allan

>If the system was advisarial, then the VA would not be "assisting" the veteran to get any needed evidence to support their claim, they would actually try to disprove the claim form the get go without seeking any evidence on the claimants behalf. That is an excellent discription of "duty to assist" at the VARO level. It's an absolute shame, but vets should expect it. If a vet is lucky enough to actually recieve an, "honest" & "complete" evaluation of all the evidence, without it being run through a shredder first, they can expect favorable evidence to be misqoated, mispelled & misinterpreted into some kind of BS that doesn't even resemble the truth. Obstruction of justice is a crime.

If you have ever requested a copy of your C-File, please answer the following questions: 1. How long did it take the VA to send you a copy of your C-File? 2. Did you write a simple request or invoke the FOIA (Freedom of Information Act)? 3. Was everything you'd ever sent to the VA in there? Was your file complete? If not, what was missing. Thanks in advance for the feedback, ts ######################################################## Hello TS How long did it take the VA to send you a copy of your C-File? It took around 20 years. So far missing about 2/3rds of my SMR's. Never recieved a responce concerning the lost records, except as reference in denials by the rating officer, as to the SMR's being "absent of any treatment records", for whatever health issue they were denying.

>Is the AMC obligated to follow the Board s remand. Recently, the ratings board sent my claim back to the pre determination area because now the ratings person is asking for medical records from a civilian doctor that is deceased and the records were destroyed years ago. This doctor was not mentioned in the remand. Probably because I sent a letter to the Board in 2003 stating that I had contacted the doctor's heirs and they told me that the medical records were destroyed. hurryupnwait, It's the old, delay the claim ploy. Send in a signed statement in regards to the issue. State that the Dr is deceased & the records have been destroyed. Fax & send a hard copy to the Appeals Center, your SO & the BVA. You may also send in a request to have your claim reviewed by the the BVA, instead of a review by the Appeals Center, or the VARO they pass it off to. Sending for decades old records that have likely been destroyed, does nothing but delay the claim from finalizing for at least a yr or maybe two before it's in someones hands for review again. A claim will get processed, denied or delayed. If a claim is not currently being reviewed, it's collecting dust while you wait. This is how my claim has been on remands from the BVA, for nearly a decade.

That's great news Stretch. Congratulations! No news about Shad? Allan PS....sorry to hear about your loss.

>I am unaware if they have ever tried to ignore his IMOs before. Hello Berta, My claim has been denied by ignoring, 3 IMO's DR Bash has sent in. My claim completely hinges on an opinion by someone who specializes in neurological radiology & a thorough evaluation of medical history. I have complete faith in DR Bashes opinions & diagnoses. Is he worth the money? He's worth every penny. After a decade of having a neuromuscular disorder of unknown cause as a diagnoses & VA neurologist that refuse to view previous medical history during their diagnostic workups, Dr Bash was able to resolve a mystery that's plagued me for decades.

hello captron, Same here. it means your claim is in limbo. It's not being reviewed or processed by anyone. It stays in this state, until someone at a Regional Office somewhere, is free for the Appeals Center to pass it off to, in order to give it the same "type of review", that you appealed to the BVA for in the first place. I'm in the same situation and this is my third time going through the appeals center. If it's sent to a RO, you can expect it to be denied again, with any type of BS. This will put you in a position to have to send in, even more evidence that they will likely ignore. See how it works? My claim is a 1998 BVA appeal, on a 1995 VARO reopened claim from the 80's. Allan

Section A. Description and General Information Overview In this Section This section contains the following topics: Topic Topic Name See Page 1 Description of the Veterans Claims Assistance Act of 2000, PL 106-475 1-A-2 2 Description of the Duty to Assist Criteria 1-A-3 1. Description of the Veterans Claims Assistance Act of 2000, PL 106-475 Introduction This section describes the Veterans Claims Assistance Act of 2000 (VCAA), PL 106-475, and contains information about the responsibilities of the Department of Veterans Affairs (VA) background of PL 106-475, and description of PL 106-475. Change Date August 1, 2002 a. Responsibilities of VA Decisions on Department of Veterans Affairs (VA) benefit eligibility and entitlement are based on the evidence of record. Evidence consists of documents, records, testimonials and information in other forms provided by, or obtained for, a claimant. VA has a duty to assist a claimant who files a substantially complete application in obtaining evidence to substantiate his or her claim before making a decision on the claim. We are charged with granting every benefit supported by the law. b. Background of PL 106-475 On November 9, 2000, PL 106-475 was enacted, superceding the decision of the Court of Appeals for Veterans Claims (CAVC) in Morton vs. West, which held that VA cannot assist in the development of a claim that is not well grounded. c. Description of PL 106-475 The new law, PL 106-475 eliminates the concept of a well grounded claim redefines VA’s duty to assist, and mandates specific notice requirements. 2. Description of the Duty to Assist Criteria Introduction This section contains information about duty to assist, including issues pertaining to claimants relevant Federal records, and non-Federal records requests for VA examinations or medical opinions, circumstances where VA will refrain from or discontinue providing assistance, and contact information for questions. Change Date June 19, 2006 a. Duty to Assist Claimants The Veterans Claims Assistance Act of 2000, PL 106-475, defines the scope of Veterans Benefits Administration’s (VBA’s) duty to assist claimants who file substantially complete applications for VA benefits. Reference: For more information on what constitutes a substantially complete application, see M21-1MR, Part I, 1.B.3.a and 38 CFR 3.159. b. Duty to Obtain Relevant Federal Records VA’s duty to assist includes developing for all relevant records in the custody of a Federal department or agency, including VA medical records, service medical records Social Security Administration records, or evidence from other Federal agencies. Note: Relevancy is determined by what is being claimed. For example, in claims for service connection, relevant documents are those that may substantiate one of the elements of service connection (incurrence, current condition, or links). However, in most cases, it may be impossible to determine relevancy before obtaining the records. Continued on next page 2. Description of the Duty to Assist Criteria, Continued c. Duty to Obtain Relevant Non-Federal Records Our duty to assist also includes developing for private medical records, and lay or other non-Federal governmental evidence, such as current or former employer records, or state and local government records. Important: VA should obtain the veteran’s authorization before including identifying data such as the veteran’s name and claim number in a development letter for lay evidence from a third-party. Authorization may be obtained on VA Form 3288, Request for and Consent to Release of Information from Claimant’s Records. This should not be used to obtain authorization and consent for release of medical evidence which is covered by VA Form 21-4142, Authorization and Consent to Release Information to the Department of Veterans Affairs, or release of employer information, which is covered by VA Form 21-4192, Request for Employment Information in Connection With Claim for Disability Benefits. Reference: For information on the limitation of use of business reply envelopes for third-party development, see M21-1 MR, Part II, 5.B.5.c (TBD) or M21-1, Part III, 11.05, and VBA Letter 20-05-42. d. Duty to Obtain Examination or Medical Opinion If an examination or a medical opinion is necessary to make a decision on a claim for compensation, then our duty to assist includes examining claimants, and/or obtaining a medical opinion from the Veterans Health Administration (VHA) or designated contracted provider. Continued on next page 2. Description of the Duty to Assist Criteria, Continued e. Circumstances Where VA Will Refrain From or Discontinue Providing Assistance VA will not provide assistance in obtaining evidence if a substantially complete application for benefits indicates that there is no reasonable possibility that any assistance VA would provide to the claimant would substantiate the claim. Discontinue providing assistance if the evidence obtained indicates that there is no reasonable possibility that further assistance would substantiate the claim. Circumstances in which to refrain from or discontinue providing assistance in obtaining evidence include, but are not limited to: the claimant's ineligibility for the benefit sought because of lack of qualifying service, lack of veteran status, or other lack of legal eligibility claims that are inherently incredible or clearly lack merit, and an application requesting a benefit to which the claimant is not entitled as a matter of law. Reference: For more information on the criteria for a substantially complete application, see, M21-1MR, Part I, 1.B.3.a, and circumstances where VA will refrain from or discontinue providing assistance, see 38 CFR 3.159(d). f. Contact Information for Questions Questions regarding duty to assist should be submitted to the Q&A mailbox at VAVBAWAS/CO/21Q&A by the Q&A station coordinator. SOURCE: http://www.warms.vba.va.gov/admin21/m21_1/...1/ch01_seca.doc

