lotzaspotz

I agree with everything Paul said. Others here may have had some success with the DRO process, but I'm not one of them. I tried it twice, both times resulting in a cut and paste denial that regurgitated the original denial and only wasted our time. I'm even losing what little faith I had in the BVA and look to the CAVC for a decent shot at a reasonable outcome. The RO will have plenty of time to conduct a "decision review" if the BVA remands the appeal back to the RO to correct the flaws that provided the basis for a remand. You will most likely have to tell the BVA what those flaws are per 38 CFR, but the important thing is making them aware that you know what the regs say and what the BVA is supposed to do, which at best would result in a grant of benefits or secondly, a remand. I normally end my BVA appeal cover letter by nicely informing them of my intention to appeal to the CAVC in the event the BVA denies the appeal. I want them to know I'm not going away quietly.

It's not bizarre at all, it's perfectly logical for the doctor's office to lawyer up and try to get you to tell their attorney who said what. It's what happens whenever there's a liability issue that involves fines, puts licenses in jeopardy, etc. They will then try to create a narrative that will attempt to neutralize any possible action on your part against them for violating HIPAA laws. They are being proactive in the event you file a formal complaint, and the fact that they expect you to do so indicates to me that they know you have adequate grounds to complain. On top of that, you were also asked what it would take to make the problem go away. I interpret that as a quid pro quo in one form or another. They're starting to get into the weeds on this thing and dragging you in with them. Remember what I said about getting an attorney to protect your interests? At the very least, you may want to rethink your position on filing a formal complaint. Although a logical move on their part, it was still real chutzpah for their attorney to expect you to name names and supply them with copies of your evidence. That alone would have pushed me over the edge to do something, and I wouldn't need six years to think about it.

So, the end result of this situation is that the RO CUE'd its CUE.

Watch, soon we'll be seeing podiatrists and dermatologists doing C & P's for sleep disorders. If they're an M.D., one size fits all, if you manage to, in fact, get an M.D. to conduct the exam. We are currently challenging a C & P that should have been conducted by an endocrinologist regarding residuals of a service connected adrenal disorder. Instead, it was conducted by an anesthesiologist. We challenged this through the RO as soon as we got the copy of the C & P, and then challenged it again when we filed the Board appeal after the RO denial. We have yet to receive anything from the VA that directly addressed this particular issue. We have to throw the BS flag when this happens.

You stated you have an IME; did Dr. Bash personally examine you? Or did he perform a records review and render an IMO (opinion vs. examination)? Our IMO from Dr. Bash was dismissed because he didn't personally examine my husband, and thus the IMO was deemed not credible. We're still battling with them on that issue, among others. If you file a reconsideration request, just remember that the meter continues to run on the 12 month deadline to file your NOD. Your deadline to file an NOD may run out before the RO makes a decision on your reconsideration request, it's been known to happen.

I read recently that roughly 85% of decisions made at the Regional Office level are denials, so the chances of your avoiding a Board appeal are slim. The mad dash to clear the claims backlogs has resulted in the VA issuing mass denials to get claims off their radar screen, since once they become appeals and are the Board's problem, that claim is no longer considered part of the claims backlog. Most reconsideration requests result in regurgitations of the original denial, with the one year meter still running on the deadline to file a Notice of Disagreement. If you file a Notice of Disagreement quickly and include your IME, that NOD is supposed to trigger a review of the decision anyway, and the IME will require that the RO review that new evidence and either grant the claim or explain why they continue to deny it. I would file the NOD with your new evidence, also cite the fact that you were not offered C&P examinations for two of your claims, then file a Board appeal asap. I don't think, in reality, you have all that many options.

When you file the TDIU application, Form 21-4140, you are asked to list the names and addresses of former employers. Then, the VA sends verification of employment forms to those you have listed. Can you list your supervisor's name along with the company name, etc., and have the inquiry sent directly to your immediate supervisor, instead of the Director? That would keep things simple. You're the one who gives the VA the contact information. Of course, this is assuming your supervisor is willing to complete it.

Thanks, Buck. I can't remember the details that long ago, I'd have to go through my file cabinets (two) of VA paperwork to figure out if that was the reason. However, when the RO doesn't act for a couple of years on a claim, then that claim gets bounced between the RO and the BVA four or five times, then the BVA gets the AMC involved, you can easily see where the time goes. I already have two writ petitions under my belt and told Gen. Hickey that I was considering another one. She had someone email me today to tell me someone from the Board Director's office would contact me by next Friday. Maybe a writ won't be necessary. I'm crossing my fingers because just from looking at the docket number, it's an embarrassment to them that it's as old as it is and has never even been to the CAVC, to boot. The docket number speaks volumes on its own merit without my having to say much of anything else.

