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http://www.va.gov/OCA/testimony/hvac/sdama/050505MW.asp lu12

H.R. 1016 would authorize appropriations for five specific budget accounts: • Medical Services, • Medical Facilities, • Medical Support and Compliance, • Information technology Systems, and • Medical and Prosthetic Research. lu12

Hello Berta, I been looking for a recent post related to either a cova or bva case, in which they relate to IMO's careful consideration. do you have this case or maybe it was post by Tbird or some body else not sure. I would like to have this information so that I can include the same on my SSOC closing statement response to the AMC. Thank, lu12

Hello Berta, I'm about to start writing my SSOC response to the AMC SOC, my question is, should I start my response referring first to the errors made on the 2009 AMC SOC or should I start referring to the original 1998 C&P VA Examiner wrongfully diagnoses and VARO claim examiner wrongfully classification of the diagnoses? Could you recommend the chronology that I should use here. Thank you, lu12

It's possible to ask the AMC(RO) to CUE them self, rather than waiting for the BVA decision and if still against the Veteran the decision, rather to ask the BVA to also CUE them self too. lu12

Under a second remand, back to the AMC. Thank you, Pete992 lu12

Hope this may help, ISSUE: Independent Medical Evidence ISSUE: Independent Medical Evidence, Adequacy of Examinations ISSUE: Adequacy of Examination Reports ISSUE(S): Sustained Improvement; Reduction In Rating - Neuropsychiatric Disorder ISSUE(S): Restored Entitlement Program for Survivors ISSUE: Payment of improved death pension benefits to a child not in the custody of the surviving spouse ISSUE: Amount of Offset of Survivors' Benefits under 38 USC 1151 (formerly 351). ISSUE: Eligibility under section 156© for purposes of the Restored Entitlement Program for Survivors (REPS) lu12 DECISION_ASSESSMENT_DOCUMENTS.doc

Is it possible that you can summit a NOD relating to a CUE and the Benefit of Doubt Rule at the same time? Thanks, lu12

Berta, thank you so much, The Problem started when the first C&P examiner after a 30-35 minutes evaluation gave a mental diagnosis classified as (Dysthymia). When in-contrast I summited a nexus opinion to begin with, which included a diagnosis of recurrent MD and Chronic Anxiety a medical opinion from a private physician whom treated me for at least for 4 years prior to the first VA Examination, here is where the damage started then like you said "raters commit legal errors in diagnostic codes -mainly based on inaccurate medical information." 30-35 minutes VA evaluation V. 4 years of (private) medical treatment It gets more complicated when a second C&P examiner then agrees that there is evidence of a mental disability (cause the Board) but continues minimizing the real conditions, now you have AMC (2x)(new)claim examiners and adjudicators that along with the last two Examiner continue to evade previous evidence 1988-1996, contemporaneous evidence 1997-2006 and a new evidence from 2007. How do I challenge - VA Examiner & Wrong Dx's. Is there any place in the CFR where I can get inf in regards to regulation and law relating to this specific matter. lu12

Then I did not received a VCAA, but they said that is what it is, now I'm really lost here: How VA Determines the Effective Date • When we received your claim; or • When the evidence shows a level of disability that supports a certain rating under the rating schedule or other applicable standards. What is WEMS ? Thank you, Meddac, lu12

Berta, I will summit a new NOD and request to the AMC to CUE them self in regard to this issue, they ask for my opinions and I been thinking to relate to every RD,SOC, and SSOC that I got since 1998 from the DVA. I will summaries each and every false and inaccurate statement including every error made by the system. This will be no concise NOD, I will also include the form - 9 and consider to request a personal hearing before the BVA. Then again I don't know if is better to wait until I get a response in regard to the cervical spine issue. Been doing lots of reading, can see all the dots, at the same time can't put them together just yet. I will also include 2007 evidence gather specially for the BVA Evidence that the Board did not refer to on their second remand. For this Issue 2007 Dx's and new evidence are similar and correlate 1998 Dx's and evidence of recurrent MD and Anxiety not Dysthymia. Berta do you remember any case related to minimized Dx's and wrong diagnostic code, I already found some information under CFR related to wrong rating but nothing on wrong Dx's. lu12

