AgentOrangeWife

IMO isn't needed anymore - he just looked at ebennies and he is now rated properly at 100%! Thanks to everyone here for all the support. It is so nice to have this resolved. We will add more info as soon as we receive the letter.

Berta- Just got a quote from your favorite IMO doctor but it is completely unaffordable. Will go to plan b now.

Even funnier is that there was no treadmill involved. It was a non-exercise stress test with an injection instead of treadmill/bike. Just a little detail but look at how the addenda gets hijacked by "treadmill".

I think you misunderstood what I meant by IME- An IME (Independent Medial Exam or evaluation) follows the criteria for IMOs/IMEs at hadit and is performed by a Non VA doctor with expertise in the field of disability. I searched hadit for "IME criteria" and came up with 134 hits so I'm attaching the exam/treatment notes with medical orders from the private doctor who is a known expert witness, has 8 years history with veteran, directs the local cath lab: exam with medical orders.pdf ===== What you attached is not an IME.So no potential CUE basis there. What about here: Is this a proper form and verbage for a cue..pdf

OMG there are 2 of them in cahoots on this?! No signature etc etc - not a very probative addendum (in my humble opinion). I'm almost certain that this would get tossed if a reasonable mind had to consider it as legal evidence.

I can't tell if it was one doctor or two who wrote it. The commentary was part of the "opinion". I only typed the title and changed the dr name. Seriously.

Check out this "medical opinion" by a VA M.D. for another comical read. Medical Opinion.docx Conflicts itself.

At this point I feel like I should and I'm not a Veteran. Honestly, I'm just really grateful that this rater is behind a desk and not in charge of the nuclear codes or covering anyone's back. Ya know? I want to be on the citizen's committee that approves bonuses for raters.....

Berta and I need to take a class in prescience. For the record, if you got a 10>100<60% in one rating, what you have is an increase from 10 to 100 as a temporary rating and then 60 as a permanent (for now) rating. That is, technically, a Fenderson Staged rating but not quite. A true Fenderson would be a retroactive grant either via a CUE correction or a 3.156(c) decision. This would generate a gradual increase over a number of years based on available medrecs from the contemporary time involved. Any time you see a 10 go to 100 and back to 60% with no proposed reduction is due to a filing you sent in. Did you ask for an increase due to a surgery? No, he asked for an increase because he was deteriorating. The increase was prompted due to METs. VA found a low METs report in the original claim file. VA said "apply for an increase for heart" in a denial letter for.....an increase for heart. I am not kidding. This first scan is the denial letter for a new claim of apnea and an increase in heart (from 10% award on original claim). THis is not the original claim this is a subsequent claim decision. They did not refer to the portion of the claim that was for a heart increase but I think it's important to note that it was part of the claim that was not acknowledged in the decision letter that follows. apply for heart increase.pdf ===== Temporary total 100% schedulars are handed out, on average, for 3 months- maybe six if the injury is slow in healing. The follow on rating you perceive as a reduction from 100 to 60% is based on the residual medical evidence of disability. A proposal to reduce always allows a 60-day window for response. No proposal to reduce would ever be preceeded by a temp. total increase to 100%. This next scan shows the 10-100-60 decision. There is no 60-day notice but does it matter? 10to100to60 decision letter.pdf ===== There is no "reconsideration" mode or form. VSOs claim there is but all they do is refile for the reconsideration on a 526 and begin a new claim. You lose your earlier filing date this way. Within 30 days of Dec 10-100-60 letter, he filed a reconsideration and it appeared on ebenefits as a new claim. It was denied. They said "if you don't like it file a NOD". We joke about this, but Hubby had another heart attack one week before the denial of the reconsideration letter was printed. We claimed it, and they merged that into the earlier dated reconsideration request. Somehow this is going to snafu but currently it's in the decision phase. As soon as they make the decision, we will file more paperwork. ===== Do we have to file all the CUE issues at the same time? Is this form the correct way to format a cue: Is this a proper form and verbage for a cue..pdf I would either fax it or take it to the VSO for uploading since I won't have an open claim and can't upload it onto ebennies. ===== This is going to be interesting. I know there are CUE's and an NOD lurking in these claims. I just have to lay it all out and decide how to build the NOD and write the CUE's properly so that they are a good foundation for the NOD. What a pain. This guy has 20-years of heart history, multiple MI's etc etc. A/O service-connected already. Less than 5 years rated. Thanks for the advice.

Need an elder to chime in here.

I realize after reading your helpful replies that I really know-almost-nothing about the advanced post-decision and appeal process. I'm still at the CUE level and am carefully watching the NOD clock. This claim has so many CUE's that it would surely get remanded. I honestly think the rater was pissed at me because it is was such a sloppy decision. I will keep your info in mind to help with planning CUE's with the appeal in mind. There should be a community college degree program: you know - maybe even a "BS" in VA Claims Advocacy. (my sense of humor).

I'm a newbie here but I am wondering: are they asking about medical benefits or financial compensation benefits? Do you get health care from the VA for your shoulder? It looks like you do not get financial compensation for the shoulder. Someone with more experience will chime in soon but I would probably write something like "I do not receive financial compensation from the Veterans Administration for my shoulder injury however I do receive healthcare from the VA for my shoulder." Not sure if the end part of that sentence is true or not - you could leave it in if you get treated for the shoulder at the VA. I'm more of a minimalist and personally, I would keep it short and simple. Why give them anymore data than they're specifically asking for? You just never know when extra data will open a can of worms. I might be wrong so wait until someone else chimes in.

buck52 Dealing with the VA and ebenefits is more adrenaline and blood pressure spiking than a cup of coffee!! I'm only starting year 3 of dealing with the VA. Are you telling me that in another 42 years I won't want to stir the pot anymore? No offense meant, cheers, A/Owife

I respectfully disagree. If we don't say something then they will keep "kidding" the next Veteran. No Veteran deserves that sort of BS. What if her "kidding" triggers someone. Some people are too ill to get "kidding". If we don't say something then they think it's all fine and it isn't. It's a fubar system and they laugh about it. Hope you don't mind that you and I disagree!

