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mclevela726
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Posts posted by mclevela726
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Hello all,
If I disenroll (cancel) from care at VA will my family lose CHAMPVA.
I ask because I have private insurance (required by my employer to opt into) and I want to see a private doctor.
Thanks.
MCleve
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On 4/30/2019 at 5:12 PM, Buck52 said:
...because the examiner never read your evidence or included it in his/her report ?
Thank for saying this in particular!
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2 hours ago, Vync said:
I'm not exactly certain how the VA considers that specific part of the exam in regards to the VA regulations. If it is read in the same fashion as the mental health exams, then a minimum of one marked as severe should qualify. You got that on your recent exam. I think it is just a case of the person reviewing your claim not reading it correctly. I am not an expert, but I hope I'm right.
PS the exam you quoted is how I got 40%!
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2 hours ago, Vync said:
I'm not exactly certain how the VA considers that specific part of the exam in regards to the VA regulations. If it is read in the same fashion as the mental health exams, then a minimum of one marked as severe should qualify. You got that on your recent exam. I think it is just a case of the person reviewing your claim not reading it correctly. I am not an expert, but I hope I'm right.
Thank Vync. I hope you are too!
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4 hours ago, vetquest said:
You will go crazy trying to see where the VA saw improvement in your claim. There is a rater in some RO somewhere who may have had a bad day or whatever causes raters to make the decisions they do. Your best bet is to appeal this decision to a higher level and then if it is denied to appeal to the BVA. Please post your SOC and we may be able to help your more.
I know all too well.
I'm going to start working on it.
Thanks.
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And for anyone wondering. Yes, I see a VSO in two weeks for this.
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And now the Exam from 08/30/2012 VA used to award me 40% for low back and 40% for right/left leg radiculopathies
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And now 2nd DBQ from December 2018
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And now 1st DBQ from December 2018
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Hello again,
Please compare the following DBQs used by VA and tell me where VA may have seen "improvement" in both the lower back and bilateral radiculopathies.
Thank you.
Exam report from November 2017
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3 hours ago, Vync said:
When they propose to reduce, they give you like 60 days (could be different now) to contest it and they must include their justification for the reduction. I recommend you respond and explain their error to them. Yes, moderate was checked for parasthesia, but severe was checked for constant pain.
The following is from the C&P exam where I was rated at 40% for each extremity
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3 hours ago, Vync said:
When they propose to reduce, they give you like 60 days (could be different now) to contest it and they must include their justification for the reduction. I recommend you respond and explain their error to them. Yes, moderate was checked for parasthesia, but severe was checked for constant pain.
Thanks for the input!
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1 hour ago, Buck52 said:
Take all these DBQ's to an experienced VA Attorney or certified accredited VA Claims Agent.
Let him/her work on this.
CUE is very hard to win even when we think we got this.
I agree Buck. I can't help but think of the saying "a person who represents him/herself in court has a fool for a client".
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A couple of thoughts.
1. I contend that VA erred in interpreting the evidence in the examiner's report
2. I contend that VA erred in its decision in that it did not consider the provisions of 38 CFR 3.344, therefore the reduction is ab initio.
Thanks for the help!
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12 minutes ago, vetquest said:
I would note that the doctors doing the DBQ's did not read your records. I would also get an IMO from a civilian doctor if you can afford one. I am also seeing a lot of things marked severe not moderate. I do not know how to read one of these exams but it seems inconsistent with the decision. Also, do you have a condition that was expected to improve? Back injuries do not usually get better do they?
I can't speak for everyone, but my back and legs haven't.
Thanks for the help!
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Can anyone shed a light on what the CFRs mean in my decision letter? I think I'm going to contend that VA erred when they didn't consider 38 CFR 3.344 when I appeal, but all the codes are confusing and I don't want to make a contention in error.
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Here is another of the DBQs (Second C&P exam) mentioned in the letter:
Here's what VA said when they proposed the reduction:
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Here is 1 of the DBQs (Second C&P exam) mentioned in the letter:
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How would you go about appeal this?