The VA state the following: How VA Determines the Effective Date • When we received your claim; or • When the evidence shows a level of disability that supports a certain rating under the rating schedule or other applicable standards. Then again your statement make sense, which way is the right direction? Thank you Tsnave, lu12

Berta, u should have pages, 1, 14,15, and 16 out of the AMC 2009 SOC. Pages from 2 to 13 relates to the same law and regulations that they continue to violate day after day. Thanks, lu12

all claims to be developed on Remand and the cervical spine claim needs VARO to satisfy those 5 factors. Board states, that I claimed for these other issues in 2008, this is not right. I claimed this in 2004 together with a response related to a VA VCAA notice. Geez- many IMOs- What is interesting is that the BVA finally make reference to most IME/O, opinions of record that they failed to disclosed on the first remand, now this time (the Board)they just minimized my IMO statements, they make reference to half of the opinions from the IMO leaving the other half in blank. More over AMC and I have to say this like this, the AMC intentional failed to disclose evidence of record ignoring BVA analysis and point of facts presented by the Board. The TMJ could have association to any mental disorder that would cause teeth grinding due to stress, the SC knee could certainly have affected the cervical problem- I have submitted evidence that relate this condition to the service and to the PP, I also submitted evidence that both Dental examiner and Claim examiner failed to make Known evidence of record. In addition Dental Examiner contradict him self in his medical report throughout his medical opinion. Proving that the claim was well grounded, raising the benefit of doubt rule, evaluation of evidence,ect... what I do see here is that the BVA distinctly raised many ways the cervical problem could be aggravated by or secondary to the SC knee. I did request a reconsideration to have my Appeal re - characterized and perfected to include this condition secondary to my lower back and rt. knee. Now they may considered it as secondary to the scd's The GERD-did you take NSAIDS for anything and were they precribed by the VA? You got my first remand and you posted it here at Hadit under 3yr to retire, I think, my case and Nexus will help others here. if you want I can provide u with a copy of the IME-IMO nexus opinion. Matter of fact evidence avoided and eluded by the RO for 8 yrs. You still have a big foot in the door on this one- a good remand in my opinion- and the VARO must honor this. Berta, is not the VARO Whom is handling this, is the AMC and this means that they are handling my appeal for the second time the same way they did the first time they are still eluding (SOME). Maybe now I can ask them to CUE them self? LU12 how is the Puerto Rico Public Advocate to deal with? Like dealing with a ghost, last time I went to his office he told me there was nothing else for me after my 100%IU/PT - well I won my GI appeal with a 30% and my psy. claim another 30% but classified and rated under a wrong Diagnostic code, evidence of record support a 50% or a 70% my contentions is that I claimed for depression characterize by anxiety, PTSD and pain disorder and they continue to ignore contemporaneous, (SOME) supportive and objective material evidence, some of then with GAF ranging from 35 to 50 evidence ignored by the last examiner that in return assigned a GAF score of 50. My last (Private) IME/O dtd 2007 states Dx's: recurrent MDD/Anxiety, Physically and Mentally Disable with a GAF 50. this IMO was submitted to the Board in 2008 and they make no reference of it on their 2008 remand neither the AMC on the 2009 SOC. Now last IMO relates to: Pt. is Physically and Mentally Disable, but 2007 examiner referred to my PSY Disorders as to: 30% which is equals to: An evaluation of 30% is granted when ever there is occupational and social impairments with OCCASIONAL DECREASE IN WORK EFFICIENCY AND INTERMITTENT PERIOD OF INABILITY TO PERFORM OCCUPATIONAL TASK... I fell up to this point that I'm not capable to perform well due to both conditions. Comments are welcome, lu12

