brokensoldier244th

Yes I was clarifying for posterity and other readers. I've worked with vets in real life that think just having a signed DBQ is enough. Its not. In any case its rare to come across a claim where the doctor provided enough rationale just in the records to not require a DBQ in order to go to rating. It happens, but its rare.

Here's the thing, you are not completely correct- the doctor has to say why, with medical rationale, WHY they feel the condition is worsened, or is SC. They can't just say "At least as likely as not....." and call it good. Most denials are due to doctors -private, contracted or VA, not following directions for whatever reason. Raters are not doctors. If its not on the form they can't render an opinion on it. If its not backed up with more than the doctors opinion, it can't be rated either.

They will still be used internally, and are still valid as of now from private docs UNLESS its one of a few types. TBI/Sexual Trauma, PTSD exams can't be done by private docs anyway, so that's not changing. Many private docs do the DBQ and don't include rationale if doing an exam for SC, so the DBQ is invalid already because they didnt submit the 'why' behind it at the same time. If you are using a DBQ for an increase then the rationale for it is already established and you are just using the DBQ to document current treatment/level of disability. So, short answer yes, still valid, until such time as an M21 change is made. OIG didnt' make them invalid, but approx 50% of the ones analyzed in their study from several RO's across the country were not done correctly, completely, or provided with rationale at the same time, so they were not valid for rating. That is why so many vets get referred for exams they thought they already did with their private doctors. Its not a plot, its because the doctors don't always fill out the form correctly or provide valid medical reasoning WITH the DBQ. Just having them fill it out and sign it is not enough.

This is good advice. The exams are done by the Examiner based on how they were entered into the original request from VA VSR. IF the VSR did not include all contentions. for example, then the examiner has no idea that it is needed- they work off the request as submitted. A missing DBQ or contention can be corrected, but it takes longer overall if its not done right the first time. The contentions used to create the exam request come from whatever you submit to VA. It doesn't have to be medical terminology, but you have to be specific enough so that the VSR knows what to assign you. If you have having PTSD issues, for example, say that, don't just say that you are having depression, etc- that's a separate type of exam. PTSD for example is routed to an expedite group that pretty much only works with PTSD and Sexual Trauma. If you are claiming an increase for PTSD but say 'depression, etc' it won't get routed correctly. If you suspect something that you have that is not SC, then say that, because otherwise the person on the other end won't know to include it for an exam for it.

That I can't tell you. Im sorry. I don't know. Claims are assigned to people electronically to work, so they DO get audited and those that are sitting in suspense somewhere get picked up and re-assigned. but I don't know much more than that.

-Correction- Thank you Buck. -I asked someone I know- M21 hasnt been updated yet to include the stuff from the OIG reaport. OIG found about 50% error/improper use of DBQ or improper exams when done by private for PTSD. OIG recommends VA as a whole then not use/allow private C/P exams for those.

Not to my knowledge. Nothing has changed other than a push for Telehealth due to not having physical access to a lot of facilities. "The following health care providers can perform initial examinations for PTSD. a board-certified or board "eligible" psychiatrist; a licensed doctorate-level psychologist; a doctorate-level mental health provider under the close supervision of a board-certified or board eligible psychiatrist or licensed doctorate-level psychologist a psychiatry resident under close supervision of a board certified or board eligible psychiatrist or licensed doctorate-level psychologist; or a clinical or counseling psychologist completing a one-year internship or residency (for purposes of a doctorate-level degree) under close supervision of a board-certified or board eligible psychiatrist or licensed doctorate-level psychologist."

https://vetsbenefits.net/higher-level-review-was-closed-t185547.html

I have all of them saved on my computer and as a google folder.

If you are waiting on an employer form there is nothing else to work on your case until either the form comes back or VA has tried twice to get the form from the employer- they request it twice, after that if they don't get it they send you a letter that says its on you to try to get the former employer to fill it out, or you can waive it and then your file can proceed.

They are all still working, just virtually through a VPN from home. Some things take longer this way, though there is still access to all the systems, its just slower because not everyone lives where there is good highspeed access.

The scan date is not the receipt date, the receipt date (based on postmark) is the one that is used for incoming forms. The scan date can be days or more after receipt depending on how busy the RO or Intake center is. How do you know your appeal is closed? The suspense date in the system holds things like requests for benefits, supplementals, and appeals from further action by anyone until A. the date is passed by at least 1 day, or B. the required form or next action is completed. If there is a case waiting for an action or document it isn't assigned or workable by anyone- unless you waive it by saying you have no more evidence to submit. If your appeal is closed it would usually mean that form 9 was not received within 60 days of the SOC, or within 30 days after an SSOC. After than the appeal can be certified and sent on for hearing due to the assumption that no more evidence is forthcoming.

Because not every medical term under the sun is in the schedule of ratings or the m21. The schedule breaks it down by body system and part for ratings. There is no diagnostic code for plantar fasciitis, for example, so it’s usually rated under flat feet diagnostic code 5276. That’s why some of the wording is changed. Va can only rate based on what’s in the ratings schedule. “When a disability is encountered that is not listed in the rating schedule it is permissible to rate under a closely related disease or injury in which the functions affected, the anatomical location and the symptomatology are closely analogous to the condition actually suffered from.-38 CFR 4.20“

It’s a shot but if you already filed you’ll either have to appeal to keep the same effective date going forward or file again for the new contention but have the later date unless they have evidence that the date of onset is earlier.

What in service evidence did you have? Buddy statements about excessive snoring and or stopping breathing? Admin Counseling’s for sleeping in formation/in class/ during guard duty? Are you within a year of discharge? If you’d gone secondary You could potentially tie it to meds, Or even if you were diagnosed pre service you could file for it based on a non service connected being aggravated by a service connected disability. Usually osa causes depression, not the other way around, unless you take heavy sedatives for your depression, then sometimes it can be secondary.