ruby

I need to chime in to a point, as I am not an expert on anything dealing with the VA. As far as reporting this in your inquiry to whomever, you need to start at the top and your questions should be made to what is the creditially process for the VA and who oversees that process, how or why could this happen, and if it happen to you how many other veterans has this happen too. Hippa laws, you need to look at them also. While non VA hospitals need to be in compliance with Jacho and AHCA, its not because its the right thing to do, it has to do with MONEY. If you lose JCAHO rating then you lose any government money--You can not take any pt where thier medical care is paid by the governement. PERIOD NO MONEY, your out of business. So they stay in compliance--with Jcaho they (health care facitities) pay them 200-500,000 to be inspected-do you really think Jacho would close a facility and lose out on that money. NO, they might put thier rating down (I beleive they do pass and fail now), but there not going to close them. They also notify a facility of when they are going to be inspected, they also offer a pre inspection for an additional sum so the facility knows where there deficits are. Thier really a joke. Research them and find out how many clients they have closed down by pulling thier accrediation. ACHA, on the other hand can and will lock the doors on a facility. A complaint to ACHA with any form of proof can cause SEVERE problems for a facility. Again this is civilan facility's. How much control does a government facility have over another govt facility? Do your complaint now start at the top, not locally. Make your concerns in your complaint rationale and clear. Key words are quality assurance, malpractice, credentially process,hippa violations, who oversees this process, if this happen to you, how many others has it happen to. How can you be assured this will not happen again. How can you ever trust the system again. If you don't counter thier reponses, they will give you the pat answers to stall. That's the whole purpose of the pat answers to stall a person, to the point they give up. With a congressional inquiry all they do is type a letter to the organization and say we recieved this, please investigate and respond. That's it, they are a go between, don't give them the opporunity to stall. If you can counter thier responses before they respond then you will be forcing them to investigate this in greater detail. Otherwise they send to the next person etc, they write we are investigating, your response is a letter we are investigating, they respond with some pat answer, you respond with why that's not correct, they repond with were investigating. Just like filing for SC, take the dots and connect them, before they can say, oops that dots missing sorry, denied. I think but am not sure the VA hates, congressional inquiry's and IG inquiry's. Heads usually role. If it were me and I said I did a CE on a date I didn't do it and got caught, I would say it was an error, that was the date I reviewed my notes and inadvertenly wrote the wrong date. Where does it say you must do a face to face for a psy exam? Her reaction to this was over the top, whatever, and thats why my I wrote this note that I feel it would be determential to her if she read it. Do I understand this correctly that you filed a complaint against this person in 2005?

How long have you been out of the service-not that really has anything to do with it. If you were never treated for any respiratory problems while in the service and you've been out for many years it would probably be harder to prove its service related. Some other disease's can cause asthma. Were you ever treated for any respiratory problems in the service? Such as pneumonia's or congestion that never went away despite treatment? You need to find out what triggers an attack? Is it related to season's, weather, activities or nothing. If you were never treated for any respiratory problems in the service, you would then goggle any disease process you many have to see if they can cause asthma secondary to that disease. If you search this site, you will find how to obtain SMR's-I don't know off the top of my head, others here will. I have asthma and it was triggered by another disease but its documented in my records that I developed the asthma in the service. I have a 30% rating, on 4 inhalers, nebulizer. These have kept me out of the hospital for the past year. I hope you get your asthma under control, nothing is worse than grasping for air and the feeling of impending doom during a severe attack.

LMAO, I have nothing to add. Glad to hear you got something. Hopefully the mailman will bring some more good news. Personally, anyone who files a claim with the VA should get 10% for anxiety. Anyone tried that yet? If not give it a try and let me now if it works.

