Informal Claim prior t 2015, and more

iThinkICan

Registered Member
#1
Long Time lurker, first time posting. Hoping someone can help make some sense of it all. You’ve all been so helpful in other posts. It has taken me months and months to finally write this...Perhaps the worst symptom of my disease.

2013- MEBd for MDD with Psychosis. Couple of days before MH C&P, diagnosed at MTF with BPD1 instead. Examiner did not receive those records although I informed him.Examiner also marked “NO” at the end of his report when asked if there were any other MH conditions etc... I know that level of functioning is more important at these exams.

2014- TDRL DOD70/VA 90 for MDD with Psychosis. Applied for SSDI before retirement.

2015- Switched from MTF to VA, multiple hospitalizations beginning January, VA also diagnosed BPD1. Changes were made to claim policies in March 2015 and I believe I fall in the hospitalization rule, and I never received notice from the VA about the benefit available to me. *I noticed an open claim in Jan 2015 but thought they were just residuals of my first claim. Denied SSDI, appealed through attorney. I had to move for personal reasons. The VA policy change can be found here:

https://www.benefits.va.gov/WARMS/d...rt3/subptii/ch02/M21-1III_ii_2_SecC_old D.doc

2016- Crappy year. Continued treatment at MTF. There was big ugly mess with some crucial VA correspondence: Missed a September re eval appointment at never knew I had, got a proposed reduction letter in October, wrote an appeal to regional office in November. I missed my SSDI hearing also in October. Told ya it was a awfully crappy year.

2017: VA accepted my appeal. Contacted by Veterans Evaluation Services for re eval appointment. Saw a civilian MH provider in mid-June and went on about my day. Got a letter from the VA about a week later and, believing it was a typical late appointment reminder for the one I just had, I threw it in my bag and forgot about it. Logged onto Ebenefits in July to print some paperwork, which had me scrambling to open that forgotten envelope. It was my award letter detailing an official change in diagnosis from MDD with psychosis to BPD1 with psychosis, and an increase to 100% Permanent and Total with an SMC housebound benefit. I am absolutely grateful for such a favorable decision. I poked around on Ebenefits a little more and noticed the claim from January 2015 had a close date of October 2016. In speaking with the VA, they told me it was an “internal claim” geared towards re eavaluation. *sigh* Started a new application for SSDI and maybe one day soon I’ll complete it.

So my questions are...
1. Will I be removed from the TDRL by separation only since my diagnosis has changed?
2. Is worth perusing an earlier effective date of at least January 2015 due to rules in the policy change and believing I was otherwise eligible?. Or by CUE or NOD or reconsideration or missing me during their “internal claim” dated Jan2015-Oct2016?
3. What is an internal claim?

Sorry for the novel. Any advice is appreciated.
 

Warrior644

PEB Forum Veteran
Registered Member
#2
Long Time lurker, first time posting. Hoping someone can help make some sense of it all. You’ve all been so helpful in other posts. It has taken me months and months to finally write this...Perhaps the worst symptom of my disease.

2013- MEBd for MDD with Psychosis. Couple of days before MH C&P, diagnosed at MTF with BPD1 instead. Examiner did not receive those records although I informed him.Examiner also marked “NO” at the end of his report when asked if there were any other MH conditions etc... I know that level of functioning is more important at these exams.

2014- TDRL DOD70/VA 90 for MDD with Psychosis. Applied for SSDI before retirement.

2015- Switched from MTF to VA, multiple hospitalizations beginning January, VA also diagnosed BPD1. Changes were made to claim policies in March 2015 and I believe I fall in the hospitalization rule, and I never received notice from the VA about the benefit available to me. *I noticed an open claim in Jan 2015 but thought they were just residuals of my first claim. Denied SSDI, appealed through attorney. I had to move for personal reasons. The VA policy change can be found here:

https://www.benefits.va.gov/WARMS/docs/admin21/m21_1/mr/part3/subptii/ch02/M21-1III_ii_2_SecC_old D.doc

2016- Crappy year. Continued treatment at MTF. There was big ugly mess with some crucial VA correspondence: Missed a September re eval appointment at never knew I had, got a proposed reduction letter in October, wrote an appeal to regional office in November. I missed my SSDI hearing also in October. Told ya it was a awfully crappy year.

2017: VA accepted my appeal. Contacted by Veterans Evaluation Services for re eval appointment. Saw a civilian MH provider in mid-June and went on about my day. Got a letter from the VA about a week later and, believing it was a typical late appointment reminder for the one I just had, I threw it in my bag and forgot about it. Logged onto Ebenefits in July to print some paperwork, which had me scrambling to open that forgotten envelope. It was my award letter detailing an official change in diagnosis from MDD with psychosis to BPD1 with psychosis, and an increase to 100% Permanent and Total with an SMC housebound benefit. I am absolutely grateful for such a favorable decision. I poked around on Ebenefits a little more and noticed the claim from January 2015 had a close date of October 2016. In speaking with the VA, they told me it was an “internal claim” geared towards re eavaluation. *sigh* Started a new application for SSDI and maybe one day soon I’ll complete it.

So my questions are...
1. Will I be removed from the TDRL by separation only since my diagnosis has changed?
2. Is worth perusing an earlier effective date of at least January 2015 due to rules in the policy change and believing I was otherwise eligible?. Or by CUE or NOD or reconsideration or missing me during their “internal claim” dated Jan2015-Oct2016?
3. What is an internal claim?

Sorry for the novel. Any advice is appreciated.
Welcome to the PEB Forum! :)

In reference to your TDRL question via my 3.9 years of experiences from an U.S. Army perspective while currently still placed onto the DoD military TDRL, it would seem that the answer is no; it's not automatic. Hmm, when is your next DoD TDRL re-evaluation; it seems that your last one was performed in calendar year 2014, correct? As such, during your next DoD TDRL re-evaluation, the DoD LDES PEB may consider the new medical evidence as awarded by the DoVA Rating Agency. It may be looked upon as favorable or not favorable; it's no way of forecasting that potential decision at this particular point in time unfortunately. Nonetheless, the DoD LDES PEB while on TDRL shall evaluate your DoD IDES PEB-referred "unfit for duty" medical condition(s) which originally placed you onto the DoD TDRL for a "permanent and stable" adjudication for DoD rating purposes only. So, this would seem to be your "MDD with Psychosis" medical condition.

In reference to your second question as annotated above, if you believe that justice has not been provided in your particular DoVA disability claim then yes! By all means, complete the necessary DoVA appealing documentation within the required submission timeframe now; don't procrastinate. In retrospect, upon becoming a DoVA disabled veteran, I submitted a DoVA NOD for three medical conditions which were deemed "not military service-connected" by the DoVA D-RAS while in the DoD IDES process. Upon completion of the DoVA NOD some three years later, I was granted full relief (e.g., full benefits sought) and awarded military service connection with a backdated effective date to one day after leaving military active duty. So, if the available medical evidence and/or medical documentation supports the DoVA disability claim then eventually a strong opportunity to be grant full relief is definitely feasible at least in my experienced opinion. Take care!

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

Best Wishes!
 
data-matched-content-ui-type="image_stacked" data-matched-content-rows-num="3" data-matched-content-columns-num="1" data-ad-format="autorelaxed">