Question For The Elders

[divine]

Hello everyone,

I have a question for anyone with some insight. I received a copy of my Claims folder from the VA and discovered something that I had completely forgotten and blacked out of my mind. I discovered that I initially submitted a compensation claim back in 12/1999. The issue is that four months after submitting my claim my mother passed away from breast cancer and I relocated to another state to try to get a grasp of myself emotionally. While in the other state I was never seen or even enrolled at the VA there however there are letters in my file regarding missing C & P appointments that I had no knowledge of. My question is do I have a leg to stand on if my service medical records are thoroughly documented showing my issues that I was awarded my first compensation rate of 40% back in 2003(this one I remembered)? Is it possible to filing a claim or fight with the VA regarding the initial claim from 1999 even though I missed the C & P, and if so how do I proceed with doing so. The very same issues that I filed the claim for in 1999 are the exact same things that I filed for on my 2003 claim. The other question is even if I did not attend the C&P exam shouldn't the VA still have made a decision either approving or denying the claim?

Another question I have is regarding my increase request...I am a VA employee and was sent to another facility for the C&P yet my C-File was not sent even though it was requested. At the time of my exam the only thing present was one sheet of paper with my general info on and nothing else. Isn't the VA required to have the person conducting the C&P to review the entire claims folder prior to an exam for an increase? If so, is there a regulation or direction I can follow up on this issue? The other question I have is, is the VA required to disclose to the veteran new findings during a C&P exam other than stating because of complaints of pain the appeal for an increase has been approved? Because the VA found some issues with my knee that was supposedly not there before but I was not made aware of this until I received my C-File.

One more thing, this has to be the absolute best site for discovering valuable information when it comes to dealing with the VA in general, not just filing claims.

[Ron II]

I'm not sure if this helps, but I submitted a claim in 1999 and although I didn't miss any C&P exams, I did not follow through with some items I should have. Consequently, my claim was denied in 2000.

I submitted additional material (new) in Aug 06 for the same claim and it was eventually approved.

However, the effective date of my grant was not 1999, but Aug 06. I'm confident this was a result of me not appealing my first claim within 12 months of denial.

Good luck...

Edited September 24, 2007 by Manitou Sprgs

[Berta]

The 2003 decision could have been appealed within the first year after you received it.

If you feel that you fit into a higher rating category now,(with your current medical records and the Schedule of Ratings) you can re-open the claim for a higher rating.

If awarded a higher rating, the earliest effective date will be the date you re-open the claim.

"Isn't the VA required to have the person conducting the C&P to review the entire claims folder prior to an exam for an increase? If so, is there a regulation or direction I can follow up on this issue? The other question I have is, is the VA required to disclose to the veteran new findings during a C&P exam other than stating because of complaints of pain the appeal for an increase has been approved? Because the VA found some issues with my knee that was supposedly not there before but I was not made aware of this until I received my C-File."

A vet can always request a copy of the actual C & P exam report.

"Because the VA found some issues with my knee that was supposedly not there before but I was not made aware of this until I received my C-File."

You could re-open with this information if it warrants a higher rating.

[sixthscents]

Further VA employees get a special folder and (in my experience) not so special treatment....

For some reason it again has been MY experience that the VA really goes over employee claims, with an extra review in there....

Am I right on this Vike?

As far as appealing back to '99 well I just dont see how you can. I am very sympathetic with your situation at the time, but the VA cant really be, even if they want to. As stated if you think the condition has worsened, then I think you should reopen the claim based upon the new evidence etc., but I just dont see an appeal for a backdate going thru, The VA can make a decision without a C&P, but once they determine that one is necessary, it is on the veteran to attend it.... or they will simply decide the case on the facts at hand. Since they were asking for a C&P, they were basically saying they did not have enough information to rate the issue. So, the 99 claim is dead... I just dont see a way to get it off the ground since you did not attend the C&P exams, or respond to their coimmunications. Did you by chance try to check in at the VARO where you were at when this was going down?

The review of the C&P is case dependent. If the issue at hand had a long history and the doctor was doing something besides evaluating the "current objective symptoms of the illness" such as taking measurements with a goinometer for flexion or ability to bend then the C&P file would be necessary - if not though if the doctor was just evaluating the current level of injury and this could be done by objective measurement devices.... then they dont need the file.

So again it depends on what the exam was for. I know of no rule that states the C&P doctor MUST have your file in hand... in fact they do have all you electronic data unless they were civilian fee based... so again it depends. You can make an argument here depending upon the illness or injury and the testing performed... but its too late, you should have done so within 12 months of the award. In this case I think anyway....

