How Do You Know Your Medical Evidence Is Adaquate?

[Hoppy]

In the most recent case, my focus on the vague comment "recent months" and the failure of the examiner to address the issue that there were known episodes of PAT triggered by exercise is no accident. I have previously made comparisons between the way claims are adjudicated under workman's compensation and the VA. What I learned when working workman's comp and civil cases is that when a doctor uses vague terminology or fails to address an issue it is no accident. Doctors are very capable of focusing on the issues and using clear descriptive terminology. Vague comments and avoiding issues are the way a defense report buries the truth. The doctors in the workers comp system become specialist in writing defense reports. A competent attorney does not seek reports from doctors who jump sides. The doctors who work labor law cases know that their reports will be reviewed by a doctor hired by the plaintiff's attorney. They are very careful not to make statements that are easily rebutted. They are masters at using words to disguise the truth. There are no laws preventing the VA from hiring examiners who previously specialized in writing defense reports for workman's comp.

Every case ever rated in the entire history of the VA should be mandatorily reviewed to re-evaluate the quality of medical exams used for rating purposes. The VA is a second class system by design. The biggest flaw in the VA system is that cases are adjudicated by doctors chosen at random by the VA. No worker's comp attorney would allow a claim to go to court with a lone vague and weak report written by the employer's doctor or a doctor chosen at random. Veterans file claims and when they are denied they usually want to get on with their life rather than fight a bureaucracy they do not understand. It is not that they do not have a case. The problem is that they were given a second class system when the congress decided to set up a non adversarial system and rely on the opinions of doctors who they presumed would be fair and impartial to veterans.

Unfortunately, my knowledge base is limited to psychology, back injuries and skin conditions. I will offer my opinion on the medical merits of these types of claims no matter how unqualified other posters might think I am. I have had way too many successful results to be intimidated by some of the raters and SO's who have posted to this board. 71M10 I am not talking about you. Our little misunderstanding was nothing compared to other posters. I am talking about a retired rating specialist from Chicago who argued with me, the late Alex Humphries and Clark Evens that the medical evidence in my angioedema claim "was a loser". There was another rating specialist and service officer who thought that I did not know anything about the medical issues in several claims that were eventually awarded.

Edited December 12, 2011 by Hoppy

[Capt.]

Hello Hoppy,,,,, There is no mistake about it. You are one of the" leaders" here. Your tireless searches of BVA and Patient records , VA denials almost always show there is a fault somewhere that needs to be addressed. I am not sure of what has gone on with some of these other folks that are not happy with Hoppy and your decisions , but maybe it just needs to thought of as.........hmmmmm...."background noise" . Like in a restaurant that is crowed and you have to lean over your table to speak to the person next to you. Just full steam ahead and know that your expertise has helped most of us here.

I think your post brings up several important issues. Vagueness is almost always an issue especially when the Progress Reports and or Examiners in Cand P note things that are incorrect.

As Wings brought up about correcting it as a CUE , It makes the most sense. I have so many issues that are incorrect listed on my reports. Such as chest and neck and arm pain ......because I was kicked by a deer.........End result , after 5 years I had a heart attack. I don't think being kicked by a deer will quite hold up in court. But can still get a stall VA denial. No reports entered or taken seriously when they finally did....like Atherosclerosis and CAD diagnosis. 2 separate reports too. Part of my basis for a Malpractice suit. Yep that was some kinda deer.....actually it was a fawn...lol.

Having Progress reports like Former Heavy Smoker but under that sentence is Mother died of lung cancer....... Like do you think maybe my Mother was a fformer heavy smoker and died from lung cancer. All of the other reports show that I did not smoke. These Progress Reports are a "Melting Pot" for the VA Regional Office and they use it for all they can. Reaching for those golden straws. Anything to get a denial ,,,,, anything to delay.

More important ,,,... It takes MONEY to fight them . The Veteran almost always has to obtain a good IMO to point out the errors of the Progress Reports , Faulty C and Ps , and VA Remands and Denials per say. It takes great time and effort for the Veteran , or his lawyer or Rep to be able to put together the discrepencies corrections. What does this mean for the Veteran ......TIME and More Time. Some of the Vets just don't have much time left. The VA knows that in most cases and a denial on any claim means years of waiting.

"avoiding the issues and burying the truth"...... you nailed it on the head Hoppy. Thats what works. Many Veterans here are frustrated ......me too...... many complain of the reports being lies or inaccurate or both.......me too....... many Veterans are tired of how long it takes to get VARO to even get the C and P exams ordered.......me too. And then the Progress reports are wrong , a mistake in a medical SMR, a C and P examiner who has never seen you before until that day, can destroy all the work the Veteran has done to present a claim properly and have it totally messed up.....still waiting if I can say me too on that one. But probably so .

