Critical Injury Benefit
- Thread starter RobA
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No luck on the CIB, they dont consider role 3 and landshtule intensive care.
But, my re-assessment worked out, I dont know how they F'd it up so bad the 1st time. I was able to read through the tables in 30 minutes with my medical form and asses my self at double what they did.
And after their review it turns out I was right, they doubled their decision. Now im rated at exactly %100 though under the new charter. I think that opens new doors but there is not much information out there.
Sucks about the CIB though, but what can ya do.
But, my re-assessment worked out, I dont know how they F'd it up so bad the 1st time. I was able to read through the tables in 30 minutes with my medical form and asses my self at double what they did.
And after their review it turns out I was right, they doubled their decision. Now im rated at exactly %100 though under the new charter. I think that opens new doors but there is not much information out there.
Sucks about the CIB though, but what can ya do.
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dunlop303 said:
Earnings Loss, Permanent Impairment Allowance, etc. Best to talk to your Case Manager.
dunlop303 said:
Also, remember, CIB is ruled under Part 3 of the NVC, which benefits from appeal rights to the Veterans Review and Appeal Board. Before going that route, take advantage of the Departmental Review process, which the Advocates at BPA can help you with.
Hi All,
I'll share my experience with this so far. Had an MVA in an MSVS just outside Winnipeg. Broke my T12 and required a 5-disc spinal fusion to stabilize the vertebra. All told, I was in hospital for 13 days recovering and doing the (very) limited rehab the neurosurgeon would allow at the time.
Got sent home and was basically only allowed to breathe (no lifting more than 5 lbs) for 2 months, till the neurosurgeon cleared me to start physio. Physio took from June until the start of October.
I applied in early July and got a decision letter on Nov 10, 2015 that my claim was not approved. They cited med records from a follow-up with my military doc 2 days after my release from hospital saying that I was 'getting out every day walking' as one of the reasons for decision. I was 'getting out walking' with the physio an an aide, while wearing a hoist belt.
When I called VAC to inquire about this, I was told that there is further 'policy guidance' that defines what VAC considers 'complex' treatment. In this document, apparently neurosurgery and extended physio for rehab don't count as 'complex,' which honestly really puzzles my military doc, physio, and everyone else I have dealt with.
I'm not whining. I've got lots to be thankful for: 10 fingers, 10 toes, breathing air, no neurological compromise. However, in my view, if VAC is going to publish regulatory criteria and then negate those same criteria with concealed regulations, that violates the stated intention that the act 'shall' be liberally interpreted, generally in favour of the member, due to 'obligation.'
Anyhow, I have a request in to get the further 'policy guidance' documents, and will let you know how I get on with that. It looks like to address the decision I will have to file for a review board hearing through Bureau of Pensions Advocates.
Thanks for the thread.
I'll share my experience with this so far. Had an MVA in an MSVS just outside Winnipeg. Broke my T12 and required a 5-disc spinal fusion to stabilize the vertebra. All told, I was in hospital for 13 days recovering and doing the (very) limited rehab the neurosurgeon would allow at the time.
Got sent home and was basically only allowed to breathe (no lifting more than 5 lbs) for 2 months, till the neurosurgeon cleared me to start physio. Physio took from June until the start of October.
I applied in early July and got a decision letter on Nov 10, 2015 that my claim was not approved. They cited med records from a follow-up with my military doc 2 days after my release from hospital saying that I was 'getting out every day walking' as one of the reasons for decision. I was 'getting out walking' with the physio an an aide, while wearing a hoist belt.
When I called VAC to inquire about this, I was told that there is further 'policy guidance' that defines what VAC considers 'complex' treatment. In this document, apparently neurosurgery and extended physio for rehab don't count as 'complex,' which honestly really puzzles my military doc, physio, and everyone else I have dealt with.
I'm not whining. I've got lots to be thankful for: 10 fingers, 10 toes, breathing air, no neurological compromise. However, in my view, if VAC is going to publish regulatory criteria and then negate those same criteria with concealed regulations, that violates the stated intention that the act 'shall' be liberally interpreted, generally in favour of the member, due to 'obligation.'
