TBI Disability awarded; new claim for back issues?

Lawyer up, find one that will take it on merit. I trust the VA to take care of my health care in general, I do not trust them to treat me fairly on my disability! I talked to them about PTSD and they're like no your alright, I think their full of it! I haven't lawyered up yet, but if I had a TBI I think I would. Some of them want to help you and some of them act like your bothering them, but that's their job isn't it.

 

I got the 50% on the migraines. The steps of care are really important. Nothing worked except Botox every three months and that got me down to 4 or 5 a month.

 

Hoping those that were watching this thread read the latest on an issue I'm having;

As you know, I'm awarded 70% which puts me at Category I

I had done everything through Palo Alto VA, which is 2 1/2 hours away, each way.

Since then, I received a packet of with how they reached my decision, why I was denied for hearing loss (even though they listed that I do have it), and some FAQ.

Fast forward 6 months to December 23rd; I had gotten pink eye and it was so bad that I was experiencing headaches and had a lot of trouble seeing.

I attempted calling the VA, which in CA directs you to a VA clinic/call center in San Francisco. I stated I was trying to get ahold of the center in Marina (only 25 minutes away) but apparently they don't offer such emergency medical service, and that they would email a nurse to call me back with further instruction.

5 minutes later, a nurse calls and asks for my symptoms. She then recommends that I drive to the nearest facility, whether civilian or not, and get treated. She stated it would be a risk to drive all the way to Palo Alto. However, she did state that the VA may not cover the entire cost and to be wary of that; however if I drove all the way out to PA it would be covered completely.

At least the conversation about seeing a civilian doctor at a local hospital was noted.

Fast forward to January 10th, after I got my medical bill, I call the VA to get this bill taken care of. I'm told that my treating hospital/etc. is the one that is supposed to take care of it; I'm confused now.

Apparently, I'm supposed to register at the nearest VA hospital, and they're supposed to cover my bill? At this point it sucks because I work 12 hour days, and it is impossible to register until my day off a week from then.

I made an appointment to register and did so on January 13th however I was told they would not be covering it?

So I'm stuck with a medical bill, and supposedly I have VA benefits that are useless because the VA hospital that has resources for everything is hours away.

Wtf?

Guess the Mission Act is a load of shit huh?

 

Paging @Boyk1182

 

If you went to a non VA facility, it should fall under some aspect of care in the community. Additionally that is who should be able to let you know if it’s covered or not based off what you qualify for, depending on % or service connected.

I’m 100% so I don’t want to say the VA will for sure cover at least a portion in your situation. For me, that’s how it works. Then if it’s not service connected, TriCare picks up the remainder. I always call the emergency care hotline (below) to confirm if I need to contact the hospital to let them know to bill Tricare. I NEVER give any insurance other then VA if I go to a civilian facility.

This might not be the right region number for you but they will still help or at least transfer you. It’s also a good starting point at least.

 

Been rated with the VA for a long time ... and it took a long time to get to 160%. I used to work with veterans on claims, as a volunteer until it was taking all of my time.

With the VA, you have to be persistent with your claim and document it well. Also be patient and always stay clam and try not to piss off anybody.

With a well documented claim, it could take many attempts, but eventually you will probably win ... and you are paid back to your application date, so don't get in a rush.

Unfortunately, at the VA, getting a good doc or a good VA rater is the luck of the draw.

Also, if you can get a VA doc to go to bat for you (this is rare) this will help a lot ... outside medical opinions are good too.

Good research is imperative to substantiate a VA claim and there are many veteran website that you can google.

Completing a successful VA claim is like a civilian lawsuit ... I have seen bad claims won and good claims denied because of preparation and getting the wrong person at the VA.

A successful VA claim takes many, many hours and much preparation and research.

It not only what you say ... but how you say it too ... good luck.

PS ... I was trying to add my wife and daughter as dependents and it took over 12 letters (14 months) to get that done and she already had a DOD-DEERS ID and CHAMPVA and VA pay. weird on how you are not a VA dependent yet you have all the VA bennies. Weird, but this happened to me.

 

Just sucks that my benefits are useless if I have to drive so far away for anything; what if I can't drive to get there? I couldn't this time around.

 

...^^^... You can't help where you live, unless you move.

Focus on the end game of having a successful VA claim.

PS .. Yes, you can get the VA to pay for private local care.

Also, at 70%, you can go for TDIU which will pay you ae the 100% rate.

 

That’s the point of care in the community. Reach out to them to ask q’s on how to use it. I’ve used it several times for service connected or not service connected stuff. I don’t even contact the VA other then to let them know I used emergency care. I tell the hospital to bill the VA then contact care in the community direct. They are not part of the VA if I remember correctly. Depending who you deal with, the VA can be stressful but most do want to help. I find the non medical staff to be the best to talk to and work with.

@CaptAmerica

 

The way I understand it, you have to notify the VA of any emergency care you received at a civilian facility within 72 hours and they should cover it. It has to be an emergency (or something to that effect). I guess it may be a little late now for that.

It’s still not a guarantee. I have heard stories where people were referred out BY THE VA to have something done at another hospital, and then got stuck with the bill.

I don’t know about your current bill, but keep the 72 hour thing in mind for the future.

 

Funny you say that; I did and when I called to follow up I was referred to my VA hospital only for me to respond with "well, that's you guys".

That's when they said I had to go to my local one to register, to which I replied "I was told there are no medical services there" which I was via phone from the nurse and call center.

 

I am not sure if you have to be registered, but that may be part of it. I am registered because I use the VA for all health care.

Either way, if you notified them within 72 hours, you need to fight this. You followed the rules and did your part, you shouldn’t pay that bill.

I am honestly not sure if being registered is a requirement, but if it is, they may try to screw you there. Maybe register now if you haven’t already. I’d still fight it though!

 

Yea, read above.

I was off on Christmas and couldn't register with the VA due to it being holiday for them as well; after that I've been working non-stop since the car business gets crazy busy on the holidays. I couldn't register with the local VA until January, which was apparently "too late".

 

Read this, being enrolled may be where they try to screw you:

https://www.va.gov/COMMUNITYCARE/programs/veterans/Emergency_Care.asp

 

I’d appeal that all the way up to a BVA judge. They are sympathetic and can make any decision they want. Your story adds up, and shouldn’t be held against you. I’d push it all they way up to the BVA if that’s what it takes.

 

Yeah, that's why I'm posting here.

Apparently, I was supposed to be enrolled when I already thought I was enrolled; that's why this is frustrating.

VA sucks

 

Thanks for chiming in!

Unfortunately, I'm at work all day until night. Same goes for each and every day until Monday.

 

How bad is the bill? I’d chalk it up as a lesson learned if it’s not bad. If it is, appeal. That’s subjective to each person’s situation though.

 

It's not that bad; it just hit me at the worst moment due to an error in my "head of household" situation where I'm getting a lot deducted for taxes on my paycheck + my significant others college + my new apartment + my HOA and father in laws expenses at my house.

It couldn't be a worse moment than it is.

 

Appealing will buy you a lot of time. You know how VA appeals work, this time the delay might be a good thing!