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El Train
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Posts posted by El Train
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Or in my case the C&P examiner was pissed I handed her an outside IME/Nexus. She asked where I found the Dr. I didn't think it was relevant. Even though I had a good amount of evidence for an increase, she crafted her C&P in a way to reduce. All because she didn't like the manner in which I obtained my evidence. So there is that risk. However, I am in the process of filing a complaint against her with the VBA regional director. We shall see how it plays out. Also, at the end, she said I defiantly should get the increase. What a crock.
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On 7/20/2019 at 3:02 PM, GBArmy said:
Sure, make sure all your personal info is redacted. I don't get it either. Did you look up what your disabilities are posted in ebenees and see if they changed. Is it by chance rated as 0%? The VA just can't disregard what your IMO said; they have to talk to his points. Tie is supposed to go to the veteran.
Here are the redacted files.
Ellis opinion lumbar, sciatica redacted0013.pdfRedacted lumbar sciatica spine decision0020.pdf
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7 hours ago, rsm-esq said:
Hi there,
You mentioned you have an MD opinion that supports your argument ("more likely than not..."), and a VA opinion that is opposed ("less likely than not..."). But it's unclear whether the MD opinion is in the record or not - that's critical in figuring out whether HLR or Appeal is a better option. Did the VA deny your claim after reviewing both opinions, or did you obtain the MD opinion after VA's decision? Here's why that's important...
If you select Higher Level Review, you will not be able to submit any new evidence. So, if the MD opinion isn't already in VA's records, they will not consider it as part of this claim. Which means that HLR will probably result in another denial.
If you select Appeal, you WILL be allowed to submit new evidence, and (at least in theory) a Judge will review your case, applying sound legal judgment along with a review of any new evidence submitted in support of your claim. Check out the attached PDF that shows the various appeal options as they currently stand.
The VA had the MD's opinion prior to the C&P. She even stated it was well written. It was from Dr. Ellis who specializes in IME. I had several other claims approved based on his expertise. I'll try to see if I can attach the denial letter PFD. It basicly disregards the MD's opinion and ROM testing. What's weird is, at the end it states 'favorable findings' You have been diagnosed with thoracolumbar spine from VA C&P (lumbosacral strain and mdd disease).
Do you mind if I send you the IME and denail info.
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I have an MD opinion stating it is more likely than not veterans lower back issue and sciatica was caused by an in service event (in my medical records). Had a VA C&P done by a nurse practitioner. ROM was all out of whack. She states veterans level of participation questionable. Less than likely as not (of course), due to the fact I didn't complain on exit physical and medical records are silent for a number of years. Have buddy and spouse statement explaining treatments when I got out and they (more than once) drove me there due to flare ups. Medical records get destroyed after 7 years when I went to retrieve them.
Should I file a higher level review or just appeal it? I'm at 100% barely, and everything I applied for approved. Based on medical evidence connecting in service incident, treatment, buddy statements and MD opinion more likely than not. I do not care if they review all other claims, as I have sufficient evidence to back them up, or have the means to get more if needed.
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I put in for an increase for PTSD with TBI (new). I had an outside IME/DBQ done by a Psyc. DR. and a general MD with the increase request. The Psyc. Dr. was pretty critical of the first PTSD C&P exam as being very shallow and incomplete. The VA sent me to QTC for another C&P. I made the mistake of giving the outside Psyc eval. to the C&P Dr. doing the increase exam. She was not amused (her words) with his critical IME/DBQ. Her exam reflected it. A week later I had another VA QTC TBI (2.5 hours). He also covered stressors and PTSD. Very different outcome from the prior week. In fact it destroyed hers with facts and tests.
Bottom line, she crafted her C&P as to not agreeing with any current, past, diagnosis or treatment. Also, a liar (claimant reports as an unreliable reporter). Now I'm not amused.
What is the best way to report her less than factual C&P. I pretty much want them to throw it out, use my evidence or re-do the whole thing. Not sure why that would be necessary. No, I have not gotten a decision on the PTSD increase or TBI approval. The TBI shouldn't be an issue whatsoever. But I've had the VA side with the more critical C&P's vs. outside Dr's opinions.
Appreciate any advice.
