Vac claim. Questions

[Pathfinder17]

Hello ice been released now for about 6 months.... Have claims in with vac since July somfor about 7 months and haven't hears a thing from tthm I know they JUsT received my med files and are reviewing them. I'm having to pay for my mess on my
Own etx right now and I know they will not reimburse my receipt. Can anyone give me advice on how
Long my decisions will take for them to make and when I will see support from them as in health coverage and also my
Pay out (that sounds bad but it's true) thanks

 

[Pathfinder17]

I will also add I served for 7 years in recce with a tour in afghan. And was diagnosed with ptsd and also tinnitus. And I go to an osi clinic for the past 6 months and I know bugging vac won't help, but I haven't heard much from progress, and I just am struggling with payments for
Medications and shit like that. Any info or related questions would help tonnes or advice.
I served as a mcpl in recce and on tour, and qualified pathfinder so I'm not used to making this claim shit although it's just adding up now and I'm wondering what my next step should be. Thanks. And if anyone needs to private msg me I'll shoot my email or phone # for advice.

 

[blackberet17]

Hi Pathfinder17.

Bugging VAC never hurts. Squeaky wheel gets the grease, etc.

The turnaround time (TAT) is 16 weeks (down from 24 weeks) from the time VAC receives of all the documents required to complete your application. This is what is posted on their Web site as relates to their service standard.

Although you've had claims in with VAC since July, the 16-week clock didn't start then. If they "just" received your service medical files, this is when the 16-week clock - in theory - has begun.

With regards to your disability assessments - should your applications be favourable - there's no way to say how much you will be assessed. It all depends on your degree of disability, and what is determined from your medical reports.

An average favourable decision for tinnitus carries a 6% assessment (Medical Impairment rating of 5, plus Quality of Life Level 1, total assessment of 6%), which is approximately worth $15,000 (2014 Table payouts).

It is more difficult to say how much you could be assessed for a favourable decision on your PTSD. You could be as "low" as 10%, and I've seen assessments in the 50% and above. It all depends on how bad your PTSD is...which we won't get into here.

If they just received your medical documents, you "should" hear something by March 2015, end April at the latest.

Feel free to pm me with any more questions.

 

[ixium]

Is there something that says it has to be done within those 16 weeks?

My 16 weeks was up early December, called them a couple times, and it's gone to a special board now that focuses on cases that are behind. Atleast that was what I was told yesterday.

 

[blackberet17]

Is there something that says it has to be done within those 16 weeks?

My 16 weeks was up early December, called them a couple times, and it's gone to a special board now that focuses on cases that are behind. Atleast that was what I was told yesterday.

VAC 2012-13 service standards and results: http://www.veterans.gc.ca/eng/about-us/service-standards

VAC must also report to parliament, through ACVA (Standing Committee on Veterans Affairs), as to how it is meeting its service standards. Ditto for VRAB, which has a quicker TAT of providing a written decision six weeks from the date of the hearing.

Each case, of course, is different. It may take longer to receive all the information required, to get a medical opinion, etc.

 

[ixium]

Ahh, just unlucky I guess.

My medical info was there in August, and they needed no extra info.

 

[reccecrewman]

An average favourable decision for tinnitus carries a 6% assessment (Medical Impairment rating of 5, plus Quality of Life Level 1, total assessment of 6%), which is approximately worth $15,000 (2014 Table payouts).

Just as an add to this - If you require a masking device for your tinnitus, that will bump the percentage up to 11% or $30,000 (2014 Table payouts).  The 6% is the base assessment for a tinnitus pension, but should your tinnitus be severe enough that you need a masking device (A hearing aid that plays bells in the background to drown out the tinnitus) then your impairment rating goes up.

 

[thunderbolt]

I'd like to know more on VAC timelines as well...
Recently was reassessed for Tinnitus to go from 6% to 11% and given money but denied for a masking device. Just doesn't add up!

 

[Occam]

I'd like to know more on VAC timelines as well...
Recently was reassessed for Tinnitus to go from 6% to 11% and given money but denied for a masking device. Just doesn't add up!

If your audiologist didn't prescribe or recommend the trial of a hearing aid or masker to manage your tinnitus, then VAC won't authorize one.

 

[upandatom]

I dont get how they justified the lump sum payments. Although even with my application in, and not quite released(7 days away) I was contacted by a Case Worker, wrt to them still being able and willing to pay for rehabilitation, which boggles my mind because a decision has yet to be reached.

How does this work?

 

[blackberet17]

I dont get how they justified the lump sum payments. Although even with my application in, and not quite released(7 days away) I was contacted by a Case Worker, wrt to them still being able and willing to pay for rehabilitation, which boggles my mind because a decision has yet to be reached.

How does this work?

Would you clarify your question, please?