New Diabetes Genetic Risk Factors Found Thursday, April 26, 2007 WASHINGTON - Scientists have found clusters of new gene variants that raise the risk of Type 2 diabetes - and how the researchers did it is as important as what they found. In one of the largest studies yet of human genetic variability, the scientists tested the DNA of more than 32,000 people in five countries to pin down spots that harbor genetic risk factors for this complicated killer. This type of research - called a "genome-wide association" study - promises to usher in a new era of genetics. Most breakthroughs so far have come from finding a mutation in a single gene that causes illness. But some of the world's most common killers, such as heart disease and diabetes, are caused by complex interactions among numerous genes and modern lifestyles - and teasing out the genetic culprits until now has been almost impossible. "We have been for all of the last decade or more looking under the lamppost to try to find those genes ... and lots of times the lamplight was not actually where we wanted it," said Dr. Francis Collins, genetics chief at the National Institutes of Health, a co-author of the research unveiled Thursday. This new approach "allows us to light up the whole street, and look what we find." What? Four previously unknown gene variants that can increase people's risk of Type 2 diabetes, and confirmation that six other genes play a role, too. The work, by three international research teams that shared their findings, was published online Thursday by the journal Science. Also Thursday in the journal Nature Genetics, another team led by Iceland researchers reported separately finding one of those same new genes - and that, interestingly, it seems to increase the diabetes risk most in people who aren't obese. Next, the researchers will have to figure out just what those genes do, in hopes they'll point toward new ways to treat or prevent a disease that affects more than 170 million people worldwide, and rising. With Type 2 diabetes, the body gradually loses its ability to use insulin, a hormone key for turning blood sugar into insulin. It is a major cause of heart disease, as high blood sugar damages blood vessels, and leads to kidney failure, blindness and amputations. Obesity and lack of exercise are chief risk factors. But heredity is involved, too: People with an affected parent or sibling are at 3.5 times greater risk of developing diabetes than people from diabetes-free families. The new work scanned DNA to find patterns of small gene variations known as SNPs (pronounced "snips") more common in diabetics. SNPs can serve as signposts for tracing disease-promoting genes. To be certain the implicated SNPs were involved, the researchers then checked for them in still more volunteers, ultimately testing DNA from 32,500 people in Britain, Finland, Poland, Sweden and the U.S. The highest-risk variants can increase by 20 percent someone's odds of developing Type 2 diabetes, the teams reported. Among the genes implicated: -One that helps pump zinc into insulin-producing pancreatic cells, raising questions about the metal's role in insulin secretion. -A pair previously linked only to certain cancers, another brand new area for diabetes researchers to probe. -A region of chromosome 11 where genes of any sort had never been described. -------------------------------------------------------------------------------- Copyright © 2006, PeoplePC Inc. All rights reserved.

