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Okay, So I Get A Denial In The Mail Today.


LarryJ

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  • HadIt.com Elder

....since they had the very paperwork necessary to make the award, in my C-file ALREADY!

I received the denial along with their "Statement of the Case".

My claim hinged on a report from the Oklahoma State Dept. of Rehab. and their consulting orthpedist.

This very report/statement was also used to award my previous claim on my ankle/foot. How do I know this for sure? Because it is specifically mentioned in my award letter for my ankle/foot.

So, I know they have it. Right?

So, my new claim also hinges on this very same report.

So, it's in my C-file. Right?

So, just to make sure, I even stated, in my denied claim THAT THEY HAD THIS REPORT, IT IS IN MY C-FILE AND THAT THAT PIECE OF PAPER IS ALL I AM GOING TO RELY UPON, AND THAT I'LL NOT BE SENDING ANYTHING ELSE, ETC.

So, in the Statement of the Case that they just sent to me, is mentioned FOURTEEN different items that they had, that they had relied upon to make my prior award.......every SINGLE ONE OF THE STATEMENTS, REPORTS, RATING DECISIONS, NOD'S, EVERY FREAKIN PIECE OF PAPER EXCEPT,

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  • HadIt.com Elder

you guessed it.......the ONLY report that was needed for them to make their decision.

It's like they intentionally (naw, really) left this item out........so my claim WOULD go to the BVA.

damn, damned, damnit, I sure be sick of all this......

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  • HadIt.com Elder

Larry J.

I am sure that those with the knowledge will tell you what to do.

I am so sorry. I know exactly what you mean.

If you must fill out that darn form-9. Why don't you do as I did.

I couldn't take crap any longer.

I sat down and typed a 11 page letter to the BVA for a Motion to Advance on the Board's docket and told them of all of the negligence that I had suffered by the errors of the Regional Office.

I spilled my guts out to them.

When I had proof read the paper and told my whole story and had it to perfection. I made several copies. I mailed one to the Regional Office to sent to the BVA with my file. I sent a copy to my Service Officer and I sent a Certified Copy to the BVA also.

I placed a waiver against the Regional Office touching or making any decisions pertaining to my claim.

My claim and this letter was sent to the BVA February 2006 and I received a notice of advancement on the boards docket within 3 weeks.

Decision to remand was April 9, 2006.

The BVA should be able to make a decision upon your claim within two months.

It is obvious to me and it will also be obvious to the BVA what is going on here.

You just came from the BVA and the AMC due to the negligence of the Regional Office.

This is what I did.

Always,

Josephine

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  • HadIt.com Elder

You're right, Betty, I did just get through going through the BVA and the AMC......heck, I still remember Ernest and the others there at the AMC.

It'll just feel like "old home week".......kinda like a pair of old, favorite, woolen socks....bad part about that is that they both have holes in 'em and they stink.

Deja vu all over again.

BTW, that is a purty quilt. I was gonna ask you if you "made it", but I know that you did.

What pattern is it?

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  • HadIt.com Elder

Hi Larry,

I am still dealing with those nuts! No wonder, I have so little sense now.

It took me 15 months for that dumb AMC to even know that I did advance on the docket.

What organization???

I have been warning others to fax that stupid advancement letter to the AMC, as they don't have any sense.

One rating specialist has finished with my claim - finally-

It has now been scanned to someone else and now a week later it has been scanned to someone else.

They are either typing me up a bunch of lies or who knows.

Larry, you know that I don't have enough sense to make that antique quilt, but it sure is pretty.

Occassionlly, I will go back into ebay and sell antiques and it was sold several months ago.

I need to put me on another picture.

I had to buy a new computer and now I don't know how to do much with it.

I will have to see if I can drag a picture of something for my site.

I guess, with that sensitive 6 file that I have poor Ernest couldn't open my file.

We both have the luck of the Irish. You think ????????????

Always,

Josephine

Betty

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  • HadIt.com Elder

LarryJ,

I am not sure what the specifics of your claims are. Thus, I will just make some general comments.

On your ankle/foot claim the IMO from OK rehab was in the file and I agree this proves the VA has the report somewhere in the file. There could be several problems. First, they did not look for it because it was to much work or they did not connect the dots between your statement and the report.. Also, they could have presumed that because it was in the file at the time of the previous award that had there been significant evidence in the report about your current/secondary/additional or what ever condition you asked them to adjudicate, such condition would have or should have been addressed at the time of the previous adjudication.

Most importantly, they could have determined that although the OK rehab. report was "part" of the previous awarded conditions reasoning, the OK rehab. report did not meet VA standards for the current condition you requested to have adjudicated. I refer to the OK report as being part of the process because you indicated that there were 14 different items in the file. The VA usually does not make an award based solely on an IMO. I think it was Josephine who met a DRO who claimed to never use IMO reports. Thus, they schedule C&P's etc. The VA exams protect the VA from the possibility of fraud on the IMO reports. The veteran could have a friend go to the IMO and the tests and results are based fraud. Labor law injury disputes also have built in protections against fraud. Thus, the VA will only use the IMO if it is also supported by a VA C&P.

The reason I say that a determination that the OK report did not meet VA standards is most important is because if this happened they would not cite it in the decision and they sometimes do not explain why the did not use the report OK report in the SOC for the new issue. The reason they do not explain why they did not use the report is because this will tip you off as to how to strengthen your claim. When confronted at a later date as to why the report was not used they will just say that the report did not meet VA standards. Anybody with training in defending insurance claims is taught not to write a defense in such an manner as to give the plaintiff insight into ways to strengthen the claim. I was trained as an insurance investigator to write reports for insurance companies. Thus, I know how the business operates. The VA is supposed to be more helpful than an insurance company. Unfortunately, I learned with my 8.5 year battle with the VA that there are folks at the VA who are experts in defenses and practice their trade at the VA.

With this in mind the issues in your claim still need to be addressed. I would not allow the claim to go to the BVA without a review of the evidence and finding ways to strengthen the evidence. Is there negative evidence in the file that was cited in the denial? Or, was it denied solely on a lack of evidence? Things to consider when writing an appeal are; did the failure of the VA to use the report cause a factual error in the decision? Or, will it be question of the weight given to the report? In either event evidence needs to be developed. In my claim I re-submitted a report they ignored because it resulted in a factual error in the decision. The RO claimed the condition did not exist. The ignored report did in-fact prove the condition existed. The RO re-opened a closed claim based on my re-submitting a report that was already in the file. They will address a factual error. Also, I think there is a process by which you can ask for a re-consideration from the RO. Ask your SO about getting a reconsideration. Berta gives some real good advice on how to get a strong IMO. You need to cover all the bases on the IMO. Credentials, the logic used to support the determination, etc. Get your SO to work with you. If you have strong evidence or can get it, do not give up.

My thoughts,

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  • HadIt.com Elder

You will not know unless you go to the VARO and review the "C" File. I bet it is in the file they just have it out of pocket.

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