Carlie, Berta... check me here am I right (I have been out of the loop sooooo long)

Good to see you all by the way.

I dont mean to discourage you friend. By all means, research the VACA cases etc that apply to your condition, ask these same questions... research M21-1... perhaps you will find something I dont know (cause there is LOTS I dont know)... I just dont see much hope in arguing the postdated claims... only in reopening them and asking for increse based on new evidence.... and the new evidence can be kinda thin, if you think the old evidence was not completely looked at....

[sixthscents]

OH and you can also just request ALL your VA med records.... but you know this... anyway for others if you want you VA medical records (not your C-File thats different) you can obtain a copy of them at any VA medical center (not the clinics normally) by going to the offive of Release of Information... they can normally print them out on the spot... and you can do your in person authentication for MyHealtheVet at the same time. Just remembere to print out the online form from the website.

If they cant print them right then, they will mail themn to you.. and in my experience they are really good at actually doing this. There is an up front link on how to go about obtaining your C-File, so I wont go into that.

[divine]

Further VA employees get a special folder and (in my experience) not so special treatment....

For some reason it again has been MY experience that the VA really goes over employee claims, with an extra review in there....

Am I right on this Vike?

As far as appealing back to '99 well I just dont see how you can. I am very sympathetic with your situation at the time, but the VA cant really be, even if they want to. As stated if you think the condition has worsened, then I think you should reopen the claim based upon the new evidence etc., but I just dont see an appeal for a backdate going thru, The VA can make a decision without a C&P, but once they determine that one is necessary, it is on the veteran to attend it.... or they will simply decide the case on the facts at hand. Since they were asking for a C&P, they were basically saying they did not have enough information to rate the issue. So, the 99 claim is dead... I just dont see a way to get it off the ground since you did not attend the C&P exams, or respond to their coimmunications. Did you by chance try to check in at the VARO where you were at when this was going down?

The review of the C&P is case dependent. If the issue at hand had a long history and the doctor was doing something besides evaluating the "current objective symptoms of the illness" such as taking measurements with a goinometer for flexion or ability to bend then the C&P file would be necessary - if not though if the doctor was just evaluating the current level of injury and this could be done by objective measurement devices.... then they dont need the file.

So again it depends on what the exam was for. I know of no rule that states the C&P doctor MUST have your file in hand... in fact they do have all you electronic data unless they were civilian fee based... so again it depends. You can make an argument here depending upon the illness or injury and the testing performed... but its too late, you should have done so within 12 months of the award. In this case I think anyway....

Carlie, Berta... check me here am I right (I have been out of the loop sooooo long)

Good to see you all by the way.

I dont mean to discourage you friend. By all means, research the VACA cases etc that apply to your condition, ask these same questions... research M21-1... perhaps you will find something I dont know (cause there is LOTS I dont know)... I just dont see much hope in arguing the postdated claims... only in reopening them and asking for increse based on new evidence.... and the new evidence can be kinda thin, if you think the old evidence was not completely looked at....

Thanks for the information...I have submitted an appeal for my previous rating decision because my condition has gotten worse since my filing in 09/2003. I have gone from being extremely active, working out and running 3 times a week to having to depend on a cane to get around because of the pain and radiation down my legs and into my hands. I submitted an appeal in March of 2006 and recently received my award letter....which I still do not agree with. I sent in my NOD regarding the issues and I am wondering what are the next steps I should take. All together there are 24 separate diagnosis or issues concerning my entire spine yet I am only rated for Cervical Strain with DDD and DDD of the Lumbo Spine with Thoracic Strain. My VA Nurse Practioner has been extremely helpful and so has the Ortho Clinic. The biggest issue I am having is the fact that I had X-rays done 2/2006 with various findings, MRI done in 04/2006 with significant findings, yet on the C & P X-rays the same Radiologist found nothing, so how do I address this issue. I have contacted my outside insurance for an IMO, MRI, etc. As far as the 1999 claim, I completely forgot about it and was not seen at the VA for some time...and the correspondence never made it to me because for about 2 years after my mother's death, I never stayed in one city or state for more than 2 to 3 months. I now have all of my medical records...to include my C-File because I retrieve copies of the notes after every appointment.

Monica

[Pete53]

Good Luck on your claim Monica. In my opinion I would rather deal with someone who served at the VA than some of the people who just show up for a pay check.

Its probably not fair but I think Six is right that they VARO will make you jump a few more hoops but eventually as they always tell us the claim will be worked and you will get the retro.