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17 Va Manuals?


Guest Morgan

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I talked to a VA adjudicator today and found out that my husband's claims are already with the rater. I told her I had sent all of the evidence and supporting documents needed for making a decision, including the CFRs and supporting statements from the M21-1 adjudication manual. She said the claim was certainly well prepared and neat, and that would be helpful in making a decision. Then she said they use 17 manuals to make the decision. I had no idea they use so many manuals. Do any of you know what the other manuals are and if they are online too?

Carrie

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I have always suspected that the VA uses their own private stuff to make their decisions and yes No is a decision.

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I have always suspected that the VA uses their own private stuff to make their decisions and yes No is a decision.

hahhahahaaa you crack me up, Pete. I hope the medicine you're taking for the flu isn't a bad mix with your regular meds .... thanks I needed the laugh B) and hope ya feel better soon ....

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They use M21-1 on line and also 38 CFR.

http://ecfr.gpoaccess.gov/cgi/t/text/text-.../38cfrv1_02.tpl

usually part 3 and Part 4-

I don't know where they got a figure of "17"

I couldn't even get them to use basic fundamental VA regs on my Sept decision.

Like-"Read the evidence"

The new DRO thought 'de novo' review meant "sameo sameo"-

but that all got changed-now I am in limbo- seems a medical report was done, they are waiting for the

files to be returned, and the files still sit here at the local VAMC- and no one knows why.

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Berta,

You are so funny! And you are so right. Just getting them to read it is half the battle.

It sure is nice to see how you keep your sense of humor, despite the tremendous frustration you have had with that bunch. I know your endurance is going to pay off soon, even if READING is a foreign thought to them.

I talked to the woman at the RO yesterday for about thirty minutes, hoping she would agree to READ my husband's file. She answered the 800# and I could tell she had a little more on the ball than most on the 800#, so I asked if she was a rater. She said she was an adjudicator. (I have this wonderful luck with getting to talk to raters and adjudicators somehow. I think it has to do with calling around noon when they cover the phones during lunch.)

She went down the hall and pulled my husband's file and flipped through it to my important points--while I was on the phone. I told her if she wanted help in meeting her quota for the day, she should just READ his file, because it's all laid out, line upon line, and all she would have to do is verify that the CFRs are right (I know they are) and READ his two IMOs for diagnosis and rationale. They hadn't even read the file, but the she said the rater was ordering exams. I told her the decision could easily be made with the evidence on file, and my husband is unable to go for a bunch of exams, which is evident from the fact he is now in the VA Home Based Primary Care program. She made notes and said she would take it to the rater right then. That's when she said my file was helpful because they had to use 17 manuals to decide a case when adequate evidence for a decision was not there. I was thinking, "WHAT! I'm having a hard enough time researching TWO!"

Berta, I know you hear this all the time, but you are so helpful to everyone, please let me know if I can ever help you with anything.

Carrie

Edited by Morgan
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Carrie- a Sec 1151 claim could hold it up since it is with the rater-

But I would not hesitate to file the 1151 claim as soon as you know something about their pending decision-

sure Dr. Bash has made this an inferred issue but still , a formal Sec 1151 would probably need to be filed by the veteran-

PS -I sent them a copy of the IMO Dr. Bash gave me (not the original)and made a few copies just in case- that is the kind of stuff they like to lose.

As to the Sec 1151 - did you husband have additional ratable disabilties due to their medical screw up-or did they somehow correct the errors?

It is the additional disabilties due to piss poor VA care that are ratable under Section 1151.

They combine them if they can with direct SC disabilties.

If Dr. Bash clearly stated what they were -that would be GREAT! If not-sounds like he wouldn't mind telling them. Maybe it is all in his opinion.

Boy- substandard care-

That is what VACO doctors told General Counsel in 1997 about my husband's care.

If I had known Dr. Bash a lot sooner I am sure Rod would still be alive.

Carrie- I wonder just how many vets get terrible care from the VA and they don't know it.

It took me months to decifer a stack of handwritten medical records in 1995-1996 and then when my daughter made me file the DMII claim in 2003 , I found what I was looking-misdiagnose of DMII- but it sure wasn't easy.

I am proud of you because you msut have put the claim together well for Dr. Bash.

