SPO

I'm sure this is a question that doesn't have a sure answer, but I am wondering what kind of wait times for a hearing people have heard of/experienced when appeal under Appeal Modernization. I am in line for an appeal hearing, but is it worth the wait when I could go into the evidence appeal line faster? The only thing I'll be pointing out to the judge is that an under qualified examiner changed a diagnosis made by a specialist and that the exam was significantly sub par (didn't even physically examine all the claimed issues). It seems like I could easily put that in writing and submit it for a judge to review without me. Any thoughts/suggestions?

I’m in line for an appeal and confused on the remand process. I was denied because a c&p examiner changed my diagnosis from arthritis to strain on some joints and said no diagnosis on others. My file has at least 2 doctors (more qualified than the c&p examiner) stating my arthritis diagnosis in the joints I claimed. Also I was granted for my back and hip. I imagine if I win it will get a remand, but if it does can the board order the RO the service connection is granted and they need to perform another exam to properly rate severity? Or is service connection up to the RO to decide on again?

I'm beginning a couple of new claims and wanted the general opinion from the group. If I have access to private medical care and documentation for a claim, would it be best to do that instead of risking some bad documentation coming from a VA doc. My concern is what I'm working on may get a little expensive when you start adding multiple specialists/tests/imaging. Am I safer having full control over what documents the VA sees vs. going through the VA and having everything covered?

The va has me rated for psoriatic arthritis of the back (I filed for lower back/ sacroiliac). I have 1 rheumatologist mention sacroilitis, but is the way the va rated going to cause an issue since technically sacriolitis is caused by the arthritis (or at least a manifestation of) which then causes Radiculopathy.

I have documentation of sciatic pain from arthritis ( it’s not true sciatica because it originates in the sacroiliac joint not the lumbar vertabrae, but it presents the exact same way) , need the doc to clarify the diagnosis before I submit. I have only had xrays, no mri. I told the c&p doc about it during my back exam, but I don’t think she acknowledged what I said.

While I wait for an appeal on some other matters I am starting a bilateral sciatica claim secondary to arthritis in the lower back (just got service connected for the back). I have to get some documentation together, but I am wondering what to expect in a c&p for sciatica. It is pretty unpredictable when the worst of it will happen so I’m not sure how the exam will go, or what the doc will look for.

I’m looking for a veteran friendly rhuematologist in Maryland/Delaware/ southeast pa. I need a better imo and my doc won’t rewrite the subpar one he wrote for me. Any suggestions

I don’t have to c&p’s yet. I requested them and according to the va they should be on the way can you point me to the format for the letter. It was like pulling teeth to get that one (which was a format DAV gave me). I tired to get him to give a better rationale it’s supporting literature but he acted like I was trying to pull a scam asking him to rewrite. He just couldn’t wrap his head around the whole va process and requirements.

finally got a copy of my decision scanned and I apologize, its a pretty long one. There are a few items I noticed that are troubling. 1. In the decision on pages 1 and 2, my hip is granted for adduction 10%, flexion 0%, and extension 0%,. However on page the list and addition rating for rotation at 10% which is not included in page 1 and 2. My ebenefits disability list does not include this either. 2. My left and right shoulders and left ankle were diagnosed with a chronic strain by the c&p doc. What grounds does she have to outweigh my docs diagnosis of psoriatic arthritis, especially when evidence of an issue was found in the exam. Also considering they accepted the diagnosis and nexus of my back and hip. 3. I submitted more than one statement, only one appears to be listed on the evidence, not sure if this is just how it would normally show. My doctors letter doesn't actually show as a separate item, but the letter was dated may 11, and they listed records through may 11. DEPARTMENT OF VETERANS AFFAIRS_Redacted.pdf Serafi letter_Redacted.pdf

Still working on getting my decision scanned. As part of my rebuttal in the appeal I was considering submitting the QTC questionnaires that I provided the examiner (she stated that I did not report flare ups) even though I did in their questionnaire. These are not signed with the date, but the file has not been altered since it was created the day before the day of my exam and you can creation date, is this valid information at all?

Anyone, know if I should complain about the bad c&P now? I sent in my appeal paperwork last week, don't know if I should just wait until I get my hearing.

It sound a like DAV gave me bad advice. Should I start fighting the bad c&p now or wait to do it when it’s my turn at the board?

would calling the white house hotline be a lost cause at this point? The VA already issued a decision. I will post a copy of the decision as soon as I can

The letter and medical record from my doctor were on the list of evidence used. as far as the exam, I contacted DAV as soon as I left and they advised to just let the VA make a decision, there wasn’t anything I could do about it. I didn’t contact anyone and I assume it’s far to late now

After multiple discussions with the DAV I have decided to file for an appeal to the BVA with a hearing. Has anyone had experience on what the wait time for a hearing is with the new Modernization Act. I know the legacy ones could take many years. Just curiosity. As I gather more evidence for my appeal, would it be advisable to try to get a VA doctor to weigh in for my favor. I usually use private doctors, but I am nervous to go to the VA because any potentially negative information is then available to the VA. I've had enough bad C&P exams to know that the VA doesn't always believe us. Would their word carry more weight and would it be worth the risk?

