Reconsideration With New Information

[Raybob]

I had surgery while on active duty (retired this June 1st) and during each of 2 surgeries they cut and removed part of my skull (mastoidectomy and atticotomy). Annotations about cutting the skull with a diamond bit drill were in the SMRs I sent in with my original 21-526. During my C&P, they took skull xrays but the xray technician's report stated that the skull was normal. I intend to either file an NOD or request for reconsideration.

During a followup appointment with my ENT doc (the surgeon) last month, I showed him the VA comments. He scoffed and sent me down to have an MRI done which verified (he showed me on the MRI) that I have a 2 centimeter diameter hole in my skull from the surgeries (would be 10% SC based on the size). He also added this comment in my medical records and verified it with the MRI folks.

1. When I re- file with VA, should I request this as a reconsideration or just a NOD?

2. Also, I now have a CD with the MRI images on it. Should I also send that in with my request? ...or

3. Should I just send in the medical record notes where the doctor verified the 2cm hole?

(I am hesitant to send the CD if there is a chance the VA could lose it... not sure to send in or if they reschedule me for a follow-on C&P that I take it with me to that appointment instead. I can always get another copy of the CD though.)

Thanks for any advice,

Cheers,

Ray

[john999]

Raybob

We have a guy here at hadit who won a very large claim based on skull loss. He got massive retro back to the 1970's I think because the VA did not adjudicate his skull loss claim and it remained open for years. Maybe he will see this post. I would probably ask for reconsideration since your in the one year from decision time period. Just remember the NOD clock is running. Show them the evidence. The VA misses these kinds of things because they are not looking at the evidence. Who did the C&P exam? Was it a doctor or a PA or NP?

[Raybob]

Raybob

We have a guy here at hadit who won a very large claim based on skull loss. He got massive retro back to the 1970's I think because the VA did not adjudicate his skull loss claim and it remained open for years. Maybe he will see this post. I would probably ask for reconsideration since your in the one year from decision time period. Just remember the NOD clock is running. Show them the evidence. The VA misses these kinds of things because they are not looking at the evidence. Who did the C&P exam? Was it a doctor or a PA or NP?

John,

Thanks for replying so fast. I saw several (about 8) VA doctors including an ENT doctor, but none of the progress notes from any of the exams mention the skull loss at all... it may have been overllooked by the doctor who was supposed to comment on it. The only comment was written on the xray disgnostic findings by a doctor. It does not even address the question skull loss at all (it does not say that there is no skull loss as claimed), just that 4 skull views were taken and that "There is no fracture of deformity or visible bone lesion. The visualized facial bones are unremarkable, visualized portions of the mandible are intact."

--Ray

[LarryJ]

Send in the recent favorable doctors report/notes. Make a copy of your CD (duh) and send that along with it. Request a DRO review. Make sure that they have recieved all of this, at the same time, making sure that your VA claim number is on EVERYTHING.........even the CD's (Sharpie's are wonderful)!

Edited September 20, 2010 by LarryJ

[carlie]

Raybob,

Was this through the BDD program or a Rating Decision from your VARO.

If it was from a rating decision,just this June then I would submit a request for reconsideration

and submit this additional medical evidence and a copy of the CD with it.

Keep in mind your time clock (one year) for a NOD is ticking.

I would be clear that in response to,

"It does not even address the question skull loss at all (it does not say that there is no skull loss as claimed), just that 4 skull views were taken and that "There is no fracture of deformity or visible bone lesion."

I felt this additional medical evidence clearly establishes that I fully met the criteria for Diagnostic Code 5296 to be directly service connected with at least a 10 percent compensable residual disability, with an effective date of day following

separation.

Here's a BVA case you might want to look at for some verbiage, the part referring to

this vets claim of CUE would not be relevant to your claim at this time.

http://www4.va.gov/vetapp06/files3/0610575.txt

[Chuck75]

Give them a copy of the CD, not the original. If nothing else Office Depot or it's competition can usually make a copy.

The records of the surgery "should" be in your service medical file. Thus predating & documenting your claim.

File at least a place holder NOD ASAP. If you have records of the MRI (copies) placed in your VA medical file, (and an RO actually looks) the records of the MRI should help.

I'd talk to a lawyer or someone with knowledge of the 1151? process. There is a possible case if harm can be shown.

An x ray tech's opinion is not usually considered as definitive in the civilian world. A radiologist's opinion is usually required, even though they may just "rubber stamp" the techs write up.

The VA is interested in keeping compensation to a minimum, even though law obligates them to do the opposite. An effective advocate is almost a necessity.

When the VA starts getting correspondence from a lawyer, they tend to start doing things differently than they do otherwise.

A good lawyer can usually poke very large holes in the VA's handling of a compensation claim.

I had surgery while on active duty (retired this June 1st) and during each of 2 surgeries they cut and removed part of my skull (mastoidectomy and atticotomy). Annotations about cutting the skull with a diamond bit drill were in the SMRs I sent in with my original 21-526. During my C&P, they took skull xrays but the xray technician's report stated that the skull was normal. I intend to either file an NOD or request for reconsideration.

During a followup appointment with my ENT doc (the surgeon) last month, I showed him the VA comments. He scoffed and sent me down to have an MRI done which verified (he showed me on the MRI) that I have a 2 centimeter diameter hole in my skull from the surgeries (would be 10% SC based on the size). He also added this comment in my medical records and verified it with the MRI folks.

1. When I re- file with VA, should I request this as a reconsideration or just a NOD?

2. Also, I now have a CD with the MRI images on it. Should I also send that in with my request? ...or

3. Should I just send in the medical record notes where the doctor verified the 2cm hole?

(I am hesitant to send the CD if there is a chance the VA could lose it... not sure to send in or if they reschedule me for a follow-on C&P that I take it with me to that appointment instead. I can always get another copy of the CD though.)

Thanks for any advice,

Cheers,

Ray

[Raybob]

Raybob,

Was this through the BDD program or a Rating Decision from your VARO.

Thanks, Carlie. Yes my process started thru the BDD process. I filed my 21-526 on 1 Dec 2009, six months before retirement on 1 Jun 2010. I have one year from the decision letter dated 9 July 2010, but now have most of my additional supporting documentation, and especially the recent CT scan from 31 Sep 2010 and my doctor's annotation in my SMR verifying the existance and size of the hole. There are a few more doctor visit reports I am going to pick up next week. So now am working on pulling together this request (and a few others I am going back on that I disagree with). All BDD process claims are done thru a VA office (North Carolina?) that is different from my RO (Philly).

And thanks, that case you attached was great and has some excellent words I can use.

File at least a place holder NOD ASAP.