Am I Legally Entitled To A Dro Review/conference

[cannoncocker]

this is what I entered into the IRIS system attempting to obtain the following:

Before I obtain an IMO and complete VA Form 9 selecting BVA hearing I request:

1. Statement of Case (were the two mailings referenced above the Statement of Case?)

2. I never received a DRO review that Is documented as requested.

3. I never recevied the DRO personal conference.

So far all I recevied was another written denial. Am I not legally entitled to a DRO personal review and conference if requested, which I did? If not I will accept that and move on in the appeals process, but I would still need clarification on the Statement of Case (SOC) or (SSOC).

This was my entry into iris

**********************************************************************

I have received 2 packages from the Winston Salem VARO.

Mailing 1

1. Dated June 22 2009

Rating Decision

Introduction

Decision

2. June 23 2009

318/YRO/VAB

CSS XXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXX

Dated 30 June 2009

1. I replied to the above decision in consultation with my DAV VSO Representative on form VA Form 21-4138 Seeking Reconsideration for my lumbar spine injury.

a. W-S VARO Acknowledgement of receipt of my written disagreement with Department of Veterans Affairs Decision of June 23, 2009.

318/213/PAD

CSS XXXXXXXXXXXXXx

XXXXXXXXXXXXXXXXXX

Additional evidence regarding Lumbar Injury Denial

b. W-S VARO Acknowledgement of receipt of my election of the Decision review Officer (DRO) to handle the appeal.

c. IRIS [inquiry: 090702-001052]

7008 2810 0001 1824 0040 date 03 July 2009 evidence

7008 2810 0001 1824 0033 dated 06 July 2009 evidence

Mailed USPS Certified Mail with Receipt copied in previous post in this inquiry for Request for Reconsideration Denial (Medical Description: Lumbar spine injury with radiating through buttocks and down legs). Response directly to 318/YRO/VAB

CSS XXXXXXXXXXXX

XXXXXXXXXXXXXXX

DECISION Dated June 22, 2009

enclosed Durham Neurology Dept. Notes

d. IRIS [inquiry: 090727-000693]

I select in consultation with my DAV Representative Mr.XXXXXXXXXXXXXXX

Asheville VAMC DAV Service Officer (828) 298-7911 EXT.15349 option 1,

the Decision Review Officer (DRO).

e. [inquiry: 090802-000091]

Currently your appeal is still pending review with the DRO. During this process, the DRO will review all evidence, arguments, statements from your representative, and any other pertinent information as it relates to your claim. At times, this can lead to a request for additional evidence. In addition, the DRO may request you participate in an informal conference with the DRO to clarify questions regarding your disagreement.

f. [inquiry: 090807-000262]

Dear Mr. XXXXXXXXXXXXX

This is in response to your inquiry of August 7, 2009, regarding your VA benefits.

We are able to assist you with both of your requests. We have forwarded your inquiry to the appeals department at the regional office to request a hearing with the Decision Review Officer (DRO) be scheduled. It may be some time before you receive a response to your request, as appeals issues are processed as they are received, oldest to newest.

XXXXXXXXXXXXx

National IRIS Response Center Manager

jmb

The appeal process, is when you disagree with a decision the VA made on your claim. At this time you may elect a Decision Review Officer (DRO) reviews your file and issue a Statement of the Case

g. submitted Charles George VAMC ATTN: FEE BASIS Approval of epidural injections, which I declined, but corroborates the hand written notes explaining my therapy options and pain orgin from S1 pinched nerve/degenerative diseases/L5S1 herniated disc.....

Mailing 2

1. Dated august 19, 2009

318/AUTH/LLS

CSS XXXXXXXXXXXXXXX

XXXXXXXXXXXX

Stated in reference to my request for reconsideration for lumbar injury:

The previous Rating Decision denied service connection for a lumbar spine injury.......

you submitted a statement requesting reconsideration of this issue.

It acknowledged receipt of VAMC Durham reports, this was not a report , it was hand written notes on the Neurologists stationary stating orgin of pain/treatment options/ he verbally stated and pointed out the age of the injury on the 2008 MRI by distinguishishing the dark and light disc fluid leakage which would be apparent to any Neurologist.

Review does not show that your current lumbar injury was incurred in or caused by your military service.

********************************************************************************

*********************************************************

Before I obtain an IMO and complete VA Form 9 selecting BVA hearing I request:

1. Statement of Case (were the two mailings referenced above the Statement of Case?)

2. I never received a DRO review that Is documented as requested.

3. I never recevied the DRO personal conference.

All I recevied was another written denial which included decisions on 2 deferred items. Am I not legally entitled to a DRO personal review and conference if requested, which I did? If not I will accept that and move on in the appeals process, but I would still need clarification on the Statement of Case (SOC) or (SSOC).

