- Hi welcome back to Hill and Ponton's
veteran's disability vlog.
I'm Natalia Jofre the company's COO.
- And I'm attorney Allison Reddick.
- So Ali today I want to talk about something
that is very bothersome to me, very concerning to me
because we see this so often where
Veterans aren't awarded what they should be.
Either they're denied completely but almost even worse
I would say, they're given a very low rating percentage
and the reason that concerns me is because
then they think that's all they're entitled to.
So, I want to first bring it back to the basics
and then maybe we can get into some more detail.
So I think that the first thing
is if you could explain to people what a rating is.
- Okay, so basically what a rating decision is
it's a document that you'll receive that basically
says that the VA has reviewed your claim
and made a decision on it.
It will state whether you received service connection or not
And if you did, it will include the evaluation
they gave you and the effective date.
The rating decision should cover what
evidence was considered.
It should include the regulations that were used
to make the decision.
- Okay.
- And in the new appeals modernization act system
it should include paper able findings.
So what positive things and positive evidence
that was used to make the decision.
- Who's making the decision?
- So basically, it's a raider.
It's someone at the VA who goes through
your evidence, goes through your file and
determines whether you have the proper elements
for service connection or if it's increase rating the
proper criteria for an increase rating.
If you appeal a decision, then it's going to be someone
higher up with a little more qualifications,
a little more experience who will be
making the decision that time.
- So based on what you just said alone, this tells me
that a less experienced person is making that
initial determination.
You perhaps are not getting the best of the best,
making a decision on your client right?
- Right, and they are going through thousands of files.
So they're trying to get through them
as quickly as possible.
So, when a veteran gets a 0% or a 10%,
a lot of times they're happy they're service-connected.
But, the evidence in their file shows that they should
be getting a 50%, a 70%.
So it's really important to not settle with that
first rating you get.
- And I think that's why I find it so bothersome.
And it really makes me sad and I mean,
I do these events and I meet veterans all the time
and they're so grateful
because they're getting 10% and
they will get 10% for 20 years.
And then you have a conversation with them and
you're like oh my goodness the severity.
They're not able to work, they're not able to hear,
they're not able to function in society.
I mean they have all of these limitations
or it's such a struggle for them and
they're getting 10% and they're just grateful
well at least I'm getting 10%.
So, I think that one of the things I want to
convey today is that you shouldn't just assume that
because that's what the VA awarded you
especially the first time around.
That, that's what you should stick with
or that, assume that it's accurate.
- Absolutely, and included it in your decision
it should state what criteria is necessary to get
the next highest rating.
So it's really important for you to read
your decisions thoroughly so you can see,
hey wait I experience all of these symptoms or
some of these symptoms in the next higher criteria
I've been experiencing them since I filed,
before I filed my claim.
I should probably appeal this decision or
if at some points, you know years down the road
and you're symptoms increase definitely
file for it increase rating.
- Can you give everyone a little bit of an idea
of what a difference in the compensation rating will make.
So for example, monetary speaking what's the
difference between 10 and 50%?
- So
- Or 30, you know whatever example you want to give.
- So, a 10% rating is around 140 dollars.
Then it slowly increases and by the time you
get to 50, 60% you're going to be above $1,000.
- Wow.
- But then, getting 100% rating that's around
$3100 a month.
- That's a huge difference.
- Yes.
- So from 10, you said about to 50,
I mean you're talking about getting 10 times more
then what you would be receiving at 10%.
So that's a lot of money over a
significant period of time.
And you said, so if initially you get 10% and
perhaps at the time that's an appropriate amount,
if you later get worse you can later appeal
or file for more?
- Absolutely, so when you get you're rating decision
you have one year to appeal that decision.
So let's say you get a decision in September
come April that following year,
your symptoms are worse, you're still within that
appeal period.
So you can file an appeal to that decision.
Or if it's years later you can file a 526 EZ or
an increase rating for that condition.
- Okay.
Are there any risks involved; because I hear
this concern often where people say I don't
want the VA to look at my claim, they're afraid
they're that they're going to loose what they have.
Are there any risks involved in asking for an increase?
- Yes.
So when you're putting someone's hands in you're file
there's eyes looking at everything.
So there's also a risk that they could potentially
reduce you're percentage.
I don't think you should worry about that though,
if you have documentation that you have these symptoms
on a daily or frequent basis, I think what's important
is that you have document evidence from your physician,
you fill out disability benefit questionnaires,
which you could get online from the VA, have your doctor
fill those out.
Even have lace statements from yourself, from your spouse
I mean who knows more about what you experiencing
than your spouse?
A lot of veterans downplay their symptoms and
spouses or other family members are very good at saying,
oh no he says it pains too, I see him bent over
you know in bed riving in pain,
that's not how it is.
Even if they were to reduce you're percentage,
they have to give you notice for it.
So what they will do is they will
send you a purposed rating.
And in that purposed rating, they will say
you have a 30% rating, we plan to reduce it to 10%
because of these reasons.
You can ask to be heard and ask for a hearing
and submit evidence to say no that's not true.
Then that's not what I'm experiencing.
And a lot of the times that comes from the C&P exams.
- Okay.
Is it a frequent problem where people are getting reduced?
Or is is it more likely that you will get increased
then you will be reduced benefits?
- If you're providing evidence that you're having
these symptoms that fit that higher criteria,
you're more likely to get increased.
The only times I really see reductions is
if it's a bad C&P exam unfortunately.
But those are things that can be
remedied at some point by asking to be heard on that issue.
I definitely think as long as you have the evidence
you're much more likely to get increased than decreased.
