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Temp 100% Convalescent Pay After A Surgery


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19 replies to this topic

#1 foleyj

 
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Posted 29 January 2010 - 07:15 AM

I submitted a claim for convalescent pay after spine surgery and the doctor put that I would be out for 3 months. I just received that payment, but it is a lower amount then I was told. I am rated at 60% with a spouse and one child. The 100% rate would be 2932.00. If I am doing the math correctly 2932.00-1129.00=1803.00. The difference is 1803.00 and that should be the amount that I should have gotten for the 3 months for a total of 5409.00. The payment that I received was 4335.00. Is this the way the VA calculates this, or is there a different rate table for this type of situation?

#2 jbasser

 
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Posted 29 January 2010 - 07:20 AM

It should be t he 100 percent rate minus your current amount times 3.
You may be correct, Call them up and ask them to re figure it.


J

#3 foleyj

 
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Posted 29 January 2010 - 07:38 AM

Thats what I thought. Thanks.

#4 Berta

 
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Posted 29 January 2010 - 07:39 AM

I get the 60% vet with 1 wife, 1 child at 1129 per month -

100% vet,wife ,child 2932 per month

2932 less 1129 (what they should have paid you for those 3 months already-as your regular 60%) = 1803.

1803 times 3 months is 5409-

YES I think you are correct too-the difference soesnt make sense

I have had some errors on VA checks in the past-some a few hundred bucks and one was almost 40 thousand bucks.

If I were you I would write to them ASAP and state to them (keep copy, send priority or certified)that they have made a clearly erroneous mathematical error to your detriment in their decision or award letter dated xx xx xxxx and I always send them my calculations.Best to do that too.

They have always responded fairly swiftly and sent the cash soon too.

Except for my most recent ordeal and I went way over their heads on it.

They can fix this easily in your case . It shouldn't take long.

(Then again-Chapter 35 had started to refund my tuition-and sent me a check sometime ago and also the form AMU needed to fill out for audit of my additional tuition. A simple task. Yesterday I learned from AMU that VA has only recently released proof of my eligibility for this-the award letter is dated April 29th,and there are 2 more award letters as well.
They (VA) apparently stopped the Chapter 35 VA people from properly processing my award.

They also have held up my REPS for months.

I asked the school to state to me exactly what VA did with my VA forms.

Perhaps this was in fact an error at AMU finance office.

But I am collecting documentations on all this in case I have opportunity to give testimony again to the H VAC.

If they are treating me,as widow of a vet who died due to direct service connection,this arbitrary and capricious way- how the heck are they treating the widows and widowers of OIF OEF veterans who died in service?)

You have a simple error they should be able to fix right away.


Maybe. I have waited 9 months for them to fix a major and obvious retro error in my award.Still waiting.

Edited by Berta, 29 January 2010 - 07:42 AM.


#5 121212

 
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Posted 29 January 2010 - 09:58 PM

If you were house bound after your spine surgery, you can file for that, I got it for 3 months and it was 3123 dollars I think, I know it was over 3100 dollars, you might want to check in to that.

Ken

#6 foleyj

 
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Posted 30 January 2010 - 06:57 AM

Well I finally got in touch with a very helpful VA rep on the phone. I was actually surprised that this person was so helpful, but anyway here is the response that was sent to me. Now keep in mind that the original claim was for 3 months.

Mr. Foley:

This is in response to your inquiry dated January 29, 2010, regarding retroactive pay.

Based on the notification letter, the VA granted temporary 100% for two months, September 2009 and October 2009. September 1, 2009 - October 31, 2009 $3,756.00 for temporary 100% with 2 dependents.


I am trying to figure out why I was only paid for two months instead of three. The letter that I sent in from the doctor clearly states that the convalescence will be 3 months.

#7 Berta

 
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Posted 30 January 2010 - 08:01 AM

I suggest you ask them to CUE themselves on their financial error-tell them why the amount is wrong and send them copy of the doctor's statement.

It seems the response you got only confounded the issue more.

