Nod Letter

[sehinchee]

Please review the attached NOD and provide some feedback. This will be my first one.

NOTICE_OF_DISAGREEMENT1.pdf

[Ricky]

Should you point out every single descrepincy that you discover in a C&P exam. For example, after looking at my C&P exam result for the 1348th time, I noticed the following:

IS WEIGHT BEARING JOINT AFFECTED: YES

DESCRIBE GAIT: NORMAL

Well the doc never had me walk, if she did she would have seen the obvious limp that I currently walk with.

ALSO

IS THERE LOSS OF A BONE OR PART OF A BONE: NO

The surgery reports that I submitted clearly state how much of my ferur and tibia where removed.

Should I bring this to their attention?

Keep in mind that your disagreement reasoning should be centered on the reasons and bases they used for denial of a specific portion of your claim. If they used such evidence (bad C&P) or you feel they failed to use your evidence then it should be brought to light. In other words if the loss of bone is a wining factor then it should be addressed in your arguments (their lack to consider it). I noticed that you also hit very,very briefly on the effective date and a temp 100 percent. If the effective date and 100 percent temp rating was incorrect then I would expand this section just a bit.

Nod's are a funny animal. A nod can be established by simply saying I disagree with your decision and request a de novo review by a dro. However, most, as you have done, tend to present a full argument type document. Either way the key is to tell them that you disagree and what you disagree with. I have always like to develop it to the point of a full frontal argument paper. That way when and if it comes time to submit a formal appeal your form 9 is 3/4 of the way complete.

Also please note that in most cases it is appropriate and necessary to request a personal hearing during the DRO process. Therefore, I would also include the request for such a hearing in the NOD (first paragraph). During the hearing you can present/expand your arguments such as no consideration given for things as bone loss. Bottom line is that it gives you time to review the nod and insure that you have presented every possible argument for wining the claim.

Good luck.

[carlie]

Very well written just needs a few tweaks as others have posted.

Ricky's suggestion on requesting a Hearing with the DRO is right on the money.

I have a question about this part,

"My orthopedic physician has advised me to take the following steps in order to alleviate the chronic symptoms that I am experiencing, and prolong the life of the prosthesis:

• Wear an orthopedic appliance, which provides additional support and stability.

**** Did the Doc write any type of script to obtain the ortho appliance (prosthetic) perhaps to have one made to your physical specifications, if so this would also be evidence.

• Limit activities as much as possible to reduce stress and strain on the joint.

• Use the RICE (Rest, Ice, Compress, Elevate) technique to alleviate the pain and swelling.

**** Is the rest bed rest -- if yes, did the Doc write the instructions down ? This would be more evidence.

• I have also been prescribed medication for pain and inflammation."

**** Any side effects that could be rated a secondary conditions ?

jmho.

Hope this helps a vet,

carlie

[lu12]

Berta, Ricky, a the NOD should be concise. But you Should point out every single discrepancy that you discover in a RD, SOC, SSOC or in a C&P exam Right?. But at the same time a NOD as Berta also said "Those generic short NODs (I disagree with the decision of --date---)I have seen prepared by reps and NSOs,with no rationale argument raised, are quaranteed to just string out the claim longer. I do also agree with this fact.

If a C&P examiner needs to f/u some sort of written guidelines when performing a C&P exam then I think that the Veterans should have some sort of a guide or example when it comes to the time to answer back to the VA decisions with a NOD.

"Concise but not to Long." Then what happen when you need to deal with 3 or 4 issues related to your claim or appeal, it also should be CONCISE OR NOT TO LONG?

Is there anyway for us to follow a electronic data document or web-page form in order to write a perfect NOD?

Maybe HADIT'S moderators, can create a format that may be similar to those used by the C&P's clinicians. A more VET friendly user format.

sehinchee, I also think it is a well written document, please consider Berta advice and try a BVA claim search related to your claim.

Good Luck,,,

lu12

[sehinchee]

Yes, he wrote a script for a medically necessary brace. I submitted it as evidence.

here is what my doc wrote:

Very well written just needs a few tweaks as others have posted.

Ricky's suggestion on requesting a Hearing with the DRO is right on the money.

I have a question about this part,

"My orthopedic physician has advised me to take the following steps in order to alleviate the chronic symptoms that I am experiencing, and prolong the life of the prosthesis:

• Wear an orthopedic appliance, which provides additional support and stability.

**** Did the Doc write any type of script to obtain the ortho appliance (prosthetic) perhaps to have one made to your physical specifications, if so this would also be evidence.

• Limit activities as much as possible to reduce stress and strain on the joint.

• Use the RICE (Rest, Ice, Compress, Elevate) technique to alleviate the pain and swelling.

**** Is the rest bed rest -- if yes, did the Doc write the instructions down ? This would be more evidence.

• I have also been prescribed medication for pain and inflammation."

**** Any side effects that could be rated a secondary conditions ?

jmho.

Hope this helps a vet,

carlie

[sehinchee]

Here is the letter that my doc wrote, it has been submitted as evidence along with anti-inflammatory prescription, pain medicine prescription, and the prescription for the knee brace.

Mr. Steven is a patient of mine that underwent a right total knee replacement on 12/07/06. He has some intermittent pain and swelling in his knee

On exam, he has 0-130 degrees of flexion. X-rays demonstrate a well-aligned right total knee replacement.

I feel that his pain and swelling is attributed to the functional use and possible overuse of the joint. He has been given an anti-inflammatory medicine to control pain and swelling, and we have prescribed a knee wrap to assist with support and stability of his joint.

[sehinchee]

NOD DENIED