George Patton

I have been with the VBA maybe 1-2-3-4 years and am still learning / discovering new things. However, there is this push to get raters out of formalized training too soon in order to make VBA appear to be diligently working on disability and compensation claims. Some of them are going to make awful and “costly” mistakes and, in some cases, unforgivable mistakes. They will miss an item or two, which for some veterans can mean receiving proper health care or not, paying rent or living in a shelter, purchasing food or obtaining it in other ways, etc. In other instances, the raters will want to grant an issue, however those damn time constraints may prevent them. I see this new generation made up of young and old, energetic people coming into the ranks of VBA with fresh ideas, open minds, and an understanding of justice as fairness. However, the organization does not embrace these employees, mentor them, or offer much guidance. They ask many questions, yet receive few honest and legitimate answers. Soon they will grow tired of trying to do the right thing, delaying a claim until it is fully developed, and examining every single medical record in that four volume GWOT claim and actually calling the veteran whether than defer his or her claim by instructing a VSR to DTA a specific issue—further delaying the claims process. There numbers are small, and there influence minuscule. To most, they go unnoticed, or when perceived are brushed away. “They having put in enough time.” Why are you asking me ‘all’ these questions”? “Sorry, I don’t have time right now.” “If the vet does not mention it, do not go looking for it.” “Yes, he is an in-country Vietnam vet, however he only claimed PTSD, he did not tell us he had been diagnosed with diabetes, and so pretend you did not come across it in his VA medical records.” There are people within VBA that have been rating claims for 30 years. They can review a new claim, a reopened claim, or a claim for increase and discover the smallest things that were missed in a DTA letter, prior decision, or SMR’s. “She was diagnosed with diabetes before …, so we can actually grant s/c one year retroactively from the date of claim.” Some of these geniuses can quote the rating guide forward and backward and recite VBA fast letters word for word. It is unfortunately that these people are not made available to the new employees coming into the agency. There are people out there that show up to grant, grant, grant—and in some instances stay beyond their eight hours. And, as you all know, there are those employees who show up to collect their check and exit, and maybe reluctantly rate a few cases, while ignoring any evidence that may hold up the claim. “We cannot always prepare the VBA for our new employees, but we can prepare our new workers for the VBA.” Someone, long ago, said something similar to this. George

This letter means nothing to me. If you do not have a confirmed stressor, you will not be service connected. In most cases, the physician is repeating what the patient has said. Has the examiner reviewed your SMR's? What medals do you have? If no medals, does your SMRS show you were exposed to a traumatic event while in the service? What is severe anxiety and in what way does the mental illness limit you socially and occupationally? Are you employed, if so, do you get along with your co=workers? Do you have any friends that you spend time with? Are there any s/i or h/i delusions or hallucinations? How many panic attacks per week / month? The physician can give as many opinions as he or she wants, but we are going to examine the entire c-folder to determine if there was a stressor. It is always best to have a physician examine all the evidence and then write a letter. George

I don't know, sorry.

When the c-folder is in RTR status, it can either be with the VSR, on the RVSR digit table, or at the RVSR's station. If the c-file is at the rater's station, it depends on other claims in which he must complete. Generally, the agency does not want the claim at the station longer than 30 days; however, it can always be handed to another rater to rate and the 30 days begin anew. Sometimes a manager may stop the rater and assigned the individual to another crisis assignment: EP 190, EP 600, or GWOT claims. Additionally, it depends on how the rater perceives the case. If it is relatively easy, more likely it will be done fairly soon. Thus, assuming the rater has performed a final RD, the c-folder goes to Post for promulgation. Once there, it can be entered immediately or lay around for one or two months. George

ED is noncompensable--0% unless the penis is deformed. In any event, you are service connected for ED and SMC K is an automatic. I do not know how a rater could have missed that, unless he/she is not apt at entering SMC codes in RBA 2000 and some are not.

