Filing Claim for an Old AF-related Injury - Any Advice?

[Bailey Guns]

Decided to update...

I got all my ducks in a row (records, current diagnosis, MRI results, original medical exam paperwork, etc) and we filed the claim on Jan 5. A few weeks ago I was notified to call the VA clinic in Walla Walla for an exam appt. I had that appt today.

I was very apprehensive about visiting a VA clinic. I've heard so many horror stories I expected to see skeletons of veterans in waiting rooms who had died waiting to get care. It was nothing like that.

I arrived a little early and the PA I had the appt with wasn't there yet. After a few minutes the receptionist came out and told me she had called the PA to tell her I was waiting. The PA apparently called in an order for xrays so I had that done prior to her getting there. Had to wait all of about 2 mins to get into the xray clinic. The radiology tech was very thorough, professional and friendly. I left there and walked back to the clinic. PA had arrived and called me right in. I knew it was going to go well when she apologized for all the pictures of her "kids" (dog photos) on the walls and she asked me if I liked dogs.

She asked a lot of historical questions and other questions related to my ability to function on a day-to-day basis, reviewed records, current xrays, old xrays, MRIs, etc, and then did the range of motion assessment. She said I was in the midst of a "spinal emergency". She flat out told me I'd get a rating, hopefully within 30 days, and she said my condition was slowly leading to paralysis. She gave me the name of a neurosurgeon and said we'd get an appt with him as soon as the rating letter was received.

After that she even walked me over to another building for an ID card. She told the guy to input all my info so I could get the card in Lewiston once I received the letter. Then she walked me to the travel desk to fill out the travel reimbursement voucher.

I don't know how she can be so sure I'm going to get a rating but she sure seemed to be. I'll believe that when it happens.

But...everyone I came in contact with was very friendly and helpful. It was nothing like I expected and I had worked myself up for nothing. At least for this visit. But everyone else seemed to be called in for various appts quickly as well. Overall it was a very positive experience.

So, now I just wait, again. It's moving much quicker than I thought it would.

[Gman]

Thanks for the update. Sounds like they care and that's a great sign.

My 2nd fusion attempt is going much better than my first. If you do end up requiring a lumbar fusion, I'd highly recommend having it done by an orthopedic surgeon. They know a lot more about structure than the neuro folks.

Sent from my SM-T700 using Tapatalk

[Irving]

I don't know how I missed this thread earlier, but my neighbor runs a non-profit that is specifically for helping vets just like you. I realize you moved away, but I can share info if you need. Sounds like you have things straightened out for now though.

[Bailey Guns]

Thanks, Irving. I've got what I need but I appreciate the offer.

[Bailey Guns]

UPDATE:

Last month I went back for another appointment related to my claim. Had another very positive experience at the Walla Walla VA hospital. Prompt, efficient and professional.

Yesterday I checked on the status and found it to be "Closed - Decision Letter Sent". The word "closed" sounded pretty ominous so I dug around the website a bit. Turns out the claim was approved at a rating higher than I expected...60%. And it was made effective back to May 2017 since that's the date I filed the "Intent to File Claim" paperwork.

So, needless to say I'm pretty happy about that. Even though I have insurance the co-pay on spinal surgery I need is going to be well over $20k and I can't swing that just yet. Now I'm hopeful that I won't have to come up with that amount and I can finally get this fixed.

For me, the process was pretty smooth and had a better than expected outcome. I actually filed the claim on Jan 5, 2018 and it was closed on June 28, 2018. I did do a lot of preparation in the time since I filed the intent in the form of rounding up records, getting physician statements, a current MRI and diagnosis by a neuro surgeon, etc... I think that really helped and it was a pretty solid claim with the evidence to back it up. So if anyone is looking for help or advice on filing a VA claim, that would be my best advice. Get everything together beforehand that supports your claim even if that means a note from your mother. You can't have too much supporting evidence.

In my situation, the VA actually ADDED conditions (nerve damage related to the stenosis) that I didn't apply for that amounted to an extra 20% rating. The extra money will be nice but the thought of the possibility of living pain free, or at least being in a lot less pain, is even more appealing.

ETA: And if you're thinking of filing a claim, FILE YOUR INTENT LETTER ASAP! Then get your claim filed within a year of filing the intent. When your claim is approved it will be effective back to the date the intent letter was filed. In my case that's going to add up to an additional 8 months of back pay. Obviously, this is a simplified example but for generic service-related injury claims like mine, that's how it works.

[CS1983]

Nice. Were you rated before and they bumped previous percentage or did you go from 0 to 60%?

[Gman]

I wish you the best with getting your back fixed. I was much happier the second time around using an ortho rather than a neuro surgeon. The ortho guys seem to have a better understanding of spinal structure.

$20k? Ouch. My not so great insurance through work at least has 100% coverage once you hit $12k out of pocket. At least the hospitals will let you set up payment plans without interest charges (at least the ones I've dealt with).

My insurance company has negotiated rates that seem to knock costs down by roughly two-thirds. Maybe you can negotiate the $20k down further?

Sent from my electronic leash using Tapatalk

[Bailey Guns]

0 to 60 in 5.8 months.

[Bailey Guns]

I wish you the best with getting your back fixed. I was much happier the second time around using an ortho rather than a neuro surgeon. The ortho guys seem to have a better understanding of spinal structure.

$20k? Ouch. My not so great insurance through work at least has 100% coverage once you hit $12k out of pocket. At least the hospitals will let you set up payment plans without interest charges (at least the ones I've dealt with).

My insurance company has negotiated rates that seem to knock costs down by roughly two-thirds. Maybe you can negotiate the $20k down further?

Sent from my electronic leash using Tapatalk

Fortunately now the VA will take care of it and I don't have to worry about the out-of-pocket costs. The big question now is when.

[Gman]

That's great to hear! Sorry for my misunderstanding.

Hopefully your employer will be flexible with treatment and recovery.

Sent from my electronic leash using Tapatalk