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El Train
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Posts posted by El Train
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I hired Dr. Valette. A former C&P contract Psych. Dr. with over 20,000 C&P's under his belt. He wrote up a thorough IME and DBQ for PTSD and TBI. That got the ball rolling for me to get too 100% PTSD w/TBI (up from 50% ptsd alone). The subsequent C&P's didn't mention his assessment much (except one C&P Psych. Dr. who did her best, and failed, to discredit his IME), but I know it had it's effect; otherwise I wouldn't have gotten the C&P's in the first place. Had it gone to BVA or further, his IME/DBQ would have played a bigger role. It was nice to have that in my back pocket.
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2 hours ago, kanewnut said:
How do you go about filing a formal complaint? Who do you send it to?
I googled it. I knew where the VARO main office was. I then put ATTN: Mrs. XXXXX. Like another poster said, they don't like to be called out by name. You will get results. Out line the issues, point out comparison to past C&P's, and medical records/notes. If a C&P examiner is winging, not making sense, making stuff up, not asking questions, or being malicious, they will review it and set you up with another C&P. This next examiner will be approaching your new C&P with due diligence. That I can tell you.
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Good advice Berta. I filed a formal complaint about a C&P examiners exam to the VARO head person. Within a few months, I had a two extra C&P exams for the same condition. They dismissed the original bogus C&P examiners exam as 'not making any sense'. Got my claim approved to 100% P&T. I can say the VA took my complaint very serious. I hope the initial claims examiner was relieved of her C&P exam duties.
I will say this, 'don't piss off a C&P examiner', like I did originally. Even if they are rubbing you the wrong way. It won't go well. Be very polite in a military manner. Yes Maam, no Maam, Thank you for your time Maam.
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I'm in the same boat with some disabilities on appeal. I'm 100% P&T with SMC-s. However, I plan on living abroad for months at a time. From what I understand, I can have any service connected disabilities covered under the FMP (someone correct me if I am wrong on this). https://www.benefits.gov/benefit/567
So I plan on riding these appeals out. Even if they are rated at 0%. Also, I'm not concerned with the VA opening up old claims and trying to reduce. I think this is a scare tactic. If it isn't, then I'll bring the Hell against them. Like I did to get my 100% P&T.
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I had favorable evidence, in my denial letter. A diagnosis and outside MD's IME linking in service incident caused the disability (lumbar spine, radiculopathy). Denial letter stated no in service incident, which isn't true. I've got another approved claim because of the in service incident (a tbi due to a rappelling accident). HLR continued the denial. I'm appealing it.
The denial letter stated lack of treatment records after service and no in-service incident (which should have been an error through HLR). The no treatment records is true since they destroy these records after 7 years. I had no intention of filing a claim until 23 years later. I sought treatment ever since I got out and still to this day. Just didn't have the records up until 7 years ago. Lay statements did no good. I didn't seek treatment for my tbi 'ever', and it got approved.
At least your HLR found errors. I think eventually you will get your claim approved.
I'm 100% P&T so the wait on any outstanding appeals doesn't really bother me. Yes, I am SMC-S for those who are wondering. No back pay there I don't think.
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I use this rating calculator. You might find it helpful.
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You should be fine then. They may have other questions on the C&P exam they are trying to sort out. I had a couple things deferred for quite awhile. I even had to come back and do multiple C&P exams to separate overlapping PTSD and TBI issues.
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Are you seeking treatment for the PTSD? You're going to need a VA Psyc. Dr. to diagnose it in order to get it. Or like you said, if they don't have a VA provider then maybe an outside diagnosis (from a PHD Psyc. Dr.) might work. I'd rather it be a VA diagnosis though. The C&P exam will probably want to see that there is some treatment and diagnosis notes for them to agree to it.
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This is normal. They are trying to determine what symptoms of your tbi overlap with your mdd. Or ptsd in my case. I had two outside ime's, then the VA put me through the wringer with their own. 5 total c&p's for tbi and ptsd. I had a bad c&p examiner for one of the ptsd. She stated I was an unreliable reporter (in other words, a liar. Even with overwhelming evidence). This set me back quite a few months. When I got my C-file, they had two Psyc. Dr's (which I never saw) fighting it out over the bad c&p exam. One Dr. sided with the unreliable reporter c&p exam, the other Dr. siding with the four favorable c&p exams. In the end they determined the bad c&p examiner as being the unreliable reporter and not making any sense. I hope they fired her ass.