VA Ousts Managers for Claims Deception A friend sent me an e-mail concerning the above article and my reply follows: No, I had not seen that report, but I was aware of the situation in New York. Management apprised its workers of the New York problem several weeks ago and have indicated that they do not want it to happen at this office. They gave amnesty to employees that had mail at their stations too long. Regional Offices (RO's) receive a tremendous amount of mail and it is supposed to be processed within 7 days. However, rarely are RO's ethically able to meet that standard. RO's are understaffed and employees are under great pressure to earn their assigned credits / points. It is not difficult for me to imagine that when mail begins to pile up that some of it is "lost," "misplaced," or destroyed. No employee wants to be placed on a performance improvement plan--PIP, because if he/she continues to under performed that individual can be fired, reassigned, demoted, etc. The New York RO is probably similar to many RO's around the country; that is, you have managers setting arbitrary performance standards and goals without relevant stakeholders' input. I am always amazed when I attend a meeting and management wants something done, without first consulting pertinent actors to determine if such a thing is possible. It does not surprise me that there were managers instructing employees to mislabel documents. There are various methods that the VA employs to suggest that it is meeting certain bench marks. For example, if a particular RO had 10, 000 claims pending and it wanted to present an image that it was doing its best to reduce the caseload, it could work on the available EP 190 (widows seeking compensation) and postpone EP 110 (veterans' initial claim). EP 190 can be done relatively fast, while some EP 110 may take hours or days to complete. There is a huge problem when an employee cannot go to his/her coach (manager) and explain that a certain claim required extra effort and his/her assigned quota should be waived for that day. My coach has indicated on numerous occasions that he/she does not want to hear it. The VA, or at least my RO, treats claims as if they are all similar--when in fact, they are not. Some veterans have military medical records that occupy 3-4 volumes and require a significant amount of time to review. However, with the time constraints in place, maybe one of those volumes wil be properly reviewed and the others--well, ignored or glanced over. The New York situation is so upsetting because, to a certain degree, it confirms what some veterans have maintained for quite some time: namely, that they have submitted claims and the VA incidentally or purposely lost it. The date of receipt is so important because it establishes the effective date of an award if compensation is granted. For instance, one RO receives a claim February 2008; however, it does not date stamp it until May 2008. In that typical VA scenario the veteran will lose a considerable amount of compensation. I know of a veteran that submitted his/her claim in three different ways: USPS mail, hand carried, and faxed. He/she did not perform all three actions in a single day, but several weeks apart. As far as I know, only one method worked, which mean, in this true example, there was a 33% probability that his/her claim would be received. I spoke with some workers and almost everyone may be inclined to ignore evidence--mail. If a rater has just completed a decision and someone in Triage brings him/her mail while the decision letter is done, that evidence may reverse his/her entire decision or worse the person may have to defer the claim in order to request a medical opinion. Raters at my office receive no credit for deferrals. Thus, that mail may be placed in the rear of the c-folder, which I have come across. Additionally, some of the responsibility must also be placed with the citizenry. Yes, we "support" our troops with bumper stickers, yellow ribbons, and enjoy our annual day off from work. However, I am not sure many of them will support the troops by agreeing to a slightly higher tax increase or even allow veterans to be relieved, to some degree-- of taxes, healthcare and education expenses. The VA is under funded and understaffed and many of us know this already. There are numerous problems with the VA: 1) not diagnosing PTSD; 2) shredding mail; 3) ignoring issues claimed by a veteran; 4) inadequate healthcare for veterans. I have read many reports where a veteran should have received compensation for a military related disability; however, the physician thought otherwise. What's striking is the lack of interest and concern our government, VSO's, and even some veterans have shown concerning veteran issues. At the very minimum, the Director of New York RO should have been demoted. In any event, the VA reacts extremely slow. Agent Orange took 20 years to recognize (but saved billions of dollars) and I am quit sure there are other disabilities related to exposure. Gulf War Syndrome took 15 years to acknowledge. Haas (blue water veterans, mainly sailors) have already been told that they were not exposed to Agent Orange as their ship were not in-country in Vietnam. I wonder how some of those barrels of herbicides made it to VN: Cargo planes, yes; ships, more likely than not. George Patton

