Justaskpat

I was all set to use the 21-0958 for for my NOD when I happened to notice the decision I am disagreeing with said to use 21-0995. I looked up 21-0995 and it said it's the "new and improved" faster response form. If there is such a thing as a "faster response" form, I'd like to use it. The 20-0995 makes it sound as if it can be used for both CUE and NOD. I need to submit multiple of both and I don't want to screw it up. Have any of you use this form? thanks

This is regarding TMJ. I was broadsided in an auto accident in 1991. Shortly thereafter TMJ began with the main point of joint dislocation being on my left which is the side of my head that hit the door. At retirement, TMJ was one of the disabilities I was to have a C&P appointment for. I had all my other appointments, but never received any notice about the TMJ appointment. When I received my decision, TMJ was denied due to my not showing up to the appointment. As evidence, the VA cited a "Notice of failure to Report for C&P Appointment" . I contacted the VA at the time to advise I'd never received either the appointment letter or the Notice, but the VA stated the matter was closed. Recently I went to my local VA Rep for copies of something else and I mentioned the TMJ matter and asked for copies of the appointment letter and Notice of failure to Report. He looked everywhere and could not find either document, nor could he find mention of the appointment being set or the dentist it had been set with. I believe now that neither document ever existed because they were somehow not generated or sent out. My military dental records show me being evaluated for TMJ and months later a nite guard being made. My question is which is the best way to approach it? Should I do a CUE, that my records were missed or ignored due to the extenuating circumstance of the appointment letter and Notice never being generated and the VA refusing to reschedule. OR Should I do a "Reopen with New Evidence" stating (the new evidence is) there is no record of either document in the VA files and that my dental records show TMJ. Either way, I'm shooting for the TMJ award to be retro to retirement. thanks

Thank you!

Hi Berta. I did a NOD on 2019 and a CUE on 2011 and used a version of the cover letter you provided. I'm uploading all 3 to my original post. Still need to double check them and possibly shrink down the font so the cover letter and CUE are only 1 page long each. Also did not do the evidence list thinking it was unnecessary here, but definitely will upload it to the VA. thanks for all your help. if you have any suggestions, please fire away! PS we are now having severe rain storms/tornado watches etc in our area.

Called LHI. They stated once a C&P is finalized they cannot change it. They suggested I call the VA to report the discrepancies in the C&P. They said the VA could then either decide to accept my word or order a new C&P or ??. The person at Corporate LHI did say it was very unusual that the doctor signing as the C&P Examiner was not the doctor who did my C&P. I am currently on hold with the VA - 20 minutes. I have gone ahead and worked on a NOD, just in case VA has no solution. As soon as the NOD is complete I will upload a copy to my original post. I was wondering if I should do the NOD for the recent decision and due a CUE for the 2011 decision and send them both to the VA at the same time. I've tried to obtain a verification from Family Services that I attended a 30 day counseling program in 1992, but so far no luck. Awaiting one more call back on that before I complete the CUE. I would like to include a written verification of my attendance as more evidence the Anxiety/depression was chronic. There is no mention of the 30 day counseling in my SMR. I wish I knew if records of MH counseling were maintained and where/who maintains them. I've searched, but have not found anything on it.

thanks for everything Berta. I will contact LHI next week. I will be working on compiling everything for the CUEs etc and working on them. Will read about NODs as well. Have a lot to learn! Hope your storms let up soon!!

Berta I just got the C&P files for the 2010 and 2019 psych C&P's. I uploaded 2010. I underlined things I thought might pertain to "severe" diag. Please see the doctor's "opinion" near the last 2 pages. I sounds to me as if he is stating military life contributed to the Anxiety and if that is the case, shouldn't it have be SC from the beginning? Possibly they did not read his entire notes or chose to pick and choose? on the 2019 C&P, I was disturbed that the doctor who signed as the examiner is not the doctor who did my exam. Also the box for "suicidal ideation" is not checked and I very definitely told her I had suicidal thoughts. I had had a suicide screening at the VA in January that showed results "revealed suicidal ideation over the last 2 weeks, which indicates a POSITIVE primary screen for Risk of Suicide.". I would like to think this is just an error that LHI did not check the box. I don't think they will talk to me directly about this. I think my rating would be increased from the 50% they gave me if LHI had completed the form properly. What should I do about the person signing not being the person who did my exam? The exam doctor was a fully certified and licensed psychologist. Thankful I had written her information down.