So you never know what they are trying to determine. But I would say they are trying to get it right. They got mine right. 100% P&T ptsd/tbi combined after the dust settled.
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Buck, my understanding is they only separate some symptoms of TBI. Thing's like Meniere's disease, headaches, eye/vision issues (which I have and not rated), incontinence, etc. The cognitive, sleep, mood/anger issues are overlapped with PTSD. I think having the 100% ptsd with tbi is a solid reasoning for P&T. It ain't gonna get better. Otherwise I may be looking at future exams without the tbi. That is just my thinking.
Here's the thing about tbi ratings; they go with any category you rated highest at (or worst at). In my case I rated a 70% in one category. I can't remember which. Actually, that might be the category. Memory, recollection, disorientation of time or place issues (I don't know what day or time it is, or siblings names when put on the spot). Otherwise, that is a high rating for tbi. The other categories, I was fairly low. Take a look at the tbi dbq if you can find one.
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They often do combine an mental health and tbi together. For instance, I got 100% ptsd and a tbi rating of 70%. They combined the two for 100% ptsd with tbi. They did separate migraines at 10%. Too many symptoms overlapped with both ratings. They gave me the higher of the two and combined them. At least that is what the award letter says. I have seen them separate the two in very rare occasion.
I have other conditions that get me to the SMC level (scarring, tinnitus, fibro, etc.)
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I had a similar situation. Increased from 50% to 100% PTSD P&T. I personally would leave well enough alone. Or let sleeping dogs lay. The VA can get pissed and start looking at other things to decrease. If you know what I mean.
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I think you will probably be increased to the date of your NOD with additional evidence. At least that's the way it worked for me. And yes, I had C&P's requested by the VA after I filed NOD's with additional evidence. A lot of them. Your lucky you're having LHI do your exam. I've gotten favorable results every time I've had a contract examiner do my C&P's.
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Regarding TBI claim: You will more than likely need to seek out a Psyc. Dr. to review your records and make the connection. There are a few of them out there that are familiar with these types of VA IMO and nexus experience. I even had a forensic MD review my records and service connect me for the tbi. PM me if you want the one I used. The VA may choose to ignore his IMO, but this will at least get the ball rolling. It will be the VA contract Dr's and raters making the ultimate decision. I had multiple QTC TBI (3) c&p's, and 2 Ptsd c&p's. I guess it was necessary to try and separate TBI symptoms from Ptsd. A lot of overlapping symptoms. Be prepared for this. When all was said and done, I got rated 100% ptsd with tbi, p&t.
I have bad photosensitivity and cognitive issues. I know some people have gotten ratings for their eye issues. I never did. I did get a low 10% rating for headaches. It should have been 30%. But I'm 100% with SMC-S, so I'm fine with it. Hit me up if you have any more questions.
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Damn Bro/Broham, I'm with you. I've never admitted SI to any Dr's. I couldn't do it. Who wants to admit that. It was easier for me to admit I wish I wasn't alive if I had a choice. But no way I would admit a plan to offing myself (and I don't have one). I got rated 100% PTSD/TBI without admitting I have SI. Probably due to the TBI would be my guess.
It's not too late to file a NOD. You have up to a year. I filed NOD's for all my claims. I went and got outside IME/IMO from Dr's I hired. Then submitted that. That triggered C&P's for all the conditions I requested to be reevaluated. This got me proper ratings for most my claims.
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Out of about a dozen outsourced C&P's, I've only had one bad one. This bad one started out with me getting arrogant with her. I don't recommend starting a C&P this way. They have the power to put your claim in peril with their professional opinion. Kill them with military kindness and you will be good. Yes Maam, no Maam, thank you for your time and kindness Maam. Now the VA C&P's were a different story. I have not had a good one. Some downplayed overwhelming evidence or didn't ask me DBQ questions and filled in their own answers. Some stated I was an unreliable reporter. Some we're outright condescending. Give me a choice, I'm doing the outsourced 100% of the time. The only issue is getting the results of the C&P in a timely manner. Sending in a FOIA and waiting sometimes 6 months is BS.