Thank you "Meddac'. Well the AMC states that is a VCAA letter I think they are wrong in regard to there own statements, apart from this, I was granted 30 percent in 2008, filed for sc in 1998, for a period of 10 years the VA denied my claim based on the fact that there was no evidence related to smr's, including VHA health records related to the One yr. PP. I prove then wrong (they lie). In 2006 the BVA recognized evidence described as MANIFESTATIONS or (S&S) and refer then to the VA examiner to consider the same. 2007 VA examiner opinion was as likely as not related to the scd's, yet they missed similar MANIFESTATIONS and (S&S) documented on my smr's. In 2004 I requested to have my claim for entitlement to s-c for a Psy. disorders Effective Date to be changed from 1998 to 1989 as the Early Effective Date based on the same information provided by the VA as described below: How VA Determines the Effective Date • When the evidence shows a level of disability that supports a certain rating under the rating schedule or other applicable standards. Or my assumptions are wrong in facts, regulations and law. Any comments are welcome. lu12

I received this letter back in 2006 from the AMC. There is no place In this letter where the AMC states that this is a VCAA letter or where you can refer as such. Is this the proper procedure by law to notified a veteran about a VCAA letter? Now in regard to an EED issue in this letter, could early manifestations (S&S) sings and symptoms of a SCD can be related to the second fact described below? How VA Determines the Effective Date If we grant your claim, the beginning date of your entitlement or increased entitlement to benefits will generally be based on the following factors: • When we received your claim; or • When the evidence shows a level of disability that supports a certain rating under the rating schedule or other applicable standards. Any advise will be appreciated, lu12 Copy_of_2006_VCAA_or_what_no_ID.doc

Berta, It is been in front of my face for the past 3 weeks. The last VA SOC was prepared by the AMC now I'm more confident to ask the AMC to CUE them self and to NOD them again for the second time since Feb 2008. The heading of the SOC received by Feb 14 2009 was prepared by: Department of Veterans Affairs APPEALS MANEGEMENT CENTER The heading on the notice letter I got on Feb 14 has the following address, DEPARTMENT OF VETERANS AFFAIRS VA REGIONAL OFFICE 640 4TH AVENUE HUNTINGTON WV 25701 HERE IS MY SECOND REMAND AND THE LAST SOC FROM THE AMC: 2009_BVA_2nd_remand.doc2009_VA_soc_NO_ID.doc lu12

Thank u Berta. I most tell you because of you, many others and Hadit I'm more positive. I also got 2 - 90 days extensions from the Board. and In August 2009 I noded the AMC in 3 issues, all because of this site and T-bird. My claim/appeal is under the BVA second remand. You already got my first BVA remand I will try to Scan my second remand and the last SOC. lu12

Back to you Berta. I got 60 days to respond. Berta this reply is in-regards to this topic, but also in addition to your: AMC Defies My BVA remand Topic. You know it is not that I dint understand you, is the fact that I'm confuse and quiet exhausted. Perhaps it is difficult to explain my self nowadays. I may not make my self understand very well in English but You know my native language is Spanish, I also realize this fact, believe me, most of the time it is very difficult for me to coordinate my sought and to also make my self understand in Spanish during my daily activities. So I would like to apologies and to thank you for your time. Now after all and after so many years I Final understand that these are symptoms of Anxiety, Stress and Depression. Please allow me to get back to your topic AMC Defies my BVA remand, by any chance and from One of your previous post " AMC is located in Huntington WV. Hope this info helps. from Marinevet" past topic under search of hadit" is this is the same building and address for the Huntington, WV VARO? I most ask this due to the following facts: BVA remanded my case for the second time to: VARO Huntington WV BVA remanded my case the first time to the AMC. What I'm trying to figure out here is if the BVA sent my case back to the AMC or to a different Regional Office. Back to my topic, I got some other issues that those claims have not been developed for appellated review, the Board refers them to the RO for appropriate action. 2scd referral. No response yet. Now in regard to the Psychiatric issue the Board remanded this issue back to the RO for issuance of SOC. RO sent me on Feb 10, 2009 the SOC along with a Denial Decision for an increase of the initial rating. My point is that the AMC clearly stated that the Decisions for the Psy and Cervical Claims were final If they were final then can I ask the last RO/orthe/AMC to CUE it self, based on the fact that evidence of record was ignored, over looked and disregarded, that they granted sc based on a erroneous diagnostic code, and again failed for a "second time" to reconcile with BVA remand. Then in my case it would be like this: VA Examiner and AMC defied First Remand. RO/or/AMC defied Second Remand. In regards to the cervical spine issue: the Board remanded my appeal back to the VA examiner due to the fact that he did not reconcile with evidence and opinion of the the records in addition that the Examiner failed to reconcile with the Board instructions per Board remand. "REMAND BY THE BOARD CONFERS ON THE VETERANS, AS A MATTER OF LAW, THE RIGHT TO COMPLIANCE WITH THE REMAND. STEGALL v. WEST VET. App.268 (1998). I noded the AMC decisions in regard to this issue based on a Faulty and Flawed VA exam, NOVO Review Inquiry, CUE, EED and the fact that the Examiner did not follow BVA instructions. No response yet. thanks, lu12