§3.103 Procedural due process and appellate rights. (a) Statement of policy. Every claimant has the right to written notice of the decision made on his or her claim, the right to a hearing, and the right of representation. Proceedings before VA are ex parte in nature, and it is the obligation of VA to assist a claimant in developing the facts pertinent to the claim and to render a decision which grants every benefit that can be supported in law while protecting the interests of the Government. The provisions of this section apply to all claims for benefits and relief, and decisions thereon, within the purview of this part 3. (b) The right to notice: (1) General. Claimants and their representatives are entitled to notice of any decision made by VA affecting the payment of benefits or the granting of relief. Such notice shall clearly set forth the decision made, any applicable effective date, the reason(s) for the decision, the right to a hearing on any issue involved in the claim, the right of representation and the right, as well as the necessary procedures and time limits, to initiate an appeal of the decision. (2) Pretermination/reduction notice. Except as otherwise provided in paragraph (b)(3) of this section, no award of compensation, pension or dependency and indemnity compensation shall be terminated, reduced or otherwise adversely affected unless the beneficiary has been notified of such adverse action and has been provided a period of 60 days in which to submit evidence for the purpose of showing that the adverse action should not be taken. (3) Exceptions. Pretermination/reduction notice is not required but notice contemporaneous with the adverse action is required when: (i) An adverse action is based solely on written, factual, unambiguous information as to income, net worth, dependency or marital status provided to VA by the beneficiary or his/her fiduciary with knowledge or notice that such information would be used to calculate benefits, and the legal standards applied to this information are numerical in nature, (ii) An adverse action is based upon the beneficiary’s or fiduciary’s failure to return a required eligibility verification report, (iii) Evidence reasonably indicates that a beneficiary is deceased. However, in the event that VA has received a death certificate, a terminal hospital report verifying the death of a beneficiary or a claim for VA burial benefits, no notice of termination (contemporaneous or otherwise) will be required, (iv) An adverse action is based upon a written and signed statement provided by the beneficiary to VA renouncing VA benefits (see §3.106 on renouncement), (v) An adverse action is based upon a written statement provided to VA by a veteran indicating that he or she has returned to active service, the nature of that service, and the date of reentry into service, with the knowledge or notice that receipt of active service pay precludes concurrent receipt of VA compensation or pension (see §3.654 regarding active service pay), or (vi) An adverse action is based upon a garnishment order issued under 42 U.S.C. 659(a). (Authority: 38 U.S.C. 501(a)) © The right to a hearing. (1) Upon request, a claimant is entitled to a hearing at any time on any issue involved in a claim within the purview of part 3 of this chapter, subject to the limitations described in §20.1304 of this chapter with respect to hearings in claims which have been certified to the Board of Veterans Appeals for appellate review. VA will provide the place of hearing in the VA office having original jurisdiction over the claim or at the VA office nearest the claimant’s home having adjudicative functions or, subject to available resources and solely at the option of VA, at any other VA facility or federal building at which suitable hearing facilities are available. VA will provide one or more employees who have original determinative authority of such issues to conduct the hearing and be responsible for establishment and preservation of the hearing record. Hearings in connection with proposed adverse actions and appeals shall be held before one or more VA employees having original determinative authority who did not participate in the proposed action or the decision being appealed. All expenses incurred by the claimant in connection with the hearing are the responsibility of the claimant. (2) The purpose of a hearing is to permit the claimant to introduce into the record, in person, any available evidence which he or she considers material and any arguments or contentions with respect to the facts and applicable law which he or she may consider pertinent. All testimony will be under oath or affirmation. The claimant is entitled to produce witnesses, but the claimant and witnesses are expected to be present. The Veterans Benefits Administration will not normally schedule a hearing for the sole purpose of receiving argument from a representative. It is the responsibility of the VA employee or employees conducting the hearings to explain fully the issues and suggest the submission of evidence which the claimant may have overlooked and which would be of advantage to the claimant’s position. To assure clarity and completeness of the hearing record, questions which are directed to the claimant and to witnesses are to be framed to explore fully the basis for claimed entitlement rather than with an intent to refute evidence or to discredit testimony. In cases in which the nature, origin, or degree of disability is in issue, the claimant may request visual examination by a physician designated by VA and the physician’s observations will be read into the record. (Authority: 38 U.S.C. 501(a)) (d) Submission of evidence. Any evidence whether documentary, testimonial, or in other form, offered by the claimant in support of a claim and any issue a claimant may raise and any contention or argument a claimant may offer with respect thereto are to be included in the records. (e) The right to representation. Subject to the provisions of §§14.626 through 14.637 of this title, claimants are entitled to representation of their choice at every stage in the prosecution of a claim. (f) Notification of decisions. The claimant or beneficiary and his or her representative will be notified in writing of decisions affecting the payment of benefits or granting relief. All notifications will advise the claimant of the reason for the decision; the date the decision will be effective; the right to a hearing subject to paragraph © of this section; the right to initiate an appeal by filing a Notice of Disagreement which will entitle the individual to a Statement of the Case for assistance in perfecting an appeal; and the periods in which an appeal must be initiated and perfected (See part 20 of this chapter, on appeals). Further, any notice that VA has denied a benefit sought will include a summary of the evidence considered. (Authority: 38 U.S.C. 5104) [55 FR 13527, Apr. 11, 1990; 55 FR 17530, Apr. 25, 1990, as amended at 55 FR 20148, May 15, 1990; 55 FR 25308, June 21, 1990; 57 FR 56993, Dec. 2, 1992; 58 FR 16359, Mar. 26, 1993; 58 FR 59366, Nov. 9, 1993; 59 FR 6218, Feb. 10, 1994; 59 FR 6901, Feb. 14, 1994] Supplement Highlights references: 7(2), 9(3), 10(2), 10(3). Reserved http://www.warms.vba.va.gov/regs/38CFR/BOO...ART3/S3_103.DOC

Chapter 5. Evaluating Evidence and Making a Decision 1. Guidelines for Evaluating Evidence http://www.warms.vba.va.gov/admin21/m21_1/...v/ch05/ch05.doc

Section A. General Information on Power of Attorney (POA) http://www.warms.vba.va.gov/admin21/m21_1/...3/ch03_seca.doc

