1151 Denial

[LeroyJohnson]

After years of waiting I finally got a denial on my 1151 claim today. The denial was based on the fact that I had a cataract that caused loss of vision prior to surgery and the fact that I am now permanently blind in that eye they said there was no increase in disability since I had no vision because of the cataract prior to its removal and no vision now therefor no increase. I almost laughed at their reasoning. A cataract is not a permanent eye condition but what I have now at their hands is. Oh well what else is new with them. Have a NOD written and will send it in Monday. This is one fight I will not let go of. I know there are BVA cases where veterans have had cataract surgery and became blind from the surgery and won guess I will have to look them up again .

can someone tell me what wording I should use when sending in BVA cases as part of my evidence want to make sure I do it right.

Thanks Leroy

[LeroyJohnson]

yes Berta they did put in the wrong lens and it is written in the record that is was wrong. they fluffed over that as if it had no bearing on the out come of the surgery. I had all the eye records but not my complete C-file The wrong lens is why I had to have so many laser surgeries to make my eye try to conform to the wrong lens. My eye is covered in laser scars cant see them unless you look into the eye .And yes I had other IMO's they noted them but dismissed them Berta the doctor who did the C&P and said "unknown etiology" is also the same doctor who said months earlier that likely detached retina caused by cataract extraction surgery he is also the one who diagnosed the glaucoma.

Nothing was said in the denial about the detached retina or glaucoma even though I sent in those records highlighted and flagged so it could not be missed.And I argued the wrong lens and the fact that it cause me to have to have all those laser surgeries.

Their denial was based on pre surgery level of my eye not what happened after the surgery. I was light perception only because of the cataract I had vision just could not see thru the cataract now I cant see and never will again out of that eye. so they say blindness before surgery blindness after they messed up the eye after surgery so no increase in disability took place. I was blind before and I am blind now . to them there is no difference seen in the two conditions.and anything they did to they eye to cause the condition to be permanent means nothing in the way of increase becaues like I said blind befor blind when they were done with me no harm on foul. This is really stupid logic and I can hardly believe it myself.

[Berta]

But yet the cataract surgery was to correct and remove the cataract????

Their logic baffles me too-You might even need another IMO- I cant believe I am suggesting this- but it seems they are not getting at all- one from an Optomalogist-who would support your point-

The fact that the doctor at the C & P went against his prior statements- I would consider that as a deficient C & P and tell them this- because how did his medical knowledge change from the first statement to the C & P statement?

I hope you have a copy of that actual report- I didnt a C & P report for my 1151 claim for 6-7 years-it was not at all like the way they presented it in an old SOC-

You have to argue against every medical point they have made.

Dont give up-they denied my claim first because I was a layperson wth no medical background- they told me (one of many things I had to fight over) at one point that my husband (dead due to their negligence) would have probably died anyway !, then in another SSOC they tried to say he took an overdose of cocaine-and this caused his death ! -I knocked down all that down and then they tried to say he did not have medical evidence of heart disease in his VA med recs nor evidence of the misdiagnosed heart attack I claimed he had at the VA which they treated with sudafed. I re-sent (for the 4-5th time not only the med evidence of this heart attack revealed by ECG done the same day but also his autopsy -showing prior mycardial infarction-which they 'lost' 6-7 times-finally they did award because they had no choice-I had the medical evidence and there was no way they were getting out of this.

They want you to give up-

"Nothing was said in the denial about the detached retina or glaucoma even though I sent in those records highlighted and flagged so it could not be missed"

Of course they didnt mention it- whatever they don't mention is your strong point- because it is what they dont have any rationale to go against-

I feel you can prove your C & P was deficient-

have you approached this doctor with his past documented statements?

I called and/or wrote to the doctors that the VA had used to go against my claim-

I argued medical points with top notch VA doctors in Washington-

My FTCA claim was won in Washington when -because I was so proactive-and the evidence was so solid- that I realised one day and the VA med Team there too realised-by my call-that they were unaware of something highly significant---

the Buffalo VA had actually held back from them the most important piece of evidence when they sent the claim to Washington (VACO not the BVA) and lied about it's existence. It seemed like a big light bulb went off in the VACO building-

Within weeks after that phone call I won my FTCA claim as I provided them the evidence that they never got-

I think you can successfully knock down that C & P statement-with the prior statement-and send them some medical information from a good medical web site as to why people get cataract surgery- to improve their vision , not to make them permanently blind!-

Berta

[LeroyJohnson]

Thanks Berta, what you are saying is what I thought I had read in the denial. I have contacted my civilian eye doctor he has a lot to say about VA care and none of it good. I am sure I can knock this denial down. I have some great internet printout one of which stated that a cataract is not a permanent condition and that cataract surgery is to restore the eye sight that is block from the cataract.

Oh yes I have the C&P as well as the med records from the eye clinic. MY wife said thank goodness we got those records as I am sure they would have disappeared once he found out that we had filed a 1151. Funny thing was I went to clinic for my good eye I never complained or said one word about my right eye. His diagnosis of that eye was of his own doing. And oh ya it made him mad when he got the order for the C&P. Tried to tell me during the C&P that I HAD LIED TO HIM in clinic because I didn't tell him I had flied a claim. I told him that I was not in clinic for my bad eye but to get glasses for my good eye, one had nothing to do with the other.which was true but I am sure I never would have gotten the diagnosis of detached retina or glaucoma right eye or for that matter severe tunnel vision in my good eye. It is my understanding that they base your rating on your good eye and that even though it has 20/40 corrected vision is considered blind because of the 10 point tunnel vision so if they award this claim they will have to award it under blind in both eyes. that will be a N award I think. that is if I ever get them to understand cataracts or the difference between correctable and permanent in nature.

everyone thanks for your opinions and your help.

Leroy

[Berta]

I am glad you confronted this doctor-

another point you could make is-VA seems to be saying that-

the cataract surgery was not even necessary because the results -in their opinion- is the same before and after-

like it was supposed to be- therefore the surgery itself was a negligence of care, in that -according to the VA- you were supposed to be in same condition after as in before-

dont know if I am saying that right-

The onus is on them when they start to manipulate medical fact.The more you draw them out via argument to everything they say, they will most surely start to put their foot in their mouth-

I think that doctor is a good example of the major conflict of interest that vets have to put up with-

if the doc says something positive during an exam , then gets called on to do the C & P- the powers that be then take control over what the doctor is supposed to say- things that go against the claim-that may have absolutely no medical rationale-

This is why I think these vet orgs who employ lousy vet reps should offer an IMO fund instead-

just can the lousy vet reps and use their saved salaries to support the fund.The lousy ones-in my mind -would be those who have the highest amount of claims at the BVA (which tells me they didnt work the claim well at the VARO level)

A vet could agree in a contract-that if the IMO makes the claim succeed, they will pay back the fund.

The SOs they do retain could assess the claims that require IMOs-and find the best professional in the specific field of disability to prepare the IMO.

This would eliminate the conflict of interest that a VA doctor is in (and I know many do not like it)

to treat the patients as normal SOP and then have to satisfy the VA's unstated motto- save money in comp-if they perform C & P exams too.

[LeroyJohnson]

Thank you Berta, I had never thought of the surgery that way. that's a great thought since they believe no negelence or lack of care took place I was stuck trying to figure out another way of wording it to them.

Leroy