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Foxhound6
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Posts posted by Foxhound6
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Just an update via the BBE I received. The cervical spine was deferred due to the following:
Clarification of conflicting medical evidence and new medical opinion.
Unsure as to what was conflicting, same info they've had really. Maybe the examiner mentioned something.
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7 hours ago, brokensoldier244th said:
They wouldn't have been doing the exam in general if they hadn't cleared at least the basic VA hurdles. More likely it was a staffing issue with the vendor, or the first vendor didnt do part of the DBQ and sent it in, and we kicked it back to them saying ???! fix it. In that case it can get re-routed to someone else. We have no idea the how or why they schedule their people as they do, as they don't fall under us. It could have simply been a crunch for time, or any number of other things. The vendors schedule as they will and we get the updates as to who they have scheduled to see who almost the same as you do, though we can log into their portals and look if we want to check while you might still be waiting for a phone call or letter.
This makes sense. I would hope its not a negative thing per se. Hoping since back was approved this one will too but just done by another doc.
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3 hours ago, kanewnut said:
The best I can remember the same individual did my lumbar and cervical at the same time.
That has been my experience too. The examiner that did my back also examined my neck. So I can only assume he maybe did not have the "proper VA credentials" to complete the specific DBQ. Or it involves more than originally thought and needed someone slightly more qualified to complete it? The original QTC examiner was a general MD. The new exam (or review since I wont be attending) is being done by an Internal Medicine MD. So some more education there that covers a broad spectrum. I actually used an internist to complete an IMO for me as it related to this claim so I can see that happening.
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52 minutes ago, Buck52 said:
To make you feel some what better if your exam is with QTC I was ok with them the examiners ask questions and were actually pleasant.
This is what I call the luck of the draw...all C&P examiners are not the same.
Hope you get a good one this time. And a favorable exam report.
Me too. The examiner I had for the back portion (he did my neck measurements too) was good. Pretty laid back too. Younger. Oddly though I think this next examiner is strictly going off of my exam done by previous examiner. He opined favorably. Just dont know how this will work out.
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3 hours ago, brokensoldier244th said:
Different sets of peripheral nerves, different sets of potential lower lumbar and cervical. That’s why there are two different dbqs.
I understood that. I was just perplexed as to why my examiner couldn't do the neck dbq. As said tho, It may be due to those different sets of things you mentioned
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19 minutes ago, El Train said:
Was your first exam by QTC or VA? Probably just need some clarification on the first exam. Be glad it's QTC. I've had all my claims approved by QTC. Even one's were the VA tried to script their DBQ to deny. I'll give VA props, they deferred it for a second opinion due to the VA C&P's oddball exam and overwhelming evidence in my medical file.
I have a feeling it may be what you are describing. Really, the VA examiner from 2019 is what screwed them. He failed to opine on secondary condition and that is what gave me the new exam a couple weeks ago. The exam that I had a few weeks ago was also QTC. They approved my back and radiculopathy and they were on the same claim. So, I assume either they needed more clarification on something or wanted someone with more medical knowledge to do it? It is odd that the examiner would have completed my back portion but had to defer my neck? I understand that internal medicine doctors are usually consulted when an injury affect multiple systems/body parts as they have more of that knowledge to link one issue to another. It could be that they feel my neck issue is more related to my back issue and not my SC knee issue, if that makes sense.
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Got a letter regarding my deferred neck claim from recent exam. QTC has to send my file to another MD to review and fill out the DBQ based on last exam I had (which was only a few weeks ago). I assume this could be due to the person who did my exam was not qualified to complete that specific DBQ? This is a new one for me lol
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14 minutes ago, broncovet said:
Correction: Did you FILE A CLAIM within a year of exit from service?
The regulations states:
I did not. I complained of back pain then but didnt file anything as i didnt know jack about it. That and the person seeing me back then, whoever it was, told me “its probably because of your knee issue”. And they left it at that
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4 minutes ago, broncovet said:
After you get the envelope, you can decide whether or not to appeal the effective date.
As always, your effective date should be "the later of" your date of claim, or facts found (the date the doc said you became disabled).
There are a number of exceptions to this general rule.
Take each part seperately. When did you file? Did you file previously but were denied? Or did you file previously and the VA blew you off and never adjtucated your claim?