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4 hours ago, broncovet said:
My advice is to get a copy of this c and p exam and see if its favorable. Dont do anything until you do that. You dont want to blow up a winning hand. You can not tell what cards the examiner is holding until he lays them down and you read them. He may be bluffing.
My advice: continue your claim and worry about bad c and p exams "after" (and only after) you read their report. About 91.4 percent of the stuff we worry about never happens. Dont fix what isnt broken, and "open up the hood" before you try to diagnose what is wrong, by getting a copy of the c and p exam.
This right here. I had a bad C&P for PTSD. I got a copy before the decision. In fact I had PTSD and a TBI by two different Dr's. in one week time. I got my hands on both. The PTSD C&P (all 20 mins) was terrible. The TBI a week later was 2.5 hours and covered PTSD as well. It destroyed the bad C&P. I wrote a written complaint to the VARO. Mailed a copy and uploaded on Ebenny. 6 months later, I had two more C&P's for the same things. These were both positive in my favor. 100% P&T with SMC-S.
I recently got my C-file. In that, I had two Psychologists whom I never seen debating which C&P they believed and which ones they didn't. I had one Dr. side with the bad C&P and state I was bad reporter. The other Dr. sided with my 3 positive C&P's and totally discredited all the negative garbage as not making any sense.
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Only thing I would worry about if I were you, is losing SMC-S. You do have that, right?
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I've had everyone of my claims approved by outside contractors (QTC). I've had everyone of my claims denied by the VA examiner. That is unless I had an outside IMO/Diagnosis. Even with a solid outside IMO/Diagnosis by a forensic MD, the VA chose the opinion of a VA NP C&P examiners opinion on some claims. Not a specialist, a general medicine Nurse Practitioner. I have had claims approved from second opinions requested by VA via QTC (one's originally denied by VA C&P examiner). At least the VA will get multiple opinions if the claim isn't crystal clear. So I'll give them that. I went through 5 C&P's for PTSD/TBI.
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If the VA C&P disagree's with your outside IMO, you will lose. Even if the VA C&P examiner is a NP vs your outside IMO from an MD. Maybe you will win on appeal, I don't know. I know, because it happened to me. However, if the evidence is there, the VA probably will agree with your outside IMO. I had several claims where the VA agreed and disagreed with my outside IMO's. The claims I did win put me at 100% P&T with SMC-S. Otherwise I'd fight the hell out of the ones they denied. Having the IMO's certainly will help advance your claims in a positive directions. The burden of proof is on the veteran for sure.
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I only claimed tinnitus. Got a 10% rating for it, and they also rated 0% for hearing loss, which I didn't claim. Sooooooo.
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On 9/26/2020 at 8:22 PM, brokensoldier244th said:
Don't get me started on the doctor/DBQ exam opinions where they are 5 states away and have never even seen you once. Ive compared several of those to each other, and other than the name at the top of each of them (veteran) the text used is mostly boilerplate. They can't truthfully say they observed you in most of them, so that lowers the strength of the evidence and their opinion from the start.
Unlike a VA contract Dr. who see's you for 20 minutes? A forensic Dr. takes all your medical conditions and forms an opinion much the same. Do they not? I had an in person examination (5 states away) that took hours to complete. Sent them every pertinent info., including past VA C&P's. The VA C&P exams for the same conditions took 45 minutes for six conditions. I don't see a difference. In fact some of these Dr's for hire are or were VA contract C&P specialists. Go figure. I'm sure it's frustrating to see as a rater.
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22 hours ago, ShuMan said:
Yes! The VA has to accept all credible medical evidence. With that being said, I would not expect to get rated solely on the DBQ. Plan for a C&P exam.
This is correct. I included medical nexus from an outside Dr. stating in their opinion 'it is more likely than not, caused by in service events'. This triggered many C&P's. Some successful, some not. The successful one's got me 100% P&T. Otherwise I'd fight the hell out of the denials and most likely would have won.
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Mine have taken anywhere from 4 to 12 months. I did have a VSO get them within a week. But he won't do it now that I've hired an attorney and took away his power of attorney.
To Appeal again or just forget it?
in Social Security Disability Questions
Posted
Sounds like you did it right. Only hire a lawyer after the second denial, is what I am told. Not before.