Nod/dro Va Obligations

[cannoncocker]

I have submitted a request for reconsideration to the VARO. They responded by requiring me to choose between the "normal appeal process" or the DRO Process. I selected the DRO process. They acknowledged this choice in writting. I then requested a personal conference with the DRO and submitted new evidence. I started the NOD request on 29 june 09. On 24 August I received a decision on 2 claim items that had been deferred and a rubber stamp denial of my lumbar injury denial. Completely in contradiction to submitted evidence, in writing from their Neurologist, on his stationary, and the approval of a fee basis epidural injection, which the VARO has denied ever happened.

So, the question is, Does the VA have any obligation regarding the DRO process, since they asked me to chose. Their decision came in the same form as the rest of the claim did. They did not accept my request for the DRO conference nor did they deny it. They did nothing but deny the lumbar claim with the same form as the other deferred claims (1 they approved, the other denied) using erroneous information regarding the lumbar injury.

I basically would like to know if they have any obligations regarding this or can they simply ignor it and in which case does anyone have a recommendation moving forward?

[cannoncocker]

Have you had a C and P exam for the back and neurological issues?

I see what they have done. Your back is maxed at 60.

You have to focus on the Sciatica. You need to get a medical opinion using the evidence you have that states your sciatica is directly resulting from your S1 Disk.

The MRI's wil help, do you have the report?

Now here is the kicker. Get your hands on your OR report. The OR report is a play by play of the events that happen during surgury.

It should tell exactly where the narrowing is.

This report was instrmental in my claim and folks who have had surgury should get copies of the reports.

You do not have to have new evidence to file a NOD. You do have to have new evidence to reopen a claim.

J

jbasser, thank you for your service to the country and in particular your service to this forum, the best resource I have found on the net or any place else for that matter.

Have you had a C and P exam for the back and neurological issues?

Kinda, the C&P exam did not really focus on my back, more my cardio vascular system. From the denial it stated some practioner stated I was SLR negative. That doesn't pass the laugh test, if you have access to he internet you know how to respond. I would let their VA Neurologist and MRI's counter that nonsense.

This is beyond any doubt confusing but here is what I have and where I am in repsponse to your post.

sinus tachycardia 30%

bilateral tinnitus 10%

Pes Planus and plantar fasiitis left foot, status post bunionectomy with scar 10%

Pes Planus and plantar fasiitis right foot, status post bunionectomy with scar 10%

Hypertension 10%

bilateral hearing loss 0%

equals 70% but however they calculate it ends up being 60%.

So I am currently 60% SC.

Lumbar Injury claim and request for reconsideration both denied. Requested DRO hearing: ignored or denied, whichever, they did not respond yea or nea, but did acnowledge my request for the DRO hearing on the IRIS system.

The VA Neurology consult written notes is the new evidence I submtted as new evidence.

You need to get a medical opinion using the evidence you have that states your sciatica is directly resulting from your S1 Disk

I do have that evidence and written opinion on the new evidence I submitted from the VA Neurology consult which stated "Left leg pain Left S1 nerve pinched"

On another part of the written note stated "left leg pain since 2005" which he misinterpreted from my statement that the pain increased in 2005, but the MRI should narrow that down with the dark and light fluid leakage indicating old and new injury, which the MRI shows both. It also states the sciatica originates from " L5-1S, herniated disc.

What can I do from there? Send it in Urdu?

Your back is maxed at 60: back (lumbar denied)

The MRI's wil help, do you have the report?: Yes I have both MRI reports from 2006 and 2008 and can relatively easily get the disc images. MRI's shows many problems.

OR report: I was given options written on the new evidence which was on his stationary. It stated "option"

1. Pain Medication

2. Physical Therapy

3. Epidural Injections ( I have the Aseheville VAMV fee basis approval letter)

4. Surgery (optional)

I selected 1 and 2. the denial letter stated that 1 and 2 was a medical directive, which as a matter of written fact it was my choice, and I choose not to have them stick me in the back or open my backup. I will have to be bed ridden before I resort to that!

You do not have to have new evidence to file a NOD. You do have to have new evidence to reopen a claim.

I have submitted new evidence which as previously stated they cut and pasted their way to another denial. The claim is still open, but just in my court as to how to proceed. I also submitted the NIOSH lifting equation which my field artillery job far exceeded the allowable limits.

From the input thus far it appears:

1. Drive to VARO and request a personal conference with the DRO and as I understand it the VA is obligated to provide a personal DRO conference since they have written acknowledgement of my request.

2. Initiate a BVA appeal with personal hearing.

Would an IME be worth the money to write a nexus letter?

I am not clear on how to initiate 2. a BVA appeal with personal hearing. A walk through on that would be helpful. I know we are talking years but it is a fools errand to expect any justice on this issue from the W-S VARO. They have denied othe items and I accept that. So I am not hard noseing this but they are vindictive on this issue and I am beginning to be more concerned on retaliation if it stays in their office. I would rather wait longer than allow them more time to retaliate against me via my claim.

Thanks J

Edited August 26, 2009 by cannoncocker

[cannoncocker]

cannon,

jbasser has posted some real good points here.

I would like to add, you do have to have new and material evidence to reopen a claim.

carlie

Hi carlie, thanks for the past help. the claim is still open, just waiting on me to accept or appeal. I did in fact submit new evidence for the request for reconsideration.

Is the VA obligated to allow me a personal hearing with a DRO? If not there would be zero point in me driving to the VARO.