Just for reference sake, due to numerous remands, my husband currently has an appeal at the Board VLJ that has been an open claim since 1994 and has a 1994 docket number. These issues have never been to the CAVC. They've been with the VLJ this particular cycle since January 2015. So no, they don't handle issues according to docket number, even if they say they do.

If a person applies for SSDI at the same time they are collecting unemployment insurance, they cancel each other out. On one hand, you're telling the unemployment office that you are able and willing to work, and are actively seeking employment. This is a condition of allowing you to collect unemployment insurance. However, on the other hand, you're telling the Social Security Administration that you're disabled and cannot work. Throw a TDIU application into the works, which also states you can't work, and you see the complication.

My husband's took around a year and a half for the New Orleans RO to certify before sending the appeal to the Board. Sorry to say...

Yes, I'm sure they feel badly but at the same time are sweating this out because it is a business, after all. There won't be any "word of mouth" if you settle with them because settlements normally include your written agreement not to discuss the grounds or terms with anyone. That's why I suggested that if you're considering something like that, you get an attorney involved. Again, I guess this all hinges on how you feel about all this and what you will accept as amends vs. filing a formal complaint that stands on its own merit, since I don't think you can be awarded any compensation. I'm very sorry this happened to you. Hopefully, no damage has been done.

By the way, don't let them try to push you into a corner to make a decision by their giving you a week to think about it. You have a six-year window, but like I said, they may want to know what you plan to do before deciding whether to self report. You're sure that was a veiled attempt to get you to tell them how much money it would take to make the problem disappear?

I'd have to check to make sure, but I don't believe there is any monetary award payable to the complaining party in a HIPAA complaint. Now, if you suffered some measureable damage or loss, hiring an attorney would be in order and you could sue. At this point, there is no discernible damage as you've described the situation -- yet. You may want to speak to an attorney yourself before you make any agreement with them if you're considering a financial settlement instead of filing a complaint. It sounds like they won't be seeing you again as a patient. If it were I considering settling with them in lieu of a complaint, I would have a lawyer contact them and do my talking for me. Otherwise, if you feel you should file a complaint on principle, you have six years to do it. Of course, get copies of any records you have there before you get too far down either road you choose. As as for self-reporting, the fact that they asked you to name a price to keep quiet tells me that they may not self report if they settle with you financially. JMO.

Green, there's a six-year statute of limitations on filing a formal HIPAA complaint, which of course is probably your healthcare provider's primary concern. That's six years to find out what kind of impact, if any, this transgression will have on your relationship with the VA. You obviously have to ask yourself if this unfortunate incident destroyed your trust in your healthcare provider to the extent that you need to switch providers, since I wouldn't advise filing a complaint against someone who you intend to continue treating you. This an excellent example of the fact that once a bell is rung, it can't be "un-rung." It's now a matter of how much this upsets you, your relationship with your doctor, and determining if any damage is done within the next six years. At least they've asked you the question about how to "make this right," even though there may not be any way to do that.

This is just my opinion. I would gather together whatever evidence is available to you and if it has not yet been submitted to the RO, submit it. If you pay for an IMO, make sure that the physician is board certified in that specialty and that he/she has personally examined you. If you've already received an SOC, this new additional evidence will trigger a supplementary SOC, aka SSOC. Of course, you can wait to see what the RO decides, and then get your IMO to submit with your Board appeal, to see if the expense becomes necessary. You would then write to the Board stating that you are waiving your right to have the RO review the new evidence; I'd just let the Board handle things from that point on. We've had to appeal almost every award my husband's received to the Board. So, yes, I would assume the worst, that the RO will deny and you'll need to appeal it to the Board. When it reaches the Board, you'll have to have all your evidence on the table there at the point it's up for a decision. That's not to say the Board doesn't get it wrong. I've always tried to act on the assumption that every claim has the potential to end up at the CAVC. If you get what you want without having to appeal to that level, all the better but at least you were prepared for the worst. Also, once you file an NOD, I recommend that you try to find an attorney to represent your appeal to the Board. If you are denied by the Board and end up at the CAVC, you know that you can no longer add new evidence, and that the Court can only consider evidence that was before the Board at the time of its decision. I don't believe in approaching the CAVC pro se because you can bet you'll be facing an army of VA lawyers. Your attorney would then have a history with you as a client and would be in a better position to help protect your interests.

Get an independent medical opinion from the physician treating you for COPD linking it to SA. Consult the information here on hadit regarding how to structure the IMO and what it needs to address.