At our local clinic, in the past year, every single counter-person, technician, nurse, and all the doctors MINUS the cardiologists are 5-star. The irony is that my husband really needed a good cardiologist and that is not what our local VA has. Ours seem to be pill pushers who don't do any digging or ask any historical questions: why, when, etc or even tie symptoms together as in cardio and pulmonary. They have their own little specialty of cardio and don't seem willing to expand from cardio into cardiopulmonary: everything is cursory to them. In the past year, the nurses and techs and social workers and patient advocates and janitors and all the other doctors (except the local VA cardiologists) are absolutely stellar in their professionalism, interaction, procedures, willingness to help. One thing we NEVER do is tell anyone at the clinic that the Veteran gets any compensation or is that he is applying for a rating increase. I found a good lawyer who is taking one issue as a tort claim on contingency. I am unsure if we should do the 1151 or not. I guess I should ask the lawyer:) However this is not the same issue as my original post. I'm still working on the reduction from 100% without an exam/evidence of improvement. Then I also have the unadjudicated original claim issue. I'm in this for the duration - I'm hoping your "CUE themselves" strategy will help reduce the timeline. We have a college kid and have been denied DEA because of the errors which go back to the original claim (sound familiar?). I've filed for everything and have good documentation but I needed to figure out the timing and the overall strategy and that's where your idea has really helped me solidify my strategy. It is a sort of "war" and the "enemy" doesn't want to pay. Best idea is to use their "ammo" (ie laws) against them. Pain in the patootey to have to fight for a "lawful benefit" and sometimes I feel I will probably die of old age before it's all caught up and properly rated. Thanks for being there, telling us to read read read the claim file, and for sharing your knowledge and your story.

Berta - They treated a heart attack with sudafed? Am I understanding that correctly? O. M. G. Seriously. They kept saying my husband had reflux. Then the VA "md" reduced my husbands heart medication 3 weeks before he had a...........heart attack. Anyway, that's not where I'm going to use the "clear the CUE so I can file my NOD". The original claim is where I found the CUE. They mentioned one symptom but not the other. It's clearly a CUE and the symptom is described verbatim in the regs. I am also going thru BVA cases and the M-21 and finding all sorts of interesting tidbits of mandatory regs relating to "inferred" and "fully developed" and "duty to assist" and "examination disclosing improvement" and "medical opinion" etc. It's going to be very interesting to see how this document shapes up. Roberson Smezraj and Moody really tie it all together nicely. I'm struggling to keep it to one page but I will make it happen. ========= The topic of my original post is an A/O reduction from 100% without an examination and it is so poorly done that my jaw drops every time I re-read it. But that's for a future date.

While she is providing medical care to you, she should remember that you are her customer and you are there for your shoulder not for a lecture. Remind the patient advocate that no Veteran deserves to be treated that way. What if she says something to someone else and triggers them. I'm still steamed just thinking about this. Also, you did the right thing because knowing the tangle of VA claims / benefits processes, they would probably ding you if you went non-VA. Let us know how it goes and what the advocate says. They are usually good, caring people.

Berta - I've been reading decision letters and evaluating the evidence listed. I think I found an unadjudicated symptom going back to the original claim (dated prior to the change in rules for inferred claims). Heart related and unadjudicated and he is only rated for heart - so it makes sense to me. I looked up the hadit posts and am studiously studying Roberson Smezraj and Moody. I am also pondering your "clear the cue so I can file my NOD" strategy and working on that too. If I remember correctly, you have been successful with the strategy. I like it because I am a fighter. A/Owife

mikehunt- Exactly! Thus the confusion. I love that "nonsensical fragment". Just for fun, I'm going to work that into the CUE. I did find a reference to "revised mets" in the bva search - so this is not the first time an RO has asked for "revised mets". RO erred and should have scheduled another C&P or an IMO. A/Owife

broncovet- Yes, I was hoping for the best. But they used that exact phrase and reduced the rating. Maybe it's possible they were trying to act in our best interest but I haven't seen it so far in "our" rating process. I'm still listing the due process violations we found in the decision..... and I'm over a dozen already. I think the RO was in a hurry trying to beat the 100 day deadline. A/Owife

kit141 VES sets up C&P (Compensation and Pension) appointments as a subcontractor to the VA. C&P is basically a medical exam where they collect legal evidence from doctors to help them decide your claim. They are supposed to notify you that it is a C&P Exam because it is a legal type of meeting. What state are you in? I would definitely return the form with proof of mailing/submission: I would scan it and upload it onto the open claim on ebenefits. That way it is time and date stamped. HOWEVER there is some sort of trigger that notices when a new document was uploaded and sometimes I see changed dates after uploading. We stopped hurrying and thinking that the VA would rate stuff properly and quickly. To me it is more important that I have proof of what we submitted. You can ask your VSO what the current status is. They have access to more detailed status on their systems than we do on ebenefits. Do your medical records report all your conditions (not just the heart)? Did you claim more than a heart condition? Did you file a hardship? Sorry about all the questions. I'm working on similar claim stuff so it's fresh in my mind. A/O wife