Failing a DRO personal hearing How do I request a BVA appeal with a personal hearing and would that get my claim out of the W-S VARO?

I do have some minor additional evidence still but would an IME nexus letter be the way to go?

Thank you

Edited August 26, 2009 by cannoncocker

[jbasser]

You need 2 things.

An IMO Doctor to review the evidence concerning the Lumbar Spine and Neurological issues. It needs to be written in Standard VA Jargon.

You can do this by contacting a SSA attorney in your area and ask who they use for Independant medical examinations.

This Doctor specializes in Medical History of an injury and the occupational ramifications they present.

They are Cheaper than Dr B. and are just as effective.

You should concentrate on the Lumbar Issue. Once it is connected the Neuro part will fall into place.

J

[cannoncocker]

You need 2 things.

An IMO Doctor to review the evidence concerning the Lumbar Spine and Neurological issues. It needs to be written in Standard VA Jargon.

You can do this by contacting a SSA attorney in your area and ask who they use for Independant medical examinations.

This Doctor specializes in Medical History of an injury and the occupational ramifications they present.

They are Cheaper than Dr B. and are just as effective.

You should concentrate on the Lumbar Issue. Once it is connected the Neuro part will fall into place.

J

Exactly what I needed to know! Thank you so much. I will do exactly that. I was going to drive to the W-S VARO and request a hearing with the /a DRO but without a sledge hammer in my hand it would be pointless.

Once I get this documentation/evidence how do I go about submitting it? on a 21-4138 requesting an appeal to the BVA referencing this new evidence?

Also I have the following submitted in the IRIS system. Should I add a reply requesting they suspend any action on my claim until I have gathered more evidence and given it more time for thought and research?

********************************************************************

I submitted a request for reconsideration on June 30th, 2009 for the denied Lumbar Injury, and then selected the DRO process and consultation with the DRO Officer.

I received a letter from the XXXXXXXXXX VARO on Friday 21 August 2009:

XXXXXXXX Dated August 19, 2009

CSS XXXXXXXXXX

XXXXXXXXXX.

XXXXXXXXXXX

The decision remained the same with disregard to additional information submitted, in particular:

1. Charles George VAMC 1/2/2009 Fee Basis Approval Epidural Steroid Injections (which I declined as I rule out invasive procedures only as a last resort).

2. Durham Medical Center Neurosurgery Consult from Dennis Tuner, MD and Kenneth Rathey, PA-C 919 -286-0411 7010 (which delineated my options in writing and identified the injury from a pinched S1 Nerve, Left, L5S1, herniated disc, numbness in thighs due to nerves in groin, options:

a. Medication

b. Physical Therapy

c. Epidural injections (I submitted the fee basis document to corroborate the Document from the Durham Medical Center Neurosurgery Consult).

d.Surgery (discretionary)

I selected medication and Physical Therapy, that was an option, not a medical directive! The epidural fee basis approval demonstrates this.

At any rate it is clear by the brief period it took to come to the conclusion I was to be denied again, the total disregard for the additional documentation since the denial totally disregarded for this new evidence, disregard for my request to confer with the DRO, as far as I know no DRO was even involved, although I was required to select the DRO or normal Appeal procedure, I can clearly see that a determination has been made and no amount of countering evidence will change the predetermined result.

I received a VA Form 20-8992 today 24 August 2009 from the Winston-Salem VARO dated August 21, 2009 in reply refer to me K. Pfanzelter Veteran Service Manager. Briefly it stated the VARO has received my application for benefits.

I have no idea what benefits this is referring to since I have been denied twice and the DRO requests have gone unanswered.

I have no plans to request further reconsiderations from the same office. I am not a genius but I can see it is clearly there is only one response coming from that office.

So my question is:

1. What is that letter referring to? (VA Form 20-8992 from the XXXXXXXXXX dated August 21, 2009)

2. Should I, in the one year response time period, decide to appeal, how do I appeal to a different adjudicatory power?

Sincerely,

Edited August 26, 2009 by cannoncocker

[carlie]

Is the VA obligated to allow me a personal hearing with a DRO? If not there would be zero point in me driving to the VARO.

Yes - If you have received a rating decision on an issue you can file a NOD and request a DRO Hearing and VA is supposed to schedule a Hearing.

Failing a DRO personal hearing How do I request a BVA appeal with a personal hearing and would that get my claim out of the W-S VARO?

To get the ball rolling for a BVA Appeal you fill out and submit a Form 9.

I do have some minor additional evidence still but would an IME nexus letter be the way to go?

Yes.

Thank you

[cannoncocker]

Thank you carlie.

I feel that covers this issue and can close this out. I am briefed enough to move forward. Time to let someone else to get helped. I will let this sit for about a month and gather the MRI discs, again, get the IMO, and request again for the DRO personal conference. If they stone wall that request I will submit the Form 9 for a BVA with personal conference.

Hopefully with the additional IMO, VA documentation, and a VARO DRO personal conference will do but am prepared to move on to the BVA.

Thanks a million to all and I hope others got some useful information from this. In general what I take from this is that you need C-4 to prove an injury if they decide you are not going to get approved so you are wasting your time if you think logic and their docotrs alone will do it. I suspect I will never get approved by the W-S VARO and the BVA is my next viable chance. Military medical notes: irrelevant once the decision is made. When 100% disability comes into reach they will resist with all methods, legal or otherwise.