donna68 Posted February 15, 2012 Author Share Posted February 15, 2012 justrluk, regarding the strong, mission driven justification you recommend for denials is the same for grants and it is called a law or regulation and in this case it is the 38 CFR. Check it out, I think there is a link on this site. Hearing loss this is an example that I see on this site a lot, veterans are upset because of a denial for hearing loss. The law says the veteran must have 1 frequency from 500 to 4000 hertz at 40 decibles or higher or 3 frequencies at 26 decibles or higher or a speech recognition score of 94% or lower . Thats the law. So if the veterans test dont show any of the above, the staff must deny the claim for hearing loss. Its that simple. Even though the the fact is the veteran may actually have difficulty hearing or have "hearing loss", but for the VA the numbers have to meet the criteria. Knees-I see alot of veterans upset because they only got 0% for knee or back conditions. The law says that during the C&P examintion, if the examiner observes and notes evidence of pain with range of motion, then that warrants 10%, but if the examiner doesnt note pain or if the veteran doesnt state the range of motion exam was painful and their range of motion is not greatly decreased the staff can only grant 0% and if the examiner doesnt give a diagnosis, the staff has to deny the claim. Link to comment Share on other sites More sharing options...
Computer Tech Posted February 15, 2012 Share Posted February 15, 2012 Donna, I must have gotten the one guy at San Diego whose motto was deny if you can because San Diego denied my DMII due to herbicides despite me submitting proof that I had received from Kurt Pressmen that AO and the other herbicides were used on the perimeters of the air bases and army camps, and I sent proof that I worked near the perimeter (I wonder if 100 feet from the perimeter fence is near) I even sent pictures showing AO drums. The VA's response was "you couldn't have been exposed to herbicides as you served in Thailand not Vietnam and herbicides were not used in Thailand." Their response to the pictures was,"the VA has no medical evidence that the toxins contained in the drums in the pictures submitted causes DMII." Needless to say that I filled a NOD on the claim and awaiting a decision. Rick Link to comment Share on other sites More sharing options...
justrluk Posted February 15, 2012 Share Posted February 15, 2012 justrluk, regarding the strong, mission driven justification you recommend for denials is the same for grants and it is called a law or regulation and in this case it is the 38 CFR. Check it out, I think there is a link on this site. Hearing loss this is an example that I see on this site a lot, veterans are upset because of a denial for hearing loss. The law says the veteran must have 1 frequency from 500 to 4000 hertz at 40 decibles or higher or 3 frequencies at 26 decibles or higher or a speech recognition score of 94% or lower . Thats the law. So if the veterans test dont show any of the above, the staff must deny the claim for hearing loss. Its that simple. Even though the the fact is the veteran may actually have difficulty hearing or have "hearing loss", but for the VA the numbers have to meet the criteria. Knees-I see alot of veterans upset because they only got 0% for knee or back conditions. The law says that during the C&P examintion, if the examiner observes and notes evidence of pain with range of motion, then that warrants 10%, but if the examiner doesnt note pain or if the veteran doesnt state the range of motion exam was painful and their range of motion is not greatly decreased the staff can only grant 0% and if the examiner doesnt give a diagnosis, the staff has to deny the claim. donna68 - Well said. The law is our standard and should be the standard by which we submit our claims. Without the evidence required, we make it easy for the VA to deny. Knowledge is power - especially when it comes to the claims process. Link to comment Share on other sites More sharing options...
donna68 Posted February 16, 2012 Author Share Posted February 16, 2012 Computer Tech, Sorry they dropped the ball. Was it a Nehmer Case. It may not be a denial based on the staff not being on board with the pro-veteran mentality, it may be an issue with the correct information being disseminated from the top management. Which hopefully, most people on this site undersatnd is a common occurrence with government employers. It is my understanding that the staff have a list of bases (non-vietnam) and ships and if the base your were stationed at or perimeter is not ont the list, they dont have the grounds to grant the claim so they to deny it. I think a new list of bases outside of Vietnam came out within the last 2 months, since VBA adds bases as cases like yours become more prevelant. R U aware of the list? If you have it or can access it, I suggest that you send it with a VA Form 21-4138. Hope it all turns out in your favor, but as I just mentioned to retiredat44, who is also in the San Deigo area, they are backed up in appelas 2 years.... Link to comment Share on other sites More sharing options...
Computer Tech Posted February 16, 2012 Share Posted February 16, 2012 Donna,; no it's not a Nehmer case as you have to have been Vietnam to be considerd a Nehmer case. In their defense even though I didn't get the decision until Oct 2010 I believe that the decision was made earlier in the year most likely before the C&P direcrive about Thailand was issued in May of 2010. The Va has acknowledged that herbicides were used on the perimeter of all of the air bases and Army camps, they say that herbicides were not used on the interior of any of the bases or camps but the entire time I was in Thailand the grass around my hotch was brown even though it rained almost every day. My concern is that they did not consider any of the evidence I submitted in support of my claim nor was it noted as being considered when they listed evidence used. And I know that it was in my c-file as I got a copy of my c-file and it was there. Of course I resubmitted everything when I sent them my NOD in Aug 2011. LOs Angeles is my usual RO and I think that their appeals are baglogged even more, I've had an appeal for my knees in since Oct 2010 and my IHD claim since Nov 2011. Rick Link to comment Share on other sites More sharing options...
HadIt.com Elder Chuck75 Posted February 16, 2012 HadIt.com Elder Share Posted February 16, 2012 I still firmly believe that denials should result in fewer points than an approval. Has to do with the difference in the way an approval gets through the system. The law requires the VA to be an advocate of the veteran, not a devil's advocate. Unfortunately, many veterans find the opposite to be true. In past years, there was some relation between the fiscal year and claim approval rates. I don't know if this is currently the case, as new presumptives, laws, etc. have changed things. Chuck75, I agree with your comment that pushing OT creates issues like burn out.... As far as denials, It is my understanding that San Diego's motto is "grant if you can, deny if you have to". They tend to take a pro-veteran approach. Though some staff may not be on board with that approach, there is a law that must support their denial As far as taking credit for denials, prior to the new SNL Rating Decisions, a write up for a denial required much more supporting information than a grant, hence more work! With the new SNL system, it looks like unfortunately there may be more denials based on inadequate examinations, but grants will be granted at a higher percentage for many conditions or issues, like migraines and mental conditions. As for taking credit or earning points, staff get points based on issues rated or developed, not the amount of claims or cases, ie asthma is 1 issues, tinnitus is another issues, so if a veteran claims asthma, tinnitus and lumbar spine strain thats 3 issues or 1 point. It takes 8 issues to earn 2 points, 16 issues to earn 3 points and each day a staff must earn about 3.5 points depending on thier pay grade.What alot of people on this site fail to understand is that there are laws or regulations that staff must follow (links are on this site) and if the staff fails to follow the law or interpretates it incorrectly, the veteran can appeal. Yes, appeals are backed up 2 to 5 years depending on the city. I know first hand, my appeal is from 2008, and Im still waiting. Notorious Kelly, u r welcome! Link to comment Share on other sites More sharing options...
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