Somethings Not Right With This Rating.

[allan]

After more than a decade on appeal with the BVA, they granted SC for my shoulder issue. They ordered an IMO from the orthopedics clinic I went to at the VAMC in 2009. The Dr opined that the shoulder issue is service connected for arthritis, chronic pain and limitation of motion.

The claim was than remanded to the VARO to be rated.

The Rater granted 10% for arthritis, nothing for chronic pain or limitation of motion and awarded retro for the arthritis (10%) back to 1995.

A month later they ordered a C&P examination from QTC to determine the extent of disability of the shoulder issues. The QTC examiner found I also have rotator cuff syndrome due to the SC injuries and ordered an MRI.

My SO informed the VARO rater that all my secondary issues I’ve been claiming since 1995 are claims for increase, further confusing the situation.

I've found out anything I send him in writing, he holds and does not turn into the VARO according to him.

I sent in an NOD to try to resolve everything. The VARO responded with, I need to choose between a DRO review or be re-rated through normal review.

Since my last DRO review took four yrs to complete and all I got out of it was an SOC and SSOC rubberstamped just like the first denial the DRO did when he was a rater, so I chose normal rating process.

I've now received a letter from my SO requesting all correspondence with the VA go through him only. How do I do this after he has already informed me he holds everything I’ve send in writing and just talks it over with the RO as he wishes?

I realize my brain doesn't work right & I need someone, but I know something is not right with the way my claim is being handled.

Why does the RO grant 10%, than order all the C&P's to determine what the disability should have been granted in the first place, unless it is to cheat you out of the decade retro you’re entitled to?

I feel after the BVA ordered the RO to rate the claim they granted, the RO should have requested the C&P's than rate according to the findings of the examiner. My SO completely disagrees.

If anyone can help me sort this out and understand the process better, please comment.

[Guest terrysturgis]

Allan, I would sit down with your SO and have a face to face and ask what is his plan for your claim. If he truly has connections to the RO that should help. If he does not send evidence to the RO and holds it, you need to know the reason why he would do that.

Take care. Terry

[jbasser]

You sit down with this person face to face and explain that you are to remain in control of your claim and that you will revoke the POA if it comes to that.

These folks have your POA and can make major decsisions on your behalf.

J

[Berta]

"I've now received a letter from my SO requesting all correspondence with the VA go through him only. How do I do this after he has already informed me he holds everything I’ve send in writing and just talks it over with the RO as he wishes?"

I think you should check you C file to see if in fact-he did submit evidence from you in the past.The C file should hold any documented notes of what he 'talked over".

He sounds like a control freak to me-what S0s have the ability and the time to 'talk' over claims with the RO as they wish?

That is absurd. I had a SO like that-trying to impress me that he knew the Buffalo DROs and could 'talk' to them whenever he wished.He made it all up.

"I realize my brain doesn't work right & I need someone, but I know something is not right with the way my claim is being handled."

Many reps do want claims evidence to go through them first. In some cases this is a good idea,but in my opinion I feel practically all evidence etc should be sent to the VARO by the claimant and CCed to the SO or Rep.

A good rep would know how to present the evidence well on a 4138.But most of us here,like yo, ion the claims process for years,know how to prepare a 4138 or a cobver letter that highlights the submissions as to their relevance to the claim.

"Why does the RO grant 10%, than order all the C&P's to determine what the disability should have been granted in the first place, unless it is to cheat you out of the decade retro you’re entitled to?

I feel after the BVA ordered the RO to rate the claim they granted, the RO should have requested the C&P's than rate according to the findings of the examiner. My SO completely disagrees."

Something is wrong there but then again- many advocates have noticed the big push is on with the VA to get claims resolved faster.Secretary Shenseki is certainly behind the big push.

But Faster doesn't necessarily mean -done right.

It almost sounds like they are using the Bilmes idea H VAC Testimony)-award something then figure out later on if the rating is correct.

John and Terry are right- have a sit down with this guy in the poffice where the POA files are and ask to see the file he has on you.You have a right to see it. It should contain what he did submit and what he didnt and also -getting a copy of your own C file can be invaluable.