sehinchee My two cents, In your NOD letter First paragraph you mentioned discrepancy on: 1) joint instability. and 2)effective date of the claim. Then you referred to "functional loss" issue that was not consider on your recent VAE. It would be a good idea if you consider a response to the the last rating, based on a re-characterization of your NOD/claim to include 1) separate rating for functional loss, 2) bilateral factor (if apply) and 3) pain disorder of your knee. I've been rated at 30% for my Knee since 1994, being rated under DC 5257. I'm 41 and my knee is all screwup, failed ACL reconstruction, post-traumatic arthritis,etc. VA physician tell I don't qualify for knee replacement because I'm still very young. My previous VSR's officer did not claimed for my functional loss of use and a separate rating to include bi-lateral factor. Think out the box here and don't wait to perfect your claim. good luck, lu12

Berta, I will appreciate if you can point me to a right direction on how can I challenge the VA new rating based on a different diagnosis other than the one that I first file for back in 1998. Also if you can comment on this other matter, if you complaint during a VA Exam about other medical conditions you believe are related to the scd condition for what you are been evaluated and if you claim to the examiner that you want that condition to also be evaluated and consider as well, the examiner respond that he can not do that but documented those conditions by name(diagnosis) Could this be consider as a an informal claim for benefits? thank you. lu12