Anyhow, I have a request in to get the further 'policy guidance' documents, and will let you know how I get on with that. It looks like to address the decision I will have to file for a review board hearing through Bureau of Pensions Advocates.
Thanks for the thread.
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Matsebula said:
Or request a Departmental Review by VAC, also done through BPA, before burning a level with VRAB.
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VAC has received some 350 applications to date of 30 Nov 15.
About 20% received a favourable decision so far, with another 130 or so in a "pending" status.
About 20% received a favourable decision so far, with another 130 or so in a "pending" status.
Hi blackberet17,
Spoke with BPA who have advised me that I need to circle back to my Disability Award application first. They awarded 10% for broken T12 but have withdrawn the two other conditions I claimed for (spinal fusion and scarring) apparently on my behalf. I will go back and ask that they adjudicate those conditions as well. How does an adjudicator have latitude to withdraw claimed conditions? The table of disabilities lays things out pretty clearly, I think. Why do they not just follow it?
After I've gone through that evolution, BPA lawyer wants to file a Departmental Review, as you've said. Have to say, I'm having difficulty understanding any of this process. It seems as though the markers are moving all the time and that all the criteria used to judge anything are highly subjective.
Spoke with BPA who have advised me that I need to circle back to my Disability Award application first. They awarded 10% for broken T12 but have withdrawn the two other conditions I claimed for (spinal fusion and scarring) apparently on my behalf. I will go back and ask that they adjudicate those conditions as well. How does an adjudicator have latitude to withdraw claimed conditions? The table of disabilities lays things out pretty clearly, I think. Why do they not just follow it?
After I've gone through that evolution, BPA lawyer wants to file a Departmental Review, as you've said. Have to say, I'm having difficulty understanding any of this process. It seems as though the markers are moving all the time and that all the criteria used to judge anything are highly subjective.
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Did the BPA rep provide reasons as to why they withdrew the spinal fusion and scarring applications? Off the top of my head - and with the usual caveat of not knowing nor getting into too many case particulars - scarring is not in and of itself a medical, pensionable/awardable condition, unless it is part of a skin condition, or due to gunshot/shrapnel and causes some form of impairment.
I'm not 100% either on the spinal fusion as a medical condition. Spinal fusion is a medical procedure used to correct a medical condition, such as a broken T12. Any disability resulting from the fusion would be related to the original reason behind said fusion, which is the broken T12.
An adjudicator has some degree of latitude in proceeding with claims as they have (in most cases, and I don't want to get into that debate here) some degree of medical expertise, and also have access via referral to medical practitioners who can review the claim and provide a medical opinion as to a service relationship, cause, etc..
Withdrawing a claim can work in the applicant's favour, providing you with time and iguidance as to what may be required to succeed in your claim, rather than the Department denying it due to lack of information, medical evidence, etc., causing you the applicant to go through possibly unsuccessful Departmental Reviews and then subsequent review and appeal levels at VRAB, due to lack of info, etc.
Also, the Table of Disabilities is used to assess the degree of disability resulting from a medical condition, and not used as a basis for awarding entitlement to a disability pension/award. The Department uses its Entitlement Eligibility Guidelines to such an end.
If you want to discuss particulars, feel free to pm me
I'm not 100% either on the spinal fusion as a medical condition. Spinal fusion is a medical procedure used to correct a medical condition, such as a broken T12. Any disability resulting from the fusion would be related to the original reason behind said fusion, which is the broken T12.
An adjudicator has some degree of latitude in proceeding with claims as they have (in most cases, and I don't want to get into that debate here) some degree of medical expertise, and also have access via referral to medical practitioners who can review the claim and provide a medical opinion as to a service relationship, cause, etc..
Withdrawing a claim can work in the applicant's favour, providing you with time and iguidance as to what may be required to succeed in your claim, rather than the Department denying it due to lack of information, medical evidence, etc., causing you the applicant to go through possibly unsuccessful Departmental Reviews and then subsequent review and appeal levels at VRAB, due to lack of info, etc.
Also, the Table of Disabilities is used to assess the degree of disability resulting from a medical condition, and not used as a basis for awarding entitlement to a disability pension/award. The Department uses its Entitlement Eligibility Guidelines to such an end.