When did your doc say you were disabled? Did you have a c and p exam? Did you magically "become disabled" at the doc's exam? The doc should have given an onset date as to when your syptoms started, and they often dont do that, so the VA assumes you got disabled at the c and p exam. That is almost never right. You may need an IMO/IME to review your file an opine a date "when your sypmptoms first appeared".
Some common exceptions to the effective date general rule, above:
1. Did you exit the service within a year? You should get the effective date the day after exit from service. - This is what I feel is meant. In the letter the reviewer stated "The evidence shows that a qualifying event, injury, or disease had its onset during your service. Multiple lay statements were submitted on OCT 16 2019 as evidence supporting your claim" It goes on to list the diagnoses of the items. Further down it states "The claimed disability is a chronic disease which may be presumptively linked to your military service. Arthritis is a presumptive condition under 38 CFR 3.309a. Your claimed issue became manifest to a degree of 10 percent or more following service, based on VA examination dated DEC 9 2019. You have sufficient service to meet the minimum requirements for presumptive service connection."
2. Did you submit new evidence? (38 cfr 3.156)?
3. Was it a claim for increase?
4. Did this involve a presumptive condition, such as Nehmer?
5. Did the laws change?
All of the above can affect your effective date.
Read more, here: https://www.law.cornell.edu/uscode/text/38/5110
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So, I had an HLR initiated awhile back. There was a DTA and I was sent to new exam on 3/23. The rating came in today on Ebenefits (I know, ickk, waiting on BBE). EED shows 2018 on my two awards for DDD in lumbar and radiculopathy on left side. Problem is, the HLR decision received explaining the DTA error that gave me the new exam stated that the condition would be presumptive to 2011. I feel like maybe the person rating did not quite see that part of the claim and went with my original intent to file date? I notified my attorney of it, maybe they can see it in system. However, with COVID they have been having a lot of......employee turnover at my attorney firm, so it has been more difficult to reach them timely than normal. Just trying to see if I misread something or not. Below is a link to the timeline I have been keeping of this claim as well as the HLR DTA error decision from Nov 2020. Thanks
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19 hours ago, brokensoldier244th said:
Glad to hear it, James!
We're not perfect, and I see a lot of cases every day with quicksand problems, I.e. some minor thing that wasn't done that gradually snowballs as it is corrected or missed by others and a day here or a day there too the overall time of the claim.
That said, this last week was spent working on lists and lists of claims from a spreadsheet of identified claims that had had their suspense (due by) extended 5 times with no other action in the last several months. With covid it's been common- vets aren't available due to sickness or local virus conditions, examiners and locations-same, archives closed, can't get str it personnel records or stressors-stuff like that.
So the date gets kicked out about 10 days if it had a pending scheduled appt after I call the vendor and ask what's up, or 30 days if the claim has been sent for exam but is still waiting for intake or if it's waiting for federal records. I found several that I could move forward to rating because uploaded or requested evidence had caught up with the claim while waiting that reduced the number of appts needed or eliminated the need completely sure too other evidence.
I dont like that they've been sitting, either, but we've all been working these in between our live cases to try to whittle them down none the less, and being computerized helped with this immensely.
We/I try to do 'better' every day. We've got 27000 other people though, sometimes they aren't all winners but as a whole Va has tried too improve over there last 18 years (for me, 17 as a personal filer, and 1 as a worker).
I appreciate you explaining how the system works where you can. Having some experience with data management systems, I know all too well how they can function and in times like these, can function in a way that just bottlenecks things..making it hard to get things done. Even if others don't feel the same, most of us can relate in some way. Honestly, having dealt with state employees trying to figure out our UI issue out here, I MUCH rather have fellow vets and those who have been thru the claims process handling these things rather than some random civie.
In the words (borrowed words?) of the infamous Joe Dirt: Keep on keepin' on!
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On 12/27/2019 at 8:31 AM, Buck52 said:
yes well maybe a hadit member that as a condition such as yours can chime in here and let you know what all is needed? , some conditions can cause a secondary condition and the claim would be a secondary claim to that S.C. Condition
Either way you need to talk to your Dr about this ask him these questions because your going to need this information coming from a Qualified Dr
our opinions do not count. but a member that has a related condition such as yours maybe able to help you. keep watching your post.
