This eBook will teach you how to get C-Files (paper and electronic) from the VA Regional Office.
How to Get your VA C-File


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    • "Blue Screen of Death" at VAOIG
      Again.  This time: WASHINGTON — A Senate investigation of poor health care at a Veterans Affairs Medical Center in Tomah, Wis., found systemic failures in a VA inspector general’s review of the facility that raise questions about the internal watchdog’s ability to ensure adequate health care for veterans nationwide. The probe by the Senate Homeland Security and Governmental Affairs Committee found the inspector general’s office, which is charged with independently investigating VA complaints, discounted key evidence and witness testimony, needlessly narrowed its inquiry and has no standard for determining wrongdoing. One of the biggest failures identified by Senate investigators was the inspector general’s decision not to release its investigation report, which concluded two providers at the facility had been prescribing alarming levels of narcotics. The facility's chief of staff at the time was David Houlihan, a physician veterans had nick-named “candy man” because he doled out so many pills. STORY FROM TOURISM AUSTRALIA Take a 360 trip to meet Australia's wildlife Releasing the report would have forced VA officials to publicly address the issue and ensured follow up by the inspector general to make sure the VA took action. Instead, the inspector general’s office briefed local VA officials and closed the case. A 35-year-old Marine Corps veteran, Jason Simcakoski, died five months later from “mixed drug toxicity” at Tomah days after Houlihan signed off on adding another opiate to the 14 drugs he was already prescribed. The 350-page Senate committee report obtained by USA TODAY also chronicles instances where other agencies could have done more to fix problems at the Tomah VA Medical Center, including the local police, the FBI, DEA, and the VA itself, but it singles out the inspector general. “Perhaps the greatest failure to identify and prevent the tragedies at the Tomah VAMC was the VA Office of Inspector General’s two-year health care inspection of the facility,” the report concludes, adding that despite the dangerous drug prescriptions, the IG did not identify any wrongdoing. After news reports chronicled Simcakoski’s death last year, VA officials conducted another investigation with very different results and ousted Houlihan, a nurse practitioner, and the medical center’s director. “In just three months, the VA investigated and substantiated a majority of the allegations that the VA OIG could not substantiate after several years,” the committee report notes. Sen. Ron Johnson, R-Wis., chairman of the committee, which is holding a hearing on the findings in Tomah on Tuesday, told USA TODAY the failures were "systemic" and indicative of a troubling pattern. "The reasons the problems were allowed to fester for so many years is because in the inspector general's office, for whatever reason, for years, the inspector general lacked the independence and had lost the sense of what its true mission was, which is being the transparent watchdog of VA system," he said. The conclusions echo other recent findings about the office tasked under federal law to be an independent watchdog exposing problems at the VA and making recommendations for improvement. The Office of Special Counsel, a federal agency that reviews whistleblower reports of wrongdoing, issued blistering critiques in recent months of the office’s investigations in Illinois, Louisiana, and Texas, which it said were incomplete and overly narrow. USA TODAY also has reported that the VA inspector general failed to release the findings of 140 health care investigations and sat on the results of more than 70 wait-time probes for months. While a new inspector general, Michael Missal, took over the office last month andpromised comprehensive investigations and greater transparency, the lead investigators on health care remain in place, including John Daigh, the physician who made the decision to keep the Tomah report secret. Assistant Inspector General for Healthcare Inspections John Daigh. (Photo: MANDEL NGAN, AFP/Getty Images) A spokesman for the Office of Inspector General, Mike Nacincik, said Friday that IG officials had not finished reviewing the Senate report and so could not comment on the findings. But he said that at the time, Daigh felt it was appropriate not to release the Tomah report when it was finished in 2014 because the investigation did not substantiate wrongdoing. “The OIG has learned important lessons from the Tomah VA Medical Center health care inspections,” Nacincik said. Daigh’s office opened its Tomah investigation in 2011 after receiving complaints that Houlihan and a nurse practitioner, Deborah Frasher, were prescribing “massive doses of opiates to veterans with post traumatic stress disorder” and employees feared retaliation if they raised concerns. The complaints