#8 Quint7

 
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Posted 31 January 2010 - 10:40 AM

I had the exact same situation post spinal surgery. You must remember that the date of the operation is not the date you are paid from. If you had the operation on Jan. 3rd (as I did last year) you will get nothing for Jan. as you weren't 100% for the entire month and VA does not pro-rate.
So if the 3 months of total disability doesn't begin on a 1st of the month and go to the last day of the 3rd month you will get bumped down to only two months pay. That is what I was given.
I had surgery on Jan 3rd and was off work until June 15th. I requested 4 months of temp 100% due to Jan. and June not being complete months. I received 2 months due to my claim being awarded in March. I have on appeal a request for the other 2 of the 4 months and should win. My claim is supposedly at the final rater and is awaiting authorization.
Hope that makes sense.

#9 foleyj

 
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Posted 01 February 2010 - 06:51 AM

Thanks for the info it does somewhat clear things up. The only problem with my situation is that the surgery was on 7/8/2009, so if the VA starts the rating on the 1st of the next month shouldn't it have started on the 1st of August? The other problem is that this is not mentioned anywhere in the regulation that explains the rating criteria. So would it help if I went back to my doctor and had him amend the order for my convalescence? I was actually off of work until November, I just read the regulation and told him to make it 3 months and he said if I needed more to just tell him.

#10 foleyj

 
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Posted 01 February 2010 - 07:03 AM

I just the regulation for this and this is what I found;

A total disability rating (100 percent) will be assigned without
regard to other provisions of the rating schedule when it is established
by report at hospital discharge (regular discharge or release to non-bed
care) or outpatient release that entitlement is warranted under
paragraph (a) (1), (2) or (3) of this section effective the date of
hospital admission or outpatient treatment and continuing for a period
of 1, 2, or 3 months from the first day of the month following such
hospital discharge or outpatient release.

So I see where it says from the first day of the month, but it also says that the effective date is the date of admission or treatment. So this is confusing. If the effective date is the date of admission, than why isn't paid from this date? This is the date at which you become 100%.

#11 broncovet

 
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Posted 01 February 2010 - 07:16 AM

I think Quint is right on this. Maybe someone can look it up, but I remember reading something about benefits starting the first day of the month following your application. So if you apply july 14, then it does not start until August.1.
Using this example, you may even get more money next month. In other words, you get 2 months of retro, and one month of "regular" 100%, so it would come out in the wash.

#12 foleyj

 
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Posted 01 February 2010 - 07:27 AM

Yes that what I would think that it would start August 1st, but in the award letter it states it is from September 1, 2009 - October 31, 2009 $3,756.00 for temporary 100% with 2 dependents. I am just wondering why it didnt start august first.

#13 Quint7

 
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Posted 01 February 2010 - 07:30 AM

I just the regulation for this and this is what I found;

A total disability rating (100 percent) will be assigned without
regard to other provisions of the rating schedule when it is established
by report at hospital discharge (regular discharge or release to non-bed
care) or outpatient release that entitlement is warranted under
paragraph (a) (1), (2) or (3) of this section effective the date of
hospital admission or outpatient treatment and continuing for a period
of 1, 2, or 3 months from the first day of the month following such
hospital discharge or outpatient release.

So I see where it says from the first day of the month, but it also says that the effective date is the date of admission or treatment. So this is confusing. If the effective date is the date of admission, than why isn't paid from this date? This is the date at which you become 100%.



The VA doesn't pro-rate so no matter what date the surgery was you get paid from the 1st of the month after the operation. As far as benefits you would be eligable from the date of the operation. Also to have a Dr. Write that you are off for 3 months might not be enough for the VA. They might want proof that you were out of work for 3 months. I was told that VA won't preapprove temp 100% because you haven't been disabled for that time (meaning you 'might') go back to work before the total time that you requested 100% for. i.e. we won't pay until you were already disabled.
This is just my experiance and hopefully others will chime in.