I am currently going thru something similar. However, my first exam (was with the VA itself) wasnt great and they had a DTA and gave me a new exam which I just finished the other day. My issues are close to yours but with my thoracic junction which I have been told is very strange place to have it as they usually see it in places like where yours is. With that it has made it difficult to see it on radiographical images. So my rheumatologist, for now, is calling it Non-radiographical axial spondyloarthritis. I have partial fusions, DDD, along with levoscoliosis and other crap going on there.
I originally claimed as an incident I had during active duty, but the examiner that I saw with the VA shot that down. However, he did not opine as to whether or not it could have been secondary to my left knee SC issues over the long term. Myself and my attorney pointed this out (I provided an IMO from a board certified internal medicine MD) and they gave a new exam. This one felt like it went well and I even had far better xray results to present and symptoms. I just have to hope the examiner opines in my favor as my issues being secondary to my left knee issue. I may have to have an EMG done as well as the examiner at recent exam noticed I had absent reflex in both my knees and ankles.
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On 3/3/2021 at 12:06 PM, flynsolo2 said:
@Foxhound6Yea, just looked on my file, they have me scheduled for a C&P exam for the 31st......but, I am going to do what someone else suggested and bring all my files, in chronological order, with all my tests and results and doctor's notes/assessments so that the examiner has everything available at this appointment. I am not really sure what a C&P exam for GERD would "look like" , since it's not like my other C&P exams, where they look for range of motion/pain. Guess we will see.......so now I wait until the 31st....and for the letter to come in the mail.
I would do the same. However, in my experience, it can be hit or miss whether the examiner will look or even accept them. I have had one examiner thank me for bringing certain documents because they had not seen them in the CFile and I have had an examiner outright tell me he didn't want it. But I believe it is ALWAYS a good idea to bring all pertinent information to the exam, you never know how it might help.
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8 hours ago, flynsolo2 said:
@pacmanx1 I hope not. That is irritating and the exam for GERD would be another endoscopy, which isn't an easy C&P exam. Also, the original decision was based off of an endoscopy that I had done. I received the endoscopy and they rated my GERD two weeks after the results. I am hoping I would NOT have to go for another endoscopy. Plus, my medical file and all the issues related to GERD are all documented all the way back to 2006, including an endoscopy even then showing the severity even then! I wish they would just review all my medical files (with the VA doctor's notes as well stating severity) that I sent them when I originally appealed this decision. I have been fighting this rating decision since they first assigned it 2 years ago. This is so frustrating.........
I hate to say it but I agree with Pac. Looks like they identified a DTA in your claim.via that HLR and it was sent back St Petersburg RO for processing. That RO put in request for another GERD C&P. I am in same boat with my HLR for exam on lower thoracic. Been waiting months for QTC to get me an exam. Hang in there.
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2 hours ago, GBArmy said:
Not saying it'll work but you could try an IRIS request and ask for the response in writing. If that doesn't work, call the WhiteHouse hot line.
I would also second this. But I also have used iris twice now for an issue with no response (been few months now). Going senator route before WH hotline. See if that goes anywhere
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Berta also posted this yesterday. Thanks for the reminder though. I need to look at it more.
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Thanks Berta! This might end up changing my entire case! LOL Not sure in what way, but reading some so far, it seems to be a little more favorable depending. I feel there is going to be A LOT of freshly denied claims when it comes to these updated regs. It also does seem tho, that if you put in for your claim PRIOR to the change (before Feb 7) then they will rate you either in the old system or new and award whatever is more favorable to the veteran? That seems nice.
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1 hour ago, shrekthetank1 said:
I think they do have a set time of 30 days to get it sent. That is what I was told at one of my C&P exams.
I think @shrekthetank1is correct here. I was also told this during a VES exam not long ago. Although, my exam was uploaded after about 3 weeks. I am currently being given the run around with QTC. Been waiting 3 months for an exam of the thoracic spine as well. Keep getting put on a list for events that pop up randomly and have to wait for a call to be scheduled but the call never comes. Unfortunately I have not found an email address (plus I would fear the email would be to the wrong individual and would just end up being forwarded from person to person as that is how these companies seem to operate). However, the number I call QTC with is: 1-800-682-9701.
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It sounds like you just had a bias examiner. They are definitely out there. Fortunately, those exams are usually simpler to disprove via a well written and medically backed IMO such as the one you may be seeking from Dr Bash. You could also include a personal statement about that exam experience and the hostility of the examiner along with it as supplemental if it is denied.
