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Template Sec 1151 Claims


Template for Section 1151 claims

To VARO etc

This is a claim filed under auspices of Section 1151,38 USC.

I believe my VA medical records will reveal that I did not receive a standard of VA medical care comparable with that of the standard medical community, regarding treatment (or non treatment) of my (put disability here that they malpracticed on) and as a result of the VA's medical errors I have incurred an additional disability of ( put the additional documented disability here that you claim is directly due to the malpractice. Add any secondarys to this that also are due to the 1151 disability.)

I have listed and enclosed the following medical records to support this claim:

(Then list the enclosures with date of the medical test or entry and brief description of what they reveal for the 1151 issue. Try to keep the focus solely on medical errors and the results that are documented.In many cases it could be an “omission of an act.”

Then sign it, make copy of it, and mail it with USPS tracking slip to your VARO

For example your med recs reveal need for MRI and ECHO regarding a VA doctor's concern over a carotid artery situation. The med recs note “W/O CAD.”after you complained of neck pain and headaches. But MRI and ECHO is never ordered. Then you have a major stroke with embolic cardiac origin.This “omission “of proper follow up testing that resulted in your additional disability of a stroke is more than likely malpractice and could involve a malpracticed heart condition as well.

Or say the VA diagnoses and treats you for bleeding hemmoroids for years.You develop another condition that involves further testing such as extensive blood work etc and these tests results cause the VA to consider cancer. They diagnose you with stage 4 colon cancer and remove your colon. You didnt get Stage 4 cancer overnight. The VA has most likely committed malpractice.

These are true cases and much more to them than this -this is just a simplified example of malpractice.

Section 1151 claims ,when first filed, should be short and sweet. Focus solely on the evidence of negligence or malpractice in the medical records.It is a good way to state the claim as 'I believe, or I think or I feel '

that VA made medical errors and caused you additional disability but from that statement on- give them documented facts supported by copies of the clinical record.

All NSOs and vet reps are trained with the same training I got on Section 1151 claims.I advise getting a POA for 1151 claims.The Section 1151, 38 UCS regs are not difficult to understand and contain the keys to what evidence you need:

1.documented proof of medical error ,omission, negligence, malpractice that is in your VA medical record file.

2.Documented proof that you have a resulting additional disability directly due to the malpractice.

If VA was negligent to point of causing you harm, this will be in the medical records. This is why it is best to obtain an IMO for these claims.It will be in there but if you don't have a medical background, it could be well hidden and attempts can be made by VA to cover up prior malpractice,

Those attempts to cover it up however will be documented in the med recs.That sounds odd but I found evidence of a VA cover up and can verify it happens. That evidence was also critical to my FTCA/1151 claims.

VA fights 1151 issues aggressively. The initial filed claim will draw them out. They might well put their foot in their mouth in the SOC.But they will try to walk all over you if you do not have an IMO. An IMO for a Section 1151 claim, if it supports the malpractice-will easily be absorbed cost wise by some of the 1151 comp checks you get , that you might never see with the IMO.

FTCAers and 1151ers:

I have alreadly posted in the FTCA forum many important things to consider if you file both types of these claims. The VA will only pay once under either of these regs.That info is detailed here and with the FTCA regs which are googleable.

If you have lawyer preparing your FTCA issue. Ask the lawyer if you can use their exact wording on the SF 95- the part where the claimant states the charges.It is under Number 8 on the SF 95 form:

after stating that this is a claim under Section 1151 , 38 USC.Instead of what I posted here.

Get the lawyer's permission if you use this statement from the SF 95 verbatim for 1151 issues.

For the claim as well as for an IMO you need to thoroughly review your medical records any many times. Get a good medical source to use to help understand the medical acronyms and abbreviations. Try to figure out anything that has line drawn through it or that appears they tried to erase or delete.

Prepare a cover letter for the IMO doctor with your take on how they malpracticed. The IMO doctor will review everything anyhow but nothing should be overlooked.For examle a minor entry on the surface might mean nothing but there could be extenuating circumstances the IMO doc needs to know.