Citation Nr: 0508095 Decision Date: 03/18/05 Archive Date: 03/30/05 DOCKET NO. 98-19 597 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUE Entitlement to service connection for a low back disability, including secondary to an already service-connected left knee disability. REPRESENTATION Appellant represented by: Sean A. Ravin, Attorney-at-Law WITNESSES AT HEARING ON APPEAL The appellant, his spouse, and C. B., MD. ATTORNEY FOR THE BOARD J. Fussell, Counsel INTRODUCTION The veteran had verified active duty from September 1970 to September 1972 and from January 1991 to May 1991. He also served in the reserves and had verified periods of active duty for training (ACDUTRA) in July and August 1974, and in July and August 1975. This appeal to the Board of Veterans' Appeals (Board) arose from an October 1997 rating decision of the Department of Veterans (VA) Regional Office (RO) in Columbia, South Carolina - which denied service connection for a low back disability. But the RO granted service connection for a left knee disability and assigned an initial 10 percent rating for it. This is currently the veteran's only service-connected disability. A hearing was held at the RO in November 2000 before a Veterans Law Judge (VLJ) of the Board. This type of hearing is often called a travel Board hearing. A transcript of that proceeding is of record. The Board remanded the case to the RO in March 2001 for further development and consideration. In July 2002 the Board denied the claim for service connection for a low back disability on both direct and secondary bases. That Board decision was appealed to the United States Court of Appeals for Veterans Claims (Court). And pursuant to a February 2003 Joint Motion, the Court entered an Order in February 2003 vacating that July 2002 Board decision and remanding the case to the Board for compliance with the Veterans Claims Assistance Act (VCAA). In response, the Board remanded the case to the RO in September 2003. And more recently, in March 2005, the veteran, his spouse, and Craig Bush, M.D., testified at a hearing at the Board's offices in Washington, DC, before the undersigned VLJ. A complete transcript of the hearing is of record. The Board advanced this case on the docket pursuant to a motion filed under 38 C.F.R. � 20.900 (2004). During the March 2005 hearing, the veteran and his attorney raised additional claims for a rating higher than 10 percent for the service-connected left knee disability and for a total disability rating based on individual unemployability (TDIU). See page 2 of the hearing transcript. These additional claims, however, have not been adjudicated by the RO, much less denied and timely appealed to the Board, so referral to the RO for initial development and consideration is required since the Board does not currently have jurisdiction to consider them. See 38 C.F.R. � 20.200 (2004). FINDING OF FACT Based on the medical and other evidence currently of record, it is just as likely as not the veteran's current low back disorder is attributable to functional impairment from his service-connected left knee disability. CONCLUSION OF LAW Resolving all reasonable doubt in the veteran's favor, his low back disorder is proximately due to and the result of his service-connected left knee disability. 38 C.F.R. � 3.310(a) (2004). REASONS AND BASES FOR FINDING AND CONCLUSION The Veterans Claims Assistance Act (VCAA) The VCAA, codified at 38 U.S.C.A. �� 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002), became effective on November 9, 2000. Implementing regulations are codified at 38 C.F.R. �� 3.102, 3.156(a), 3.159 and 3.326 (2004). The VCAA requires that VA notify the veteran of the type of evidence needed to substantiate his claim, including insofar as whose specific responsibility - his or VA's, it is for obtaining the supporting evidence. The VCAA also requires that VA assist the veteran in obtaining evidence necessary to substantiate a claim, but is not required to provide assistance if there is no reasonable possibility that it would aid in substantiating the claim. Charles v. Principi, 16 Vet. App. 370, 373-74 (2002); Quartuccio v. Principi, 16 Vet. App. 183, 186-87 (2002). The Board has determined that the evidence and information currently of record supports a complete grant of the benefit requested. Therefore, no further notification and/or development is required to comply with the VCAA or the implementing regulations because it would be inconsequential. So the Board will address the merits of the veteran's claim for service connection for a low back disorder. Legal Analysis Disability that is proximately due to or the result of a service-connected disorder shall be service-connected. 38 C.F.R. � 3.310(a) (2004). Service connection will also be granted for aggravation of a nonservice-connected condition by a service-connected disorder, although compensation is limited to the degree of disability (and only that degree) over and above the degree of disability existing prior to the aggravation. See Allen v. Brown, 7 Vet. App. 439 (1995). In determining whether service connection is warranted for a disability alleged, VA is responsible for considering evidence both for and against the claim. If the evidence, as a whole, supports the claim or is in relative equipoise (i.e., about evenly balanced), then the veteran prevails. Conversely, if the preponderance of the evidence is against the claim, then it must be denied. See 38 C.F.R. � 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The veteran's only service-connected disability is impairment of the left knee, which currently has a 10 percent rating. In a January 2004 report, Dr. Craig Bash stated that he had reviewed the veteran's claims file for the purpose of providing a medical opinion concerning his low back disability. Dr. Bash pointed out this case was well within his area of expertise. And after reviewing the record he stated, in pertinent part, that: It is my opinion based on the medical record, x- ray findings, and the patient's statements that this patient's spine is most likely secondary to his longstanding service connected lower leg disability and his accompanying abnormal gait, which likely damaged his perivertebral spinal ligaments due to undue and abnormal stress. It is also my opinion that this patient's spine disc disease presented with sciatica, nerve damage, gait abnormalities and muscle atrophy in 1997 .... A great deal of confusion is present in the C-File record concerning this patient's spine disease. He currently has very severe advanced degenerative spine disease with sciatica, antalgic gait, uses a cane for ambulation, has muscle atrophy, and has had multiple epidural steroid injections and a herniated disc. The question presented in the file is whether or not the spine disease is related to his service connected abnormal knee and not whether his currently [sic] spine disease was caused by his knee surgery in 1996 ..... It is well known that patient's [sic] with lower extremity orthopedic problems often have abnormal gaits and these patients often rapidly develop abnormal painful spines. The abnormal forces which are secondary to the gait problems places excessive stresses across the vertebral column, which in turn damages the ligaments. As Turik states in the following, once ligaments are damaged then the patient will experience advanced degenerative arthritis: "... At the onset, tearing of ligaments and subluxation are manifest by local symptoms of low back pain accentuated by the motion which stretches the ligaments ... Eventually, symptoms of localized degenerative arthritis are superimposed ... (Turik page 853) It is my opinion that this patient's spine disease is most likely secondary to this longstanding service connected lower leg disability and his accompanying abnormal gait, which likely damaged his perivertebral spinal ligaments due to undue and abnormal stress for the following reasons: 1. The patient entered service with normal legs and spine. 2. The patient had a serious in service leg injury which is service connected. 3. The patient has had a longstanding abnormal gait. 4. The patient now has advanced premature degenerative spine disease with sciatica, atrophy and a herniated disc. 5. The patient does not have another plausible etiology for his spine disease. 6. The literature supports an association between advance spine disease and a longstanding abnormal gait. 7. The medical opinions stating that this patients [sic] spine is not related to his leg surgery are non germane [sic] to the case because this patient's spine disease is most likely secondary to his longstanding abnormal gait. The veteran underwent a VA orthopedic examination in May 2004, also to obtain a medical opinion concerning the etiology of his low back disability at issue. His claims file was apparently available for review by the evaluating physician inasmuch as the examiner related the veteran's medical history. In doing so it was reported that, in February 1997, about six months after his left knee surgery, he experienced the sudden onset of severe low back pain, for which he underwent an MRI that revealed bulging discs. After a physical examination it was reported that: Given the apparently routine nature of the left knee arthroscopy, and the subsequent negative history relative to that joint as well as currently normal examination of that joint, it is, in my mind, very unlikely that the left knee condition would have led to significant lumbar spine abnormalities. While it is known that chronic gait abnormalities can lead to lumbar spine injury and wear and tear, the length of time involved here makes this unlikely in my opinion. [The veteran's] surgery was in August of 1996 and his onset of low back pain was six months later in February 1997. Again, given the apparently satisfactory outcome of his knee arthroscopic surgery, it is in my opinion very unlikely that the degree and duration of gait abnormality subsequent to that surgery was sufficient to cause the currently observed degenerative disk disease in the