no expert here, but I believe you have the right to view your records, in attendance with someone else if they feel that what they wrote is determental to your well being. you can sign over poa to your husband, which is another route. I believe your case is with a Judge and what you may do now will not effect that outcome. The Judge should be viewing your case on its merits and case laws. AHCA has more authority then JACHO in civilian world ( I don't know about the VA), JACHO is a joke in the health care industry. The facility pays to be inspected, do you think they will do anything to remove there accreditation. Nope, also they use to grade facility's if a facility got anything below a 90, run for the hills, cause it should have been closed. The yank thier accreditation at 80. I would do a congressional inquiry then follow that up with copies to everyone you can think of. Now in doing a congressional inquiry and to get anywhere with it, you will need to counter every possible answer they can come up with in your inquiry. My office when I was in the military use to handle Congrits, so when I did one I knew how they would respond, I said it before they could--they really had to think long and hard on mine. If you say the sky is blue and you know they will say the sky is pink, in your congrit say thier response will be the sky is pink, let me tell you why they are saying its pink. They have standard responses to stall, to force them to take action, eliminate the standard response before they get a chance to use them. While I can't remember the names of things in the VA system, I would send a copy of the congrit to the IG, don't go local, go to the top IG in DC, let the crap roll down hill. If you go local it will stay local, start at the top and let them answer to the top. Send a copy to quality medical assurance with the VA again let it roll down hill. I would file a congrit asking why any professional would in your opinion would fraudulent state they did an exam. What credentials does this Doctor have and what quality assurance does the VA use in hiring staff or contract personnel. Don't forget to say they have now blocked you from viewing your records when they became aware you took some action regarding this issue. Then say why you think they are blocking you from viewing your record, its a cover up. When ever you say anything negative preface with in my opinion or the best of my memory or knowledge--legally that covers you for almost anything you say or do. I would also add that if what is written would be that determential to your welling being then you don't understand why your not a 100% disabled. Now apply for independent care whatever its called for private psy. You have no faith in the system and could never trust the system again. Put that in the congrit also. Good Luck

Just recieved in the mail 3 additional release of information forms. Has anyone else encountered this before. I only signed one at the office and all my medical records are at the VA.

It has been suggested to me that I should apply for secondary condition of Reactive arthritis to the cyst which is 0%. It is already documented in my smr's and vamc's that I had this cyst and it was at times infected and they can't deny the cyst is service connected. ReA is caused from an infection thereby bypassing the 3.307 and trying to prove 10% rating within a year. Any raters willing to give opinion, I think this sounds good but I also think the HD needs to be rated. I guess I could just go to my primary and start getting it documented its infected. I would probably have another CE, which is fine with me.

Chantix is available through the VA, you have to have tried everything and or get the doc incharge of the program to request approval. In my case I have asthma, and had 3 er visits and on 4 meds to prevent severe attacks. It was approved for 3 months. I did well on it until I had a major stressor, and I went back to my crutch. I am going to ask for more in the near future but under too much stress now to waste it. Good luck to all

Be careful in what you do or say that is negative, they can go after you- make sure you have the evidence to support your statements. While you may feel that you are doing all the work, it could be that what your doing isn't necessary to win your claim. It could be lots of reason that are valid on her part.--Just being devils advocate. If you don't have documentation of what you said and you SLANDER thier names and caused them to lose potential clients then they could sue you and get all your back pay. You need to look at your state laws and see what is considered slander. Evidence is everytime you call them you log it in a book, with the time they took to respond or no response, when you get off the phone document your conversation--if you live in a one party state then you can record your phone calls without them knowing it. DO NOT RECORD UNLESS YOU ARE A ONE PARTY STATE-with that said, if you record and your in a 2 party state don't tell anyone. It is a felon in some states. You can get around this, but why go through that, just keep your mouth shut. In Federal courts recordings are legal even if its a 2 party state. In other words the fed gov considers all states as one party. Do everything in writing, always be polite, stick to the facts only. Always CMRR. The turn around time in most legal communities is 14 days( it might be 30 days, I forgot) then its considered not in a timely manner. I would send them a letter with your questions and document your attempts to reach them without success and that you ARE CONCERNED THEY MAY HAVE MISSED OR WILL MISS A DEADLINE. DO NOT FILE A COMPLAINT with anyone at this time--Many reasons for this---In order for a complaint to be really valid you need lots of documentation--based on your thread you don't have that at this time. You have to know what the laws are in your state to file a complaint that takes research on what the Boards require, they do make it difficult. You can look them up on the internet for your state- google - your state bars association. The rules and regs are there. Not trying to scare anyone but be warned, you can't say things in a public arena that can harm someones reputation or character. While it would be stupid for them to go after someone,they could. If you can back up what you say its not slander. The best way to get them is to start with putting all communication in writing. If they screw up and miss a deadline, sue them for malpractice, again this requires evidence which you will have with your written communications. While I am not an attorney, been there done that. I only know Florida laws, but some laws are similiar in every state.

