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1151 Claim?


sbrewer

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Hi,

Just wondering if you are suppose to send an 1151 claim to the VARO office. My husband was told

from 2 people at the VA hospital to complete the form and send it to the VARO. If so, what happens

after they receive it?

Thanks,

sbrewer

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a form?

WHat kind of form?

I have never seen a form for Sec 1151 claims- maybe this is something new?

A Section 1151 claim only has to be a letter to your VARO with your c file number on it stating :

"This is a claim under Sec 1151 , 38 USC. I believe my VA medical records will reveal that medical errors and negligence committed by the VA during my care, have been detrimental to me, and have caused me to suffer additional disability."

This is what I recommend if it is an obvious case of negligence-

But in most cases - you can give some specifics - state them and attach copies of the med recs that support this.

Example-

VA doctor (Dr. ____) told me , after my recent admission to the ____VAMC,that the lisinopril dosage prescribed by VA for 4 years was an ineffective dosage for 4 years due to my body weight and age, to control my HBP, and this was a strong factor for the reason that I have suffered a recent stroke.

He immediately prescribed a more effective medication for my HBP.

I have enclosed copies of my Drug profile for 4 years and you can readily see the lisinopril and dosage which never changed until he prescribed the new meds.

I have also enclosed my discharge certificate from the ____ VAMC ,where I was hospitalized with the stroke,and you can see clearly that the medication and dosage for my HBP is not the same lisinopril and dosage, and also within the Med charts Dr. _______ clearly notes this change too.

The MRI summary (copy enclosed too) shows that I had a particular type of cerebral vascular accident consistent with highly elevated and inadequately controlled high blood pressure.

words to that affect- if you give details ---focus it sole on cause (wrong meds, wrong surgery, wrong diagnosis etc) and affect- how it gave you additional disability.

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He went to the C&P office and they gave him a copy of a form. The copy wasn't very good, so he

found it online and filled it out and printed it. I mailed it today to the VARO office also he included

two pages from his medical records. What is the C file number?

This was printed on it "This is a claim under Sec 1151 , 38 USC. I believe my VA medical records will reveal that medical errors and negligence committed by the VA during my care, have been detrimental to me, and have caused me to suffer additional disability."

Oh well, it's in the mail now so I guess we'll see what happens.

Do you know what happens after they recieve the form? AS in, do they call you in for C&P or what?

thanks,

sbrewer

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This is from the M21-1 Adjudication Procedure Manual online. It will give you the scoop on the development of his claim. I think I read somewhere that the auto grant is now part of 1151 benefits, if applicable to the veteran's 1151 disability.

(Berta, the form mentioned here is 21-256, but this says it's not required.)

Carrie

22.02 CLAIMS REQUIREMENTS

a. The veteran need only submit a statement showing an intent to apply for compensation under 38 U.S.C. 1151. There is no requirement for submission of VA Form 21-526. A formal claim, however, for compensation or pension is a claim for compensation under 38 U.S.C. 1151 (38 CFR 3.154).

b. The effective date of entitlement to compensation for a 38 U.S.C. 1151 disability is either the date of the injury or aggravation if a claim is received within 1 year of the incident or, otherwise, the date of receipt of the claim. See 38 CFR 3.400(i).

NOTE: If a formal claim for compensation or pension is received and entitlement under 38 U.S.C. 1151 is ultimately established, that formal claim ordinarily must be accepted as the claim for 38 U.S.C. 1151 benefits.