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My outside DBQ and nexus (from a VES examiner) specifically recommended 70% PTSD and should be separated from TBI rated at 40% in his opinion. It'll be interesting how the VA rates it. I'm with you. If they try to lump them together than I will ask for a reconsideration. These are the last of my claims out of about 8 things. I'm at 100%, and most say 'let sleeping dogs lie', but that ain't me. They need to get it right. It could make a difference down the road.
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I'm going through the same thing. Provided an outside nexus and dbq from a Psyc PHD on Seperate claims for PTSD and TBI. Then the VA sends me to their contractors for the same stuff. Two weeks later, I have an additional C&P through QTC for headaches (never claimed headaches). It has been deferred for the time being. ETA on a decision is Oct 1, according to ebennefit.
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With a mountain of evidence in my STR's for skin conditions (painful scarring due to cystic acne), the VA did everything it could to deny me. One positive is, they sent me to QTC; that DR. disagreed with the VA C&P (less likely as not) I had. They gave me 10%. I got an outside MD nexus letter and filed an NOD. Had another VA C&P (wasn't expecting much), increased rating to 80%. From a potential denial, to 10%, then increased to 80%. Keep fighting. If you appeal it could take years to resolve.
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HD denied me vet discount. Said I needed some special ID. Poor cashier (not her fault), said see deals with pissed off vets all the time, leave without buying stuff. Never to return I'm sure. Lowes laughed when I told them this story. Said, accept VA cards everyday. Now I just give them my phone number for the discount.
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Good news Broncovet. I had a very reputable law firm take my case.
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Just an update. I got increased from 10% to 80%. Painful scarring on neck, face, back, and chest, with palpable tissue, underlying tissue damage, gross distortion. Fairly significant increase I would say.
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I've contacted a few attorneys. Including the one you hired. I've yet to get a reply back. So I'm guessing it's not a strong case. If it was, I would think a 6 figure favorable outcome would be enticing. Maybe it takes time for them to get back to me.
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I recently was awarded 80% for painful scarring with underlying tissue damage due to severe cystic acne. This was originally denied in 1993. Reason was, it existed prior to military and the VA could not locate military service records. They have since been located and used to prove the disability was aggravated in service. I originally was low balled at 10%. I got an outside IME that helped in getting the correct percentage (80% overall). The C&P in 1993 stated I still had cystic nodular's. Also, low grade photos show them as well. The scars were obvious and never went away (Thus, the 80%).
Is there any way to get my claim retroactive to 1993?
This article gave me a glimmer of hope.
https://www.veteranslawblog.org/2-times-that-veterans-should-argue-for-an-earlier-effective-date/
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Well Ladies and Gents, I just got my overdue 100% thanks to Dr. Ellis IME. Also, there are about 8 more claims deferred. Most likely these will get approved as well. What blows me away, is the VA gave me 10% for scars. After Ellis IME, I got 80% for the same scars. They just low balled me.
Keep up the good fight.
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Got a call from QTC stating residuals from TBI are present (just had psyc eval for TBI). Now need a C&P for headaches and alterations in smell/taste. You think they will rate all together or separately? I know, just wait, but was hoping someone has been down this road.
The only issue about headaches, I never sought treatment for them. Just self medicated over the years. MJ, otc stuff like excederin, advil, etc. I am taking Lyrica for myalgia symptoms. It does seem to dull headache pain to some degree. Perfumes/cologne or diesel fumes are instant triggers. Same with photo-sensitivity. I work part time from home and have been out for 26 years.
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Had C&P today for the rest of my claims by VA nurse practitioner. Basically filled out DBQ's like I thought. I refereed her to Ellis diagnoses a couple times. She did say they were pretty extensive from Dr. Ellis. I'm feeling positive since an MD opinion should outweigh a NP. But I think the C&P went pretty good. We shall see.
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1 minute ago, wood78221 said:
Interesting. I’ve only been scheduled for one so far.
Ya. I'm guessing they need to do DBQ's since Ellis doesn't do them. Just want to get them done and over with. Heck I had a Psyc. Dr. do a nexus with a DBQ, and still had to do two C&P exams. Just more proof I guess.
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On 3/1/2019 at 4:22 PM, ed33 said:
Did you have to prove the acne was service connected first?
Aggravated, yes. It's well documented in my records as when it started and treatments.