If you want to discuss particulars, feel free to pm me
The scarring was considered part of the overall condition, and unless it caused impairment on its own it is included in the main condition.
Had a look at the EEGs, and they don't mention anything musculoskeletal per se, so I'm not sure what bearing they have on this condition. I know there are separate tables for lumbar and thoracic spine, and I know that my fusion touches both the lumbar and thoracic portions of the spine.
What frustrates me is that I now have 5 vertebrae fused and VAC is not keen to recognize that. Interestingly, I'm also dealing with WCB and their correspondence refers to 'burst frcture T12, post-surgical: T10-L2 fusion.' So WCB gets it, I'm just not sure I understand how VAC views it. My VAC contact mentioned she'd see if the fusion is admissible as a consequential claim following the T12 fracture, since the fusion resulted from the fracture. She is also inquiring about why the fusion was withdrawn, so we'll see what happens there.
There just must be a simpler way to manage this.
Had a look at the EEGs, and they don't mention anything musculoskeletal per se, so I'm not sure what bearing they have on this condition. I know there are separate tables for lumbar and thoracic spine, and I know that my fusion touches both the lumbar and thoracic portions of the spine.
What frustrates me is that I now have 5 vertebrae fused and VAC is not keen to recognize that. Interestingly, I'm also dealing with WCB and their correspondence refers to 'burst frcture T12, post-surgical: T10-L2 fusion.' So WCB gets it, I'm just not sure I understand how VAC views it. My VAC contact mentioned she'd see if the fusion is admissible as a consequential claim following the T12 fracture, since the fusion resulted from the fracture. She is also inquiring about why the fusion was withdrawn, so we'll see what happens there.
There just must be a simpler way to manage this.
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I thought as much on the scarring. Unless it's due to gunshot wound, etc., it will almost always be included in the main condition, unless it causes impairment. Something to keep an eye on, Matsebula, in case the scarring does cause limitations in your movement or what have you down the road.
To me, the fusion is a result of the fracture (rather obvious to me, but again, not a medical professional) - the fracture required (I assume) fusioning of the vertebrae IOT stabilize the joint. The problem may be that, from a medical standpoint, the fusion is a symptom of the fracture, and not in and of itself a medical condition. Apples to oranges, but the fusion may be viewed as the congestion (symptom) of the head cold (medical condition).
It is possible a medical opinion was obtained from one of the department doctors, who recommended the fusion be withdrawn, based on what I described above. Talk to your BPA rep and see if getting a medical opinion would be a good idea, in support of your claim, such as from the surgeon who did the T10-L2 fusion?
One question you may want to ask the surgeon is, is the fusion of the verterbrae causing any limitations over and above the limitations caused by the T12 fracture? He/she should be able to describe this IOT support your claim.
To me, the fusion is a result of the fracture (rather obvious to me, but again, not a medical professional) - the fracture required (I assume) fusioning of the vertebrae IOT stabilize the joint. The problem may be that, from a medical standpoint, the fusion is a symptom of the fracture, and not in and of itself a medical condition. Apples to oranges, but the fusion may be viewed as the congestion (symptom) of the head cold (medical condition).
It is possible a medical opinion was obtained from one of the department doctors, who recommended the fusion be withdrawn, based on what I described above. Talk to your BPA rep and see if getting a medical opinion would be a good idea, in support of your claim, such as from the surgeon who did the T10-L2 fusion?
One question you may want to ask the surgeon is, is the fusion of the verterbrae causing any limitations over and above the limitations caused by the T12 fracture? He/she should be able to describe this IOT support your claim.
Had a VRAB hearing yesterday on this as they don't really define 'complex treatments' very well under Criterion H. Definition 'may include but is not limited to' the examples noted. Hard to see how major spinal surgery wouldn't be considered complex, but then I don't think like VAC.
I'm certainly not holding my breath, but at least the decision from VRAB will be a real written decision based on legislation, policy, and actual reason instead of telling me I was 'getting out every day walking' when I was actually doing OT/PT in hospital with supervision and a hoist belt on.
I'm certainly not holding my breath, but at least the decision from VRAB will be a real written decision based on legislation, policy, and actual reason instead of telling me I was 'getting out every day walking' when I was actually doing OT/PT in hospital with supervision and a hoist belt on.
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