V.A. disability Decision

[Jimmer]

I am not sure if I am on the right area, if not, please direct me.  I have followed you guys for almost a year, and really appreciate your help.  You guys have a wealth of knowledge, and I appreciate it.   My situation is, back in June 2015, I e-mailed a letter to Alison Hickey, because I felt the V.A.  was "stonewalling" me on my claim for a paralyzed left lung and my   lower back.  Two days later I received a call from a RO, who said she was handling my claim.  I fax to her exactly what she requested.   I had a "nexus" letter from three board certified Pulmonologists for my left lung, had one fill out a DBQ, also a medical opinion DBQ, also medical journal articles supporting my claim.   I had one board certified orthopedic surgeon do the same for my back.  I was told by the RO that I did NOT need a C & P exam.  ( I have e-mail to verify this).  She told me she received everything, and was working on my file.  Two weeks later, I received a phone call, and a letter for a scheduled C &  P exam.  I tried to contact the RO but to no avail.  ( Later found out she was transferred from Phoenix, Az., to San Diego, Ca.).  I went to the C & P exam, and the doctor said within five minutes, it looks like I am going to deny your claim.  He said hover "file a appeal, because you do have a strong case, and you should win on appeal". (His exact words.  He also indicate that the V.A likes him because  "I am very picky, every has to be dotted and t crossed".  My evidence supported a service connected disability.  I feel I was blindsided by the RO, and the doctor.   How should I appeal?  Contact "Bob"?  I also have contacted Senator McCain (I live in Arizona) and was told he has a big hearing on the VA next month and they would like to hear more from me.  Also I have just been contacted about IU, which I mailed the forms in.  I am 80% disability, one 60% one 50%.  Will any kind of appeal hold up the IU?  I know why they are stonewalling the lung, because that one is the biggie.  Sorry for the length, but any help is very much appreciated. 

[Jimmer]

Broncovet, Thanks for the info.  I understand completely what you are saying.  Believe me I am going to appeal.  The lung issue is a biggie, so that's why they pulled this crap.  I made sure that I had all the information. nexus letters,  board certified doctors reports,  etc. The doctors did the DBQ's and medical opinion DBQ's.  They did had all the information.   I had a physical exam on my lung (sniff test, breathing tests) and they came up with the exact same results, and diagnosis as my board certified doctors did.  This C & P doctor stated right from the "get go" that he was going to do a  " less likely or not" decision.  But then he stated several times that I had a "strong case", and should win on appeal".  I had a small writing tablet in my pocket, and after the exam, I sat down and wrote the words, exactly how he said them.

[georgiapapa]

Your experience with the C & P examiner is another good example of why C & P exams should be audio recorded and even better if they were video recorded. JMO

GP

[ArNG11]

GP I agree totally.  Then there would be no question of whether the exam was conducted in a hostile environment, no need to verify if the C&P doc looked at all medical records. No need to doubt a Veterans words, injuries, and illnesses.  

I personally think if this were allowed there would a significant number, drastic numbers in reductions of low ball and bogus exams that are allowed to pass the "Veteran Friendly Claims Process"  

 

[Jimmer]

Georgia Papa & ArNG11, I completely agree with you.   Ms. Hickey contacted my Phoenix, Az., VA office, and a Rating Officer contacted me.  She  said they had no information or records from my doctors, so that is why the first C & P doctor denied it.  I told her I had the information available.  She said if my doctors provided "nexus" letters, filled out the DBQ forms and another DBQ medical opinion forms that I would NOT need another C & P exam.  I provided all that to her.  I had had a lung test done, and my doctors diagnosis matched the V.A. doctor diagnosis, and the test percentages were exactly the same.  I was called for this C & P exam, and when I arrived a 9:00 a.m., the C& P doctor said he arrive early "to look at my files".  But yet when I asked him some questions, pertaining  some information in the files he said "yes, yes it's all there", and dismissed my questions.  He really didn't do an exam, looked at my back, and said "boy, your in bad shape".  He then began  to tell me how he was "sought after by the V.A.", and was considered their top doctor that the other doctors "looked up to him", at the V.A.   He told me right away that he was going to write "less likely then not", then said   "you should appeal, because you do have a strong case, for the appeal board".

[ArNG11]

Georgia Papa & ArNG11, I completely agree with you.   Ms. Hickey contacted my Phoenix, Az., VA office, and a Rating Officer contacted me.  She  said they had no information or records from my doctors, so that is why the first C & P doctor denied it.  I told her I had the information available.  She said if my doctors provided "nexus" letters, filled out the DBQ forms and another DBQ medical opinion forms that I would NOT need another C & P exam.  I provided all that to her.  I had had a lung test done, and my doctors diagnosis matched the V.A. doctor diagnosis, and the test percentages were exactly the same.  I was called for this C & P exam, and when I arrived a 9:00 a.m., the C& P doctor said he arrive early "to look at my files".  But yet when I asked him some questions, pertaining  some information in the files he said "yes, yes it's all there", and dismissed my questions.  He really didn't do an exam, looked at my back, and said "boy, your in bad shape".  He then began  to tell me how he was "sought after by the V.A.", and was considered their top doctor that the other doctors "looked up to him", at the V.A.   He told me right away that he was going to write "less likely then not", then said   "you should appeal, because you do have a strong case, for the appeal board".

Wow.  I can't say all my experiences have been bad.  Which I dread stating in VA's defense, I have had one positive experience in a C&P exam. One.  The Doctor was attentive, read my records, even did and extra DBQ in my favor. A favorable exam, and she wrote a nexus for a condition that I did not explicably ask for but knew I qualified for.

The funny part.  It never made it into my C-file.  At least from information the DRO verified my last hearing.  So I asked for a copy, even though I have a very audible recording of the exam.  The VA still has not provided me a copy of the exam, nor did they provide a copy to my previous attorney.  Imagine that.  I wonder if I will ever get it.  Who knows maybe the sun will shine on the dogs ass, one time. 

Point to take from this is that unfortunately even if you have the evidence and a rock solid case, the game is fixed and you are on the loosing end of the statistics.  However, knowing and preparing for these events, it is possible to out flank the VA and win what you are entitled to by law, according to the regulations and all medical evidence.  JMO

[Gastone]

RO Staff MD C & P Examiner, completed a NEW DBQ during my exam in 2014.

02/14 I filed FDC for a Secondary condition. More research indicated I was wrong regarding Pulmonary issue and probable causative SC. Filed a 2nd FDC, early 04/14. Mid 04 received C & P ofr 02 FDC.

In the very beginning of Exam, I indicated that I had been in error regarding )@ FDC DX and Nexus, Dr agreed, but said he had to complete the Rater's requested 02 FDC DBQ; which he did. At the end of the C&P, we discussed my 04 FDC filing. He verbally agreed with my DX and Nexus. We discussed the VA reg, requiring a VA Dr to complete a DBQ, if requested by a Vet at the time of a medical appointment. Then and there, I officially requested a DBQ for my 04 FDC. He complied, somewhat under protest, gave me a copy, put a copy in my VMC record and forwarded a Copy to the RO Rating Dept.

I was never afforded an official C & P for the 04 FDC. Received 2 separate VA notifications in late 07/14. 02/14 FDC Denied, as expected, 04/14 FDC Granted.

Semper Fi