also said some patients kept getting early refills, suggesting they were abusing or selling their medications. Little progress was made on the case until February 2012, when Alan Mallinger, a physician in the inspector general’s Washington, D.C., office, was put in charge. It was his first case as lead investigator, the Senate committee found. Over the next two years, he and his team conducted dozens of interviews, pored through more than 225,000 emails and analyzed opioid prescription rates at hospitals and clinics across the Great Lakes region. But they didn’t look into whether Houlihan and Frasher were prescribing opiates in dangerous combinations with other drugs – something the VA later concluded was rampant. One of the inspector general’s employees who reviewed charts from patients of Houlihan and Frasher actually noted during the investigation “A LOT of polypharmacy – patients on both uppers and downers, would really love to have a pharmacist look at some of these combos.” But that didn’t happen because it was outside the scope of the investigation. “The allegation that we had was that he was using opioids to treat PTSD, and that was the allegation we looked at,” Mallinger told Senate investigators. They did have independent experts listen to audio of interviews with former Tomah pharmacists who recounted dangerous amounts of narcotics prescribed at the facility and said Houlihan would get hostile if they didn’t fill them. The experts told Mallinger’s team they were alarmed by what they heard. One said the facility could be in danger of losing its DEA license. But Mallinger said his team did not have those experts review prescription data and could not independently corroborate the concerns with evidence and so discounted them. “It was not valuable in terms of supporting allegations,” he told Senate investigators. In the end, the IG didn’t have a standard for deciding when to substantiate allegations and instead decided ad hoc by committee. Their report, released after intense media scrutiny last year, concluded Houlihan and Frasher were among the highest prescribers of opiates in a multistate region, raising "potentially serious concerns." But those conclusions “do not constitute proof of wrongdoing,” the report concluded. The IG investigation team had intended all along to publish a public report on the findings, but Daigh decided instead to brief local VA officials and close it privately. “I do not publish reports that repeat salacious allegations that I can’t support,” he told Senate investigators. “So to write a report with all sorts of accusations that I can’t support and throw that into a small community destroys the community and destroys the VA.” After the report was released last year, a separate VA clinical review found Houlihan had failed to meet standards of care in 92% of cases and Frasher failed in 80%, according to a VA report provided to the Senate committee. Houlihan and Frasher could not be reached for comment. Houlihan's lawyer did not respond to a message seeking comment. Houlihan defended his record in an interview with WKOW in March. "I am a good doctor, I do care very much for my patients," he said. "There is a need for good care, great care for our veterans and I think my record really has shown that I've done that." Nacincik, the spokesman for the new inspector general, Missal, said he is reviewing the office’s operations “with an eye towards making enhancements.” “We believe that our actions will enhance OIG investigations and increase the confidence that veterans, veterans service organizations, Congress and the American public have in the work of the OIG,” Nacincik said.
    • Mental Health C&P
      jlduty, I know I'm only one of a million Vets getting the shaft, but knowing that sure doesn't make me feel any less penned in and segregated from the herd.  Learned this weekend that I now have one less person to talk to, he thinks I talk too much, rambling on, and so forth.  At what age does a son stop seeking his Father's approval? Or is that something that you either have or don't have? I can recall only 2 C&P exams that I felt good about, and they were the 2 that got me bumped up in the past year or so.
    • Sleep Apnea Claim
      Yeah, SA is pretty much a half or nothing, or all or nothing kinda deal.  Which is one of the main reasons the VA probably resists it so much. I think SA or OSA with out Cpap should be 30%, with = 50% and O2 added in should be 70-100%, or  something like that.   Semper Fi
    • Question about NOD wait time after applying.