lumbar spine. The question relating to the unusual physical therapy exercises is a highly speculative one. Given the veteran's description of what he did during these exercises they do sound a bit unusual, but not potential [sic] traumatic enough to have caused severe lumbar spine injury without first significantly exacerbating the knee symptoms. It is my opinion, therefore, that it is less likely than not that his degenerative disk disease of the lumbar spine was secondary to either the knee injury with gait abnormalities or to the physical therapy used subsequent to the knee surgery. The May 2004 VA examiner further stated that he had reviewed Dr. Bash's opinion, and that it appeared that Dr. Bash had not examined the veteran to ascertain the severity of the degenerative disc disease or, more importantly, of the knee. Given an essentially normal examination of the knee and an admission on the part of the veteran that he has had very little symptomatology from the knee since his convalescence, the May 2004 VA examiner felt justified in disagreeing with Dr. Bash's January 2004 opinion. An addendum to the May 2004 VA examination report indicates that X-rays revealed three compartment osteoarthritis of the left knee associated with a large Baker's cyst containing multiple osteochondral fragments. At the March 2005 hearing at the Board before the undersigned VLJ, Dr. Bash testified that he had reviewed the veteran's claims files on two occasions. See pages 11 and 12 of the transcript. He said there was no evidence of a spinal herniated nucleus pulposis (HNP) or back pain prior to the veteran's left knee injury, and that he first developed back pain after the left knee injury. See pages 14 and 15 of the transcript. After Dr. Bash had rendered his January 2004 opinion and after the VA examination in May 2004, Dr. Bash had personally examined the veteran in March 2005 - just a day prior to the hearing. See Page 16 of the transcript. That examination found many more positive clinical findings as to the veteran's left knee than were found on the May 2004 VA examination. Page 17. Of particular note, the veteran's left thigh was smaller in circumference than his right thigh - so atrophied, and he had crepitus (a grinding, clicking sensation) in his left knee. Page 20. Dr. Bash felt that it was most likely the veteran's left knee pain and abnormal gait (due to his service-connected left knee disability) contributed to his current spinal pathology. Page 22. Dr. Bash further stated that he felt the report of the May 2004 VA examination was inaccurate because it did not incorporate the results of imaging and the veteran did not have a normal left knee, as indicated in the May 2004 VA examination report. Page 22. So in substance, said Dr. Bash, the fact that the veteran does not have a normal left knee invalidates the opinion to the contrary expressed by the May 2004 VA examiner. Page 23. The veteran testified that the May 2004 VA examination only lasted about 30 to 35 minutes, but that, in comparison, Dr. Bash's examination was for an hour or even an hour and 15 minutes. Page 26. The veteran's wife, a nurse, also testified that he had no complaints of low back problems prior to June 1996, but since that time has experienced an abnormal gait. Page 32. Also during the March 2005 hearing, another statement from Dr. Bash was submitted into evidence (it is dated in March 2005), along with a waiver of initial consideration by the RO. In the statement Dr. Bash reported that he had reviewed the veteran's claims files for, in part, the purpose of providing a medical opinion regarding the relationship between his left knee and spinal disabilities. Dr. Bash reiterated this case is well within his area of expertise because he is a Board Certified Radiologist with subspecialty training as a Neuroradiologist and has special knowledge in the area of spine disease. He submitted a copy of his curriculum vitae as proof of his qualifications. He further stated that: It is my opinion that certain medical opinions and certain findings provided by Dr. Anderson are clearly erroneous and have no basis in fact. Further, [the] opinion [of the May 2004 VA examiner] is inconsistent with my recent physical exam finding of 1 March; the patient's medical history; and the radiology imaging evidence as I have outlined in the table below: Dr. Bash went on to state: In addition to the above discrepancies, I noted that the patient could not squat, bend, stoop, walk un-aided or lift from chair without assistance. The patient also was using a left knee brace, cane, lumbar spine TENS unit/wet-heat device. The report [of the May 2004 VA examiner] is, in my opinion very inaccurate, which may be due to the fact that he dictated his findings about a different patient into this patient's record or that he did not integrate his addendum or the imaging finding or his physical findings with his medical history and/or that his medical training in preventive/occupational medicine provides him with an inadequate background to interpret this complicated multi-joint/spine set of problems and/or that he did not reference any literature to support his opinions. In addition, his report contains several medical logic disconnects. For example, he basically says that this patient's left knee is normal and without crepitus but he also states that the knee has moderate three-compartmental osteoarthritis. This is a disconnect. This osteoarthritis is the imaging equivalent to the crepitus that I felt and heard on my exam. He also states that the patient has had very little symptomatology over the years but he also states that the patient uses a cane and crutches, takes large doss of pain medications, has difficulty with bathroom duties and had to use a bed pain [sic] recently. This is another disconnect. Overall, I do not find any basis for his opinion concerning the severity of this patient's left knee or why/why not this patient's knee problems contributed to his spine problems. In my opinion this patient has had a longstanding knee problems [sic] since service, which required surgery and subsequently developed osteoarthritis as documented on both imaging and exam. The patient has had left knee pain for years and an abnormal gait that has been documented in his records and he now uses a cane/crutches and knee brace and he has left knee swelling. The patient developed back pain several months (9 months to be exact - please note that [the May 2004 VA examiner] inaccurately stated 6 months) following his knee surgery. In my opinion 9 months is a long enough period of time to develop serious back problems secondary to an abnormal gait and or chronic knee pain. I have seen back pain develop immediately after an acute injury and within several days following chronic gait abnormalities. It is my opinion that this patient's longstanding gait problems have caused his lumbar spine to fail with resultant sciatica ... I have reviewed his current MRI images dated 2 Aug 2004 and I agree with [the May 2004 VA examiner] that this patient has multilevel lumbar disc disease. It is my opinion that this patient's physical exam (back pain-spasm as documented on attached ER reports and sciatica), medical history and imaging findings are all consistent with his multilevel lumbar disc disease and that this disease is due to his longstanding service induced left knee gait problems as his medical record does not contain another likely etiology. In summary, I do not find any new information in this patient's medical record that convinces me to change my previous opinion. On the contrary, my recent medical exam supports my previous opinions that this patient has serious service induced left knee and spine problems .... It is the obligation of the Board to weigh any contrasting or conflicting medical diagnoses or opinions. See Schoolman v. West, 12 Vet. App. 307, 310-11 (1999); Evans v. West, 12 Vet. App. 22, 30 (1998), citing Owens v. Brown, 7 Vet. App. 429, 433 (1995). This responsibility is more difficult when medical opinions diverge. The Board cannot make its own independent medical determination and there must be plausible reasons for favoring one medical opinion over another. Evans v. West, 12 Vet. App. 22, 31 (1998); see also Rucker v. Brown, 10 Vet. App. 67, 74 (1997), citing Colvin v. Derwinski, 1 Vet. App. 171 (1991). Probative weight should not be given to medical opinions when the veteran's records were not reviewed. See Bielby v. Brown, 7 Vet. App. 260, 269 (1994) (medical opinion is of no evidentiary value when doctor failed to review veteran's record before rendering an opinion). Here, though, both the May 2004 VA examiner and Dr. Bash have reviewed the veteran's claims files. Nevertheless, it must be noted that Dr. Bash reviewed the claims files on two separate occasions - and, like the evaluating VA physician, has now actually examined the veteran to complement this. So there are legitimate reasons for accepting this private physician's medical opinion over the VA examiner's medical opinion to the contrary. The private physician's opinions are much more focused by addressing the impairment cause by the veteran abnormal gait. Also, Dr. Bash cited more specific evidence in the record to support his opinion. In fact, Dr. Bash noted inconsistencies in the May 2004 VA examiner's opinion and, in particular, the fact that the VA examiner indicated the veteran's left knee was essentially normal; whereas, X-rays revealed three- compartment osteoarthritis in this knee. So resolving all reasonable doubt in the veteran's favor, it is certainly just as likely as not that his current low back disorder is a residual of the functional impairment (especially his abnormal gait) stemming from his already service-connected left knee disability. Thus, service connection for a low back disorder, as secondary to his service-connected left knee disability, is warranted. ORDER Service connection for a low back disability is granted. ____________________________________________ Keith W. Allen Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs

TS, also, I had no problem finding information on DR BASH using the search engine, Dogpile. It's one of my favorites. http://dogpile.com/

Hello TS, heres DR Bash's contact information. I have recieved IMO's from DR Bash, but my claim is still pending before the BVA. All I can say about him with my claim still pending, is hes one of the best in the country. If you need an IMO, I highly recomend DR Bash. Allan ################### You may contact Dr. Bash by either of the options below. Usually, e-mail is the most efficient and quickest for first contact. Craig Nicolas Bash, M.D., M.B.A. Neuroradiologist 7831 Woodmont Avenue Phone: 301.767.9525 Bethesda, MD 20814 Fax: 301.365.2589 myelinman@hotmail.com drbash@doctor.com Veterans Medical Advisor Providing Independent Medical Evaluations for Veterans http://www.veteransmedadvisor.com/

>Maybe when the VA is made to pay penalty and interest for a delayed claim things will improve. Hello Pete, Thet would speed up the claims process alright. What if the RO raters, NSO's, could be sued for false & misleading statements, with intent to deprive veterans of their earned benefits?

fwd from: Kelley Veterans Issues – Justice and ACCOUNTABLY at its very finest by our united states government April 25, 2007 Below are some comments by leaders in Veterans Groups around the nation. I would like to add my dollar two ninety-eight comments as one who has fought the injustices with data, logic, rationale, stated scientific and legal misconduct, etc. Obviously, the Walter Reed issues by our media and our honorable politicians are now being swept under the old political magic carpet. Rise to put out the media brush fire and now back to the normal stump breaking of Veterans and their families. The Walter Reed Exposures brought up a lot of issues that the media seems less concerned with than dirty rooms. Many of those issues affect the Veterans and family for life. The Veterans reward for honorable service is met with less than an honorable government and its less than honorable leaders. The inside 495 standard response to cover up issues is to assign some "so-called" independent committee that is appointed by politicians who are less than honorable themselves. Assign former politicians to the committee who also were less than honorable to cover up the issues or at least mislead the facts to minimize the effects and the damages and the absolute miscarriage of justice and accountability that Veterans face on a daily basis. A miscarriage of justice and lack of accountability that no other segment of society is subjected, including the illegal alien. Mr. Bob Dole, while a former Veteran, was in federal politics for how many decades and did nothing to stop the injustices against our nations finest and most honorable citizens. Ms. Donna Shalala, former health secretary stood by while more Vietnam Veterans died or became disabled uncompensated than the Viet Cong and the North Vietnamese Army manage to kill or disabled. She also did nothing. These two are heading up the committee of what Washington normally does and that is; "the search for the guilty but punishment of the innocent." This is just another inside 495 Kabuki dance, otherwise known as the old DoD/VA federal agency two step. Then we have Mr. Bush asking Mr. Nicholson the Secretary of Veterans Affairs to head a ‘so-called’ independent panel. What a joke! Whenever the Veterans win a legitimate constitutional court battle against the crooked VA who is the first person to oppose the legitimate court ruling for Veterans? Of course, Mr. Nicholson, (or any other Secretary of the Department of Veterans Affairs) who then not only opposes the court rulings of our nation but also with the power given him by Congress in U.S.C 38 Paragraph 511 thumbs his nose at the mandamus court order. In any other segment of our society, the Secretary would be charged with obstruction of justice. Not so for our Nation’s Veterans and their families. They have no justice or even a legal forum to get justice or accountability for death and disability. Death and disability caused not only by the enemies of our government but our ‘own government’ as well. Therefore, Mr. Bush’s actions, exclaimed in the press, are less than authentic and are certainly less than honorable. Now this is not just a republican president issue. In fact, for the past 60 years, our presidents and many members of congress on both sides of the aisle have not acted honorably with our Nation’s Veterans. To say they did not know what was going on within the DoD and especially the VA/NAS-IOM/Ranch Hand connection misconduct with the massive use of toxic chemical herbicides in the 60’s and 70’s would be giving them just an excuse. To say they did not know the Secretary of Defense had the complete and legal authority to authorize biological chemical warfare testing of our Veterans and did so from 1962 to 1973 would also allow them nothing but an excuse. These are supposed to educated men and women who all of sudden when it comes to Veterans and Veteran’s Family Issues become brain dead! I will say, as a former Republican, I myself was shocked at the uncovering of the Reagan/Bush White House memo that clearly indicated an obvious lack of support for toxic chemical Veterans directed to all federal agencies. Along with an obvious, support for the Chemical Companies and their lobby money. Before this memo, the foot dragging by all concerned in government, as well as the then VA, is well noted and documented. Yet, nothing was done by congress to protect their constituents from these brazen acts of corruption. As the evidence mounted against the government and the Chemical Companies even more brazen scientific misconduct took place; the VA changed names with new powers given; government studies were interfered with, real scientific study protocols were mandated changed as even the government could not stop the found issues within the government’s own exoneration studies; Veterans Courts, outside the constitution, were set up; executive, judicial, legislative powers were given to the new Department of Veterans Affairs. In a recent article sent to me by one our New Zealand Veterans states the follows in the New Zealand media. "Indeed, the Prime Minister of New Zealand, (a Vietnam War Protestor), is reported in the media as, "Feeling Sick At the Suffering and Consequence of War upon communities. "Really! She does not seem to have a problem in spending some $10 million in order to enhance the National War Memorial when her Government continues to "rort" the actual combatants, their surviving widows, and DNA damaged children of previous conflicts in South East Asia whilst she was a University Student." That just about sums up what our own government has done. About nothing except for deceit, interference, scientific misconduct, and out and out lies for over 40 years. Except the New Zealanders, Aussies, and Korean allies all depend on the processes used by our government as their own government cite Ranch Hand issues that we now know were not only covered up, minimized, and in total with the cohort assumptions of exposures flawed in all categories of medical findings including birth defects and DNA damages. The Ranch Hand Study used as a government exoneration tool we now find was like running a 25 year clinical trial on a new medication, and you found out some of the people who were in your cohort comparison group were actually taking medications. That would spoil your whole study. Moreover, that's what's going on here to deny Veterans death and disability compensations created by our own government. In this studies case at least 600 of the 1300 are in question in comparison as to if they took the medication under study instead of placebos. Nice touch on the part of caring government. The government’s custodian of this study, the United States Air Force, when confronted by these facts and the reanalysis done by the former lead DoD scientists was? Destroy the DATA! All present and future military veterans must be made aware of these government actions before they sign any retention or enlistment papers. To care for those that have borne the battle and their widows and orphans has become nothing but a political joke. If the United States Government in all most total harmony can do what I described above, of which most of you know I can provide documentation to these stated facts. Then does anyone ‘not believe’ with men like Dr. David Chu in the pentagon that what is described below of minimizing the effects of war on our soldiers and keeping the percentage less than 30% is not an unofficial goal of the DoD. As well as in conjunction with the VA keeping the numbers per year down of disabled Veterans along with the many conflicts of interest in the VA’s own definitions, which demonstrate a complete bias towards stalling the Veterans and Widows claims even more and more. The classic government propaganda fraud is the following released on the 25th. By Steve Vogel Washington Post Staff Writer Wednesday, April 25, 2007; Page A04 "President Bush last night ordered the Pentagon and Department of Veterans