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VA is sending me for C&P for all my claims I filed with Ellis IME. Heck I did one for a PTSD followup and another for PTSD & TBI in one week. Both contractors which I felt went well. I have VA C&P's for 6 claims coming up. They are doing them all in one day. Now the VA C&P's have been way different than the contract one's. I'll keep you posted how they go, but I think they are going to try and hammer Ellis IME. I'm going to throw a binder at them with all my evidence. They want to play? I like to play, so let's get it on. If it goes not as planned, then on to plan B. They'll be wasting everyone's time when all is said and done.
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8 hours ago, MarkInTexas said:
Agreed! Also, side note on the raters not liking Dr. Ellis' IME/IMO reports. Raters try to kill everything they can at their level. However, in my own case at the BVA level, Dr. Ellis' report destroyed the C&P examiner's and rater's opinions. Make sure you upload a copy of his curriculum vitae if you are going to compare his IME/IMO's to the C&P's.
Good luck!
Mark
Curriculum Vitae? Would that be his front page of his IME? Or does he have a whole separate sheet outlining his Curriculum Vitae? That would be nice to hand the VA C&P doc I'm seeing next week. Thanks.
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My face from collar up to cheek bones is scarred from bad cystic acne. Easily 50% of my face. The VA Doc denied me, the QTC second opinion disagreed with her and I was low balled at 10%. Got a third opinion from a Dr. I hired who suggested based on VA ratings 50%. Have another VA C&P next week by VA for re-eval. I'd guess an increase from 10%, but who knows with the VA docs. They may decrease me for the hell of it. Then I'll get another opinion to overrule them again. They are painful, palpable, discolored, and well documented in my records. I'll let you know how it goes.
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20 hours ago, Banarep said:
I went to Dr. Ellis a year ago, turned in his report, 4 buddy letters, two nexus letters from physical therapist and chiropractor, DBQ from a psych doctor and was turned down on almost every thing I claimed. In the middle of a reconsideration with another buddy letter, nexus from my doctor referencing all my claims, 3DBQ's and 3 additional nexus letters and one more DBQ psych evaluation and copies of VA medical notes of diagnosis for PTSD and adjustment disorder. We shall see.
At this point I'm turning it over to a law firm. Seems like you have done everything and they are pissed about it. I would think a law firm would love an easy case like this. You've done all the medical work for them.
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7 hours ago, dajoker12 said:
You seriously think that the VA schedules everyone for a C&P exam for every contention that they claim? Not if they don’t meet the three pillars for direct service connection. For re opens, but if they don’t submit new and material evidence. For secondary, not if there isn’t evidence of a cureent condition, though a simple statement from the Veteran is sufficient for this purpose.
I see what you are saying. In my case they did. Because I meet the 3 pillars. I guess some file with no evidence (no pillars). Auto denied, no C&P. I stand corrected.
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21 hours ago, dajoker12 said:
Just to give you a head's up, any IME from an out of state examiner, especially a "frequent flier" is always a red flag and will be highly scrutinized; it is at the rater's discretion whether or not they opt to even use it. Buyer beware.
The VA is going to schedule you for C&P for all claims you put in. I had one today for mental in which I had a detailed report and DBQ from an outside psychologist for hire. She was not amused at all that he tore my last mental C&P a new arse. I have about 5 coming up with Dr. Ellis IME reports. I expect them to hammer his reports. But you know what? It is what it is, and I will reference his reports often, as he is an MD, and it his opinion. Not much different from theirs. Deny me and it's on to plan B. I suspect I will get approved on some of them, I hope. Keep ya posted.
TBI and PTSD VES exams
in VA Disability Claims Research
Posted
Yes it is a good thing. Sounds like your original rating at 0% is low. VA will sometimes lowball you to see if you just accept it. I had two different C&P's for PTSD increase and TBI two weeks later. A month later a C&P for headaches was ordered (not by me). TBI c&p went good. Should get approved no problem. Not sure about the headaches yet. I haven't got the copy of the c&p yet.
The c&p for PTSD increase went bad from the start. I handed her an outside dbq and nexus that was critical of my first c&p and separating tbi. She was not amused. To put it lightly. She crafted her c&p in a way to reduce, ignoring all evidence given to her. She basically called me a liar (unreliable reporter). So I got a formal complaint going against that DR. So we shall see. Sorry to get off subject.