      Buck; im sorry but inhale to disagree with you regarding 'if the DRO says he will get back to you in 60 days that's not good'. Several factors play out in a DRO hearing. Not all DRO's are the same. My case in point. I had a 'stand in' DRO. WACO told me after speaking to my DAV rep that they are back logged regarding getting a decision. Some hearings go well and they are decided right away. I know for a fact after my hearing my case basically went and sat on a desk awaiting a DRO to review it.  My DAV rep spoke to the DRO who held my hearing and they indicated they are looking at 6-12 months for a decision. i know many years ago you had a quick turn around but not the case for all.    Wayne; unfortunatley you have to go through the process Lima most of us that had a lousy rater. My rater never looked at the evidence. He took this one examiner's two sentence note stating my injuries were not S/C. That foot never even looked at me. This was a medical opinion!  I have the evidence and I have more evidence as well. I got a lot of advice on this site. I chose an informal hearing BTW.   YOU WILL HAVE TO LEARN PATIENCE WITH THIS PROCESS!!! i know you know you should have been rated and most of us are or have been in the same boat   I've been waiting since the day I filed back in November 2014  I did inquire after one year like I stated in my earlier response to you   best of luck!  
    • Sleep Apnea Claim
      There is nothing between 50 and 100%.  You can get: Persistent day-time hypersomnolence ................................... 30   Travis  
    • Footnote One Nehmer (A0)
      38 CFR 3.307 (a)(2) is thrown out the window. They treated me for malaria, but just like described in all medical journals, when a victim is already infected, they "will have a reaction to chloroquine". The VA is denying every reason for me being hospitalized for a month. i told them before I was even admitted as an inpatient that I was eaten alive by misquotes because I had no net the first night or two in the Delta. A month for a chloroquine reaction? Really? Who would believe that? An entire month? A few hours, even a day, but a month? No what! sorry Berta, but it is still just a cover up, hiding the facts, and denying a large retro pay. That is all it has ever been.  Whem my claim was denied, they said Agent Orange "DID NO DAMAGE", and there was "THERE IS NO CAUSAL RELATIONSHIP YET ESTABLISHED///stop there. "Yet established". My claim was denied because they knew in 1968 that the diseases in the Delta were rampant, to the point it was affecting military operations. So, in my denial they did not list a single presumptive condition that is now law. Not one. Nothing was coded.  Time to lawyer up it seems. The VA is wrong, and every last cent I have will be spent proving it, it looks like. Time for the media!
    • Question about NOD wait time after applying.
      II will add this  if your homeless and have or show good reason you need your claim adjudicated  for hardship  they are suppose to speed up/ Expedite   your claim within 30 days.  other than that  they will take there time... The process of changing over to the digitized world is what is slowing down all the claims now...hopefully next year the change over will be done.
    • Question about NOD wait time after applying.
      Wayne Usually after you send in your NOD Request  DRO Hearing  it depends on how many  hearings is ahead of you?...I was let known about my Hearing in 2 months  when an where and time it would be after I sent in my NOD requesting the DRO Hearing.  but it just depends on how busy they are...my last claim  Waco RO sent my claim to Salt Lake City to have a decision made...this was last Jan/Feb 2016 The only explanation I can give  is the rater that read what your C&P examiner wrote down  ''skip your evidence'' he must not have read it?, ...what was their reason for denying your claim the first time? Anyway this is why we Have the DRO Hearings  its better to get your claim decided at the RO Level than wait in line at the BVA.  So the DRO can sort through all this and read your evidence you have now & Listen to you. and its your chance to tell him what you had at your C&P Exam ''clear evidence was right in front of him/her'' why was I denied?? you mention/ show a DRO that and I'll guarantee you will walk out of there knowing that your going to win your claim or increase or what ever....evidence is the whole key to winning your claim. Usually if a DRO Says I'll let ya know in 60 days  after your hearing this is not a good sign  because there unsure of a decision...and it could take a year or two or three. if you don't hear from them in 60 days after your hearing  I'd bug the hell out of them. until I got results.  you can say you did your part now do your part and make a decision on my claim  so that other veterans can get there claims adjudicated as well. Thank you Sir. Its just that some raters & C&P Examiners choose not to read it. I ask a DRO at my hearing one time after the Hearing was over  I ask him why in the hell didn't the C&P Doc read all my evidence?  and by him not reading it obviously I was denied...I ask him what will happen to that examiner? will he get fired? he said probably not...I said well what about all the lies he stated at my exam  will those documents go into my C-FILE ? HE SAID UNFORTUNATELY Yes they will but will never be used against you in any claim you file as this has been adjudicated  once adjudicated they can't go back.

