RBrogen

Check your E-Benefits and see if it has updated info. You can usually get an idea of what the decision was based on the entries there.

Definitely ... I think they did this because the errors were so demonstrably egregious that the just thing was to do a new exam. Her boss is now involved as well.

UPDATE: I was told on teleconference call today that the Regional Office is going to schedule me a new C&P exam! I'll keep you updated.

UPDATE: I contacted the local C&P office where the exam was done (there's really only one doc doing the exams at that location). The person scheduling the exams told me that I should come back in on a Tuesday or Thursday when there is an open Regional Office teleconference call so that I could explain my issue. I went back in on Thursday May 23rd and after speaking with the RO, they had me fax my detailed documentation of issues so they could hand carry them to the person handling my claim. Additionally, I happened to have the contact information for the Deputy Chief Medical Officer who I sent a note to about the situation. He, in turn took all of my evidence and then passed it along to the Chief of C&P for that location. My goal is to have the inaccurate C&P expunged from my record and a new C&P performed. I'll keep you posted and thanks for the feedback.

Thanks Paul. I have a boat load of facts that clearly show she didn't review my documents. She claimed on several questions that my neck and knees were non-service-connected conditions when in fact, they are both direct service connected. She also claimed she did a "Raised leg test" but didn't. I never laid down on the exam table which would be required to properly administer a raised leg test. I only sat on the edge of the table and she did reflex testing on my knees and achilles. There were several instances where I specifically gave her information on my condition like with flare-ups and functional loss and she checked No Flare-ups reported.

Hey Paul ... thanks for the info and congrats on your new C&P. I took VetRequests advice earlier and called the local C&P office where I had my C&P. I explained the situation and the lady on the other end said that the regional office rep would be at their location tomorrow and Thursday and that I should come in and speak directly to them because it has a potential negative impact on my claim. I'm going in on Thursday morning because I already have to be somewhere else on Tuesday. So I guess by doing this I'm goin to the regional level similar to your approach as well. I'll keep you posted and I hope your new C&P goes well.

Hey Everyone, I wanted to post here to get some advice. I went to my latest C&P this past Friday May 17th, 2019 for an increase to my original condition of Lumbosacral strain as well as secondary NSAID induced GERD because of taking NSAIDS for years of treating the pain from my back and legs. Here are the issues that I had and am wondering should I submit an additional document to my claim to let the RO know of my concerns before they make a decision or should I wait for decision and then go for higher-level, supplemental, appeal road. Examiner did not use Goniometer to measure ROM on my back (indicated that I was up to 70 degrees and 20 degrees on everything else) Examiner noted pain during ROM testing but did not indicate at what point in ROM that the pain started so that the accurate ROM could be determined Examiner did not fully review my records as indicated by: they did not note spinal stenosis as a diagnosis which is clearly indicated on my MRI results they indicated that they did a straight leg test with negative results when in fact they never did that test. I never layed down. they indicated that I had not sought treatment for my back since 2017 which is completely false. I have documented treatment records at the VA beginning back in Nov 2018 through this month. they referenced a 2 year old MRI result instead of my MRI from 2 weeks ago they indicated that I was taking pain medication for non-service-connected conditions (neck/knees) which are actually service connected conditions in my file. they didn't record my specific statements about flare-ups and the functional impact saying that I didn't report any at all. Any thoughts would be greatly appreciated. Thanks in advance.

I wanted to share my experience with this new "fast track appeal" option called Higher Level Review (HLR) and see if anyone else has had this experience. My original claim for IVDS of Cervical Spine and Knee Conditions, Bilateral ( Arthritis in both and have had 2 surgeries on left and 1 on right for meniscus tears) was approved at 10% neck, 10% left knee arthritis and 10% right knee arthritis. My contention is that all three conditions should be rated at least at 20% each. First, my neck has "straightened/revers lordosis" which is a qualifying condition for 20%. On both of my knees, the meniscus are frequently popping out, causing swelling, pain and locking which should qualify each knee for 20%. I filed the HLR on March 12, 2019. The form to file the HLR didn't have a place that I could find to submit any supporting information. It only had a section to list the specific conditions to which you wanted them to take another look at. The HLR form did have an option on the form to request an "INFORMAL CONFERENCE CALL" which I checked off so I could explain my disagreement with the rating given. About 32 days after submitting my claim, and ironically while I was at VA appointment stuffed into an MRI machine, the decision officer Marcus called and left a message. I called him back within 45 minutes of his call and the number the give you is out on the west coast and only has a voicemail option. You can't speak to a live person. I left a message and told them day/times that I had available. I waited 2 days and hadn't heard back so I called again and left a message. I went onto my e-benefits to check something else and noticed that my claims appeal had been closed as of April 15, 2019 and a decision sent ... WTF. I called the main VA number and let them know the situation and they sent an internal message to the decision office Marcus. Well Marcus called me back later that day ... and when I picked up the phone he sounded surprised that I picked up. He then went on to say he was calling to schedule an informal conference call with the decision officer .... UGH WHAT? I told him my availability and he said he'd forward right over to the decision officer and I'd likely get a call in a few minutes. Guess what .... that call NEVER CAME! I called back to the main VA number several times and they sent messages and finally one of the people who picked up the phone said just wait for the decision letter. Well I waited (and am still waiting for the original decision letter), when the required 7-10 days passed I called and had them do a verbal FOIA and fax me the decision letter while I was on the phone with them. Yup, you guessed it, the appeal was denied and the reasoning was a cut and past from the original claim decision. Fortunately, at least I hope so, I have the option of a Supplemental claim, which I put all of the supporting information together in a nice package and faxed it to them, called 3 days later to confirm receipt and hopefully that will address the issue. Bottom line, it looks like the HLR process is really BS at this point and they are all about making it look like they are processing these HLRs at about 30 days, at least it was in my experience. Anyone else have HLR experience?