Affairs to come up with a joint process for establishing the level of disability of injured service members, and to implement other recommendations from a presidential task force." What that article should have read is: President Bush last night ordered the Pentagon and Department of Veterans Affairs to come up with a joint process for establishing the level of disability of injured service members, and to implement other recommendations from a presidential task force. Addendum: Just as long as the cost is held to a minimum; no more than 4% per year of all claims will be adjudicated, and no more than 2% of the 4% will be approved at any level of disability per year. Thereby our government in total wants to make sure the Veterans of this nation shoulder the burden of the nation’s wars by supporting their own disabilities (enemy or government created) and their families supporting the Veterans government caused death with a lifetime of loss. Charles Kelley Author and Veteran of the DMZ 67-68 -------------------------------------------------------------------------------- Ralph Parrott ralphparrott@cox.net www.empoweringveterans.org Folks, When I read this my blood boiled again. It is becoming increasingly clear that this problem is being treated as an issue of bureaucratic bungling rather than a question of justice for the service member. Folks, what you are seeing is classic "slow walking" and it is pure bullshit. We cannot let it happen. These guys are getting ready to redraw lines on a damned organization chart and declare the problem solved. It is outrageous. To date this problem is being approached as a problem of red tape and bureaucracy run amok. Nothing could be farther from the truth. It is a conscious effort on the part of the military services to pass the problem along to the VA and in the process short change our service members and their families. To begin to correct this problem one must start to question some fundamental assumptions and practices that underlie the current program: Assumption 1 - The current program assumes that it is OK to withhold retirement benefits, the most important of which is medical care and Tricare insurance from a large subset (less than 30% disabled) of service members that are separated from the service for service connected disabilities. Assumption 2 - The burden of proof is on the service member to prove he is 30% or more disabled despite the complete control of the decision to separate the member and the PEB process being under the complete control of the military service. Assumption 3 - In the absence of grievous physical wounds service members are assumed to be faking mental disorders and pain disorders. I believe after you cut through the rhetoric of the DOD officials and listen to their denials you will come to believe as I do that these assumptions are alive and well in the current situation. Before any meaningful reform can be implemented these assumptions must be replaced as follows: Assumption 1 - At the time of separation for disability, service members and their families are in their most vulnerable states emotionally and economically facing huge uncertainties about their futures. Simple justice demands that they be accorded continuation of benefits, especially health care and Tricare at least until their situation stabilizes. Under the current system this involves the assumption of at least 30% disability at the time the service decides to separate the member for a service connected disability. Assumption 2 - Final disability determination of disability would be the responsibility of the VA. If the VA returns a determination of less than 30%, there would be an appeals board independent of both the services and the VA where the service member could appeal with the burden of proof being upon the services and the VA with counsel being provided to the service member. Assumption 3 - Mental and pain disorders carry equal weight with physical injuries in disability determination. I know you guys are getting tired of hearing this from me, but it is pretty damned clear that the politicians are not getting the message. I thought the statement by Bradley Mays was telling. He said, "It is a question of expenses." Why is it not a question of justice? Why is it never a question of expenses when handing out goodies to the rich and corporations but it becomes a question of expenses when doing justice by our service members? I urge each of you to register your protest with the Dole / Shalala Commission by simply forwarding this message or, preferably, one of your own that uses even stronger language. Remember the "slow walking" is well underway and we simply must stop it in its tracks before our politicians use Dole / Shalala and the other variants as cover for doing not one damned thing. Ralph Parrott ralphparrott@cox.net www.empoweringveterans.org -------------------------------------------------------------------------------- -----Original Message----- From: maddogusmc@bellsouth.net Sent: Tuesday, April 24, 2007 9:42 AM To: ralphparrott@cox.net Subject: Pentagon May be Shorting Troop Benefits "May?" Pentagon May be Shorting Troop Benefits Associated Press April 24, 2007 Military.com WASHINGTON - An injured Soldier's disability should be determined by Veterans Affairs officials - and not the Pentagon - because the Army might be shortchanging troops, a presidential commission was told on Monday. At a public meeting, the nine-member commission on veterans care chaired by former Sen. Bob Dole, R-Kan., and former Health and Human Services Secretary Donna Shalala delved into ways to cut down on paperwork and problems in the disability ratings system. Under the current system, each of the armed services assign ratings to service members when they become injured. The ratings determine whether the service member is discharged from active service and if so, the amount of disability benefits to which he or she is entitled. The VA operates a separate system to determine benefits for retired veterans. Critics say the Army rates its injured Soldiers at a lower level of disability compared with the other armed services and the VA so it can save on the costs of disability payments. Veterans groups urged the commission to make a change so injured Soldiers aren't underpaid disability benefits. Such a proposal would be a major shift in how disability benefits are administered, with both critics and supporters acknowledging it would likely add significantly to costs since the VA takes into account all the disabilities a Soldier has - not just one. "We want to add our voice to others deeply disturbed by concerns of lowballing in Army disability ratings," said Robert Norton, deputy director for the Military Officers Association of America. "The ratings gaps are unacceptable." In recent weeks, a separate review group found consistently lower disability ratings by the Army and suggested it might be because officials didn't want to pay benefits. The Army says it is perplexed by the finding but would investigate. Bradley Mayes, director of compensation and pension service at the VA, told the commission that shifting the ratings work to the VA could be done. But he cautioned that the Pentagon would still need to be involved in making judgments on whether an active service member was fit for duty, as well as his level of military and severance pay for service. As a result, changing the current system could add to the level of bureaucracy. "The question is expenses," Mayes added. Dole and Shalala expressed openness to the proposal, which was made by a 2003 presidential task force co-chaired by Gail Wilensky, now a member of the Dole-Shalala commission. But they also cautioned against a rush to judgment. At least nine congressional committees are currently investigating ways to improve care following disclosures of shoddy treatment at Walter Reed Army Medical Center, and well-meaning lawmakers could unintentionally add to the problem, they said. "Although red tape in this country have a bad name, we often have legislation upon legislation as people try to fix problems," Shalala said. "This has led to complex systems that have grown up over the years that often aren't user-friendly." "Simplify, simplify, simplify - keep those words in mind," she added. "While detail is important, our purpose is clearly to foster a seamless system." Dole wondered if shifting the disability system to the VA might actually create additional bureaucratic hassles. He noted that Pentagon officials have already begun to examine ways to overhaul its disability system. "If it's that easy to fix, I don't know why it hasn't been fixed," he said. President Bush created the commission last month to make recommendations following disclosures of shoddy outpatient treatment at Walter Reed Army Medical Center. The panel plans about a dozen hearings and site visits to military and VA facilities around the country and will issue a report by late July. Its next hearing, in San Antonio on May 3-4, will focus on traumatic brain injury and rehabilitative care. SOURCE: http://www.2ndbattalion94thartillery.com/C...eransIssues.htm