#14 foleyj

 
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Posted 01 February 2010 - 09:37 AM

The VA doesn't pro-rate so no matter what date the surgery was you get paid from the 1st of the month after the operation. As far as benefits you would be eligable from the date of the operation. Also to have a Dr. Write that you are off for 3 months might not be enough for the VA. They might want proof that you were out of work for 3 months. I was told that VA won't preapprove temp 100% because you haven't been disabled for that time (meaning you 'might') go back to work before the total time that you requested 100% for. i.e. we won't pay until you were already disabled.
This is just my experiance and hopefully others will chime in.



Quint thanks for the info. After more digging it seems that instead of the effective date of the claim being the day I had surgery, which was 7/8/2009, the VA applied the effective date that they received the claim which was 8/6/2009. Now I guess I have to go back and submitted an NOD and explain everything all over again.

#15 AimHigh1986

 
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Posted 03 March 2010 - 05:18 AM

Foleyj: Any update? I have a similar situation, and I'm wondering if you had any success. I was supposed to get 3 month temp 100% for heart surgery. My surgery was 7/2/09; the VA rec'd my claim on 8/3/09; the effective date of my temp 100% is 1 Sep 09, ending 1 Nov 09. 2 months instead of 3. I understand that they don't prorate - so I'm wondering why it wouldn't be 1 Sep 09 thru 1 Dec 09 for the temp 100%.

#16 foleyj

 
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Posted 03 March 2010 - 08:08 AM

Foleyj: Any update? I have a similar situation, and I'm wondering if you had any success. I was supposed to get 3 month temp 100% for heart surgery. My surgery was 7/2/09; the VA rec'd my claim on 8/3/09; the effective date of my temp 100% is 1 Sep 09, ending 1 Nov 09. 2 months instead of 3. I understand that they don't prorate - so I'm wondering why it wouldn't be 1 Sep 09 thru 1 Dec 09 for the temp 100%.



Hi,
No I haven't heard anything yet. I contacted the VA office and spoke with the VA rep that is also my POA and she sent an email to someone she said would take care of it. I have emailed her and have not heard back from her. You might want to contact someone about this because I think that the VA is not rating this correctly. If you go back and look at 4.30 Convalescent ratings you will see that it states A total disability rating (100 percent) will be assigned without regard to other provisions of the rating schedule when it is established by report at hospital discharge (regular discharge or release to non-bed care) or outpatient release that entitlement is warranted under paragraph (a) (1), (2) or (3) of this section effective the date of hospital admission or outpatient treatment and continuing for a period of 1, 2, or 3 months from the first day of the month following such hospital discharge or outpatient release. My surgery was 7/8/09 and I was released on 7/12/09. I sent the claim in and it was received on 8/6/09. So they made 8/6/09 my effective date and then began the 100% rating on Sept 1st. I sent messages to them through IRIS and the response that I got was that the VA only takes the advice of the doctors for the period of convalescence and they can determine what they think is an adequate convalescence. This is crap because if the doctors note says that you get 3 months then that is what you get. I would definitely contact your VSO or the VA office in your state. I will post something when I get an answer.

#17 AimHigh1986

 
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Posted 03 March 2010 - 12:29 PM

Good luck to you. What I don't understand in my situation is that the schedule of ratings for heart bypass surgery specifically states:

7017 Coronary bypass surgery:



For three months following hospital admission for surgery.......................................... 100


Seemed like a no-brainer to me, but I guess I was wrong.

#18 foleyj

 
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Posted 03 March 2010 - 01:04 PM

Good luck to you. What I don't understand in my situation is that the schedule of ratings for heart bypass surgery specifically states:

7017 Coronary bypass surgery:



For three months following hospital admission for surgery.......................................... 100


Seemed like a no-brainer to me, but I guess I was wrong.


Yeah you would think so. I have a feeling that they just automatically just give 2 months and then hope that you just get frustrated and forget about it. I can't seem to find anyone that actually understands the rating schedule. Good luck with yours.

#19 kookiebean2001

 
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Posted 27 October 2011 - 09:52 AM

What was the outcome?

#20 caubulldog

 
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Posted 30 October 2011 - 08:15 AM

Still waiting since 3/11 when I filed for a scope knee surgery and missed one month of work.Sent in with all evidence and no movement since then.