When I summited my NOD to the BVA it was done also based on a VA mental health Exam rebuttal. the examiner stated that she completed the report together with the SW survey report. I refer to the Board that this statement as wrong, false and unjust due to the following facts: Examiner report makes no reference to social worker information reported and well documented in fact SW report is by far quiet different from examiner final report. Also the Examiner contradict her own opinions on the same report when refer as a AXISI: DYSTHYMIC DISORDER, CHRONIC. while at the same time refer about That condition as: This veterans' mental disorder symptoms represent a moderate impairment for social and occupational functioning. Further more failed to consider VHA & IMO"S evidence of record described in sections III & IV I designed a diagram/chart in order to make my point and submitted to the Board with the following information. I Examiner report: Reports of social and industrial field survey previously requested was reviewed, prior to our statement, all the evidence in the (5) volumes of veterans claims folders;: Although this veterans does not appears as having received psychiatric treatment until at least 10 years. After his initial injury, there notes in the service records and in records from Hawaii that indicate veteran was experiencing worry, anxiety, lack of concentration, difficulties sleeping etc…Related to back pain and his physical conditions. Throughout the years and in notes of others specialist, including private chiropractor these elements are shown to be present although not at a degree that required separate treatment, nor did the veteran seek psychiatric treatment for these symptoms never the less, the existence of those symptoms, no matter how sporadic they appear reported in notes of treatment, establish a relationship between veteran's actual symptoms and his different musculoskeletal conditions. Therefore, based on that evidence, it is our opinion that the veterans presently diagnosed mental disorders is at least as likely as not related to his service orthopedic service connected disabilities. E. Diagnosis: AXISI: DYSTHYMIC DISORDER, CHRONIC AXISII: NOT ENOUGH INFORMATION AXISIII: SEE MEDICAL REPORTS, MEDICAL RECORDS AXISIV: SEE OPINION STATEMENT AXISV: GAF: 60 E. 4. This veterans' mental disorder symptoms represent a moderate impairment for social and occupational functioning it is important to mention that the principal and primary reason for this veteran not working and receiving SS disability is not his mental disorder, but his orthopedics conditions. MIRIAM MARTI, MD. Signed: 01/28/2008 II CLINICAL SOCIAL WORKER M. Summary & Conclusions Discussion: This is a 41 year's old disabled veteran. There is no history of adjustment problems in young years. He was an excellent student with special interest in math and science. He was also very interested in Armed Forces and since early age he expressed his dream to become a soldier. He joined the ROTC while in college and when decided to quit college to join the Marines. He adjusted well to military and was very satisfied with his work and job assignment. During his military service he injured his right knee and after long time treatment and care was discharged from the Marines due to medical reason (un-fit for duty). This situation was the source of great stress, disappointment and frustration, anxiety and depression. He made attempt for rehabilitation, studying and working but was not successful. Summary Ratings: Veteran is extremely disabled to work due to knee condition and back pain, his service connected condition. He made attempts to complete college education and work but resigned due to the fact his knee and back condition worsen with work. Veteran's service connected condition adversely impacted his social interaction due to severe depression, anxiety, chronic pain INDUSTRIAL impairment: [x] EXTREME SOCIAL impairment: [x] SEVERE SONIA BURGOS CLINICAL SOCIAL WORKER Signed: 01/11/2008 09:08 Consult no. : 12830744 III VHA evidence of record Ponce, Out Patient Clinic: 2001 Dr. N. (PCP), Ass: Anxiety and Depression. 2002 Dr. N. (PCP). Ass: Anxiety and Depression. 2002 Dr.Y. P., Psy. Dx: MDD; GAF 60 2003 Dr.Y. P., Psy. Dx. MDD; GAF 60 Mayaguez, Out Patient Clinic: 2003 Dr. Q.A., (PCP). Dx Anxiety and Depression. May 2 004 Dr. L.N., Psy. Dx: Major Depression. Jul 2004 Dr. L.N., Psy. Dx: Recurrent Depression. Aug 2005 Dr. L.N., Psy. Dx: Depression, *nos. Aug 2006 Dr. L.N., Psy. Dx: Depression, *nos. Mar 2007 Dr. L.N., Psy Dx: MD, Recurrent. Apr 2007 Dr. L.N., Psy. Dx: MD, Recurrent. Jul 2007. Dr. R.R., Psy. Dx: Chronic pain affects Depression. Oct 2007 Dr. R.R., Psy. Dx: Pain syndrome due to neuropathy increase depressive syndrome. Oct 2007 Dr. M.T., clinical pharmacist comments: Pt. with chronic pain and MDD, incomplete response to previous Rx /change to new Rx: trial. Dec 2007 Dr. R.R., Psy. Dx: Chronic Pain, Anxiety Attack GAF 50. Jan 2008 Dr. R.R., Psy. Dx: chronic pain and medical complications that increases depressive' symptoms. GAF 50. Apr 2008 Dr. R.R., Psyc. Dx: MDD. Jul 2008 Dr. R.R., Psy. Dx: Poor adjustment to chronic illness, Pain Syndrome, Depression. IV IMO's 2001 IMO: Dr. Cesar Padilla, Psychiatric, PTSD. 2003 IMO: Dr. S.G. diagnosis: PTSD, Anxiety, and Depression. Cervical Pain associated with Anxiety. 2004 IMO: Dr. Moraima Velez Diagnosis: PTSD, Anxiety, and Depression. The Anxiety might and could be related to his service connected conditions. 2004 IMO: Dr. Alberto Rodríguez Robles, Psychiatric: diagnostic code 296.23 (DSM IV). 2005 IMO: Dr Cesar Cubano, Psychiatric, diagnostic: Axis I: 296.23 (DSM IV); Axis IV: Occupational Problems; Axis IV: GAF 50. 2006 IMO: Dr. Hiram Luigi, Ortho-surgeon diagnosis: PTSD, Anxiety, and Depression. Medical opinion, "all conditions may be related to service connected conditions." 2007 IMO: Dr. Ibzan Pérez Muñoz, Psychiatric. Diagnostic DSM IV: Axis I: Major chronic depression and anxiety due to chronic physical medical conditions. Axis IV: physical, labor and emotional disability; Axis IV: GAF 50. unfortunately the aforementioned evidence was ignored again on FEB 10, 2009 by a different VARO. lu12,