>Since there is no workers comp or disability except for $1,000 per month from the federal civil service. How can it be done? Hello SABruce1, It's not easy. At first it gets hard, than it gets worse. It takes sacrifice from all the family members. We had our land paid for when I became totally disabled, or the cost of a place to live, would have taken most of the $1000. It took ten yrs to get power & running water to our place & now the well needs drilled deeper. We recieve $1100 now, but in 1994 & a family of four, it was several hundred less. I'm still waiting for the same issues to be decided on now, as I filed for back then. Cervical, Thoracic & lumbar stenosis & spondilosis, left arm & shoulder issues, right leg, neurological, visual, hearng, mental, gastrointestinal & lung disorders. So far, i've recieved a 30% SC rating. If your totally disabled, the choices are very limited. Best prepare for hard times the best you can. Allan

VA Advance Directive: Living Will & Durable Power of Attorney for Health Care 6/5/2003 12/2006 6pgs http://www.va.gov/vaforms/medical/pdf/vha-10-0137-fill.pdf WHAT YOU SHOULD KNOW ABOUT ADVANCE DIRECTIVES 1/8/2007 1pg http://www.va.gov/vaforms/medical/pdf/vha-10-0137B.pdf Your Rights Regarding Advance Directives - fillable 1/8/2007 1 pg http://www.va.gov/vaforms/medical/pdf/vha-10-0137A-fill.pdf

>If you are 100% you have no choice but to wait on the VA. I think the delays and bogus ratings are part of the plan to discourage vets from getting the ratings they deserve. It should be illegal John.

>This way there is no surprise for the doctor, nor one for you when they say she cant come in. I didn't realize it was a privalage at the examiners discression? I was under the impression it was a RIGHT of all veterans to be attended to by their spouce. Guess wen the examiner yelled my name & saw my wife of 33 yrs walk up with me he yelled again. "you can just have your lady friend sit down" I walked straight to him & said,"my wife acompanies me, or I leave. It's your choice"? I didn't have any more disrespect after that. Maybe the examiners need to get their crap together & learn a law governing, VETERANS RIGHTS. One of them says, that at "ALL" examinations, Veterans have the right to be accompanied by their spouce. Maybe the examiner could learn to respect that right & extend a hand & introduce themselves. If they lack manners, maybe examining our dsabled vets isn't for them. Maybe washing dishes in some dive bar for minamum wage would be better? Just a thought!

Hello Angela, This is where I think I found it, Allan September 12, 2002 M21-1, Part VI Change 92 CHAPTER 2. RATING ACTIVITY--GENERAL 2.07 EVALUATION OF EVIDENCE The rating specialist has responsibility to recognize the need for evidence in relation to a claim. The members have responsibility to determine admissibility of and the weight to be afforded evidence that is presented, the need for additional evidence, and the need for physical examination. If all the evidence is favorable, the claim must be granted. (See Beaty v. Brown, 6 Vet. App. 532 (1994).) a. Probative Value. The rating specialist will determine the probative value of medical or lay testimony. Accept evidence at face value unless contradicted by other evidence or sound medical or legal principles. In the presence of questionable or conflicting evidence, further development may be needed to corroborate testimony to include, if in order, field examinations and/or social surveys to obtain transcripts of original or other appropriate records. Rating decisions must clearly explain why evidence is found to be persuasive or unpersuasive. Decisions must address all the evidence and all of the claimant's contentions. b. Medical Opinions. Medical conclusions must be supported by evidence in the file. Rating specialists cannot refute with their own unsubstantiated medical conclusions medical evidence submitted by the claimant. Recognized medical treatises or an independent medical opinion may be cited to support a conclusion. Such evidence, when relied upon, must be identified in the decision. http://www.warms.vba.va.gov/Admin21/M21_1/PART6/CH02.DOC

Contacting someone for congressional help, may delay your claim as much as two yrs. Overflow?, Ready to rate?, Appeals center = no action. It is in limbo, untill the AMC, passes it off to another regional office that will pump out false, twisted remarks as a reason to deny. In order to avoid this, you can send in a waiver of your rights to review by a lower agency, THE APPEALS CENTER or regional office. If you want it reviewed by the BVA instead, you must send a waiver in, asking that this be done. After nearly 10 yrs of this, im sending in a waiver, anytime I get a remand, starting now.

Theres atleast a yrs wait at the Appeals Center in DC. When they get a VARO rating officer open they can send it to, it will take about a yr for them to order another C&P,(you do not have to be present). They simply send what information they choose to a medical consultant that contracts with the Dept of Veterans affairs, somewhere in the country. Each time they do this, you will need to have another "favorable" medical opinion, to rebut their pack of BS. Doctor shopping? That would be my guess.

TS, nothing can stop your spouce from having a a tablet, to keep a written journal of what was said during examinations, exspecally C&P's, hearings, meetings with SO's, etc. Your spouce does NOT have to leave the room. I've had doctors ask her to leave right away, and than do nothing but ask questions, only she keeps track of & has the answers to. Medications? Whats been order, what needs refilled, effects of meds, etc. I had one C&P examiner, push my wife back out a door & said your not allowed. My wife & both my daughters have medical power of attorney. I understand they DON'T keep these at the, VAMC. After 10 yrs, mine seems to have disapeared. Appointments can be made with the VAMC's, team "Social Worker" for the forms & assistance in filing out the forms, for "Medical Power of Attorney", Living Wills, etc. I have nothing but respect for the Social Workers at the VAMC's i've been to. Veterans having problems with facility staff, in need of lodging, etc. they are the ones to contact.