I would put your questions to her in writing and then send them CMRR-certified mail return receipt for your records. Be professional and polite in your letter, state that you have attempted to contact her on dates with no response, that you find it necessary at this point to put your questions in writing and your concerns regarding her lack of communicating with you in a timely manner. Give her 14 days to respond. Basically your giving her the rope to breach her contract. Hope this helps

Thanks for the info. I think I am screwed. I am close to giving up. The stress is tearing my body up.The more stress I have the more infected cyst I get, been on antibiotics 2 months now. I feel like crap. On 11/22/78 (DC 9/22/78) I was seen at the VA for this, they documented it as cellulitis R upper leg they gave me PCN I develeoped an allergy to this and went back within the hour. On the ER exam they wrote Acute lymphadenitis ? infection From this point on I removed them myself with either hot heat/soaks and when needed I lanced them myself. However, I did locate someone I knew back then that is aware that I had them all the time and they wrote a letter to that effect. I was in school then 30 yrs ago I didn't work. No, I didn't go tell people about this. I was told years ago, but it wasn't documented anywhere that they will come back and there's nothing to do about them except, hot soaks or lancing if needed. In 1985 on a CE it is noted it is present at 2-3mm (very small). "She had a cyst on her right thigh in 1976. She was at Paris Island at the time. She had it lanced while she was on leave and it had quieted down, however, it had retuned recently and is still present." In 1986 the decision states A cyst of the right thigh, not more than 2-3 mm in diameter, recurred in 1984; the cyst is not currently infected or otherwise shown to be symptomatic. I guess I have to look more in my records for this in 1984 to see what it says. The dx of Hidradenitis is a chronic condition. It would have been ratable I think, but what do I know. Any other thoughts or recommendations.

Congratulations on getting this IME, it sounds like a winner. Best of Luck.

In my denial they are using this statute "as the medical evidence fails to show a dx of etc within the time period specified under 38 cfr 3.307" Where is the statute that says if you didn't miss dx it would have been within the year. 2nd question---if I ask for an increase based on the 0 sc for cyst(scar) and say this is now dx as HS how do you combat the 1 yr dx thing. It said something to the effect of 10% rating or dx in 1 yr. I have a 0 and dx 32 yrs later. If anyone understands what I am saying help me, I am not sure myself what I am asking.

thanks guys, but I looking for regs that I can use against them for not assisting me in my claim. If I wrote it up wrong and they have a duty to get it right, then I can use that against them should I need to take it to the BVA level or higher. I think I am screwed but I am going to try. They are primarily denying based on 3.307 where is says a dx within 1 year which I don't have, I was missed diagnosised for 32 years.

I have looked but can't find what I am looking for. Does duty to assist also mean if you apply for one thing and thats not the correct application for what your applying for, are the RO's or whom ever suppose to assist you in what your really applying for rather then a straight denial. If that makes sense. Ex: I applied for arthritis as secondary to my current arthritis (degenerative) which is kinda right--if I over use a nsc part of my body then I have to rest the nsc forcing me to use the sc parts which now makes these areas worse. They go hand in hand. Ex: the SI joints etc are documented as reactive, you can show that it started in the service. When you applied for the SI joints under secondary do they have to look at your request and notify you that its not correct and you need to file for a new sc or not. Is this in the M21-1?

Thanks Wings and Cowgirl. I really do appreciate how to word it, I am really confused on this issue. I have at least 2 types of arthritis degenerative and reactive, of course the reactive is the worse I think, how do you tell, pain and swelling happen with both. Again thank you

Here's where I am confused. How do I use the same evidence that I have a 0 SC for and now use that evidence for a new SC.

