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? for Veterans using the VA

EL34

Sergeant
Full Member
Minuteman
Jan 25, 2011
194
2
AR
I'll try to make this as short as possible, little bit of back story. Approximately 20 years ago I got hurt on an FTX, and was rated 0% upon ETS. My first few visits to the VA, were disappointing at best, usually an air-cast, and some ibuprofen, and a $50 charge, so I just quit going. In the last year or so, my old injury has gotten worse, and it's caused or exacerbated some other areas. So, finally they have agreed to some MRIs, X-rays, and an Ortho consult outside of the VA system. Now all of this is service connected, so here is my question.......Are they justified in dinging my insurance for all this?
I have filed a claim to up my percentage from 0%, to something higher though who knows if they are even going to give me anything for it. Just been an extremely frustrating experience.
 
50.00 sounds like a co-pay fee, which is rated by whatever division you are in per your income. Stop in and talk to accounting at the VA,and have them explain better than I can to you what that means. Not sure how they work going to outside of VA.

You might be getting dinged on your insurance by using an outside the VA clinic, again check with VA accounting and they will explain the charges.
I go to the VA and have all my shit done with no co-pays larger than 50 bucks. Never a charge against my other insurance either.
 
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Sounds like they are doing an ortho work up for your claim. I have been sent to outside ortho sources in the past for my injuries. Never knew why but they forwarded info to VA. Also for hearing issues. If they are using your insurance there is probably some kind of reciprocation to be reimbursed after claim is settled. Most of the VA system is flooded right now. They are under a boat load of scrutiny from every alphabet org. out there and for every reason. From care quality, quality/ cleanliness of facilities to wait time. My local patient office is back logged for months. But they can only schedule X number of appointments per day to keep you from sitting in waiting room for 2 hours. I know there are problems but many of them are regulation created and the rest are MONEY related. This could become a VA bashing thread, not my intention. I would recommend making a phone call to your VA advocate. He will be able to answer your questions or get them. The ones I have dealt with over the last 25 years have been good people.
 
Thanks guys. Not my intention to bash the VA, I think we all know the problems they have so no use going over them here. I just thought for service connected injuries, that it was on them, my insurance, nor I should have to pay anything for them?
 
You`re faced with the same situation I was in before I retired..... I had good ins. at work...my wife had ins. where she worked and I had the VA tooo..... they would fight amongst themselves and me on who was gonna pay what....
Your problem is you`re dealing with the ins. companies and beauracrcies .
You should be drawing some kinda disablility from the gov. if not...get that done...it will pay in later years...
Now I use the VA exclusively and it works......... try to do the same....
 
Okay, here's the deal. If you were 0% rated from such and such date to such and such date (my medical ETS in '04 garnered me a 0% rating, that I could have appealed, but was made fully aware it could take two years --during which time I'd have ETS'd nomrally. So I opted not to appeal it. VA got me rated 30, 60, 75 and now I'm finally rated 100% and unable to work. I also got SSDI, and by all accounts, I was approved extremely fast and on the first application --just a few months passed.

So out of the blue 9 months ago I get a letter from DOD saying they screwed up the medical board and that everyone was basically given 0% the first time! So they got caught, and now they are reviewing your ETS board file in addition to any medical evidence you can submit (from VA or civilian doctors) --in essence, they are now considering not just the military medical records, but everything from then until now, which can likely give you a significant increase in your military rating.

However, you won't be getting additional pay. Pay is capped to whoever pays the highest I think, so if VA pays you more than military will, you'll only get the VA check if I'm reading it right. If you haven't gotten this letter, you need to look into it.

I've been round and round with VA, it's a full time job if you're damaged enough. Folks with good things to say about VA likely haven't been admitted or had to go through the byzantine system for more indepth healthcare (which is dubious to say the least).

As for them dinging your insurance, I tell them I have no insurance outside the VA. And I really don't, just SSDI. I do use a civilian pain doc, as the VA just totally screwed that all up. They're one horror story after another.

They mention you getting checked out by a doctor outside the VA, a third party, in order to "speed things up" to usher along your claim. These guys are half assed and I'll never go back to one again. You DO have the right to request an in-house VA doctor to look you over. You don't HAVE to go to the one they try to send you to.

If you haven't, you need to get set up with American Legion (who I use) or some other advocacy group. They know how to navigate the VA and get shit done when you can't. See, if you miss one of these comp and pen. exams, they only use whatever they have to come to a decision. You'll need to contest their decision to send you to a third party and it works best when using a liaison like the Legion, etc. They usually go out of their way to help you.

Good luck, and if you have any other questions or specific questions and I can help, PM me and I'll do my best. But my best advice now is to get aligned with an advocacy group and get ahold of one of those letters that allow you contest the military's findings. File increases in your claim, if you're service connected disabilities do in fact get worse and affect quality of life, you are entitled to compensation. You earned it, it was part of the dotted line.
 
Thanks for the info guys! I did file to increase from 0%, and I had to get the DAV to help me, some of this stuff is esoteric as hell. I'm not completely sure why the let me go outside the VA system, but I did make them let me pick the Dr., thing is that MRI showed quite a bit of damage, and it's possible it's been like that since the '91-92 time frame. Oh, one other thing, all this began rolling before I even filed for the increase, not sure what that means. I'll call my DAV guy tomorrow, and see about that letter too.
Stryker, thanks for the offer, I may have to take you up on that, it's nice to have some intel from someone who has BTDT sometimes.