Lump-sum payments are for disability award entitlements, under the Canadian Forces Members and Veterans Re-establishment and Compensation Act (aka the NVC).

The "rehabilitation" you refer to, I assume vocational rehab, is a separate benefit under the NVC, for which you may qualify if you are being medically released from the CAF.

http://www.veterans.gc.ca/eng/services/transition/rehabilitation

If you mean, is your eligibility for voc rehab tied to having a decision (yay or nay) on your disability award application, ask the Case Worker, they should know!

In any case upandatom, wait out. I'll ask around

 

[upandatom]

Would you clarify your question, please?

Lump-sum payments are for disability award entitlements, under the Canadian Forces Members and Veterans Re-establishment and Compensation Act (aka the NVC).

The "rehabilitation" you refer to, I assume vocational rehab, is a separate benefit under the NVC, for which you may qualify if you are being medically released from the CAF.

http://www.veterans.gc.ca/eng/services/transition/rehabilitation

If you mean, is your eligibility for voc rehab tied to having a decision (yay or nay) on your disability award application, ask the Case Worker, they should know!

In any case upandatom, wait out. I'll ask around

My fault, I mixed two questions.

1. I dont get how they justified switching to a Lump Sum Payment, unless the book keepers saw it as a major change in cost?

2. I was contacted by my case worker, stating I am allowed to put in claims for my right knee, for physiotherapy. How is this possible, when I havent recieved word about the decision on my claims yet?

 

[blackberet17]

1. I dont get how they justified switching to a Lump Sum Payment, unless the book keepers saw it as a major change in cost?

The financial compensation is one reason.

Another is the Pension Act had not received any significant changes/updates/upgrades since its last major revision in 1985.

In any case, the PA and the NVC are actually very similar. The biggest we (current and ex service members) see is the monthly to lump sum payment.

The whole idea, aside from bottom dollar, was this "plan" to have a pension system which was more "fiducially responsible", but "better" to meet the needs of Canada's newest generation of serving members and veterans...

Like I said, last major revision in 1985...but even then, the PA was itself has its roots in the Soldier Settlement Act (1917), Soldier's Civil Re-establishment Act (1918), War Veteran's Allowance Act, etc. So, as you can see, some pretty outdated stuff, with outdated policies which no longer met the modern veteran's needs.

**Edit to add**: There was also a desire to move to a system comparable to a worker's compensation. Now, I don't know how those work, I've never (touch wood) had to access such a thing, so...

2. I was contacted by my case worker, stating I am allowed to put in claims for my right knee, for physiotherapy. How is this possible, when I havent recieved word about the decision on my claims yet?

Hunh. Interesting. Your question may be more specific than I can dig into (Privacy Act, etc.), but I'll see what I can find out general terms.

 

[thunderbolt]

If your audiologist didn't prescribe or recommend the trial of a hearing aid or masker to manage your tinnitus, then VAC won't authorize one.

That is what confuses me...A prescription was sent with the reassessment documentation. Part of the new level of disability refers to "requires Continuous tinnitus, present all day and all night, every day, affecting one or both ears, and has been prescribed a masking device and/or other prescribed modalities"

I was totally expecting no lump sum settlement because my Audiologist called telling me my claim was denied before I got any mail. First letter gave me a settlement and second letter denied claim for masking device.

 

[Occam]

thunderbolt:  Did the denial letter offer any explanation for the denial?  If they upped you to 11%, and a prescription or recommendation for a hearing aid accompanied the claim, it's beyond me why you wouldn't be covered for the cost of hearing aid(s).  Very puzzling.

 

[thunderbolt]

I think I figured it out, but now have to wait for an appeal to fix it.
The denial letter listed that my hearing loss was insufficient to require a hearing aid. It wasn't for hearing loss, but as a masking device ...

We shall see how this works out. I'm just waiting to hear back for my 1st level review

 

[Occam]

I think I figured it out, but now have to wait for an appeal to fix it.
The denial letter listed that my hearing loss was insufficient to require a hearing aid. It wasn't for hearing loss, but as a masking device ...

We shall see how this works out. I'm just waiting to hear back for my 1st level review

Not sure if you understand the distinction, so I'll point it out - you don't want to appeal, you want a Departmental Review.  You can only appeal so many times.  You can have as many Departmental Reviews as it takes.  The Departmental Review would address their misinterpretation as to the purpose of the hearing aid.

You don't want to burn up an appeal for that - it's an administrative error. (The kind which they make way, way too frequently, unfortunately)

 

[thunderbolt]

Thanks! Maybe I chose my wording incorrectly. I've sent a letter requesting a 1st level review. So I guess not really an appeal?

 

[Occam]

If you call BPA (Bureau of Pensions Advocates - their number should be on your PFO letter), they can probably initiate the departmental review much faster than by you handling it by snail mail.

 

[thunderbolt]

Thanks!