hypertension Can/will Dro Rate New Claim While Reviewing A Nod

[71M10]

Greetings all:

I just finished talking with 800 number folks and thought I would run the information through the HADIT handy dandy B/S detector.

BACKGROUND

I received an increase on my back in May 2007, In August I filed a NOD on that decision. In October I filed a new claim for hypertension (original diagnosis in service). In December they sent me a letter about the new claim and indicated they were scheduling me for an examination and asked for information/medical records(i provided), and VCAA form (which i completed and returned - rate do not wait). I called two weeks ago about not having been scheduled for an examination yet and they told me it was an OPPS (they forgot) and someone would set that up in the next couple of days. Checked VAMC today and no pending appointments so I called 800 number.

TODAY'S INFO

Person on 800 number said they couldn't schedule the appointment until my appeal was decieded(projecting April 08). I asked him if that ment they wouldn't work my hypertension claim if I decied to appeal the DRO decision to BVA? He indicated if there was enough evidence in the file to rate it the DRO may rate it without a exam. Can a DRO rate a new claim (as a rater nor DRO) at the same time they are conducting a Decision Review? Has anyone had this happen (just because it can doesn't mean they will)?

On my new claim I have inservice diagnosis of essential hypertension on the Army's medical referal form, from an internal Medicine Doc.

Current treatment and medication for hypertension from VA

and last but not least a report on a VA echocardiogram showing heart enlargment and a LVF of 50%

CONCLUSION

It would make sense that the DRO could rate something else as a rater if it is ready to rate, but the Cynical/Logical part of me just doesn't see it happening since it is VA.

What does the board think?

Best regards,

Tyler

Edited March 10, 2008 by 71M10

[Ricky]

71M - A DRO WILL NOT, review or decide your claim. DRO's will only work appeal issues. If you will look at the overall VA stats you will see that they have their hands full with appeal issues.

If you have an appeal pending and submit a new claim, the predetermination team will prepare the new claim for processing. It will then go to a RATER (not DRO) who will work the new issue. Normal procedure is that all new claims will be processed prior to the appeal. However, in todays times it the tend to be which ever one pops up on the radar screen first in an attempt to decrease their backlog. Normally what happens is the predetermination team determines that an exam is needed in order to rate the claim and recommends this to the rater. It then goes to the rating team if all other evidence is in order. The rating team then looks at their work sheet and agrees or not. If they agree then an exam is scheduled for only the rating team can and will request that an exam be scheduled. Once this is done then the exam is scheduled. (also keep in mind that the VAMC is backlogged on C&P claims)

During all of this time your file may be jumping back and forth between the rating team and the appeals team if the appeals team has work to do on it (your number comes on the appeal). If not then the file sits in the rating team area until the exam is complete and the results and your file have been returned to the VARO. Once this is done you file once again sits in the rating area (not appeal area) until either the rater or DRO checks it out. If it is the DRO he/she is only going to work on the appeal issues.

To the second part of your question - all actions/issues must be resolved by the VARO prior to your appeal/claims folder being certifies to the BVA.

Bottom line is a DRO will only work appeal issues----all claims actions must be completed prior to the file being transfered to the BVA (there are some exceptions). Even if he/she determines that a new claim exist, they will ask the predetermination team to notify you and ask if you want to open a new claim, If you do they will give your file back to the predetermination team which will forward the VCAA to you on they new claim. Once the requested info is received normal processing begins.

As you can see this causes your claims folder to jump around all over the VA so it is always better to allow the appeal to be completed prior to sending in a new claim - always. Most are worried about EED's but they fail to think about the appeal. They must always weigh the fact of which claim is more important---appeal or new claim?

[71M10]

Thank you all for the input.

It appears that my file is in with the DRO (for my appeal) and it remains their until they do the SOC. I thought what the person was describing seemed overly optimistic.

Well we will see if the SOC appears in April like the service rep indicated. Im not holding my breath.

My hypertension claim isn't going anywhere...they will eventually have to deal with it.

Best regards,

Tyler

[Berta]

Great assessment Ricky-of what the DRO can and cannot do-

I have a claim at Buffalo that-in 5 years-has never received a decision- it is a legal question issue- and the GC knows about it-

If I file a Writ at this point with the CAVC that would bugger up whatever they are doing now- (3 other claims with DR0)

My point is the VA had the audacity at add this to my appeal sent to the BVA-

when I got the claims and folder back (I didnt even get a docket as I raised 3 legal errors)-the VA again was stuck with it all-

Make sure when and if they transfer any of your claims-to the BVA- that they themselves have identified the issues correctly.

I dont think this type of error happens much- but just make sure-anyone out there- that they dont add to your appeal something they never decided in the first place-

The BVA transfer in my opinion is often just to get many claims out of their hair-

the vet reps love BVA transfers-

they dont see that claim again maybe for years-

and of course if we croak during the long BVA process the VA saves money.

The NOD should clearly define the issues too-as this vet's NOD did- that way they can't 'alter' the issues.

Maybe I should have just gotten remand on the AO claim but somehow left the other claim at the BVA!

That would have been good-

BVA gets a claim on appeal that has never been denied!

Shows what we deal with at the Buffalo VARO.

[danang_1969]

A bit of advice. If you are oxygen 24/7, on much medication and you are very weak and you decline a hearing in writing and verbally; that you feel you have enough written doctor's evidence for your claim increase; without driving over a 100 miles for a hearing because of your situation; weakness and immobility; look out the VA will schedule you for so many C&P's; it will knock your socks off. Suspicion: they are hoping you won't be able to get to the C&P's and they can justly deny your claim when you miss the C&P exams. I had to reach way down by the grace of God and pull some reserves I didn't have; but I got there.

Danang_1969

[71M10]

A bit of advice. If you are oxygen 24/7, on much medication and you are very weak and you decline a hearing in writing and verbally; that you feel you have enough written doctor's evidence for your claim increase; without driving over a 100 miles for a hearing because of your situation; weakness and immobility; look out the VA will schedule you for so many C&P's; it will knock your socks off. Suspicion: they are hoping you won't be able to get to the C&P's and they can justly deny your claim when you miss the C&P exams. I had to reach way down by the grace of God and pull some reserves I didn't have; but I got there.

Danang_1969

Let them have at it, I have a spouse and 2 boys with drivers Licenses. What I worry about are the C&P's that get scheduled that they don't tell you about.

Best regards,

Tyler