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Great Claims Advise


Berta

Question

The other day Broncovet made a statement in a reply in a sub forum here that was so important I wanted to copy and post it in Claim's Research but I had satellite dish problems lately and couldn't save it and still cannot find where he posted it.

He made the point that many claimants do not read their decision carefully enough to understand why the VA denied. That ,to me, is the main reason many claims go on and on for years in the appeal process.

I am sure he also made the point that the VCAA letter must be read over carefully. Not just when you receive it but at many stages of the appeal process when you prepare any responses to VA or seek more evidence.

Supplying the VA with what they ask for in the VCAA letter (which might well mean the claim will require an IMO) and carefully assessing everything as stated in the SOC or SSOC, then checking the evidence list to see if something critical was not listed in it, and then to focus on the denial ,word for word ,– making sure the C & P results are properly reflected in the VA's Reasons and Bases.....these are the keys to succeeding in a claim.

One good reason to have a vet rep is that he/she could readily tell if the VCAA letter is deficient and could cause a BVA remand years down the road. Probably almost every VCAA letter is properly prepared these days as the BVA remands due to improper VCAA letters has sure calmed down in the past few years.

The VCAA letter is almost like following a recipe.

If you leave one ingredient out, the result will be awful.

Thanks Broncovet for the way you had put this in your brief post the other day.

You stated in less words then I did here, the main reason in my opinion, that many claims end up in the appellate process for years and still fail :because the VCAA letter was not followed nor did the claimant fully take the time to comprehend the VA denial as to the Reasons and Bases and then adequately respond to it.

And again I need to make this point. An IMO doctor needs to have not only all available medical records ( some claims require that they review the SMRs too),they should also have all SOCs,SSOC, and VA C & P results and prepare the IMO with the specific terms and wording that VA is familiar with, as explained in our IMO forum.

The VA can and will reject any medical opinion, even from the VA itself, that is too speculative.

Following the IMO criteria here can prevent a costly IMO from being rejected by VA due to speculation, because the IMO doctor might not have had all of the medical facts.

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Thanks again Berta, and I will add this. After thoroughly reading and rereading your decision (AND other VA letters such as the VCAA letter),

FIND OUT WHAT THE CRITERIA IS for the rating you desire. If you are seeking compensation for a mental disorder, such as PTSD, the criteria is here:

http://www.vva.org/ptsd_levels.html

If you think you should get a 70% rating, for example, here is the 70% criteria:

"Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships ...................................... 70%"

If you dont know what ANY of these terms mean, then you need to look them up. Then, go through your medical records. If you got a divorce and did not remarry, you can point out that you have an "inability to establish and maintain effective relationships". If you said something to your doctor and he sounded confused, maybe your speech was "intermittently illogical"...etc. Doing this could take hours, or even weeks...but if you got your rating, then it would be worth it.

Of course, never lie, it will come back to bite you. But you can show how you meet the criteria.

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I agree with Berta 100%. I have adopted a policy when the VA sends me a letter. First I read it, have my emotional response (usually irritation, sarcasam, and anger). Then I set it aside and wait two days, then read it again slowly. I find I miss the little things the first day it is in front of me, no matter how many times I read it. Taking a look later after I have ranted and raved helps me to understand thier carefully parsed words and phrases.

Best regards,

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Great points!

Many of us didn't think of this as a legal process when we first applied, but as some sort of medical operation, so we didn't regard it as seriously as necessary to win.

The 'recipe' for winning is in the wording of your denial and, if you're not equipped to utilize that, then it's best to use a VSO and/or attorney to win.

Good luck! smile.png

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The point as to addressing the specific reasons noted for the denial is great.

However, I still have my reservations about this statement. "Probably almost every VCAA letter is properly prepared these days as the BVA remands due to improper VCAA letters has sure calmed down in the past few years."

The problem with most of the denials I get involved with is that the medical evidence is flawed. It can be as simple as a doctor noting one episode per week and ommitting the duration of the symptoms during these weekly events. Without knowing the duration of the weekly events the raters determine the frequency requirements of the rating schedule are not met. Once the duration is identified the claim is awarded. With mental health claims the VA C&P examiners are still making bogus determinations of non service connectable personality disorders and substance abuse disorders. I have seen claims in which the medical evidence was clearly not fully and properly developed. The VCAA letters and duty to assist letters make vague references to the veterans obligation to obtain medical evidence. I still feel the entire system is a second class remedy to disability claims. They would be better off adding an additional requirement notifying the veteran that the medical reports developed by VA C&P examiers are known to be flawed and the medical reports should be reviewed by a clinician of the veterans choice. This might give rise to a stable of veteran friendly C&P examiners.

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many claimants do not read their decision carefully enough to understand why the VA denied.

That ,to me, is the main reason many claims go on and on for years in the appeal process.

The above is one of my biggest beefs when I am trying to help a claimant.

Many, many times they want to obsess about something that was stated

in the decision - but has absolutely nothing to do with the reason for denial

and sometimes a statement in a decision doesn't even relate to the issue at hand,

it's just filler crap (but still important to read and understand).

We absolutely have to concentrate on the exact how's, what's and why's that were applied

to support the denial, lowball or incorrect effective date's of an issue.

We absolutely have to concentrate on what evidence will satisfactorily overcome.

JMHO

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