An HLR would likely just net you a new exam and delay your claim more and then you are rolling the dice again with nabbing a poor examiner. So that's probably not the best route.
Honestly it sounds like you are taking the correct steps to keep your claim alive and on the road to getting approved. Patience is something all of us struggle with during these claims, me included. I HATE waiting but we know it's part of the game. My anxiety gets the best of me some days but we know what our mission is. Keep at it brother. Stay the course. Give Dr Bash some time to reply, if you haven't heard anything just send a nicely written followup asking if they received your files and if they have any questions to contact you. The wait is one of the hardest parts of these claims.
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As everyone has stated above, it doesn't look bad. It appears more an "administrative" error. At some point, the VA just failed to attempt to get a portion or your records, whether that is STR's, private docs or even LAY STATEMENTS.
Side note: even under other circumstances, lack of STR's for an issues is never a deal breaker. Could it be a little more challenging? Yes. However, it is not a deal breaker. My own experience, so far, can attest to that. My current claim appears to be stating that my issues will be presumptive and that is directly due to lay/buddy statements.
If you could find a way to upload a redacted copy of letter or just the evidence list as Berta mentioned, it may help in wrapping our heads around the Nexus/In-service event conundrum?
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On 12/20/2020 at 6:08 PM, SPO said:
So I got a response to my email. He added a not that said his comments were not meant to minimize my symptoms. But it looks like he didn’t actually remove the comments I asked about
If it were me I might email back and explain that I understood that but, if possible, you would like to have that "corrected on the record/his notes". The statement, while not meaning to minimize the issue, that language may be taken out of context by the VA and possibly lead to a reduction of benefits.
The fact that you got a response in email means you now have "counter weight" evidence. I feel that his response itself could serve helpful in any review as it at least provides some sort of contextual sense of what he meant. It isn't the best but it is something. I would likely send another email similar to what I stated above.
Hang in there
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Berta, great post! Id like to offer a couple buddy statements I used in my claims as an example. The redacted info I will explain in the post itself here.
The first is from a former NCO I had. It is a good example of a buddy statement you described in your post. The bottom redacted info lists all as you said. It identifies the individual by name, address, phone number, and email. It also describes the who, what, where, how and why of the event in the narrative.
The second is from my father. So, it is differently formatted than the VA form 4138. However, we included the "I CERTIFY THAT the statements on this form are true and correct to the best of my knowledge and belief" in it and had it notarized. It also provides the same information needed. Identifies the individual by name, address, phone number and email. I hope this is ok to post. Thanks for all you do!
SSG Signed VA_Redacted.pdf Dad Signed Statement_Redacted.pdf
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On 12/20/2020 at 1:54 PM, OldJoe said:
Forgive me if my replies seem a bit off. My anxiety has really had an uptick recently and it has affected me mentally and physically. This information helps ,me get myself back under control and helps me plan my next move.
I fully understand that, no worries. Takes me awhile a lot of the times to send off a solid, coherent post on here LOL. Anxiety sucks..
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I am not the most versed here by any means but I have found the info from this source to be pretty solid. Have a look at these, maybe they can help? I'll provide link too.
http://www.militarydisabilitymadeeasy.org/kneeandleg.html#limo
Awarded rating for DDD and Radiculopathy but EED seems off
in VA Disability Claims Research
Posted · Edited by Foxhound6
I ran into this under 38 CFR 3.307 - This is what I believe the HLR reviewer was referring to. I have lay statements, CP exam (from 2019 with one of the Va examiners) and continuity that can show the 10% or higher rating back within the one year window. Have a look, perhaps I am interpreting this wrong?
(c) Prohibition of certain presumptions. No presumptions may be invoked on the basis of advancement of the disease when first definitely diagnosed for the purpose of showing its existence to a degree of 10 percent within the applicable period. This will not be interpreted as requiring that the disease be diagnosed in the presumptive period, but only that there be then shown by acceptable medical or lay evidence characteristic manifestations of the disease to the required degree, followed without unreasonable time lapse by definite diagnosis. Symptomatology shown in the prescribed period may have no particular significance when first observed, but in the light of subsequent developments it may gain considerable significance. Cases in which a chronic condition is shown to exist within a short time following the applicable presumptive period, but without evidence of manifestations within the period, should be developed to determine whether there was symptomatology which in retrospect may be identified and evaluated as manifestation of the chronic disease to the required 10-percent degree.