22.03 DEVELOPMENT OF 38 U.S.C. 1151 CLAIMS

a. Referral to Rating Activity. Refer claims for compensation under 38 U.S.C. 1151 to the rating activity for review prior to initiating development. The purpose of the initial rating activity review is to determine if the issue can be resolved without further development. If development is required, the rating activity will indicate specific types of evidence to be requested.

b. Requests for Information. Usually VA Form 10-7131, "Exchange of Beneficiary Information and Request for Administrative and Adjudicative Action," does not provide sufficient space for details surrounding the incident; therefore, request information from the medical facility by locally generated letter. Furnish as much information as possible about the incident in the request. The electronic 7131 request functionality in the Compensation and Pension Record Interchange (CAPRI) will support text entry of up to four pages and maintains tracking information regarding the status of requests. Locally generated letters may be copied and pasted into the general comments area of CAPRI 7131 requests. If the rating activity does not specify the types of evidence to request, request all evidence and documents pertinent to the incident upon which the claim is based. Possible sources of information about the incident include:

22-I-1

M21-1, Part IV June 20, 2002

Change 156

(1) Medical records,

(2) Surgical records,

(3) Hospital clinical records,

(4) Nurses' notes,

NOTE: Do not request quality assurance investigative reports. These reports are confidential under 38 U.S.C. 5705 and cannot be used as evidence in adjudication of claims under 38 U.S.C. 1151. If quality assurance investigative reports are received from a VA medical facility, return the reports immediately. Do not file copies of these reports in the veteran's claims folder.

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SBrewer some claims are so obvious that the veteran doesn't have to send in much-

example- veteran is set for amputation of left leg due to complications of diabetes-

After the surgery vet wakes up and finds his left leg is still there- right leg is gone-

vet files simply stated 1151-a no brainer-

This is a true case.

The cancer vet I had -we only filed a simple statement - and he was awarded very quickly-it was an obvious medical error- fully documented on his discharge summary.

Other claims need detail.

My husband filed a Sec 1151 6 months before he died. He stated he felt that VA had misdianosed his PTSD to such a degree that it could cause him to have a heart attack- or another stroke and since it took them so long to diagnose his major stroke properly they were probably misdiagnosing the extent of his PTSD and that this,he believed , would eventually lead to his death due to a heart attack.

They did not really act on it -they never asked him for details-just said it was at the rating board-but I re-opened it- when he died as he died suddenly of a heart attack- yet the VA had said he had no heart disease. The autopsy revealed a prior misdiagnosed heart attack,occurring while he was at work at the VA- and many strokes that they had misdiagnosed as well as significant heart disease.I also found medication errors- this all took time -these involved decifering handwritten medical entries-from numerous physicians and a lot of research in medical books about the heart disease.

The 1151 PTSD issue is still an open claim that I realised last year and reminded them of-

My point is some 1151 claims need specific details-

If the VA screwed up in their care-the errors will be found in the medical records-

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SBrewer some claims are so obvious that the veteran doesn't have to send in much-

example- veteran is set for amputation of left leg due to complications of diabetes-

After the surgery vet wakes up and finds his left leg is still there- right leg is gone-

vet files simply stated 1151-a no brainer-

This is a true case.

The cancer vet I had -we only filed a simple statement - and he was awarded very quickly-it was an obvious medical error- fully documented on his discharge summary.

Other claims need detail.

My husband filed a Sec 1151 6 months before he died. He stated he felt that VA had misdianosed his PTSD to such a degree that it could cause him to have a heart attack- or another stroke and since it took them so long to diagnose his major stroke properly they were probably misdiagnosing the extent of his PTSD and that this,he believed , would eventually lead to his death due to a heart attack.

They did not really act on it -they never asked him for details-just said it was at the rating board-but I re-opened it- when he died as he died suddenly of a heart attack- yet the VA had said he had no heart disease. The autopsy revealed a prior misdiagnosed heart attack,occurring while he was at work at the VA- and many strokes that they had misdiagnosed as well as significant heart disease.I also found medication errors- this all took time -these involved decifering handwritten medical entries-from numerous physicians and a lot of research in medical books about the heart disease.

The 1151 PTSD issue is still an open claim that I realised last year and reminded them of-

My point is some 1151 claims need specific details-

If the VA screwed up in their care-the errors will be found in the medical records-

I think they mean the 21-526-in that regulation- which is the initial comp/pension claim form.

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Thanks for your help.

I know I keep asking questions, but we know nothing of this process, so we were trying to get

everything lined up before sending in the claim. I guess we'll hear something one way or the

other letting us know what to do next. Again, thanks for all your help.

sbrewer

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