I am perplexed on how to write my NOD for the simply reason the arthritis I have is reactive arthritis caused by several bacteria's, we are fairly sure I was exposed to at least 2 if not all 3 of the causes. They denied my arthritis, right hand , knees, right foot and sacroilac. If I write it up for Reactive Arthritis secondary to Hidradenitis as a new SC then I can't do a NOD. However I can do a NOD and use the fact that the non service connected arthritis is effecting my SC arthritis. NSC secondary to SC. When I rest the NSC then I am over using the SC and making it worse. What do I do. Do I do both? The SC arthritis is degenerative in areas that I injuried if that helps. If I do a new SC how do I bypass the 0% for scars that I have for the cyst's that were misdiagnosed and they were Hidradenitis that I was treated for in the service. Someone guide me on doing the right thing. or give me the name of a good SO in the Tampa area. Thanks

Making sure I don't screw up, I have asked this question before, just making sure I am doing the right thing, perhaps someone can advise me on how to word it. Its confusing to me I am SC for -- 0% for New skin growth, benign, will be rated as scars. This a cyst. This is what my comp exam says from 86 (found in old chart)-She had a cyst on her right thigh in 1976. She was at Paris Island at the time. This was lanced while she was on leave and it had quieted down, however, it had returned recently and is still present.--(Denied increase at that time.) Now 32 yrs later they tell me this is hidrandenitis supportiva a disease process. I have been told to file for new SC am confused on how to do this. Can someone help me with the wording. More info if needed: 19 Dec 1975: c/o of swollen lymp node in inner aspect of L thing leg x yesterday-very painful- states she applied hot soaks to leg last PM with no relief: RX: hot soaks dinapen #40 Missing notes for the 20th I went back. Undated note - know it was in Dec 75 home from Macdill Hospital. Infected sub cysts groin -no treatment ordered (saw private md couple of days before) 25 Jan 76 Staph infection-was treated by civilian doctor for staph infection (subacecous cyst in groin area without success pt c/o discomfor and fatigue Nov 22 1978 (2 mos post DC) Fever 2-3 days large swollen area near perineum and top of L thigh A: cellulitis- no abscess yet, involving the leg P: RTC 1 wk, PCN, Nov 29 78- Pt returns for follow up of cellulitis- resolution of celluitis (this was a cyst not celluilits After this point I never saw a doc for this problem. I took care of it myself. During Comp Exam in 86 cyst was present 2-3mm very small. So how do I word this as a new SC Today's notes from Rhemuatology---patient with reactive arthritis secondary to hydradinitis suppurtiva-pt completely physically disabled. (AS/reactive arthritis). 3rd time he has documented this. Recently I was denied SC for arthritis, right hand, knees, right foot and sacroiliac Wording in denial is: We requested a medical opinion to determine if these claimed conditions were secondary to your service connected disability of arthritis, cervical spine. I am in the process of writing a NOD not sure how to handle it. I can't disagree with the denial since it is not connected to my DJD/traumatic arthritis. I really need help on how to approach this.

Just wondering if they know of hadit and they are blocking it, could they be watching the site also and any info given that can ID a person could that be harmful to them in some fashion?

not trying to steal this thread but anyone know of a good rep in the Tampa Bay area willing to travel if they are good. Thanks Ruby