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nanaeris

Va Doctor Did Not Have Service Medical Records

6 posts in this topic

I am in the process of going through the Appears process for an increase for bilateral knee disability. I think some of you will remember when I asked about a CUE claim about 6 month ago. I have been going through my C-File for evidence. I was discharged in November 1974. I filed a claim in 1975. I am looking at the VA C&P exam results for Osgood Schlatters Disease. The Rating Decision stated the Evidence of Record is insufficient to substantiate the clain aggravation of veteran's pre-service knee condition and the Veterans was hopitalized for myocarditis subsequent to to service. In 1999 when I reopen the case. The VA wrote me and ask me if I had a copy of my Service Medical Records because they would have to send and request them from the Air Force. I am getting the impression from this that the 1976 decision was made without my service record. I am considering filing a CUE claim based on the fact that all the evidence was not before the Rating specialist. I was granted service connection in 2001 after a long and hard fight. Also when the VA denied me for Myocarditis they fell to realize that the claim was filed within the presumptive period. My understanding is this condition is considered to be one of the presumptive condition and the VA failed to recognized this. Although I was considered to be one of the lucky ones be cause I did not have any permanment damage to my heart i was still disabled for about 3 months. Although the VA still denied my claim in 1999 I won the case on appeal. At the time I did not know about asking for an eariler effective date. My question is should I asked the V A to CUE themselves and with this kind of clear evidence, do you think the VA will still try to drag this out because it is very clear they did not have my service medical records and made a decision without this knowledge. Any advice with be greatly appreciated. I don't think I will be able to CUE this claim until I get through the current appeal concerning my knee disability. This involve where the VA had rated my knee disability un range of motion using limitation of flexion but my last C& P exam the doctor stated my range of motion under limitation of extension is limited to 20 degrees which would give me 30%. I did not think this would be such a problem if the doctor stated this in his C&P exam report. Any insight on the range of motion limitation which change for flexion to extension. I can't see the problem and the VA will not give me a clear and percise answer. this has been going on over 3 years. When I responded to the SSOC, I pointed out to the VA what the chart they had on the SSOC stated and that if another DC in this case 5261 would give me a higher rating the VA should revied the rating and what the GC stated about rating knee disabilities. I know this is the wrong forum for the last part of this topic but I have learned so much and how much research is required is to get the VA to get it right from this web site and froums. Thank again everybody for all the help. Since I join this form my percentage has went from 40% to 60%.

nanaeris

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nan,

I think you would be going about it the wrong way in filing a CUE claim for your EED.

If you have SMR's / STR's that were not of record in the original decision, that

are strong enough to have gotten an issue granted SC, then I would file a 21-4138

and refer to 38 CFR 3.156 © and request the EED due to these records.

CUE is a much harder ladder to try and climb.

JMHO,

Hope this helps a vet.

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Actually, if your claim(s) were static, (no change etc.) --- After a number of years, the VA may return your service records to the custodians. (Usually at the ST Louis Mo center) I was able to sort of trace mine from an original VA medical records request, then back to the repository for several decades, then to the VARO that is handling my current claims. It's really difficult to prove that the VA did or did not look at the appropriate records in making a decision. Often, a statement of case (SOC) is a cut and paste document, with language so general that it's actually almost useless to a veteran. I always felt that the repository should send the VA a "certified copy" rather than the original document. Fairly recently, the service record custodians were complaining that the VA was returning incomplete service records to them.