I quoted something a VA doctor told me in Aug 1992in my FTCA/1151s but had no proof of what he said- then I realized the very same day I talked to him, his entries revealed what we had discussed.His handwriting was awful and copies of this entire page of the med rec always comes up very light and hard to read.It took many hours but I could decifer the whole thing and it was critical to my 1151/FTCA issues and my IMO. It was also the day the cover up began. I had asked the wrong question. They started to scramble.

Another entry was very very hard to read and I had the VA contact the doctor and her secretary transcribed it to for me.

On the hard to read entry I couldnt' believe how ridiculous what the VA doctor had written was. .I was sure I was reading it wrong.

The transcribed version was verbatim to my decifered transcription. More proof of VA malpractice.

One cannot overlook a single entry or chart or test results when filng FTCA and/or 1151 against the VA.

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Here let me help you bump it up again cause I'm reading all your information! You are one knowledgeable and strong woman for sure!

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Thank you Doug....welcome to hadit.

My husband;s untimely and wriongful death has helped others here with the knowledge I gained from the FTCA and 1151 cases I had.

Since those older posts here, VA has changed the claims  form criteria but I don't think they have any specific form for 1151 claims yet. Some of the major vet orgs might have their own template.




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bumping this template up for potential new member from my locale with possible 1151 issues.

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bumping it up again

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I asked someone from another site to read this info so am bumping it up again.

The Veterans Administration saves countless lives all the time.I would think just about every VA pt gets adequate health care.

But mistakes can be made and the consequences can be further disabling or even deadly.

A vet with a potential Section 1151 issue should first obtain their complete VA med recs and C file from the VA without suggesting in any way, that they intend to file a 1151 claim.

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bumping it up again-

and please read all info here and in the 1151 forum as to FTCA offsets and 1151 awards if you file both.