I accept denial of my psychiatric claim as I have no in service documentation but that is absolutely not the case for the lumbar injury.

Sincerely,

[john999]

If you ask for a personal hearing with the DRO you are entitled to get one before you go to the BVA.

[carlie]

cannon,

Study

Part 1 - Duty to assist

Chapter 5 - Appeals

Hope this helps a vet.

carlie

http://www.warms.vba.va.gov/M21_1MR.html

[cannoncocker]

First, thank you guys for posting our rights!

Also I hate to disillusion anyone reading this, but I sent that request in for a DRO Hearing, well I forgot, I didn't use Urdu, but by all means available: IRIS, certified ltr. and this is the result:

This message is in response to your inquiry dated August 28, 2009. We do show your request for a DRO hearing. We are currently working on getting that hearing scheduled. The Appeals Team at our Winston-Salem Regional Office will contact you regarding this hearing. No SOC will be issued until after the DRO hearing.

Thank you for contacting us. If you have questions or need additional help with the information in our reply, please respond to this message or see our other contact information below.

Sincerely yours,

So they were sitting on it hoping I would drop dead or whatever or were just backlogged but zero correspondence till I Inquired. Up to that point is was simply no, move along, nothing to see here. It would have been nice had they told me their intentions/next action in this maze. but oh no.

You guys were right though, spot on. The VA just didn't confirm that they were going to adhere to the rules. I don't just assume they will do the right thing/adhere to their own rules.

I do have 1 further question regarding a "SOC". What exactly does that entail? Revealuation of my entire claim or only the denied claim item for which I requested the DRO hearing for. Still paranoid regarding retaliation and reducing claim items they just increased. Or to do that would they have to reschedule another C&P or just arbitrarily assign any value they want to get the desired total they are looking for. Simply, I may be right, but that doesn't alone make it end up right. Another way of stating it is: I don't want to jump into the frying pan into the fire.

I am pefectly perpared to debate this any time, anywhere, so that is not an issue.

I'd be a goner without this forum and the members.

Edited August 29, 2009 by cannoncocker (see edit history)

[john999]

The Statement of the Case is pretty much a reiteration of your rating decision. It is supposed to explain why you got the rating you got and why you didn't get a higher rating. It is useful because it contains the clues that help you win your appeal. It lists the reasons why a complete grant of all benefits was not awarded and why. The "why" is what you attack in your appeal. I found the best why to attack an SOC is to get a doctor to refute the SOC point by point.

[cannoncocker]

The Statement of the Case is pretty much a reiteration of your rating decision. It is supposed to explain why you got the rating you got and why you didn't get a higher rating. It is useful because it contains the clues that help you win your appeal. It lists the reasons why a complete grant of all benefits was not awarded and why. The "why" is what you attack in your appeal. I found the best why to attack an SOC is to get a doctor to refute the SOC point by point.

Thank you john, the was exactly what I needed, the in context. I already had a definition:

http://www1.va.gov/opa/is1/12.asp

Which gives zero information on how it is relevant to me.

Very useful and hope so for others.

[carlie]

And a SSOC,

Supplemental Statement of the Case =

Prepared by the agency of original jurisdiction, when additional pertinent evidence

has been introduced, an amended decision has been made, or a material defect

in the Statement of the Case has been discovered (38 CFR19.31 (2008)).

[cannoncocker]

And a SSOC,

Supplemental Statement of the Case =

Prepared by the agency of original jurisdiction, when additional pertinent evidence

has been introduced, an amended decision has been made, or a material defect

in the Statement of the Case has been discovered (38 CFR19.31 (2008)).

I haven't had the DRO Hearing yet but will come bearing new evidence (IMO) and the chronological evidence I intend to rebut their denial, which was the VARO ignoring presented evidence which I can debate with them mano y mano and corner them in minutes. As far as I am concerned My MRI and the NIOSH lifting chart ought to do but I don't plan on just relying on that and their own Neurolgists written notes. I'm not really sure what category i would fall into. They have reviwed my claim (request for reconsideration) on the lumbar injury and rubber stamped the denial and gave a wink at the new evidence which primarily ignored it. But no actual SOC has been issued, just waiting on the DRO Hearing, which I have some work to do so not in a big hurry on it.

Material defect yes on their denial but no SOC yet so It looks like I am still in the SOC category although they have reviewd their denial with new evidence.

As I see it, the W-S VARO just plain doesn't plan on giving me 100% without a knock down drag out. Evidence just be Dam......

thanks

PS for instance they rated my sinus tachycardia at 30% which just happens to be one jump below the unemployability cutoff IAW my DAV REP.