I am in the process of going through the Appears process for an increase for bilateral knee disability. I think some of you will remember when I asked about a CUE claim about 6 month ago. I have been going through my C-File for evidence. I was discharged in November 1974. I filed a claim in 1975. I am looking at the VA C&P exam results for Osgood Schlatters Disease. The Rating Decision stated the Evidence of Record is insufficient to substantiate the clain aggravation of veteran's pre-service knee condition and the Veterans was hopitalized for myocarditis subsequent to to service. In 1999 when I reopen the case. The VA wrote me and ask me if I had a copy of my Service Medical Records because they would have to send and request them from the Air Force. I am getting the impression from this that the 1976 decision was made without my service record. I am considering filing a CUE claim based on the fact that all the evidence was not before the Rating specialist. I was granted service connection in 2001 after a long and hard fight. Also when the VA denied me for Myocarditis they fell to realize that the claim was filed within the presumptive period. My understanding is this condition is considered to be one of the presumptive condition and the VA failed to recognized this. Although I was considered to be one of the lucky ones be cause I did not have any permanment damage to my heart i was still disabled for about 3 months. Although the VA still denied my claim in 1999 I won the case on appeal. At the time I did not know about asking for an eariler effective date. My question is should I asked the V A to CUE themselves and with this kind of clear evidence, do you think the VA will still try to drag this out because it is very clear they did not have my service medical records and made a decision without this knowledge. Any advice with be greatly appreciated. I don't think I will be able to CUE this claim until I get through the current appeal concerning my knee disability. This involve where the VA had rated my knee disability un range of motion using limitation of flexion but my last C& P exam the doctor stated my range of motion under limitation of extension is limited to 20 degrees which would give me 30%. I did not think this would be such a problem if the doctor stated this in his C&P exam report. Any insight on the range of motion limitation which change for flexion to extension. I can't see the problem and the VA will not give me a clear and percise answer. this has been going on over 3 years. When I responded to the SSOC, I pointed out to the VA what the chart they had on the SSOC stated and that if another DC in this case 5261 would give me a higher rating the VA should revied the rating and what the GC stated about rating knee disabilities. I know this is the wrong forum for the last part of this topic but I have learned so much and how much research is required is to get the VA to get it right from this web site and froums. Thank again everybody for all the help. Since I join this form my percentage has went from 40% to 60%.