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      Note Title:
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      No CA Healthcare Sys-Martinez
      Signed By:
      Co-signed By:
      Date/Time Signed:
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      LOCAL TITLE: C&P Audiology 13294
      DATE OF NOTE: JUN 02, 2016@08:24:04 ENTRY DATE: JUN 02, 2016@08:24:04
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      Name of patient/Veteran m…..Xxxxxx 1234
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      ACE and Evidence Review
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      Page 18 of 44
      [X] CPRS
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      | A | B | C | D | E | F | G |
      | 500 | 1000 | 2000 | 3000 | 4000 | 6000 | 8000 | Avg Hz |
      | Hz* | Hz | Hz | Hz | Hz | Hz | Hz | (B-E)**|
      | 30 | 50 | 75 | 85 | 95 | 105+ | 100+ | 76 |
      LEFT EAR
      | A | B | C | D | E | F | G |
      | 500 | 1000 | 2000 | 3000 | 4000 | 6000 | 8000 | Avg Hz |
      | Hz* | Hz | Hz | Hz | Hz | Hz | Hz | (B-E)**|
      | 35 | 50 | 70 | 80 | 85 | 105+ | 100+ | 71 |
      * The puretone threshold at 500 Hz is not used in determining the
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      ** The average of B, C, D, and E.
      *** CNT - Could Not Test
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      | RIGHT EAR | 56% |
      XXXXXX, xxxxxx
      Page 19 of 44
      | LEFT EAR | 56% |
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      Word Discrimination Score appropriateness:
      Use of word recognition score is appropriate for this Veteran.
      Left Ear:
      Is Word Discrimination Score available? Yes
      Word Discrimination Score appropriateness:
      Use of word recognition score is appropriate for this Veteran.
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      Summary of Immittance (Tympanometry) Findings:
      | | RIGHT EAR | LEFT EAR
      | Acoustic immittance | [ ] Normal [ ] Abnormal | [ ] Normal [ ] Abnormal
      | Ipsilateral | |
      | Acoustic Reflexes | [ ] Normal [ ] Abnormal | [ ] Normal [ ] Abnormal
      | Contralateral | |
      | Acoustic Reflexes | [ ] Normal [ ] Abnormal | [ ] Normal [ ] Abnormal
      | Unable to interpret | |
      | reflexes due to | [ ] | [ ]
      | artifact | |
      | Unable to obtain/ | |
      | maintain seal | [X] | [X]
      Page 20 of 44
      2. Diagnosis
      [ ] Normal hearing
      [ ] Conductive hearing loss ICD code:
      [ ] Mixed hearing loss ICD code:
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      [X] Sensorineural hearing loss (in the frequency range of 6000 Hz or
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      [ ] Significant changes in hearing thresholds in service***
      LEFT EAR
      [ ] Normal hearing
      [ ] Conductive hearing loss ICD code:
      [ ] Mixed hearing loss ICD code:
      [X] Sensorineural hearing loss (in the frequency range of 500-4000 Hz)*
      ICD code: H90.3
      [X] Sensorineural hearing loss (in the frequency range of 6000 Hz or
      higher frequencies)** ICD code: H90.3
      [ ] Significant changes in hearing thresholds in service***
      * The Veteran may have hearing loss at a level that is not considered to
      a disability for VA purposes. This can occur when the auditory
      thresholds are greater than 25 dB at one or more frequencies in the
      500-4000 Hz range.
      ** The Veteran may have impaired hearing, but it does not meet the criteria
      to be considered a disability for VA purposes. For VA purposes, the
      diagnosis of hearing impairment is based upon testing at frequency
      of 500, 1000, 2000, 3000, and 4000 Hz. If there is no HL in the
      Hz range, but there is HL above 4000 Hz, check this box.
      *** The Veteran may have a significant change in hearing threshold in
      service, but it does not meet the criteria to be considered a disability
      for VA purposes. (A signi
      ficant change in hearing threshold may indicate
      Page 21 of 44
      noise exposure or acoustic trauma.)
      3. Etiology
      [X] Etiology opinion not indicated as:
      [X] Service connected condition
      [X] VBA did not request etiology
      4. Functional impact of hearing loss
      Does the Veteran's hearing loss impact ordinary conditions of daily
      including ability to work: Yes
      If yes, describe impact in the Veteran's own words: DIFFICULTY
      5. Remarks, if any, pertaining to hearing loss:
      1. Medical history
      Does the Veteran report recurrent tinnitus: Yes
      Date and circumstances of onset of tinnitus: FROM 2.16.16 EVALUATION:
      describes a subjective, bilateral, constant tinnitus with an unsure
      2. Etiology of tinnitus
      [X] Etiology opinion not indicated as:
      [X] VBA did not request etiology
      3. Functional impact of tinnitus
      Does the Veteran's tinnitus impact ordinary conditions of daily life,
      including ability to work: No
      4. Remarks, if any, pertaining to tinnitus::
      No response provided
      NOTE: VA may request additional medical information, including additional
      examinations if necessary to complete VA's review of the
      NIC…., MARK
      Page 22 of 44
    • By Michigander
      My heart goes out to all of my fellow survivors of MST ...
      For me, I have found I can no longer suppress and manage the daily physical and emotional affects of the sexual assault that took place on December 25, 1985 while serving on active duty.  In effort to find some help, relief and hopefully someday healing I am starting the uphill journey to deal with this and try to share some of the highlights of my battle.  I will be the first to admit I have no idea what I am doing and can only hope that God the father.... will guide my feet day by day. 
      First step locating documentation of the event.  A few weeks ago I was able to locate the police dept. and requested a copy of the report.  I received a copy of the 15 page report this past week and it makes me emotionally and physically sick just to look at the envelope it's in.
      I also tried to locate medical records over the years from prior mental health therapists and physicians that would have documented my history as it related to these events, but the practices were closed or my records were no longer available due to time.
      April I called the VA to inquire about mental health services for MST and hesitated to start the process because the MST would not be marked in my record for all my providers to see.  This was a big hurdle mentally as I have always hid this event at all costs from my providers.   I am sure this did not help my physicians treat me and fully understand my ongoing medical problems especially those in which are usually brought on by some big life event which I always adamantly denied when asked. 
      May 2nd 2017, I submitted a "intent to file".
      May 4th 2017, I went to a VSO rep?? to asked questions about the process to file a claim related to MST.  The rep was belittling, insulting, hurtful, rude and I walked out of that office with no more information and the psychological affects were pretty devastating.  At the encouragement from my daughter to go straight to the patient advocate office and file a complaint....I did just that.  I found myself have a total mental breakdown just trying to give the details of what just went down and was thankfully met with support and many reassurances that I would have a team of people helping moving forward and that person would be brought in...dealt with and re-trained.  I will spare you all the details.
      My next step is hearing from the mental health dept. to set up an appt. to do some type of baseline evaluation of my symptoms etc. as it related to MST... I guess to get an official diagnosis on record and to get me the specific therapy I need started.  I will likely opt for tele-therapy once I have a few sessions onsite at the VA. 
      That's it for now
    • By bright
      I have been 100% perm and total since 2003, before that i was 70%.
      I just got an appointment for a C and P exam to reevaluate. WHY!
      Has anyone ever heard of this?  Has anyone ever had one after being perm and total?
      What is going on?
    • By mrkman123
      Forgive the first effort, injuries have a way of making things difficult.....   Twenty-four years of dealing with the VA, and the difficulties at hand ensure negative results.....  These are the copies of a C and P recently done at the VA, and leaves me to doubt this system is capable of conducting themselves in an ethical manner.   Enjoy the insanity, this veteran is tired of paying the piper; Eighteen Years were Enough !!!!    (Remand posted earlier.)  Still waiting to address attorney with the results of this remand and the Shabby, Disrespectful, and unethical way in which this Veteran has been treated at the VA hands......   Document 1.pdf ...   Comments, opinions, and suggestion greatly needed and appreciated....   Sincerely, Mark
      Document 38.pdf
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      Document 39.pdf
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      Document 2.pdf
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      Document 34.pdf
  • Our picks