I have been seeing a new physchiatrist for about several months. On my first visit I explained that I would need a letter from him to submit to the VA in support of my claim. He seemed very reluctant; I later learned that he also rotates at the VA medical center. Well, very recently, I asked him if he reviewed my medical records and if he was willing to provide a medical opinion on my behalf. In three to four months he has not reviewed them and informed me that he does not know if that is his proper role, so he will need to check with his boss for an answer. He asked what exactly I wanted him to do. I responded, review my private medical records and service treatment records and provide a medical opinion as to whether or not my disability is related to service. Moreover, I said he did not have to say it is certain--that he could state, it is my medical opinion, after reviewing private records and military records, that his mental disability is at least as likely as not related to servioce. Nevertheless, the physician seemed uncomfortable. Thus, I will obtain an IMO and seek another psychiatrist. I was not trying to lead / guide him in anyway. I told him to examine the evidence and offer a medical opinion based on them. For whatever reason he does not appear willing to do it, although I do have some ideas.

If you have been diagnosed with PTSD, depression, and anxiety--you will only be compensated for one mental disability. The most dominant disability will be be evaluated. For instance, in the above scenario, if PTSD is the major illness--the diagnosis will be PTSD to include depression and anxiety, or PTSD with symptoms of depression and anxiety.

If you have submitted sufficient medical evidence showing that your depression is aggravated by tinnitus, I suspect that you could receive compensation for it. However, I am reluctant to say that the VA would award an evaluation greater than 10 percent, although a 30 percent evaluation may be possible.

Claims are returned for a variety of reasons: failure to properly DTA an issue, ambigous medical opinion, missing documents, etc. I am not sure if you are able to receive complete and accurate information concerning the status of your claim from the 800 number. It really depends on what system the VA emloyee is viewing and whether the notes found there are clear.

A pit sniper in 3 main. I was a MM in 2 main machinery room when I was in the service. I served aboard another air craft carrier. Last to leave and first to return. Sometimes, 6 and 6 whle underway. Anyway, anyone familiar with machinery rooms know that the noise one is continously exposed to can cause serious damage. With what you have described, I would think you have an at least as likely than not chance of receiving sc.

If there is sufficient evidence of record, medical records that show treatment / diagnosis during service, and qualified IMO provides a nexus that the current disability is related to service, then a VA exam may not be warranted. However, the C&P is strictly structured to comform with the rating schedule. If the person providing the opinion is qualified and provides enough information--the claim can be evaluated without a VA exam. However, this is rare. Therefore, even when a case can be completed based on an IMO, raters are so accustomed to requesting exams that they may not know it.

The VA will have no problem with you marking out any information that you wish to keep private. That is totally your choice. However, I would reframe from sending treatment records that are not pertinent to your claim. For the most part, the VA only need to see a confirmed diagnosis with an official letter head, a date, and the signature of the clinician. I see veterans submitting numerous records--all of which are not relevant to their claim. Rarely, are private treatment records thorough to allow the VA to make a decision based on them.

I am also a grown man and I also cried during my mental examination. I really did not wamt to talk about certain issues, but the physician persisted. Anyway, before I walked into his office--I could tell that he had made up his mind about me. Certain questions that are mandatory during a mental exam were never asked during the session. I soon discovered that this physician is a chronic denial. I am in the process of gathering adequate information to be reconsidered for my mental disability.