I am 100% sure the diagnosis is in there from my doctor. DAV double checked It was in my file and said it was listed on evidence used. I don’t know what additional evidence I could give. Edit: After another conversation with DAV, I've decided to just go ahead and appeal to the board. According to DAV even if I have the diagnosis in my file from my doctor the VARO is just going to say its older than my C&P exam. Its wasting time that I could be in line for the board. The last question is whether to ask for a hearing or just a review.

This might get a little long winded but please stick with me. I just had my supplemental claim for arthritis closed. I was awarded 2 out of about 15 affected joints, and suprise, suprise it seems that the reason the others were denied was because of the C&P examiner not doing a thorough exam and incorrect reporting on the paperwork. The reason for denial on all of them was no diagnosis. Now the problem with this was that she was provided with a letter and medical records from my rhuematologist (an M.D.) stating specifically which joints are diagnosed and affected, and the letter is from May 2020, so it is current information (she is a nurse practitioner, and best I can tell specializing in family medicine). She decided she didn't believe me when I told her joints hurt during the exam so basically said nothing was wrong, thus no diagnosis. In particular I know she lied about the range of motion of my shoulders. I have a difficult time getting to 90 degrees on either arm, but her range of motion says 120 degrees. she did actually measure this, but I know where my arms were and it was less than 90. She did measure my back (which was approved) but nothing else. She didn't even actually examine my hands or feet. She "examined my elbows and knee from across the room. Also, she stated I have no flare ups, but I know for a fact the QTC questionairre I submitted to her stated that I do, as well as my statement I filed with the claim to the VA. I called DAV as soon as I left the exam and asked them what to do and they said, just wait for the exams to come in and see what they say. When the exams came in I couldn't get anyone at DAV to actually look through them all, so they said just wait for the decision. I finally got someone to look through a few of them (after the decision was made) and from what the DAV is telling me, many of the joints don't look like the reach the compensable level based on her C&P. Now I am at a crossroads. I can either Higher level review and see if maybe they will give me 0% service connection because my doc's diagnosis should outweigh her 10 minute "exam"(maybe a couple 10% ratings if I'm lucky), or get in line at the the BVA. I'm not sure what to do next and I've heard advice to go both ways from the DAV. They say I can't fight the bad C&P through HLR. Any thoughts or advice?

So I found out that I was increased from 80% to 90%, (aside from the fact that this should have been 100%), I have issues with the amount of back pay. They gave me my effective date all the way back to 11/2018, but miscalculated. From 11/2018 until 03/2020 I was 70%, from 3/2020 until now I was 80%. They are saying the owe 1/2 the back pay they should. My rough estimate says they used 80% for the calculation all the way back. How can I have them fix this?

I saw that something in(M-21) analogous to Rheumatoid (diagnostic code 5002) wouldn't have to show up on X-rays, I'm just wondering if all the raters understand this and don't just assume the its should be treated like osteo or degenerative. I guess they will take x-rays (not like I can say no) and hope they use x-rays findings to increase the rating if anything shows, not to deny if it doesn't. (Obviously I trust the VA about as far I can throw them)

I had a C&P on the 7th and today I was told I need to go get x-rays done. I'm going to assume this is because the doc returned my exam with a positive arthritis diagnosis. This arthritis seems to usually be rated analogous to rheumatoid and the early stages often don't show in x-rays. Are X-rays mandatory for all arthritis claims of any type? QTC quality department said they are required to request x-rays on arthritis, but I don't know if they are differentiating types. Is there anything I can do to remind them that their manual even says Rheumatoid (and I would assume analogous condition) may not show on X-rays? I am concerned based off some VBA decisions I've read that they jump to conclusions and deny if the X-rays come back normal.

Had my C&P this morning. The examiner seemed to be somewhat knowledgeable on the condition and said she didn't understand why I wasn't service connected in the first place. She said she knows that it causes pain in a lot of joint and that she was going to give an opinion that all my joints are service connected. However, actual physical exam left a lot to be desired. Pushed my through on range of motion a couple times and I'm totally unsure how this will play out as far as rating percentages are concerned. She did say she knows these conditions don't cause actual range of motion loss in most cases. So hopefully she notes a least painful motion so I don't end up with a 0% and have to keep fighting.

since my condition is still in early stages it has not been incapacitating. I'm pretty sure it will then be rated on the residuals for each joint. I'm not sure how to convince the examiner that it hurts to move each joint at a certain point. Last time I tried to tell the examiner when it hurt and she basically said nothing was wrong with me.

So I will am heading to my in person C&P tomorrow. This claim is for arthritis (analogous to Rhuematoid). This is round 2 for this condition, I'm pretty sure I was a little to friendly with the last examiner and it didn't help things. I'm sure it has been covered many times before, but any suggestions on how to handle this exam.

So I am now scheduled for my C&P next week. I am filling out the questionnaire that QTC provided. Should I mention that the doc said it is plantar faciitis associated with the arthritis, or just describe the pain and how it effects me?

Just got scheduled for my exam. They tried to give me the same NP as last time that did a half ass job. Asked for someone else. Turns out they scheduled me with another NP in the same practice. I'm going to have to get that changed, no way she will disagree with someone in the same practice.