    • Do not post your question in someone else's thread. If you are reading a topic that sounds similar to your question, start a new topic and post your question. When you add your question to a topic someone else started both your questions get lost in the thread. So best to start your own thread so you can follow your question and the other member can follow theirs.

      All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

      Tips on posting on the forums.

      Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.

      Knowledgable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title. I don’t read all posts every login and will gravitate towards those I have more info on.

      Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.

      Leading to:

      Post clear questions and then give background info on them.


      A. I was previously denied for apnea – Should I refile a claim?

      I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?

      B. I may have PTSD- how can I be sure?

      I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?

      This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.


      Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview.

      This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
      • 0 replies
    • I have a 30% hearing loss and 10% Tinnitus rating since 5/17.  I have Meniere's Syndrome which was diagnosed by a VA facility in 2010 yet I never thought to include this in my quest for a rating.  Meniere's is very debilitating for me, but I have not made any noise about it because I could lose my license to drive.  I am thinking of applying for additional compensation as I am unable to work at any meaningful employment as I cannot communicate effectively because of my hearing and comprehension difficulties.  I don't know whether to file for a TDUI, or just ask for additional compensation.  My county Veterans service contact who helped me get my current rating has been totally useless on this when I asked her for help.  Does anyone know which forms I should use?  There are so many different directions to proceed on this that I am confused.  Any help would be appreciated.  Vietnam Vet 64-67. 
    • e-Benefits Status Messages 

      Claims Process – Your claim can go from any step to back a step depending on the specifics of the claim, so you may go from Pending Decision Approval back to Review of Evidence. Ebenefits status is helpful but not definitive. Continue Reading
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    • I was rated at 10% for tinnitus last year by the VA. I went to my private doctor yesterday and I described to him the problems that I have been having with my sense of balance. Any sudden movement of my head or movement while sitting in my desk chair causes me to lose my balance and become nauseous. Also when seeing TV if there are certain scenes,such as movement across or up and down the screen my balance is affected. The doctor said that what is causing the problem is Meniere's Disease. Does any know if this could be secondary to tinnitus and if it would be rated separately from the tinnitus? If I am already rated at 10% for tinnitus and I could filed for Meniere's does any one know what it might be rated at? Thanks for your help. 68mustang
      • 15 replies
    • Feb 2018 on HadIt.com Veteran to Veteran. Sharing top posts and a few statistics with you.
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