Snake Eyes

Thanks for adding your $.02. I also forgot to mention he also has been at conferences where VSOs learn the latest. My own VSO says he's highly respected. I don't need help contacting him -- he always reminds me to "bug" him in xxxx days. We're in the final review stage of his next letter/exam report. It does take time... And you will need to work with him through one or more drafts. Tip for those considering someone like Dr. Bash: You really need to know the facts of your own case. An IME/IMO doc may help you see claim issues you overlook, but it is your claim. Bash is very thorough, though.

Thanks for the replies. I'll have to see how it plays out. As a new claim within the six month window, it may be hard to find an attorney who will take the case.

John999, I agree its a coin toss. We spend hours -- and accumulated months -- writing our claims, gathering info, getting professional opinions, etc. and then it almost seems like the result came right off the Craps table in Vegas. I was stunned at the stuff rated in my claim that the VSO included in my fax imformal by accident. The C&P examiner reviewed those anyway and I got SC for two items I didn't even intend to file for in the final claim. On the other hand -- a condition that was documented in my SMR -- and I gave the SMR dates and BP readings in a statement with the claim -- was denied because the doc who filled out the DBQ gave his own diagnosis date rather than refer to all the readings from my SMR. NOD will be sent on that one. All, On the issue of Dr. Bash being hard to get hold of, I share your frustration, and as others have said, you have to be persistent -- AND patient. Depending on when you connect with Dr. Bash and sign on to his services, you may also have a problem getting documentation to him. I've had him "miss" things in mail, fax and email, sending some several times. I don't know if that's a result of him being out of town at the time I sent the items or what (he can speak for himself :-) ). Once you get a finished product from him, you'll be impressed with the CV he sends with it. His SSDI IME was four pages long. His CV was about 13 pages. Quite a brag sheet.... And his work is being decided by people who probably have a BS degree or less.

Not so sure about the Dr. Bash angle. In his original letter, he had several factual errors, which I corrected. He also had me re-write some of his language to more accurately reflect my conditions. For those who haven't used his services yet, this is NOT unusual. He sends his initial draft in Word format, and if you have Word you can make corrections, which he'll see in "review mode" in Word and approve (or make his own corrections). However, getting information into his hands has been very difficult for me. He originally requested DBQs with my personal info and his signature blocks filled in, which he'd complete based on his notes from when he did the exam. I sent those by mail and I don't know if he ever got them, but he has requested items I hand-carried to our appoinment on a few occasions. He was not at his Mariland office over the summer; I suspect that accounts for a lot of the phone-email-postal mail-fax tag we've played over the summer. Hopping it gets better.

UPDATE: I got the 30 day letter saying he was going to remove me from the program and then the final letter saying I was removed from the program (but it did not say I was withdrawing). More specifically, it said my enrollment was "discontinued" due to "medical conditions" that would prevent me from completing the program at this time. Not a denial but not an acceptance either. I sent a follow-up email to him asking for a copy of his report and an explanation of what "discontinued due to medical conditions" meant and whether this constituted a denial. No answer. Tried to call him today and got a voice mail saying he'd be out of the office until October 16th. Is there a QUICK way to get a Voc Rehab report online without having to go through all the hoops? I don't see it on eBennies.

I had a mental exam for SSDI yesterday with the primary complaint being Generalized Anxiety Disorder and depression. The psychologist and I had a wide ranging conversation and I don't think she got in all the canned questions Social Security has on their forms. As a result, she talked like she thought I was "over stressed" and had a "bruised ego from rejection" (jobs I lost or were downsized from) and so forth. The SSDI claim has several medical conditions along with the GAD, and I have a physical exam next month. What are the implications of Consultative Exams? Would they give more weight to the person who talks with you for an hour than say, a letter from Dr. Bash after he examined me and reviewed over 1,000 pages of my medical records? Dr. Bash's letter points out that I'm over 60 years old -- apparently because age is a factor Social Security considers when you come close but do not fully meet their disability guidelines for a given condition. If she "diagnoses" stress and anger issues for Social Security, would that potentially cause a reversal of my GAD rating from the VA if I include SSDI as part of a TDIU claim?

The intake person at Social Security worked with me to determine that I had worked more than 13 hours a month during my "under employment years" and thus did not qualify for SSDI during that time. As a result, the onset date was set to 6/30/2014. If the case goes in my favor, would I be paid beginning January, 2015 or would there be retro pay back to the onset date?

Re Dr Bash: i think he had issues like that in the past but not recently. You should get with Dr. Bash and your RSO with the specific denial wording. He does both IMEs and IMOs, and if he did an exam with you before writing his letter, they can't justify a denial based on no exam.

I believe Dr. Bash can do IMEs for vets who have mental health ratings already (he wouldn't diagnose PTSD, but can address unemployability). He can speak for himself, of course... I'm just pointing out that once diagnosed by the VA (and rated), a VA doc doesn't have to be the one to write the IME.