I am sorry to learn of your father's passing. When my dad past away while I was in the military, it really had a significant impact on me and that will always be the case. It is good that you have a physician that is understanding and attempts to alleviate your stress and pain. As you indicated, if your cancer will continue for the forseeable future then the VA should not reduce your total evaluation. However, that must be indicated in your medical records by a medical examiner able to make such determinations. I am not sure if you are taking radiation, chemo, or other antineoplastic medication; If you are the VA should not propose to reduce your total evaluation. Now, if you visit the VAMC for a RFE and the physician note that the cancer is in remission, your total evaluation will be reduced and any residuals you have will be evaluated. I have seen a person's cancer, at the time of the GU exam, in remission. However, during the due process period (proposal to reduce), the evaluator discovered that he had started treatment for cancer of the prostate and he was not reduced.

If you have appled for PTSD and the VA is unable to locate your records, you will have a difficult time proving your claim--it also depends on the type of PTSD you are claiming. If you have private records that show a diagnosis or treatment of PTSD during service that will help. You will need buddy statements, military medical personnel, etc.--people who were aware of your condition in service.

Yes, you should have received a 50 percent evaluation based upon what I read on the examination. Certain symptoms warrant an automatic percentage. However, the medical doctor mentioned that further formulation was not possible due to prescription "narcotics" tranquilizers, and alcohol. (Although in some cases abuse of alcohol and medications may not be seen as willful misconduct if the veteran is attempting to self-medicate.) The physician concluded by noting you suffer from "mild" to "moderate" impairment in vocational function and significant impairment in social function, and gave a GAF score of 50-55. Also, the doctor mentioned you have not seen your psychiatrist since 1/2007--a specialist in mental disorders. Currently, you are employed full-time and have no difficulties at this point. The doctor noted you brought records to the assessment that were not included in the c-file--I hope those records were seen by the evaluator. In most instances, reports from a spouse carries significant weight, as the patient is sometime unable/unwilling to discuss his/her problem and it is the spouse that fully observes the behavior. With the medication you are taking (buspar, ativan) it seems that you have an anxiety disorder as diagnosed by the physician and the anxiety/panic attacks you experience. The rater should have reconciled the adjustment disorder by stating: adjustment disorder to now include anxiety disorder; or your diagnosis has changed from adjustment disorder to anxiety disorder to more accurately reflect the disability picture. In any event, it is noted in VA regulations that two evaluators may come up with different percentages when reviewing evidence--this is especially true with mental examinations. Thus, if you were to request to be re-evaluated because you believe a higher evaluation is warranted, it is unlikely that the previous 30 percent evaluation will be increased. However, again, I saw a 50 percent evaluation.

I hope I did not come across as being rude, as that was not my intention. I would just hate to give you advice that somehow adversely affects your claim. However, I am here to answer general questions.

I will reframe from giving advice. However, I assume you know that an NOD, assuming a DRO does not rule in your favor, can take years if it leads to a formal appeal. It is importnat that you read your decision letter and try to understand why the VA thought you warranted a 30 percent evaluation. You say that you are not working, but is that due to just to your service connected disabilities or are non-service connected disabilities a factor as well. If you believe you were rated too low you can always ask to be reconsidered, but there must be new evidence. If indeed you were rated low, I am sure that in time your outpatient treatment records would show that you warrant a higher evaluation--submit those records and you will receive a higher evaluation. If you do not have one already, you may want to consider being represented by a veterans service organization; they can be helpful, at times.

