[My VA claim estimated completion date changed to 05/03/2019- 04/30/2019 Good sign or bad ?]

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.

[C&P Errors]

Just now, Richard1954 said:

Im glad they responded.. usually they tell you to just wait and appeal

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.

[C&P Errors]

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.

[C&P Errors]

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.

[C&P Errors]

On 5/20/2019 at 4:49 PM, Berta said:

I think the best bet is to complain directly to the QTC, LHI, or VES, whoever did  the faulty C & P exam.

I called the WH Hot Line 2 week ago to complain on a posthumous C & P exam done by an actual VA employed doctor.

Some joker from the VHA called me up to discuss this.He didn't seem to have a clue on what to do.

He kept saying if I brought up the claim it involved, that VHA has nothing to do with the VBA.

I realized he did not understand that our benefits are determined by C & P exams, under the VBA, not the VHA.

I just told him I would take my concerns to Congress. 

There is a bill there about these lousy C & P exams but it is not a viable bill.

It is easier to write a legitimate bill and see if someone will introduce it- then deal with clowns.

This is what the Bill should be based on:

https://cck-law.com/news/va-contracted-cp-exams-not-meeting-quality-timeliness-standards-gao/

 

 

[C&P Errors]

3 minutes ago, paulstrgn said:

@RBrogen that is great, yes you need to push the issue when they do wrong. Be prepared to tell them facts, also if you have any evidence that helps your case bring it too. 

 

Good luck on Thursday.

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.

[C&P Errors]

14 minutes ago, paulstrgn said:

I called the White House hotline at 855-948-2311 and complained. I also emailed the regional director about my issues with the C&P. She had someone call me and we spoke for over an hour, I have my new C&P on Friday.

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.

[C&P Errors]

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.

[Higher Level Review]

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?

[VA Disability Claim Decision Rating Calculation]

13 hours ago, broncovet said:

If you read this over, you can probably find your answer:

http://www.danaise.com/understanding-rating-for-knee-injury/

Great info Broncovet ... thank you.

[VA Disability Claim Decision Rating Calculation]

1 minute ago, broncovet said:

There may be "overlap" of symptoms between the arthritis and meniscal tear.  

Example:  Pain in your knee.  This could be caused by either, or both.  Maybe for loss of ROM, also.  

Pyramiding prevents you from being paid for the same symptoms twice.  In other words, if you are getting paid for "pain"in your knee from arthritis, you probably wont get paid again for pain in the knee from meniscal tear.  

You see this with mental health disorders a lot.  You could have multiple diagnosis..PTSD, depresstion, bipolar, schizo, etc.  

HOwever you will only get compensated for "1" set of symptoms, even if they are caused both from depression and bipolar, for example.  

Go ahead and appeal, but I would not be suprised if pyramiding prevents you from getting paid for both.  

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.

 

[VA Decision Accuracy Question]

14 minutes ago, broncovet said:

Read the critieria for your condition:  https://www.law.cornell.edu/cfr/text/38/4.71a

See how the symptoms listed in the critiera compare with what the doctor said about your's.  If the doc did not document all your symptoms, then you may need an IMO/IME.    Then you can decide if rated properly, or you are likely to win on appeal.  

That is my advice.  

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.

[VA Decision Accuracy Question]

1 minute ago, paulstrgn said:

You can not be rated for both "arthritis" and "meniscus" for your knees, that would be considered pyramiding. Were the tears corrected through surgery? I do agree that the rating should be higher if your knee is locking up on a frequent basis as stated on the C&P. If you have new evidence that show these issues then I would do a reconsideration and explain what the examiner has missed.

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.

[VA Decision Accuracy Question]

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:

[C&P Exam Report Rating Question]

7 minutes ago, megajunk said:

Congrats! 

Thanks Mega.

[VA Disability Claim Decision Rating Calculation]

1 hour ago, broncovet said:

The VA is supposed to explain the decision and why they arrived at a certain percentage.  Its remandable error when VA fails to give an "adequate reasons and bases for decision".   They should show how your condition meets the rating critieria in the CFR's but no higher.  If you feel they should have assigned the bilateral factor, you can likewise appeal it.  

Shinseki tried to get rid of the required "reasons and bases" for decision.  Im glad he did not.  

If you feel their reasons were gone for bilateral factor, you can appeal it, arguing you are entitled to bilateral factor, citing the regulations.  

Bilateral factor means both joints are involved, such as the right knee and left knee.  Often, if you injure one knee, the other will suffer similar symptoms.  You body "limps" for the injured knee and inflicts damage to the better knee.  If you have symptoms documetented in your file showing both joints are affected, then I suggest you appeal for the bilateral factor.  

