disability examination Finally DRO moving forward, but got questions about appointment letter

[OldJoe]

Been quite awhile since I posted anything...

(Last post was this

Been in that hurry up and wait limbo status that everyone hates, but after 630 on appeal via DRO process (average time was somewhere between 311 and 400 days I think) I finally receive a letter informing me that I have a disability examination.

Since this is my first time through this part of the process I would like some simplified translation of what all of this means.  At face value it looks as if it means they are going to look at my records and do an exam.  But I also, understand that some of these individuals aren't really working in the best interest of the vet.  This fact pretty much is giving me an anxiety attack worrying about it.  I know this is irrational, but, with hearing all of the horror stories it isn't surprising to feel this way.

I want to be fair and honest going into this exam, but I also know, that by being too "helpful" can actually be detrimental to a claim and getting subsequent medical services (my knees and back are shot).

Like with my back, flex, I can only bend about 12 Degrees before I have to bend at the waste.  This was measured during therapy I was receiving through private insurance with a galvanometer.

I know this doesn't mean a hill of beans when it comes to a VA disability examination.

So any tidbits of sage advice would be greatly appreciated (as long as it doesn't mean committing fraud.)

I don't know if this will be used as the C&P examination or if this just means a very small step in a "direction" (not necessarily favorable).

 

Thanks for the advice and encouragement

Joe

Edited March 14, 2018 by OldJoe
Mispelt word

[vetquest]

I do not know all about IMO's but my last two VA C&P examinations were IMO's and they supposedly done well, I do not have the final opinion yet as the V.A. is late on producing the paperwork.  The doctors were good to me and the final decision by the board was good. 

Go in there and believe the doctor is there to help you, if he isn't it will not help either way.  If he is there to help you going in with a bad feeling can skew the exam.  I always believe the examiner is there to help me.

The best advice I can give is to always keep a good attitude and know things will work out in the end.  

[vern2]

Suggest you take notes as soon as exam is over. Then when you can get a copy of the exam and immediately challenge anything this is contrary to what you private exams  have found. The  exams are not in your best interest and they will usually put unfavorable  conclusions vs trying to help the vet. I fought them for 10 years before I was successful. The examining doctor is supposed to review you outside medical records, but rarely do this, even when given hard copies. My doctor told me he did not have time to read then but would read later! This never happened.

[OldJoe]

Thanks I will definitely do that

[Buck52]

Sounds like a VA PCP or Speciality Clinic reported that your symptoms have improved and R.O. read your medical notes  Prompt a C&P to see if you have actually improved  or if your disability has worsen?

...if it has worsen  an Increase in your compensation  if it has Improved a reduction in your ratings  but they will need to send you to another exam afther this one to reduce your ratings.

You should do two things  check with your VA Speciality Clinic Dr and ask if he will fill out a DBQ about your disability. & get a copy....if he won't

get you a IMO.

ask the Examiner to add this IMO to your records

before this exam if you have time?

 go to a private Dr and ask him to fill out the DBQ and read some of your medical records the pertain to this S.C. Disability/disabilities  that your claiming, ask the private Dr to compare your medical records to his present exam...ask him to give his professional opinion after examining you that it is likely as not 50% greater that your disability has worsened according to your symptoms and ROM from a goimenter at  the examination...dated  **-**-****

 

give the  ROM # of last exam and compare them to this exam.

you need proof that your disability has not improved..and mostly you need to show they have actually worsened.

they may just keep your ratings the same or give you an increase...it should keep you from filing a NOD but if they send you a reduction letter   then disagree with NOD. They should send you the information and  time and dates for you to respond  you need to do this in a timely manner.opt for  DRO Hearing or DRO Complete Review of your records.

I would choose the DRO Hearing  face to face and show him  just how bad your S.C Disability is..and present your IMO as medical evidence.

Edited March 15, 2018 by Buck52

[OldJoe]

Thanks Buck for the advice. 

If I hadn't been so busy I would have tried to  do most of what you suggested if there was time.

But also, as a note this is part of a DRO review.  It has taken me over 1.7 years to get to this point (a bit over the national average for DRO appeal averages I believe).  But on that note, this whole claim was a round about way to  to kill two birds with one stone and get the VA to correct a mistake they had made back in 1996 (kids and fellow vets do not try this at home, trying something like this will usually wind up an abysmal failure, unless you have ALL your ducks in a row, standing at perfect attention while an old school drill instructor is bearing down on them and screaming obscenities, and the ducks don't flinch. In short; I haven't won yet).  I made a mistake by not making a "timely appeal" but they made a bigger mistake and put it in writing by not using all the available evidence at the time the decision was made (thank God I am a pack rat and saved so much of the paperwork).

Though on one point I will probably need to very soon have my private  primary medical physician fill out a DBQ for hip flexion.  It was the one test they did in my initial eval back in 1996 but not this time.  I assumed (I know never assume) that that was just going to be part of the exam.  This was for hip and leg flexion.
 

[OldJoe]

But on a fairly positive note (assuming I got one of the honest physicians) I definitely will get an increase.  Of course this can be a big assumption, knowing that even though the Dr. gave a positive review that the VA won't ignore everything.

In the beginning of the examination process they went through the review "interview" of when did this start and all of those laborious questions that they should have all of the information for anyway.  I told him, back when I was in the military and showed him a copy of my SMC displaying the "NEXUS" event that demonstrated that it was a recurring issue in the military.  If that didn't demonstrate a connection to the military, then all the measurements don't mean a hill of beans, until I go before the board (if it gets that far I think I have a solid win regardless, just the wait will be a pain).

My math will need to be double checked because of how bi-laterals are computed.

Current ratings:

1. Mental 10 %
2. Tinnitus 10%

This current DRO process hoping to rectify (based on claim for secondary for knees) without going through long drawn out process of board or calling for a CUE (yes, it is that obvious.  Of course we are talking about the VA here...):

1. Hoping for retro for back because of the mistake as noted in previous reply.  Hopes are for 20% rating for scoliosis (stated in SMCs while still in service and by exams after exiting service)

Results of this exam (correct my percentages if wrong):

1. Left knee flex measurement of 52 degrees ( 50% rating)
2. Right Knee flex measurement of 60 degrees (50% rating)
3. Back flex measurement of 30 degrees (40%)
   • And they "assisted" me a bit to get that far.  I was in utter agony to the point of tears (I think they did feel sorry for me at that point)
4. Knee stability/cartilage; there are several ways that could go
   1. code 5257 I could be rated at 10%, 20%, or 30%
      • If rated here fairly confident that I would at least be rated at 20% which will put me at 100% shedular (if my math is correct with bilateral computations)
   2. code 5258 or 5259
      1. if these are not able to be combined then I wind up at 90% schedular
      2. If they can be used in conjunction with then
         1. 5258 (20%) I will be at schedular 100%
         2. 5259 (10%) I will be at schedular 90%

The one item they didn't measure that would put me at 100% schedular regardless of how they did number 4 about is hip/leg flexion.  They did this in my very first eval back in 1996 but it wasn't requested this time by the VA thus the physician didn't preform that measurement.

So, with just raw percentages from the measurements and depending how they rate the knee stability (if my math is correct) I am looking at 90% or 100%.

Anybody willing to check my math?