If he withheld probative evidence that would have impacted on your claim- go to the highest person in his org,with documentation of that, and complain.

[Berta]

PS - I based my opinion that claims 'seem' to be moving faster on a few factors-and wanted to mention that per the VA Morning Reports on line -although the incoming claims seem to have grown by over 40,000 filed from May to June 2010-

the percent of claims that are pending over 125 days seems to have gotten lower.

http://www.vba.va.gov/reports/

You need Excel Spreadsheet to read this info.

Also these reports seem to question the amount of "million" claims in the VA system. ?

The VA has done some work at their web site and I had to email VACO to find the actual regional office's Monday Morning Reports as to their claims stats.Hope they email me back with the link.

Also vets with claims filed under the three new AO presumptives are going to be part of a new automated claims process.Hopefully for a faster decision.

Larry Scott in reporting this news at VA Watchdog raises the question do you want to be denied by a person or by a computer? or words to that affect-I forget exactly how he put it-

but what gets me-is since Sen Webb put the stall on the new AO claims, they should be in fact so EASY to award that a good rater could be able to award and rate them maybe even faster than a computer program that is supposedly to select specific items that are within the med recs etc that would show diagnosis and lead to a faster award (if exposure is proven)meaning they can determine fast if the veteran served in Vietnam.(I guess other claims for exposure outside of Vietnam would be denied by the computer program)???

If the vet has the diagnosis of a new presumptive, and proven exposure-the only time consuming factor would be a proper rating and even that- in the case of the 3 new pesumptives- should not be difficult task for a rater.But I wonder how a PC program would really be able to rate these conditions. ?

I guess the C & P exam results will be automated too ????

[JR Reihs]

Allen,

Not only would I have a face to face with the SO, I would also get my own IME or IMO on the shoulder since the VA has acknowledged it is now a SC injury.

I went through this crap when I was dealing with the VA, as I had a shoulder issue the RO acknowledged but the C&P doc would not...I went to a private ortho and got his opinion and also his rating, sent that in with appeal, got another C&P with the same doc, got the same results, got sent back again to the same doc.......I got the "What are you doing back again, I sent my reports in".....I ask the C&P doc if he had ever read the IMO from my ortho, he stated no it was not in my file...I got the file off the desk, within 30 seconds I found the report and handed it to him......Got the "Hmmm" reply, no exam, but his next report was more likely than not, and it was rated....The rating was low-balled,and was not what my doc said it should be, but since it was included with the IU award I did not appeal it.

IMO, I would take the award letter to a private Ortho so that you may get a fair rating from the RO, since that is the issue they want resolved.....10% on the issues with your shoulder is LOW. You have been fighting these turds for a long time, I would not leave this issue for the VA to resolve alone.

[Berta]

Jeff-that is good advice!

I commend you for making sure the C & P doc read that IMO.If they did that more often maybe those C & P results for many vets would be different.

My former rep was supposed to ask the DRO to make sure the VA doc had my IMos ( 2 at that time).He called me after this conference (it wasnt a DRO hearing-this conference occurred occurred because I asked them to CUE themselves and they did-because the first DRO review didnt mention the IMOs.

The rep assured me that the C & P doc would have my IMOs.

Funny how they never were mentioned by VA up to that point and even though he said he gave them directly to the DRO to make sure,if lost, they would now be considered-they disappeared from the C file again.

All of that is history because I sent them (3 IMOs by then) to the BVA and the BVA awarded .

It just goes to show we need to trust ourselves on this stuff.Many here said I should have gone to the VARO for this conference myself to make sure the IMos got into the record.I had known this vet rep for about 16 years and had a great deal of confidence in him. They were right.

The SSOC I got indicated to me that the rep had lied.I sent a copy of it to his boss and to the OGC.

In person hearings and also face to face dealings with a SO or vet rep can do wonders.As well as bringing independent medical evidence to a C & P exam!

Edited July 5, 2010 by Berta