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45 minutes ago, Vync said:
Based on what you posted, here is my opinion:
It sounds like you have issues with the sciatic nerve (runs down the leg). I have the same issues you indicate and mine was rated under the sciatic nerve. Using that nerve table as reference, but advise you double-check against your medical records.
If you become service connected, it looks like a potential 40% rating in each limb. If SC in both legs at 40% each, it likely will be rated as bilateral, which means they will roll both ratings into a single rating. The 40% and 40% would calculate to 64%, then 10% is added (6.4%), to equal 70.4%. That would be rounded it down to 70% even.
The "no records were reviewed" part might be a factor. If the DBQ was filled out by a non-VA doctor, the VA might want you to come in for one of their doctors to perform a C&P exam. I have seen them do this because they want to ensure the records were reviewed.
A medical nexus was not included in the material you uploaded, so I cannot advise on the likelihood you might get SC.
Depending on your situation, the VA might want to bring you back in a year for reevaluation. If your doctor has determined your disability is not likely to improve, that might not happen.
Thank you for responding, Vync. This was from my RFE C&P exam.
VA used this exam to reduce my benefits from 40% bilateral to 20% bilateral. They alleged this said "moderate"!
I thought "I must be crazy cause I see it saying "moderately severe''!? I guess, according to VA, I'm not the only one who's crazy!?
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Please decipher.
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11 hours ago, Buck52 said:
send this in as evidence to rebut the rater
''However, the report (noted above) from the most recent C&P shows that the examiner opined that the radiculopathy, right lower extremity was “Severe”.
My condition for Radiculopathy has not improved and is servere I request VA cancel the proposed reduction
Thank you Buck 52!
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So, back in February I received a letter from VA proposing to reduce my benefits. Because I am in dispute of this proposal, I requested a copy of the C&P exam report to see what it said.
The decision letter proposing the reduction states that:“Upon review of your service connect radiculopathy, left lower extremity, your current evaluation is most consistent with a 20 percent evaluation. Your VA examinations dated ######## and ######## state mild and moderate respectively. Improvement was noted on both examinations.”
However, the report (noted above) from the most recent C&P shows that the examiner opined that the radiculopathy, left lower extremity was “Severe”.
The decision letter proposing the reduction states that:“Upon review of your service connect radiculopathy, right lower extremity, your current evaluation is most consistent with a 20 percent evaluation. Your VA examinations dated ######## and ######## state mild and moderate respectively. Improvement was noted on both examinations.”
However, the report (noted above) from the most recent C&P shows that the examiner opined that the radiculopathy, right lower extremity was “Severe”.
I’d hate to accuse anyone of lying but based on what I see it sure feels that the rater did.
Has anyone else ever had a favorable C&P exam and still received a proposal to reduce benefits? If so, what did you do to stop this?
On a side note, my ratings for these conditions have been in place for more than 5 years!
Will my family lose CHAMPVA
in CHAMPVA
Posted · Edited by mclevela726
Thank you all for your comments.
I am approaching this from a continuity of care standpoint. I do not feel that I get the level of care at local VA that I get from my private care physician nor do I feel that I am being allowed to be a part of my care. For example, local VA doc has prescribed medication inappropriate for a diabetic, because it is known and well documented to cause a rise in blood sugar (My credentials include a degree in nutrition with an emphasis in dietetics as well as having been registered with the Academy of Nutrition and Dietetics). As such, I have experienced a fasting blood sugar that has gone from around 126 mg/dL to over 300 mg/dL. And while I have asked to be changed to a medication from the same class and that is appropriate for a diabetic, VA doctor refuses to do so.
As far as compensation, I am 100% T & P with the VA stating that "no other exams will be scheduled".
I agree with the VA as a back-up plan. However, how might I approach this is a manner that I am not being double treated for the same thing without "burning bridges" with VA?
Thanks again for your time.