nanaeris

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This was my orginal and first claim when the doctor made the decision and did not refer to my Service Medical Records. I thought after the first decision was denied the information would have been added to my C-file. The doctor and the Rating specialist did not refer to any thing in my Service Medical records. The doctor stated he did not have enough information to determine if my supposely pre-existing osgood schlatters disease was aggravated or not by military service. As for the heart condition, the only thing the doctor stated was he could not determine if I had permernat damage from rheumatic fever. In other words it was possible but he could'nt tell. I thought after the inital determination the information was part of the C-file. On this matter of the supposely Osgood-schallter disease the doctor stated this was unusual for a individual of my age to have osgood-schllatter disease because I was 24 years old. This is another matter I would to know about. I went into the Air Force when I was 20 years old my induction Physical did not indicate I had any thing wrong with my knees. I had other problems with my knees such as patella tendonistis, chondromalacia from injuries during some type of training and playing basketball. I had been in the military 2 1/2 years before the doctors told me I had this condition and I had it before I entered the military. The only thing I told the doctors when they asked me whether I had any knee injuries before I entered the service and I stated I injuried my knee while playing basketball when I was in the 11th grade. How they got osgood schlatters disease from this I don't know. Although I had seen orthropedics doctors for my other injuries and had x-rays they didn't state I had this condition. It was 2 1/2 years latter that the doctor at the Air Force clinic in Okinawa told me I had this condition. When I went to March AFB for an evaluation by another Orhopedic doctor he stated I had chondromalacia and patella tendonistis. The two MEB stated the condition was permanment aggaratavate by military service and after a hospital stay was able to return to duty and to wait for orders. Then they call me back to the hospital and told me I would have to finish my tour in Okinawa. The treating orthropedic doctor stated I was able to return to work without any limitations. I was then sent back to the barracks to wait for orders. After about 2 weeks I was called back to the hospital and told I would have to wait for a PEB. The PEB disagreed with the two MED and stated I had this condition and it wasn't aggravated by military service. I was told about five years ago the reason this happened the military was downsizing after Vietnam and the just found a way to get you out of the way with out paying you disability retirement because they had rated my knee disability at 20% and didn't rate my hearing loss although it appeared on my profile as a 2 which mean they knew about it and they didn't rate the heart murmur discovered while I was stationed in Okinawa because if they had rated either one at 10% combined with the 20% for knee disability they would have had to give you disability retirement. So what they did is stiffed you. If all this is true is there any thing I can do about it or is it two late and I just have to keep fighting with the VA? It is very easy to prove that I didn't have Osgood-schlatters disease before I entered the military and hearing loss and heart murmur is part of the record.

Thank you again,

nanaeris

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If the VA made a legal error in any past denied claim you have had, then you could file a CUE claim on it.

The error however must have manifestly altered the outcome-

meaning their error cost yo compensation.

There is considerable info here on CUE claims and many BVA decision posted that show how they can succeed and why many fail.

It has to be a legal error in a final decision that involves the regulations at time of the alleged CUE.

This was my orginal and first claim when the doctor made the decision and did not refer to my Service Medical Records."

Were they missing? If so the recent post here in Claims Research regarding Evidence (from Allan) might help you.

Or search hadit for "newly discovered Service Records" as this might be better approach then CUE claim.

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Sec. 3.156 New and material evidence. (a) General. A claimant may reopen a finally adjudicated claim by submitting new and material evidence. New evidence means existing evidence not previously submitted to agency decisionmakers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. (b) Pending claim. New and material evidence received prior to the expiration of the appeal period, or prior to the appellate decision if a timely appeal has been filed (including evidence received prior to an appellate decision and referred to the agency of original jurisdiction by the Board of Veterans Appeals without consideration in that decision in accordance with the provisions of Sec. 20.1304(b)(1) of this chapter), will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period. © Service department records.(1) Notwithstanding any other section in this part, at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim, notwithstanding paragraph (a) of this section. Such records include, but are not limited to: (i) Service records that are related to a claimed in-service event, injury, or disease, regardless of whether such records mention the veteran by name, as long as the other requirements of paragraph © of this section are met; (ii) Additional service records forwarded by the Department of Defense or the service department to VA any time after VA's original request for service records; and (iii) Declassified records that could not have been obtained because the records were classified when VA decided the claim. (2) Paragraph ©(1) of this section does not apply to records that VA could not have obtained when it decided the claim because the records did not exist when VA decided the claim, or because the claimant failed to provide sufficient information for VA to identify and obtain the records from the respective service department, the Joint Services Records Research Center, or from any other official source. (3) An award made based all or in part on the records identified by paragraph ©(1) of this section is effective on the date entitlement arose or the date VA received the previously decided claim, whichever is later, or such other date as may be authorized by the provisions of this part applicable to the previously decided claim. (4) A retroactive evaluation of disability resulting from disease or injury subsequently service connected on the basis of the new evidence from the service department must be supported adequately by medical evidence. Where such records clearly support the assignment of a specific rating over a part or the entire period of time involved, a retroactive evaluation will be assigned accordingly, except as it may be affected by the filing date of the original claim.

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