Do you have a link or know where he posted? Search doesn't behave well for me on this forum :-)

I think that's definitely the case. He only has my C&P exams and a few of my civilian records (submitted with one of my claims) to go on. I got the clear impression I'd be strung along for several months before being told Voc Rehab was unfeasable. He did say that the raters would eventually see his report.... and that my withdrawing from the program would not be a determining factor. I find that hard to believe :-)

His approach was "I can't give a specific denial at this time because there is not enough in your medical records to make a determination yet...." Then, "There are multiple concerns with your potential ability to succeed in getting gainful employment." I tried repeatedly to extract an actual answer and finally he just said, "I'm repeating myself now... "

Had a nice visit with the Voc Rehab counselor today for orientation. He took all my transcripts, resume, forms and results from my assessment and asked tons of probing questions. All that is what I expected as the VA needs to do its due dilligence for this kind of program. What I did not expect was to be confronted with two options.... 1). Withdraw from Voc Rehab voluntarily based on "multiple concerns about my employability" with the promise that I could re-apply within a year if my SSDI and TDIU claims are denied... or 2) Continue making the 200 mile round-trip to his office for several months until he could make a final determination that I'm "unemployable". He was clear that that was the likely outcome based on the interview and his review of my VA records. Unfortunately, he couldn't state clearly one way or the other whether Voc Rehab was feasable or not. He did say that his report would show that there are multiple concerns about my unemployability. He won't be able to file his report for several months (after the TDIU and SSDI claims have had time to resolve. So now... it looks like I'm in some kind of "Limbo" -- not qualitied enough to continue with a meaningful hope of success and not enough of a history in the VA system to make a clear determination of unemployability. I don't do well with ambiguity and gray areas. You should either be trainable or not. Has anyone else had a situation like this (being told you're not likely to be deemed "employable" if continuing the program but cannot say that yet)?

Had my Voc Rehab orientation today. The counselor was very "discouraging" regarding whether I should continue, but stopped short of saying directly that I'm unemployable. In his opinion (with a high degree of weaselness), he said there were "multiple concerns about my employability", but he couldn't make that determination without going through a lengthy process and continued 200 mile round trips. I couldn't pin him down on specifically whether his report would make clear whether voc rehab was feasable or not and finally, he said, "now I'm beginning to repeat myself" and the session ended. He took a tone of intake, lots of lengthy forms to fill out and of course the assessment. His only encouragement was that if I were to continue trying to become employable to focus on IT rather than the areas of interest that surfaced during the assessment. Voc Rehab is a great program for those who can get a clear determination that they can be rehabilitated. For those where there is a doubt, something in VA culture must make these guys squeamish about coming out directly and telling the veteran, "you're unemployable". To his credit, he took over an hour while I went to lunch to review my medical record. He saw all the same indicators the VA shrink saw, but since my "time in the system" is fairly short, not enough to be conclusive. Off the record, he said it should be obvious to anyone looking at my records what the barriers to rehab were and that his report would state that WE had multiple concerns about my employability. Unless he states what those were in his report, I'm in Voc Rehab/TDIU limbo. BTW: My 2014 earnings were just over $12K when I stopped working at the end of June. So unless the IMEs and disability letters Dr. Bash is doing for me explain clearly.... I may be in the same boat you're in. Hopefully, if I do have to go to the hearing level, I will come out with the same results you did....Congrats!

In my case, the IME/IMO and DBQs with Dr. Bash mounted up in the money department because he not only is doing the letters, but an exam and DBQs, as many letters as needed regarding my student loan and an SSDI letter. The old saying, you get what you pay for may apply here, but there doesn't seem to be any objective way of figuring that out. These people do not publish their "wins and losses" scorecard -- only a handful of wins on their Websites, and there is no objective third party to evaluate their services. I went with the recommendations of vets who used Dr. Bash's services -- and the fact that he seems to have support from Hadit without necessarily having an advertizing relationship. Depending on how my claims pan out, I may need a "second" second opinion, and the next guy on my radar is Dr. Anaise.

UPDATE... I had an exam with Dr. Bash on the overal TDIU and diabetes claims. He is familiar with the research showing a link between sleep apnea and diabetes, albeit by virtue of apnea's impact on glucose levels causing weight gain and then diabetes. I gave him a handful of analytical studies with a lot of references so he may find a different nexus after a lit review. For those who have not used his services, he is very pro-veteran and he is open minded about research (at least in this particular issue). I should have his final IME/IMO letters and DBQs in a few weeks, after which I'll be filing both a TDIU/CUE and a fully developed diabetes claim. Which brings me to this: Dr. Bash doesn't just follow your lead (in my case, it would have been to document whether there is a link between apnea and my other diabetes related issues.... he looked over my records and found an error in my latest determination (apparently, the VA DID NOT look at my SMR on a hypertension claim) and other potential errors. Sounds like he may be a good CUE doc -- at least, he can see them more readily than average (GI) Joe can ;-)