Okay, I am confused, I thought they got a copy of my VA medical records to see if there is documentation to support or deny my claims. I know when I first filed in the 80's they went through all my VA medical records and SMR's they used those in thier decision. Thats why I said any and all from inception--- Am I not understanding whats in a C file is there more information on me in some other file that I need to request? I am in the process of writing a NOD--here is what they said they used to make a decision in my case. rating decision dated xxx 2007 and the evidence therein our letter, dated Jxxxxx, 2007, sent to you explaining VA's duty to assist and what information and evidence is needed to establish entitlement to benefits claimed your statement, dated xxxx 2007 with copies of your service treatment records and progress notes from xxxx VA strs from the period xxxxx, 1975 to xxxx 1978 va exam dated xxxx conducted through xxxx VA xxxx VAMC treatment records date Feb 10 through Nov 19. reason for decision: arthritis is given a 10% based on pain and since thier is a likelyhood of improvement this assigned value is not permanent. If they have a cure for arthritis I think I should know about it and my doctors so they can help others. Denied: Service connection for arthritis of other areas is denied since this condition neither occurred in nor was caused by service. as the medical evidence fails to show a diagnosis of arthritis is the other areas within the time period specified under 38 CFR 3.307 service connection on a presumptive basis must be denied. WE REQUESTED A MEDICAL OPINION TO DETERMINE IF THESE CLAIMED CONDITIONS WERE SECONDARY TO YOUR SERVICE CONNECTED DISABILITY OF ARTHRITIS, CERVICIAL SPINE. VA examiner opines your current other issues are not secondary to service connected, nor are these secondary to the other issues. Xrays of the feet dated March 2006 was normal and the hands on March 2006 were normal.---They may have been normal then (21 months ago) but they can't be now, I have 3 fingers and both thumbs that are sausage in appearance and I have to have injected to move my thumb or use my right hand, now I have to have the left injected since I am using it as my dominant to rest my right. I can't raise my arm above my shoulder due to the pain in my shoulder since I am using other parts of my right arm so I can rest my hand. Va exaimer states your major pains and disability is related to SI and lumbar spine. Service treatment records do not provide evidence of incurrence in service of these claimed conditions. I sent them the xray reports that says SI abnormal ie child birth or AS further determination needed-I was never informed of this in the service and I sent them copies of my VA records that show I C/O back and leg pain within the first year.. Consideration of reasonable doubt was given and there is no approximate balance of positive and negative evidence to give rise to substantial doubt which can be resolved in your favor. the doesn't apply beause of the preponderance of evidence is unfavorable. Based on the evidence of record, there is no compelling medical testimony or substantiated opinion that these claimed conditions were incurred in service or aggravated by a service connected condition, nor can service connection be established as presumptive conditions. Is this a normal denial? Then they denied the depression as secondary to the service connected disability of arthritis Then they also deny IU it says that one disability at 60 percent or two or more one of which is 40 persent with a combined of 70 which I don't have. What am I looking for in a C file? Whats the "lots of other stuff" Thanks

Is this too much in requesting my C file? 1. Any and All information in possession of this Organization that pertains to me. 2. Including but not limited to all C-files from inception to date. 3. Provide all notes, memorandams, emails and compture records and any and all documents in the VA's possession. 4. Provide any and all documents in the VA's possession that was used to make a determination on any and all claims made by me me= my name and ss# Thanks

I have used it twice, did well on it. Cut down to a couple of cigs a day, they just didn't taste good, I would lite it and take a couple of puffs and then put it out. Stress came back and I started again, my stress isn't going to go away for another year at least, between home, va, work-should say no work, ssd. I am one of the few that had severe nausea from it and I mean lay down and take something to sleep through the nausea. I have only met a couple of people that had the nausea and most did quit on it. I never lost the desire to stop smoking just they tasted really bad, I think I need to take wellbrutrin with it, there are some clinics that give both, mine doesn't. I did well on the wellburtrin also cut down to a couple of cigs a day, just didn't think about smoking. Its worth the money to try it, in Florida, Publix is the cheapest that I found at 126.00 a month.--I finally got it from the VA.