I was a member of a FB group that deals with issues similar to hadit, only I was vilified for answering a veteran's question, asked in astonishment, by telling him that he could, in fact, apply for SMC(s) by virtue of the fact that he was literally housebound. The owner of the page kept telling everyone to depend on the DAV, once they've reached 100% to "not rock the boat," and similar bad advice. I was respectful and reserved, but the question that sent him over the edge was why on earth would he advise his housebound members not to apply for housebound benefits. He called me disruptive and told me to go get my own page, that he had enough administrators to help him. He flattered himself because I would never consider working with someone like that. He continues to do his readers a great disservice. I did discuss hadit there and suggested that people consult more than one website to educate themselves. Funny because I had a lot of his members messaging me with questions and I answered every single one of them. How dare I!

I am mailing this as well, but I have correspondence I need to also fax to BVA Litigation Support. I've faxed it to the Customer Service Number (202) 343-1889. The numbers 202/565-4720 and 202/565-5270 are no longer working. Would really like the one going directly to Litigation Support if anyone out there has it, thanks!

There may well come a day in the near future when contacting Gen. Hickey or Sec. MacDonald will no longer be productive, but so far, many veterans have been helped, while others have either not received the answer they wanted to hear or never received an answer at all. I agree about this particular case not being a good candidate for her intervention, only because it looks like extra-schedular consideration is in play, which might end up working to MrRob's benefit. It hasn't played out to a conclusion yet, so there's really nothing for her to address. At least it appears the BVA is either trying to find grounds to award a benefit, or establish grounds to explain why extra-schedular benefit cannot be awarded. In the latter case, the information is useful so the veteran can rebut it if he appeals to the next step, the CAVC. Two remands is not an unreasonable number. If MrRob is denied in the end, he should appeal to the CAVC, and at that point, I normally recommend a veteran get an attorney because you can bet the VA will have a few of their own ready to fight. JMO.

It sounds like it may be a denial under regular schedular criteria, but they are reviewing the appeal to see if your circumstances qualify you for extra-scheduler consideration that would otherwise grant you benefits. My understanding is that granting extra-scheduler benefits is the exception and not done with any degree of frequency. There is no formal limit to the number of times an appeal can be remanded. I've seen where it took so long for the Board to hear an appeal that the C&P exam related to the case was too old, not considered "contemporaneous" as required by law, and the remand was issued for the purpose of getting a new one. Then there's the situation where the Board issued a remand, but the RO didn't follow the Board's instructions, and the Board gave the RO a pass on it, which resulted in the appeal going to the Court of Veterans Appeals, which caught the error and remanded the appeal back to the Board to be corrected. That happened to one of my husband's appeals, which is still sitting with a VLJ at the Board, and that's with an attorney. So, yes, you can find yourself going up and down the RO/AMC-Board-CAVC ladder numerous times.

BTW, when a veteran files a formal NOD on a denial, that is supposed to automatically trigger a review of the decision, then RO either reaches a different decision or sends the SOC explaining the denial. This thing about filing a formal request for a DRO to review it has confused me, because the NOD is suppose to make that happen, anyway ( I guess, unless you're providing additional evidence not previously available). That being said, I have never received anything but a regurgitation of the original denial in the SOC received after filing an NOD with my arguments as to why the denial was wrong. I just file the I-9 and appeal to the Board to get it out of the RO.

To me, this is an easy decision. If you can find capable counsel to represent you, I vote for getting an attorney. The saying holds true that 80% of something is better than 100% of nothing. Sinusitis is a tough claim to win; my husband had to appeal it to the BVA before it was finally awarded, and that was with the IMO from the USAF ENT surgeon who worked on him while he was active duty. The VA prefers to think that these are episodic head colds. Do you also have a deviated septum and/or suffer from Sleep Apnea?

What is being reduced? Did the VA have you attend a C&P examination before they proposed to reduce your rating? How long have you held a rating for the condition the VA wants to reduce? Do you have any evidence to contest the VA's grounds for reduction? Do you have a VSO helping you with this hearing? You've requested a hearing, so make sure you show up for it prepared. If the hearing doesn't go your way, you'll need to file a formal Notice of Disagreement if you haven't already and then a Board Appeal as the next step. Pay attention to deadlines. Sorry, but the attachment doesn't answer these questions, so I'm asking for the information we'd need to assist you.

I would advise periodically checking it for any surprise C&P exams that may be scheduled if anyone has a pending claim or appeal. You're supposed to be notified through the mail, but that doesn't always happen.