It will take a great deal of time and effort to correct what is wrong with the VA. I mean the way the system is currently set up, evaluators (RVSRS) have little incentive to examine the entire claims folder--and believe me, in most instances, they should. They are concerned with making a certain number of credits per day in order to keep their managers happy. A veteran submitted a claim several decades ago and it was denied because he/she has not been diagnosed with a disability. The person is merely claiming a symptom; however, that symptom was also present in the military medical records. In 2007, he/she submits another claim and this time notes a specific disability. However, he/she submits no medical evidence of a "current" disability. The person responsible for reviewing the claims folder before it is given to the RVSR notes that there is no evidence that the claimed disability actually exists. Thus, usually, the RVSR take the reviewer's word and denies the claim. However, in this instance, the RVSR actually examines the claims folder--that is, he/she reviews previous rating decisions and other correspondence. The RVSR discovers that the denial several decades ago (the veteran's claimed symptom) of the symptom may be related to the current disability being claimned--in fact, it is. Additionally, review of the veteran's electronic medical records (VA) show their is a current disability. Thus, a medical exam is warranted to determine if their is a link between the current diagnosed disabiity and the symptom claimed several decades ago, which is also listed in the military medical records. This RVSR has spent a great deal of time on this case. However, the case must be deferred for an examination, which mean the evaluator will receive no credits--they are only awarded for completed decisions. The point here is 95% of the time that veteran would have had his/her claim denied: the person responsible for reviewing the claims folder noted there were no evidence of a "current" disability. In most cases, the evaluator see that note from the reviewer and proceeds from there; however, in this case, the evaluator actually examined the entire claims folder and discovered that the current disability being claimed may be related to symptom claimed long ago. You would think that the evaluator would get a pat on the back for doing a good job--not exactly. He/she did not earrn any credit for that case. Nevertheless, the manager can decide to wave the credit if he/she thinks it is warranted. In this case, the manager did not. You would think that the ultimate goal is to assist the veteran--give him/her the compensation earned. In the VA, it is complete rating decisions as soon as possible. There is no incentive for an evaluator to thoroughly examine the claims folder; there is not a enough time. In any event, the person risks getting behind in production. Sadly, this is true

With certain exceptions, the VBA is not authorized to throw away any mail or documents submitted by a veteran or on his/her behalf. Every piece of mail should be received in the mailroom and inputed into VBA's tracking system. However, some mailrooms are so understaffed that materials get lost or misfiled, and when they are located, say, about four weeks later--in most cases, they are correctly placed in the claims folder. Nevertheless, for whatever reason, some people do place mail in the shredder bins. Just an observation, but it may be done because a claim has been evaluated (completed) and ready to be promulgated, and the additional evidence may make it necessary to re-evaluate the case--thus, not getting the high number of pending claims down. In other instances, they may be afraid of a supervisor discovering that mail was misfiled and get into trouble. In any event, it is my opinion that mail should be handled carefullyand appropriately. Duplicate materials are supposed to be sent back to the veteran. According to VBA, you may throw away envelopes, claims folder tracking forms, and returned VA forms/documents, and PIES request forms--this is used to request military records and verify periods of service. I would caution that envelopes and returned VA forms/documents have value. For instance, a veteran may resubmit an official VA form because the person wants to point out to the powers that be that the RO made a mistake--perhaps it failed to include an IU questionnaire went it sent the VCAA. An envelope may be important because it verifies that the information came from a physican, for example. In a personal case I know of, a veteran saw a physican several years ago. He completed a questionnaire and other documents while waiting to be seen. Several years later, he requests those medical records from that physician and receives them via mail. However, he only saw this medical doctor once and the medical records consists of that questionnaire he completed and a list of symptoms listed by the physican. Thus, no where on those records is there a name of the physician or medical facility. However, that information is on the envelope in which the medical records arrived, which gives weight that they are accurate. All RO's are forbidden from shredding any documents until further notice is received from central office. The shredding bins have been taken away for now. Each employee must now place disposal material at a basket at his/her station and each night his/her coach must search it and identify documents that should not be there. Also, RO's are receiving additional training on personal identifiable information (PII). That is, materials that can identify a veteran (name, ssn, address, etc) must be be properly disposed. I am a veteran and have met non-veterans that believe some veterans are simply gaming the system. On the other hand, I have also come across other veterans responsible for evaluating disabilities that are biased toward the claimant. It really depends upon the nature of the employee. One non-veteran says, "when warranted, my job is to grant, grant, grant--regardless of the amount of revenue it costs uncle Sam.