For those of you that are going to apply for SSD perhaps this might help you. I called and got an appointment to take in my paperwork. This was the wrong thing to do, why, when I go there they are required to put it all in the computer anyway. The hard copies (paper) that I did was wasted time and effort. I looked at the app on line and knew it would not show how my condition disables me, after a lot of research on the internet I chose to go in person for this reason. I filled the app out and I also did my own additional paperwork. I reviewed what I had researched on the internet and prepared all the paperwork they could ask for at the begininng so I could by pass the waiting period for approval or denial. When I went to the appt and the intake person submitted everything on line, I was upset that my matrices were not going to be submitted. This person was nice and said they could fax 15 additional pages to DDS board. I took the most important papers, the ones from my DOC saying I was P&T disabled along with a letter I had him sign for the VA saying the same thing and the matrices I made. I told him that I had already gotten a copy of my medical records and I had letters from family friends and employers along with a copy of my X-rays (computer disk) it was imperative that DDS recieved this material. This person was really nice, and said that they are required by law to send the signed consent to release records by mail and that he would put my disk in that file--Who knows if he will? He also said I could send DDS anything I wanted to and gave me his personal office number and DDS's number. Told me to call him in a couple of days to get the name of my claims rep at DDS. my appointment took 4 hours. Here is what I would recommend call and get an appointment in person. In the mean time do the app on line. So when you get to the appt all they need to do is review it to make sure its correct. While I don't know what will happen to my case, I do beleive the information I have researched on SSD that writing your own matrices on how your disabilities effect me will help--only you know your body and your symptoms. I wrote how I functioned prior to being disabled this included work, home and weekends and how my disablities now effect my work, home and weekend activities. I did this in great detail. I sit at the computer for 15-20 minutes at a time and then due to the pain in my wrist,back and , swelling my hands I must rest for 15-20 minutes. I said my co workers having been helping me at work to get my job done in detail giving examples. I had them sign statements to that effect. If I get approved I will post my matrices for other to see how to do them, that was the hardest part. I paid someone to give me examples. I also ask for legal advice. I will share what he said the normal process is at SSD, what I did was everything they could ask during this 5 month waiting period and gave it all to them(prepared it all) so all they had to do is make a decision. This was recommended by another source. I might have already pasted this here I don't remember. January 1, 2000 - Claimant files application by calling or writing January 10, 2000 - Social Security acknowledges receipt of application and schedules a phone or office interview. January 25, 2000 - Social Security intake clerk takes down information contained in formal Application for Benefits Form SSA-16-F6). I called got the appointment first it took 10 days --I eliminated the first 30 days by doing it my way. February 1 - March 30, 2000 - DAS claims processor sends form requests for medical records to all doctors and hospitals listed on Form SSA-16-F6. The claims processor may also send you a Disability Report (Form SSA-3368-BK) and a Work History Report (Form SSA-3369-BK). April 1 - 15, 2000 - DAS claims processor collects, organizes and reviews medical records, Disability Report and Work History Report. Adjudicator will also send your file to staff physician and/or staff psychologist for review. I have copies of my records and I did the Work History Report. Again saving time for the claims processor. Which just saved me 4 months of waiting time. In my case, I feel my medical records do not support my claim, all the doc writes is P&T and not specifically why I am P&T and this is what SSD wants, however, my X-rays clearly demonstrate that I am disabled by anyone that knows how to read X-rays. This is the reason the docs don't write anything specific regarding my ability to do anything. It will take me months for me to get the docs to write it the way SSD wants it written, my next appointment isn't until March. If I am denied in the next 30-60 days I will have an appointment and all the information I need for the doc to document in my records and an RFC (residual functional capacity form) so I can submit that for a request for reconsideration. [if evidence supports a favorable decision, claimant is notified and claim is sent for payment processing.] April 25, 2000 - Claims processor issues a form based denial notice. You have 60 days to appeal. June 1, 2000 - you file your appeal (Request for Reconsideration form SSA-561-U2 and Reconsideration Disability Report form SSA-3441-F6). June 10, 2000 - DAS acknowledges claim June 15, 2000 - DAS claims processor reviews Reconsideration Disability Report and sends out form requests for updated medical information and records from any new physicians. If mental health or physical consultative exams are called for, the claims processor will schedule appointment and send you an appointment notice letter. June 20, 2000 - DAS claims processor sends you Daily Living Questionnaire and will request statement from a person who knows you. August 1, 2000 - Claims processor organizes file, reviews it and takes it to an in-house physician/psychologist for review. [if evidence supports a favorable decision, claimant is notified and claim is sent for payment processing.] August 15, 2000 - Claims processor issues a form based reconsideration denial notice. You have 60 days to appeal. September 15, 2000 - you file Request for Hearing (form HA-501-U5) and Claimant's Statement when Request for Hearing is Filed and the Issue is Disability (form HA-4486). September 30, 2000 - Social Security office issues confirmation of receipt of hearing request. November 1, 2000 - your claims file is physically moved from the DAS to the Office of Hearings and Appeals (OHA). June 15, 2000 - OHA personnel unpack file and begin to organize it. August 1, 2001 - OHA finishes working up file and sends notice to you (and your attorney) that file is ready to be reviewed. September 1, 2001 - Case is assigned to a Judge and a hearing notice is issued for hearing on October 15, 2002. October 15, 2002 - case is called by Administrative Law Judge March 1, 2002 - Judge issues decision. Hope this helps other.