Thanks for the input, Hamslice. Indeed, in talking with Dr. Bash, he only needed less than a minute to look at my records and a 21-438 I submitted in support of a claim to see that the HTN was SC. Whether I get 10% because of meds or 0% doesn't matter as it won't have much of an impact on whether I get an increase (I'm at 90% now -- very hard to get over that particular finish line). Dr. Bash was very realistic about the DM II claim for which I brought him onboard. Very hard to win based on a primary SC condition of sleep apnea, but apparently he has won some of these. So even if I get TDIU P&T, I'd pursue these two for the reason you mentioned -- DIC. Think of it as veteran's "estate planning" :-)

Hi Berta, Thanks for the detailed info above. I had the privilege of spending nearly two hours with Dr. Bash going over my records -- He is very thorough and energetic -- my wife sat in on the meeting and it took both of us to keep up with him as he paged through the documents, asked questions and made suggestions. For those considering an IME/IMO from one of these docs, if Dr. Bash is any example, they're in good hands. Some of the areas of inquiry he wants to explore after giving a first look at my records lead me to believe he is all about helping the vet both understand the process and get all of the benefits he or she has earned. Which brings me to this: EVEN IF YOU HAVE A GREAT VSO.... it may be worth the huge expense to get someone like Dr. Bash (or if you need a lawyer as well, Dr. Anaise) to go through your records. VSOs don't have time to do much more than explain how claims are filed and hopefully work out a strategy for winning your claim. I say that not as a critic of VSOs so much as having a healthy respect for what they do and HOW MANY vets they do it for.

That seems to be the likely route... unless a NOD is necessary (I don't know if you can simply resubmit a claim for something if it was already denied and still within the appeal window. If it were approved in the original claim, it would not have affected the overall rating, so having it approved "later" is not a problem. Much of what I'm working on is for the benefit of those I'll eventually leave behind :-)

LOL... I wondered if there was a connection... like the VA shoots for the goal if it's a VSO filing for a vet and shreds for the goal if it's the Vet filing for himself (yes, they're talking in the media about shredding mail at some ROs).

I just got the progress notes the other day... She did not say, "Veteran should quit his job and go on disability" -- of course, they can't say something that obvious. She basically described my symptoms in clinical terms with a view toward what analysts would be looking for at Social Security or raters at the VA would be looking for in showing how my work would be impacted. I'll review again and I wonder if she should say something more overt. Also... FWIW, she's an LCSW and not an M.D. For whatever reason, they don't seem eager to get your head in a vice if not necessary. The C&P shrink had a lot of lovely "resume enhancers", if you get my drift. Best thing they did for me is "Rule out PTSD"... the thinking was what I have is in some ways more work prohibitive than PTSD. She said, "A guy with PTSD might be able to work in a warehouse... a guy with your symptoms would avoid the warehouse as well." Gee thanks. :-)

My VSO says if he submits a claim it gets cleared within 125 days... if I try to do it myself, it could take much longer and of course would likely require an appeal. Do these guys get compensated based on the number of claims they file on behalf of vets? My guy knows his stuff, but that is a costly mistake I could have prevented if I had used the Reagan Doctrine :-) What is the basis of the 125 day claim? Does anyone know how a vet can file his own claim and get on that kind of fast track? (Fax... upload to eBennies... mail?)

I took another poster at face value that there is no "Zero" percent in the rating schedule (thought there was on all conditions). If he was correct, you're an exception. If he was not correct, I might need to consider a NOD.

Guess they were right to deny my claim based on the numbers in my SMR (none over 160 Sys or 100 Dia). However, it should be a "at as likely as not" situation when you look at the progression over time (unfortunately, I didn't submit any civilian readings until the DBQ. The cardiologist listed the diagnosed date as the date he took the last of three measurements -- and he didn't consider my civilian records at all. Dr. Bash is reviewing my records for another claim purpose, but I wouldn't be surprised if he notices the pattern the VA either missed or didn't have access to. Since there's no "Zero" rating, it is probably moot.... but if I leave this world with a stroke or heart attack, I'd hate for my wife to miss out on DIC because a doc trying to "help" me filled out a DBQ wrong.

VA denied hypertension in my most recent claim based on this: "The evidence does not show an event, disease or injury in service. Your service treatment records do not show a diagnosis of hypertension in service..." Here are the BP readings in service I used: 140/90 02 December, 1976 120/90 04 March, 1981 154/90 11 January, 1982 (Retention Physical) -- States "Hypertension" 140/84 03 June, 1986 136/84 20 August, 1987 150/88 08 April, 1988 130/90 07 April, 1989 139/82 08 May, 1989 138/82 11 September, 1989 138/82 09 November, 1989 138/82 02 March, 1990 130/84 28 May, 1992 (Periodic Medical Exam) VA denial also cites DBQ from my cardiologist stating HTN was diagnosed in 2013. My civilian records show I've had it for some time (but since I had the above record in service, it didn't occur to me to submit civilian records). SO WHAT DOES THE VA CONSIDER "Hypertension"? I'm currently on medication, but even if I weren't, shouldn't the above numbers be worth a "zero" rating?