.

Have you reached out to find another VSO? The DAV should have alternates who can assist with your claim. If you don't mind me asking, what RO is your claim assigned to?

Is my assumption correct that you do not live close to an MTF to receive treatment?

Take care and good luck to you.
 
I believe I am in the legacy VA rating. Couldn't get rated til discharge. Yes, my initial claim is 2013 with the 2015 completion. My ebenies says it is under review and request 3rd party review. The VA told me that my claim was pushed back, due to the government shutdown. (but I don't believe that).
 
I don't know how to quote parts of your messages, but thank Psychofficer and DCMD124. I will look into some of this, "patient advocate" and "VA office of communications"
 
spinal said:
I don't know how to quote parts of your messages, but thank Psychofficer and DCMD124. I will look into some of this, "patient advocate" and "VA office of communications"
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Since your claim has been so prolonged, I would call the VA Office of Communications and Case Management at 1-202-273-7453. Fair warning, you will more likely than not have to leave a message but they will call you back.

I called and left a message on three occasions until I received a call back. They told me that my claim would be done by the end of this month.

You've mentioned DAV as a VSO, have you been in contact with them? If they aren't helping you with the desired outcomes, there are plenty of other VSO's.

Take care and good luck to you.
 
The VA accepts Tricare, go see the OIF/OEF coordinator. You should be eligible for five years free healthcare from the VA
 
spinal said:
Hi, I was medically retired May 2013 @50%.My Jag said I could fight for more, but I just wanted to be done. My PEB took 2 years. I got sent back home for my wife and kids to care for me on convalescent leave for 10 months, as my command knew I was disabled, but my file just sat there. After discharge with 50% PDRL I applied for VA benefits may, 2013. I have tricare prime. I am using the DAV. But the bastard representing me just quit one day. The VA said they would NOT see me until I get a rating from them. Also, the VA just accepted and reviewed my civilian doc files, and I am now going to QTC appointments. Last QTC this month. Yet, my rating is expected to be completed by Feb 2015 to July 2015. Am I the only one in LIMBO like this, and do I have the right to go to the VA hospital for my monthly procedures and treatment, rather than paying $12 & $25 co-pay and $200+ in monthly meds? Also I requested a speedy case based on financial hardship on me my wife and kids, but because I'm not behind on my bills they can't help me. WTF? I am in up to my eyeballs in debt and family loans. Sorry just needed to vent.
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Yea unless you are behind on bills or don't have funds to pay the bills you have then VA won't give you finiacial hardship But look into AER loans they help retired militaryhttp://www.aerhq.org/dnn563/FinancialAssistance.aspx
 
gsfowler said:
The VA accepts Tricare, go see the OIF/OEF coordinator. You should be eligible for five years free healthcare from the VA
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@spinal

I would like to suggest,

Go to a VA Outpatient Clinic to enroll may be an easier route.

Fill out the 1010EZ and bring copy of your DD214

https://www.1010ez.med.va.gov/

Financial Disclosure Requirements Do Not Apply To:
· a former Prisoner of War; or
· those in receipt of a Purple Heart; or
· a recently discharged Combat Veteran; or
· those discharged for a disability incurred or aggravated in the line of duty; or
· those receiving VA SC disability compensation; or
· those receiving VA pension; or
· those in receipt of Medicaid benefits; or
· those who served in Vietnam between January 9, 1962 and May 7, 1975; or
· those who served in SW Asia during the Gulf War between August 2, 1990 and November 11, 1998; or
· those who served at least 30 days at Camp Lejeune between January 1, 1957 and December 31, 1987.















 
I believe they can give you a provisional rating while they work through your claim. Ask your VSO. What health care needs are not being met by TRICARE?

Mike
 
gsfowler said:
The VA accepts Tricare, go see the OIF/OEF coordinator. You should be eligible for five years free healthcare from the VA
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BINGO!! The OIF/OEF Coordinator will process you via this route. They set up all your appointments. PCM, BH and any specialty appointments you need. They do not need ratings because you are a VETERAN, and have a DD 214 to show that. Look on the VA website and find the coordinator nearest to you, and call them.
 
ranger2992 said:
BINGO!! The OIF/OEF Coordinator will process you via this route. They set up all your appointments. PCM, BH and any specialty appointments you need. They do not need ratings because you are a VETERAN, and have a DD 214 to show that. Look on the VA website and find the coordinator nearest to you, and call them.
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A medical support personnel/clerk at a VA Outpatient Clinic has the same ability.
 
siestasundance said:
A medical support personnel/clerk at a VA Outpatient Clinic has the same ability.
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Great! To me it's not really about ability, but more about the fact the OIF/OEF coordinator is responsible for this. Since the OP has had problems so far, maybe the person can break through the red tape for him.
 
ranger2992 said:
Great! To me it's not really about ability, but more about the fact the OIF/OEF coordinator is responsible for this. Since the OP has had problems so far, maybe the person can break through the red tape for him.
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I hear ya, I used to work for the VA and most Medical support assistants can over see some of those problems as well, they can enroll any type of Veteran; WWII, Viet, DS, OEF etc. correct data entry during enrollment of the veterans demographics needs to be 100% accuracy because sometimes the automated program will kick back or give a message that the Veteran is not qualified, when indeed he/she really is. The automated system they use is a bit outdated.
 
siestasundance said:
I hear ya, I used to work for the VA and most Medical support assistants can over see some of those problems as well, they can enroll any type of Veteran; WWII, Viet, DS, OEF etc. correct data entry during enrollment of the veterans demographics needs to be 100% accuracy because sometimes the automated program will kick back or give a message that the Veteran is not qualified, when indeed he/she really is. The automated system they use is a bit outdated.
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I believe the system is updated now with the issue of the new ID cards, i only say that because i just recently went to get my VA ID card and the guy putting my info was saying thats this new system is retarded lol
 
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