Berta, everything you've said, all I can say is wow and thanks! I'm reading everything over, trying to absorb it all. I have another issue with the most recent award that I somehow need to add to the CUE. they gave me 50% rating for Anxiety but it should have been 70%. they stated they did not give 70% because I did not consider suicide. In my psy C&P I did tell the Psy doc I considered suicide. I'm trying to get her notes now to confirm she wrote my statement into her notes. If she did include it in her notes, I need to add a copy of her notes to the CUE for the most recent award as well and somehow bring this up in the CUE. if she did not write it into her notes, is it basically her word against mine? Should I bring it up and say the psy doc made an error in not including my full statement? Here's another issue: with regard to the 2011 denial, that psy C&P doc's statement contradicted itself in that at first he said I had a single episode "Severe", then a sentence later he said I had a single episode "Moderate". First of all, we know he was wrong in stating it was a single episode and my SMR supports this, but for him to at first say "Severe", then change to "Moderate". It's been so long ago, but I would imagine I told him I considered suicide as well. His notes do not reflect it, but I'm wondering what the requirements would be for him to be able to use the word "Severe". If there was a way for me to bring this to light on the 2011 CUE, I would do it. Another thing: the VA did the exact same thing with IBS/Acid Reflux aka GERD. In 2011 they denied IBS/Acid Reflux, even though my SMR contains proof of chronic problem. In 2019 they awarded for GERD using the same records. The GERD C&P examiner said they should have awarded at retirement as well because my record is replete with backup showing treatment. So when the Anxiety CUEs get nailed down, maybe I could use the same template for the IBS/acid reflux GERD CUEs.

Berta thank you for the CUE template and the insight you provided. I will wait until you comment on the missed appointment to see if you make any changes, then I'm going to fill it out and get all the back up paperwork together and file it. I hope you are seeing my responses. I'm still a bit confused on how to reply to specific people.

on both the 2010 and 2019 decisions, the evidence stated SMR from 7-14-80 to 9-30-10. When I was redacting personal information, I redacted this information by accident, in error.

Thank you so much for taking the time to help me with this. The only appointment I that I missed was on July 7, 2010 for TMJ. I never received the notice for the appointment and advised VA of this, but as far as they were concerned, the issue was closed. I will do what you suggest and have my TMJ evaluated, then reapply with "new evidence" and see what they do. The appointment referred to on August 13, 2010, I think is just a blatant error. I had never noticed that date referenced before you mentioned it. I've read over this decision so many times, it's hard to believe I didn't see it. I believe it is an error, that they intended to refer to the missed TMJ appointment on July 7, 2010 and got it mixed up with someone else's missed appointment date or (??). I attended all other C&P appointments.

I've uploaded my decision letters as attachments to my initial question.

I'm uploading the 2010 and 2019 decision letters.

Thanks for the info.

Sorry for late response. I've been out of town. Thanks for all the input. I am trying to absorb everything everyone has said. It's a lot to process, but I'm thankful and I'm working on it.

PS Thank you for your time.