Its one thing to be blind in one eye, quite another to be blind in both eyes.

If they failed to explain the bilateral factor, then your remedy is appeal.  

The reasons and bases for decision is where they explain it.  There are attorneys who literally make a living appealing on an inadequate reasons and bases for decision.  The CAVC will remand it every time..if the reasons and bases are inadequate.  

Further, the VA has to rationalize their decision based on the criteria.  They can not rate on "non criteria", which is everything else but the criteria found in the cfr's.  You can appeal if they denied for "non criteria" reasons.  

For example, I was denied hearing loss because "it was too long since military service".  I looked in the criteria.  "Length of time since military service" was not there.  I had an in service event (excessive airplane noise), a diagnosis of hearing loss, and my audioligist had also provided a nexus linking my hearing loss to exposure to loud jet engine noise because my barracks was at the end of San Diego airport runway...I showed them on a map!!  

When they denied based on "length of time since service" it was a "bluff".  Its non criteria.  But, if I bought it and did not appeal, it would become final in a year.  This is a tactic VA often employes.  They make stuff up, and if you dont appeal, it becomes final in a year.  

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:

[VA Disability Claim Decision Rating Calculation]

1 minute ago, paulstrgn said:

@RBrogen In my decision letter it tells me, below is what I copied from my last decision from the VA.

60% from 02/23/2016 (Bilateral factor of 2.7 Percent for diagnostic codes 5279, 8520, 8520)
60% from 03/13/2016 (Bilateral factor of 2.7 Percent for diagnostic codes 5276, 8520, 8520)
70% from 09/13/2016 (Bilateral factor of 4.2 Percent for diagnostic codes 5276, 8520, 8520)
80% from 09/25/2017 (Bilateral factor of 6.3 Percent for diagnostic codes 5276, 8520, 8520, 8526, 8526)
90% from 05/26/2018 (Bilateral factor of 7 Percent for diagnostic codes 5276, 8520, 8520, 8526, 8526, 5251,
5251)

Let me know if this is what you are looking for.

Thanks Paul

 

That is very close Paul ... yes 

[VA Disability Claim Decision Rating Calculation]

3 minutes ago, Buck52 said:

I think he means  

How does the VA come up with a %  of the disability its self?

not the calculation of the disability...as we all know is what our conditions is rating at or suppose to be rating at  from the rating CRITERIA schedule Sheet/Manual for our S.C.disability

Like bilateral combined ratings there's is a rating formula  for them  as they are a rating formula  criteria for them to decide how to rate our S.C. Disability

this is not in e-benefits

All I know is I look at my S.C. disability and look at the  criteria rating scheduled for that disability and the severity of that disability to make sure I'm not getting low-balled  or the wrong rating.

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.

[VA Disability Claim Decision Rating Calculation]

1 minute ago, paulstrgn said:

I use eBenefits all the time to see my over all percentage. The only problem it does not show which disabilities are considered bi-lateral where you get an extra 10% for each of those ratings. Flat feet will get you an extra 10% or left and right knee will also get you an extra 10%. I have 4 - 20% and 3 10% disabilities which are bi-lateral and I gain an extra 7% to the disability 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.

[VA Disability Claim Decision Rating Calculation]

1 minute ago, Buck52 said:

well they use a rating chart  depending on how bad your conditions is rating  or the severity of them.

  they get that information from a rating schedule  manual and the Dr's them self.

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.

[VA Disability Claim Decision Rating Calculation]

1 minute ago, Buck52 said:

They give a close estimate percentage to your condition  ...

if the condition is at 4% you get a 0% S.C....If it was at 6%you get a 10% rating. they round the numbers at .5.0%   below the 5 % would go toward the 0% above 5% they round it off at the 10%   & all the way to 100%

How they come up with the % like they do is any body's guess

They have a special calculator they use for VA Math.

you have  combined  50% rating  at 51%

now if you had the 50% rating before the 2 -10%ers  10%tinnitus and 10% for Jaw...your combined rating should be 70% combined.

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.

 

[VA Disability Claim Decision Rating Calculation]

4 minutes ago, Buck52 said:

They give a close estimate percentage to your condition  ...

if the condition is at 4% you get a 0% S.C....If it was at 6%you get a 10% rating. they round the numbers at .5.0%   below the 5 % would go toward the 0% above 5% they round it off at the 10%   & all the way to 100%

How they come up with the % like they do is any body's guess

They have a special calculator they use for VA Math.

you have  combined  50% rating  at 51%

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.

[VA Disability Claim Decision Rating Calculation]

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)

 

[VA Disability Claim Decision Rating Calculation]

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

[C&P Exam Report Rating Question]

2 minutes ago, megajunk said:

Any update?

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.