I knew ,even before I called him, he would agree with my claim but like you said-it sure sounds good coming from a professional-(who can read)

Are you concerned about the Statute of Limits?

Two years from day you first knew of the malpractice-for an FTCA claim-

but Sec 1151 has no time limit-

If you need info on filing a FTCA claim (lump sum settlement compared to more comp but it is offset to the 1151 comp) I will be happy to post the info you need.

I filed both in 1994 for wrongful death. It was easier for me to succeed in the wrongful death FTCA claim than the Sec 1151 DIC claim.

I mean-I succeeded in both- but an FTCA claim goes to VA lawyers and like Dr. Bash- they also can READ!

Edited by Berta
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Yes, I was concerned about the statute of limitation, but only because I thought an earlier effective date might be lost if it is is not claimed within a year for the 1151. I knew the tort statute of limitation was longer than it will probably take for the pending decision, so I felt comfortable waiting for that.

I did work hard at getting the file ready for Dr. Bash, and he has no doubt helped me keep my husband alive. I have no doubt he could have done the same for your husband. He has written letters that were so helpful in my husband's care. He wrote to our senator about the substandard care. Well that helped more than I can say; I even got a personal letter from the senator after that. Then the senator contacted the VA.

During the process of reviewing his records, I did find out the he was diagnosed with sleep apnea and it was never treated. Outside studies were ordered by the VA and the results determined CPAP was needed. That was three years ago. I had tried to get copies from the VA but the VA said he was a "no show" for the two studies, which we both knew was untrue. I finally tracked the sleep lab down and got copies. I took it to the PCP here and he ordered the CPAP on three-years-old tests.

Also he had hyperparathyroidism diagnosed in 2002 and it hasn't been followed since then. He was put on meds for it, but the next visit, the doctor said the meds needed to be discontinued because it raised his blood calcium level. We didn't know that until I got his records recently. He has been on the medication that should have been discontinued since 2002. We're working through that now with his new PCP at home. The meds can't be stopped suddenly.

So as you can see, his care has been severely mishandled for a long time. I don't guess we will ever get to the bottom of it. Right now my goal is to get the SMC R rating so we can cover the expense of taking him outside the VA for care and to get every possible condition rated in case it might be the cause of death down the road.

Carrie

Edited by Morgan
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Carrie- I sure understand your concern to focus on the SMC R-

If you do consider the Sec 1151-

you could just make it a ball park claim-

"The veteran's entire set of VA medical records will reveal that he was misdiagnosed numerous times and has received additional disability due to these medical errors."

And maybe send a copy of Dr. Bash's letter with it- as to the substandard care.

That way- they might have to come up with something definitive-and grant the 1151 claim.

I have a Sec 1151 vet who believes that he will die of the Section 1151 causes and his widow will get DIC with little trouble.

But he also has potential other direct SC claims and will not file them (he gets 50% comp for PTSD and also 100% for 1151 and something else is SC)

I think a vet should claim both direct SC disabilities and Sec 1151 SC when appropriate because no one can predict what their cause of death will actually be from.

And DIC is usually never too easy- I really believe the VARO (and most SOs) take advantage of a grief stricken spouse and can make these claims miserable for them.

I mentioned a case on the old board-

A vet with severe SC hearing loss died of NSC heart attack.

The VARO and BVA denied the DIC claim.

The widow appealed to the court and proved with medical evidence that the SC hearing loss and it's affect on the veteran's balance and walking had made him so sedentary that he developed heart disease and died of it.

The CAVC granted her DIC as the SC disability had contributed to his death.

She was persistent and had laid out a logical argument with medical rationale. I dont remember if she had an IMO but she probably did.

How easy it would have been fot the VA if she had just given up.

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Berta,

I'll wait until the pending claims are settled and then do that. I like your statement and will use it. I talked with an attorney this morning about another veteran's denied claim for AO tongue cancer. I briefly told her what is going on with my husband and she wants to work on this with me. A very nice lady who handles tort claims as well.

You know, I need a breath of energy. I am exhausted and all of this is so intense that I feel like the little red engine that couldn't ...

I understand what you say about wanting your claim to succeed in honor of your husband. I am praying that it does. I can hardly wait to hear your good news. You have sown good seed into the lives of many veterans and their families, and a harvest is coming for you and yours! You will reap what you have sown. B) Sure would be a good Christmas present for you.

Carrie

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