Edited August 29, 2009 by cannoncocker (see edit history)

[tagandbag]

This message is in response to your inquiry dated August 28, 2009. We do show your request for a DRO hearing. We are currently working on getting that hearing scheduled. The Appeals Team at our Winston-Salem Regional Office will contact you regarding this hearing. No SOC will be issued until after the DRO hearing.

cannon, your VARO seems to be a lot more forthcoming with telling you about A DRO hearing, before the SOC is sent out. I requested a DRO hearing before any SOC, but I have gotten an SOC and a SSOC and still no DRO hearing. But, the SOC and SSOC were for a rating of 50% and 70% respectively. Still waiting on award letter for 70% and that has been almost two months. Its funny how every claim has it's own path through the VA maze.

t&b

[john999]

Cannoncocker

That's right. The VA does not want to award IU or 100% without a brawl. They hope you will just give up and take the denial. Persistence is the key to VA claims.

It is frustrating trying to get these dimwits to read your evidence. They just don't care, but a DRO can make a decision that will grant your claim. All my claims have been appealed even the simple ones that were granted, but low balled.

[cannoncocker]

This message is in response to your inquiry dated August 28, 2009. We do show your request for a DRO hearing. We are currently working on getting that hearing scheduled. The Appeals Team at our Winston-Salem Regional Office will contact you regarding this hearing. No SOC will be issued until after the DRO hearing.

cannon, your VARO seems to be a lot more forthcoming with telling you about A DRO hearing, before the SOC is sent out. I requested a DRO hearing before any SOC, but I have gotten an SOC and a SSOC and still no DRO hearing. But, the SOC and SSOC were for a rating of 50% and 70% respectively. Still waiting on award letter for 70% and that has been almost two months. Its funny how every claim has it's own path through the VA maze.

t&b

By and large they have been forthecoming, but you are seeing a snipet of a long stream of back and forth. It has in no way been a giveaway. The IRIS post prior to this one resulted in no response at all.

I haven't received an SOC yet, they are just saying I will (maybe) receive one after the DRO Hearing. Please don't take my usual ranting the wrong way. I really could just walk away from this as is because I have a tight family and they would take care of me buck naked standing at their door. I just have this bizarre sense of justice and will not be steam rolled. The W-S office by and large has been pretty decent. A little on the low ball side but acceptable so I am not appealling everything I sent in. Just one thing. I also point out they approved one item just 10% below the unemployability cutoff, and deny an item which is clear to a blind man.

I never claimed to be the sharpest tool ....but for crying out loud, I know a plan to an agenda when I see one. I have much more of a beef with the so called VSO operation. If they aren't in bed with the VA it is a sure good mock up of it. I have had to go to the top of my so called VSO organization to get a ball rolling and that lasts just long enough to get the heat off them. Few days later, shoes off and feet back on the table. Calling their office comes second to walking barefoot through a field of cockleburrs. It makes you want to jump out of a window hearing how miserable the receptionist is......

The IRIS system has been the saving grace IMHO and in my limited experience. It seems to get other eyes on the issue therefore get a response. I don't demand they agree with my point of view at every juncture, only that they communicate and play by the rules. Here recently had they communicated, a few sentences and my issue would have been clear and no problem.

John, if they, well not if they, of course they are going to make me fight for it. Same thing with property tax in FL and SC, they jack it up, knowing x% will never even look at the ltr., x% will just put it in the too hard to do box and accept the increase, then the few x% will get up and go to the appraisers office and raise Kane. They have a predetermined fall back position they will give up immediately, which I usually go for, but it could go on. I will see how fair the W-S VARO is at the hearing which I will be standing at alone. I have donated about 225.00 to the DAV and as I mentioned before pigs will fly before they get up and provide me any moral support at that meeting. But alone I will stand and I will be ready. I just consider that 225 bucks as a donation to their van system that hopefully will get a few vets in need to the doctor.

Another rant is that Asheville VAMC. I have been going there for about 2 years and have had about 5 different doctors. Terrible service. Dorn in Columbia, SC and the Pensacola FL clinic were both excellent. So it is a dice roll. This Asheville bunch will change your meds and you won't know it till you open the bottle. Cattle comes to mind.

tagandbag I wish you better luck at your VARO but in my experince using IRIS leaves a trail they can't dodge and you have it in writing which you know in any beauracracy is rule one, don't write it down.

I think we need to look for another description than "funny" how claims track. I find myself very seldom regarding this. Making you go out and spend your own money for nothing other thsn they have a quota and aren't concerned with the merits or reality of the claim.

Edited August 30, 2009 by cannoncocker (see edit history)