Completely understand not wanting to contact personally. the 2010 denial says "you told the examiner that your past symptoms were related to marital and other personal problems to include your imminent retirement. You denied any current symptoms. Yo denied combat experience. The examiner noted sad and anxious mood and affect. Your mental status examination was otherwise normal. The examiner provided the opinion that you suffered from the single psychiatric entity of major depressive disorder, single episode, severe, in sustained full remission directly secondard to your marital problems in 1998. The examiner noted these problems have currently resolved. The examiner provided the the diagnosis of major depressive disorder, single episode, moderate, without psychotic features, fully resolved." The 2018 SC award states 50% based on: difficulty in adapting to stressful circumstances, depressed mood, disturbances of motivation and mood, anxiety, difficulty in establishing and maintaining effective work and social relationships, chronic sleep impairment, occupational and social impairment with reduced reliability and productivity. and a higher evaluation of 70% is not warranted for major depressive disorder (aka anxiety) unless I had suicidal idealization, among several other things that were already named under the 50% requirements. I did tell the C&P psy examiner that I had suicidal thoughts. It is also in my medical record with the VA.

Thank you for your response Berta. Is there a way to send you this information confidentially? it includes some very personal information.

No, his license was reinstated in 1996 in the state of Virginia. His providership for CHAMPUS, Medicare & Medicaid is permanently revoked. My C&P was 2010.

I had a C&P exam for anxiety at retirement in 2010. it was denied SC. I did not appeal because I was basically overwhelmed by the whole process. I recently found out the psychiatrist who did my C&P had been convicted of 2 federal crimes (medicare improper billing and mail fraud), punishment = suspended medical license 1993-96 and 3yrs 6months active supervised probation. CHAMPUS, Medicare and Medicaid revoked his providership status in 1994 due to these federal convictions. medical licenses for MA, NY,CA surrendered due to these federal convictions. At some point after his Virginia medical license was reinstated in 1996, QTC hired this doctor as a C&P examiner. December 2018 I resubmitted for Anxiety with "new evidence" and was seen by VA C&P psych doc (LHI). This time they found the Anxiety was SC. The 2010 convict psychiatrist said, "single episode, severe", not SC. I'm going to do a CUE based on my medical record which shows treatment for anxiety for the last 12 years I was active. I'm wondering if I should also include the above information about the C&P doctor being a convicted felon. In my mind, C&P examiners are basically diagnosing medical problems, so how could he be allowed to diagnose a Federal employee for a C&P contractor when he is permanently prohibited from diagnosing or treating that Federal employee's family covered by CHAMPUS/TRICARE? I hope this makes sense. 19July2019 Addendum: I just obtained the C&P notes from both the 2010 and 2019 Psych C&P's. I uploaded 2010. There is an issue with the 2019: LHI did the exam, but the person signing as the psy doc who did my exam is not the doc who did the exam. Also, and this is the biggest problem, even though I told the doctor I contemplated suicide, the box next to "suicidal idealization" is not checked. I'm not sure how to get this rectified. I don't think I can contact LHI directly. 2010 VA Disability Rating Decision.pdf 2019 VA Disability Rating Decision.pdf 2010 Psych C&P.pdf

I had a C&P exam for anxiety at retirement in 2010. it was denied SC. I recently found out the examiner was a psy doc who had been convicted of a 2 federal crimes (medicare improper billing and mail fraud), due to this conviction, Virginia medical license suspended from 1993-96, and served 1 year supervised probation for mail fraud and 3 year sentence of supervised probation for Medicare improper billing. CHAMPUS revoked his provider status in 1994 due to these federal convictions. medical licenses for MA, NY,CA surrendered due to these federal convictions. Then QTC hired this guy as a C&P examiner at some point after his medical license was reinstated in 1996. My question is this: can his C&P exam be invalidated due to the fact he is a convicted federal criminal? CHAMPUS and all other gov't medical agencies had permanently revoked his privileges . thanks Addendum: Just to make this picture a little more clear: December 2018 I resubmitted for Anxiety with "new evidence" consisting basically of being seen by VA psy doc for anxiety. This time they found the Anxiety to be SC. So, my second question is 2 part: If the VA initially found in 2010 Anxiety not SC, then in 2018 found Anxiety is SC, would a CUE then be appropriate to show the first C&P examiner was... what? An invalid examiner? wrong? I don't know which. I've looked at this so long my eyes are crossed. It just seems like something is not right with the way this was handled but I don't know how to identify and verbalize exactly what it is.