Great info Broncovet ... thank you.

I'm not actually asking about pyramiding ... the claim for my knee should be 20% because of the meniscus not in addition too ... I wasn't sure originally if the VA would rate in addition to arthritis but only want the correct rating and to understand how/why the rating was given or not whichever is the case.

Thanks Broncovet. I have all sorts of IMO/IMEs documented. The other thing is also they noted pain in ROM but didn't indicate at what point in the ROM that the pain started so that the ROM limitation was accurate. I have already requested a higher-level review to see if they will adjust the knees and my IVDS/DDD because they didn't consider my straightening lordosis diagnosis documented in the C&P, only arthritis.

The surgeries didn't correct the issues, only cleaned up the debris and hanging edges of the tears. The main issues of locking, pain etc still exist. I wasn't sure if arthritis and meniscus would be pyramiding or considered 2 different conditions. Thanks for the info Paul.

I got a decision letter from a recent claim I submitted and it does explain for the most part how they reached their decision. If I am reading it correctly, I believe that they left out several important things when applying the rating: For example, I have a 2 claims, one for each knee. I'll post thee Right Knee as both are the exact same issue as I've had meniscus tears and scope surgery on both, 2x on Left and 1x on Right). They only gave me Arthritis for each knee at 10%. Shouldn't that be at least 20% because there are meniscus tears, popping out etc. or should it be 10% for arthritis and 20% for meniscus on both? Here's what my decision letter has: Here is what my C&P wrote:

Thanks Mega.

I did get a decision letter and it does explain for the most part how they reached their decision. I found that they left out several things when applying the rating: For instance, I have a 2 claims, one for each knee. I'll post thee Right Knee as both are the exact same issue as I've had meniscus tears and scope surgery on both, 2x on Left and 1x on Right). They only gave me Arthritis for each knee at 10%. Shouldn't that be at least 20% because there are meniscus tears, popping out etc on both? Here's what my decision letter has: Here is what my C&P wrote:

That is very close Paul ... yes

I am actually aware of what goes into the VA individual condition rating ... what I was/am looking for is to see if the va would provide the actual breakdown like my original post shows so that it shows exactly how they achieved the final combined rating, not the individual condition ratings.

Hey Paul ... I use eBenefits all the time as well and am very familiar with the "VA Math". I wish they did annotate which conditions were considered as bilateral in nature specifically. I was just curious was there some way to actually get the VA to provide the breakdown of the exact calculation they used to arrive at the final combined rating percentage. Without know exactly how they arrived at the calculation they arrived at, there's no way to double check and make sure you are getting an accurate rating.

Right ... what I'm actually wondering is once all of the ratings have been decided on the severity etc. and they have all of the individual issues with a number, I want to know what issues they actually combine for the bilateral factor. It is just guess work with trying to understand what ratings were used if I don't have that ... for instance ... do they consider my radiculopathy left and right conditions into the bilateral? Common sense would say yes but without knowing for sure it's a guess.

Right ... the post I used as an example was just numbers I put there for sake of discussion ... my own numbers are more complicated which is why I was trying to figure out if they provide the actual calculation. For example my numbers are: 20% - original disability for chronic lower lumbar strain Latest decision added these conditions: 10% - Left Knee Arthritis 10% - ddd, cervical spine, with spinal stenosis and IVDS 10% - Right Knee Arthritis 0% - Bilateral hearing loss 20% - Right shoulder s/p arthroscopy with subacromial decompression and excision of distal clavical due to shoulder impingement 0% - Right shoulder surgery scars 20% - radiculopathy right upper extremity 20% - radiculopathy left upper extremity So there are several potential bilateral elements but not knowing exactly what they do then it's hard to see how the get their number.

Hey Buck ... thanks for responding. Yeah I did have all of the info on "VA Math" rounding up/down etc, including the bilateral factor situation but I am curious how we can tell whether they made any errors with the calculation without having their exact process like I showed in the OP.

Does anyone know if you can request that the VA provide you with the actual calculation they did to arrive at their final combined rating? Something like this: Bilateral Conditions 20% Right Shoulder Condition 10% Left Knee Condition 10% Right Knee Condition Bilateral Conditions Results = 20% + 10% = 28% + 10% = 35% + 3.5% Bilateral Factor = 38.5 (39%) Bilateral Conditions 39% Tinnitus 10% Jaw 10% Combined Rating = 39% + 10% = 45% + 10% = 51% (51% Final Combined Rating)

Does anyone know if you can request that the VA provide you with the actual calculation they did to arrive at their final combined rating? Something like this: 10% Left Knee Condition

Hey Mega ... I got 80% which I'm very excited about. I have several outstanding elements that are still being reviewed to go so hopefully it will go higher.