Hoppy again you are on track about the Veteran filing his claim..... getting denied . The Veteran wants to move on with their life but it is a second class system because of Congress as you pointed out....... Yes if it was a nonadversarial system as it is suppose to be then the backlog would automatically take care of itself. It is kind of an oxy- moron. It is nonadversarial until you get to court.....which in most cases should never have happened if the VA , the reports, examiners, doctors would just be fair or in the worst case senario just correct their mistakes to reflect the truth.....and not bury it under the beaucreacy as you pointed out. I will post more C and P exams results as I get them in so lets see how accurate they are.

Hoppy , your one of the good guys ...you wear a white hat and ride a white horse so remember that . You are needed here . Alot of Veterans need your help . I am one of the Happy with Hoppy crowd. Just remember as always .....NEVER GIVE UP. God Bless, Merry Christmas . C.C.

Edited December 14, 2011 by Capt.Contaminate

[71M10]

Greetings all:

How will you know if your Medical Evidence is Adaquate? I guess the ultimate proof that your medical evidence is adaquate, is when the VA disappears it!

Unfortunately we cannot find out if our medical evidence is adaquate until someone actually reads it. My experience is the at the RO they won't read what you have sent them until you have a DRO hearing and actually read your evidence into the record. Then it is a crap shoot if they are actually going to understand it and properly relate it to the governing laws and regulations. It seems they ignore favorable evidence and statements until things get to the BVA, then they try to discount the value or discredit it. What amazes me is that after doing this for so many years, they really haven't gotten good at it. They really are still fairly dependent on Veterans getting discouraged and giving up. To date, I havn't needed to get an IMO ( think that may change on these last two issues), the work that many of these C&P examiners do is so poor and riddled with inconsistancies, I have had no problem getting a new C&P in the DRO process and have had good success forcing them to recognize their own test results. I am lucky that much of what I am rated on is fairly objective criteria(excluding how a physician can really effectively read A gioniometer(sp)). Veterans with TBI or psycological issues I think have the largest challenge since what the examiner suposses instead of knows is so important to the claim being rated/granted accurately. In some instances these veterans disabilities preclude them from effectively representing themselves, which leave them to the mercy of service organizations that don't seem to want to do the heavy lifting that is required. Thank God there are people here that are willing to do the heavy lifting. I try to occassionally lift up a dumbell around here(and some of my responses reflect that) now and then, but there are people on this board that are true power lifters that grab on with both hands and snatch issues up and will keep pushing with you until the goal is achieved.

My parting comment comes from an old book on building traps and snares. It describes making a deadfall trap for a bear. The quote is not exact but more of a paraphrase. How much is enough weight? Think of the size of the bear you are trying to trap and put as much weight as you think necessary to hold him, then increase it by three times!

Best regards to all!

[bm6546]

Greetings all:

How will you know if your Medical Evidence is Adaquate? I guess the ultimate proof that your medical evidence is adaquate, is when the VA disappears it!

Unfortunately we cannot find out if our medical evidence is adaquate until someone actually reads it. My experience is the at the RO they won't read what you have sent them until you have a DRO hearing and actually read your evidence into the record. Then it is a crap shoot if they are actually going to understand it and properly relate it to the governing laws and regulations. It seems they ignore favorable evidence and statements until things get to the BVA, then they try to discount the value or discredit it. What amazes me is that after doing this for so many years, they really haven't gotten good at it. They really are still fairly dependent on Veterans getting discouraged and giving up. To date, I havn't needed to get an IMO ( think that may change on these last two issues), the work that many of these C&P examiners do is so poor and riddled with inconsistancies, I have had no problem getting a new C&P in the DRO process and have had good success forcing them to recognize their own test results. I am lucky that much of what I am rated on is fairly objective criteria(excluding how a physician can really effectively read A gioniometer(sp)). Veterans with TBI or psycological issues I think have the largest challenge since what the examiner suposses instead of knows is so important to the claim being rated/granted accurately. In some instances these veterans disabilities preclude them from effectively representing themselves, which leave them to the mercy of service organizations that don't seem to want to do the heavy lifting that is required. Thank God there are people here that are willing to do the heavy lifting. I try to occassionally lift up a dumbell around here(and some of my responses reflect that) now and then, but there are people on this board that are true power lifters that grab on with both hands and snatch issues up and will keep pushing with you until the goal is achieved.

My parting comment comes from an old book on building traps and snares. It describes making a deadfall trap for a bear. The quote is not exact but more of a paraphrase. How much is enough weight? Think of the size of the bear you are trying to trap and put as much weight as you think necessary to hold him, then increase it by three times!

Best regards to all!