I don't want people to be afraid to file for
increase ratings because of reductions.
- Right.
- They're not, majority of them are not trying
to reduce you, it's just making sure you have
the right evidence.
- It's almost as thought it's a potential issue that
could
- Yes
- Happen, so you need to be aware of it.
But it's not the most common place thing to occur.
- No.
- You're more probably, more likely to to be
increased or left the same then to be decreased
would you say?
- Absolutely and sometimes when you have routine
compensation and pinching exams,
during that exam they'll even say
oh you're symptoms are better but you've had
past exams where they were worse so we're going to
keep you at the same rating.
So, they may even say something like that.
So I really wouldn't worry about reductions unless
you're symptoms have actually decreased.
- Right.
There's one thing that you mentioned that I think
we should expand on just a little bit
in terms of the documentation.
So when you're talking about documentation,
I'm assuming this is you are frequently or at least
going to the doctor when you're supposed to be going.
- Yes.
- So you know, having those scheduled visits,
if exams are ordered you're keeping those exams,
if you're taking, you know prescribing medication,
you're being compliant the people
that normally have issues, probably I would think
are people that have gaps in their treatment.
So in other words, I'm asking for an increase
but I haven't been to the doctor in two years.
Right?
- Yeah, I would agree with that to an extent.
I would say you don't need to go to the doctor every week.
Or every month.
- Right.
- It's just having a continuity of care.
If you see your doctor twice a year and you're taking
the medication that you're supposed to be taking
then that's fine.
As long as you just don't stop going to the doctor
for five years.
However in this society, with medical insurance
sometimes that happens.
So don't be discouraged if you are in that situation
and you haven't been able to go to the doctor.
That's where lace statements from yourself,
from your family, from your employers are very important.
Because that evidence has as much weight
as medical evidence.
- Really?
- Well, I mean of course medical evidence
is going to be better.
- Right.
- But it does carry some weight.
- But it does carry significant weight.
They have to review it.
- Right.
- They can't disregard it.
- They can't just be like well this is the likely
mistake and I'm not going to paying attention to this.
- Now a lace statement, they can't diagnose you
but they can state their observations,
they can say what they experience on a daily basis
and how it affects your daily living.
Absolutely that is great evidence.
- Okay.
How can you ask for an increase rating?
So, two phrases or terms that I hear swirling around
a lot lately are legacy, the legacy system and AMA.
So can you explain a little bit about what those two are
and what the difference is I guess?
- So legacy, we're to the point where you can't file
anything in legacy.
Everything is AMA.
The only way you would be in legacy is if you
have a pending appeal that is still being worked.
- So these are two different claims or were?
- Yes.
Prior to February 19th of 2019, it was legacy.
On that day, AMA started.
- Okay.
- So, February 20th going more forward, you had
to file 526 EZ to file a new claim or
file an increase rating.
- Okay.
- Prior to that, you can write on a 4138 statement and
support a claim, I want an increase rating.
But now they're very strict about putting it on
the proper documentation.
- Okay.
And what needs to be included in that,
are there big differences between what was required
then and what's required now?
- No, I meant the 526 EZ still existed and that was
something that you should have used.
But basically it's just information about yourself
and where you're getting treatment and
listing weather your asking for an increased rating
or service connection.
You're not really giving too much information,
however I would suggest submitting additional evidence
with that form.
It's just a form to put in to say,
hey I want to file a claim.
What's interesting is that you can file
an attentive file prior
and for up to an year, lets say you're thinking about
filing a claim so you put in the attentive file
and as long as you put in that official document
within a year, you can go back to the date
of that attentive file.
- Okay great.
So, we often hear about things that the VA gets wrong.
Is it possible that they can get an effective date wrong?
- Yes.
Effective date is something that is commonly wrong.
Especially if you're filing for increase rating,
if you file a new claim for an increase rating and
then you have a compensation in pinching exam,
and then you're rating comes out.
A lot of times they will give you the date of your
compensation in pinching exam.
Because they will say that's the date that the symptoms
were noted, that's the date we are giving you.
That's not always right, especially if you have evidence
prior from your doctor or in your medical record or
lace statement showing that you had those symptoms prior.
You should get it back to the date that you originally
filed that new increase rating.
Now let's say you have a claim that you filed a year ago,
you just got a decision, you're still within
the appeal period.
You want to get an increase rating, if you have had
symptoms, documented symptoms all the way back to
that original claim
- Yeah
- It's as long as you continuously appealed it,
you potentially can get an effective date all the way
back to that original claim.
- Wow that's significant.
Okay.
When should a veteran consider applying for
an individual unemployability?
- I think it really depends on what conditions you have
and how disabling they are.
Certain decisions, conditions are extremely disabling
to the point where you can't work.
And so it may take time for you to get the correct ratings
but I would go ahead and apply for it when you stop working.
I mean that put is it in, puts the VA on notice
that these conditions are affecting your ability to work.
A lot of conditions that I see, that severely affect
your ability to work; back conditions, migraines,
you know if you're in remission from cancer,
the residuals you have things like that.
I don't think that it necessarily matters when
you put it in, as long as you put it in.
Because, if you're not scheduled qualified
they're going to deny you.
- Right.
- But, it puts in at that point you are having these issues
and you are unable to work and it shows the VA,
okay this is an issue that we should be
looking at that in the future.
- Okay.
That's great, thank you Ali.
That was super helpful.
All right so we're going to keep talking about VA related
topics.
Of course in the meantime, if you have questions please
feel free to visit our website or call our office.
Thank you.