My experience, so far, I submitted additional evidence before my claim was submitted to the BVA. Apparently, the BVA didn't read any of it or totally ignored several issues on the BVA remand back to the AMC/RO. How do you get anyone to read any additional evidence you submit. And at what level does someone actually read it.

They expect you to get an expensive IMO, which I can't afford, in order to point out their mistakes and then they totally ignore it. At what point do you go to the DRO and how do you get a DRO hearing?

As far as my VSO, I think they are about as useless as T---s on a bull and pretty much don't want to deal with them anymore. I am very thankful for all the people here on Hadit that are willing to help as much as they can. Without their help I would have given up a long time ago.

I'm just saying.....Brian

[71M10]

<br />My experience, so far, I submitted additional evidence before my claim was submitted to the BVA. Apparently, the BVA didn't read any of it or totally ignored several issues  on the BVA remand back to the AMC/RO. How do you get anyone to read any additional evidence you submit. And at what level does someone actually read it.<br /><br />They expect you to get an expensive IMO, which I can't afford, in order to point out their mistakes and then they totally ignore it. At what point do you go to the DRO and how do you get a DRO hearing?<br /><br /><br />As far as my VSO, I think they are about as useless as T---s on a bull and pretty much don't want to deal with them anymore. I am very thankful for all the people here on Hadit that are willing to help as much as they can. Without their help I would have given up a long time ago.<br /><br />I'm just saying.....Brian<br />

<br /><br /><br />

If you are already at BVA you are past the point where you can choose to have your decision reviewed by a DRO. I have had good luck with the DRO process, but I have had a lot of clear evidence documented in SMR's and VA test results. At one point I had to push very hard for them to do a DRO hearing, they wanted to complete the review with out one. If a person chooses the DRO process I strongly suggest you ask for a DRO hearing. It is one more tool you have to get evidence and your point of view in front of a rater. You can lay your case out for the DRO and even if they didn't read the file they will at least hear you state your reasons and basis. If one chooses the DRO it does ultimately delay going to BVA so it does increase the wait, but if the DRO sees the error, you get a decision much sooner than the BVA process. I see little downside to using it.

When you file your NOD, you can ask for a DRO review, if you do not address the DRO Issue in the NOD VA will send you a form asking if you want to appeal to the BVA, have the Decision reviewed (also called Denovo review), and I think they also offer you the option to withdraw your NOD (only saw form once, askec for review all other times).

Last I knew you were remanded, Have you found an attorney to represent you?

If my final two issues are not approved with the DRO I am going the lawyer route myself prior to my materials going to BVA.

Best regards,

[bm6546]

<br /><br /><br />

If you are already at BVA you are past the point where you can choose to have your decision reviewed by a DRO. I have had good luck with the DRO process, but I have had a lot of clear evidence documented in SMR's and VA test results. At one point I had to push very hard for them to do a DRO hearing, they wanted to complete the review with out one. If a person chooses the DRO process I strongly suggest you ask for a DRO hearing. It is one more tool you have to get evidence and your point of view in front of a rater. You can lay your case out for the DRO and even if they didn't read the file they will at least hear you state your reasons and basis. If one chooses the DRO it does ultimately delay going to BVA so it does increase the wait, but if the DRO sees the error, you get a decision much sooner than the BVA process. I see little downside to using it.

When you file your NOD, you can ask for a DRO review, if you do not address the DRO Issue in the NOD VA will send you a form asking if you want to appeal to the BVA, have the Decision reviewed (also called Denovo review), and I think they also offer you the option to withdraw your NOD (only saw form once, askec for review all other times).

Last I knew you were remanded, Have you found an attorney to represent you?

If my final two issues are not approved with the DRO I am going the lawyer route myself prior to my materials going to BVA.

Best regards,

I have talked with an attorney but they can't take my case until I am denied. The attorney has reviewed part of my case and is helping with any questions I have.

[broncovet]

Hoppy...

I would like to thank you for your contributions. I have a fairly good idea of who the individual(s)you had a dispute with, and happen to know that at least one of these has "taken a break" from posting, largely because he tended to insult anyone who dared to take a position differering from his.

I say "individuals" because this poster has a very large "fan club" with many who vehemently defend his non sense.

This individual claims to have 3 decades experience. However, this is not the case. He does not have 30 years experience, he has ONE year of experience 30 times, as so often happens with government workers. You see, they get stuck in a cubicle and can not see outside of it. This individual reminds me so much of the proverbial eye glass doctor: When his patient complained that he could not see with the glasses he fit him with, the doc tried on the eyeglasses and declared that they worked just fine...he (the doc) had used that same prescription of eyeglasses for 20 years, so surely the patient must be wrong. The "doc" does not "get" that the eyeglass prescription that works fine for the doc, does nothing for the patient but makes him dizzy.