hypertension Wrong Diagnostic Code On Nod For Request For Increase

[Capt.]

Hello All,

Well to say I am livid may be an understatement but hopefully my problem will be brought to the board as a warning to all Veterans on another tactic that the VA is doing to cause a more delays.

Ok if anyone has an idea I would like to hear it so here goes.

I was rated at 30 percent for COPD and Restricted Lung Disease. Just for the record they are Diagnostic code 6604 and 6845.

So we also have PULMONARY HYPERTENSION which is a 100 percent disability if found by heart cath or by echocardiogram.

Today I was looking closely at my NOD/SOC for a higher percentage because of the Pulmonary Hypertension and it says that I am not entitled because they don't see it in the records. But much worse ,,,,they put down a diagnostic code of 6602 which is Asthma and that is not a disease that will pay 100 percent for Pulmonary Hypertension under the regulations. So they are now in error of the SOC and I do not have Asthma. The award letters show COPD and Restricted Lung Disease which do show under the Diagnostic codes 6604 and 6845 as Pulmonary Hypertension ancillarary awards. Worse than that, in the SOC from Regional office to our NOD for Pulmonary Hypertension, the VA did not even list the Restricted lung disease at all. In the original NOD sent in May we NOD them for a higher rating for PULMONARY HYPERTENSION.

I just sent the lawyer a note on this and am not happy that the lawyer did not find this mistake and am waiting to see what the next move is. This is outright fraud,,,,,on VAs part,,,,,,you cannot get it wrong everytime. Criminal and just plain evil.

How in the world do you get this kind of thing back on track? Calling the 800 line will not do anything and I do not want to do an IRIS because it will come back as a new claim ....their favorite trick.

I guess since it happened to me , this is another tactic for them to use on all Veterans so I better sound the alarm and just say that we as Veterans are our best advocate and we have to constantly make sure that not just our statements and such are correct, but really run over the VAs SOCs and decision letters with a fine tooth comb. Hopefully my mistake by the VA will help others here to WATCHOUT for this tactic of using wrong diagnostic numbers which of course changes everything in a decision.

Just think if I would have not found this mistake. I have the SOC from them and is only about 4-5 months old. So there is a way to get the word out.

Anybody have some ideas here. I do have a lawyer but don't know what that will open for instances. As usual .....NEVER GIVE UP. God Bless, C.C.

Edited January 17, 2013 by Capt.Contaminate

[carlie]

CC,

Some to include you may not agree, especially since you have an attorney -

BUT

Were I in this situation, I would visit my VARO in person ask nicely

and wait for some type of supervisor

and do an in person - on the record inquiry regarding the difference

in diagnostic code usage.

[broncovet]

I found it Cap'n! Its on page 24 DAV Court Citations, under ambigious DC's.

BENEFIT OF THE DOUBT

AMBIGUOUS DIAGNOSTIC CODE RESOLVED IN FAVOR OF VETERAN

§ Where the rating criteria in a diagnostic code (“DC”) are ambiguous, the interpretative doubt must be resolved in favor of the veteran. Otero-Castro v. Principi, 16 Vet. App. 375, 382 (2002) (The Court found that Diagnostic Codes 7005 and 7007 were ambiguous when deciding whether or not a veteran should be granted a rating of 60% based on “a separate showing of left ventricular dysfunction in addition to an ejection fraction of 30% through 50%.”).

APPELLANT’S TESTIMONY MAY PLACE THE EVIDENCE IN EQUIPOISE

§ “The Secretary cannot ignore appellant’s testimony simply because appellant is an interested party. [] Appellant’s sworn statement, then, unless sufficiently rebutted, may serve to place the evidence in equipoise.” Cartright v. Derwinski, 2 Vet.App. 24, 25-26 (1991).

BALANCE OF POSITIVE AND NEGATIVE EVIDENCE (RELATIVE EQUIPOISE)

§ “When after consideration of all evidence and material of record in a case before the Department with respect to benefits under laws administered by the Secretary, there is an approximate balance of positive and negative evidence regarding merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant.” 38 U.S.C.A. § 5107(b) (West 1995).

[carlie]

I found it Cap'n! Its on page 24 DAV Court Citations, under ambigious DC's.

BENEFIT OF THE DOUBT

AMBIGUOUS DIAGNOSTIC CODE RESOLVED IN FAVOR OF VETERAN

§ Where the rating criteria in a diagnostic code (“DC”) are ambiguous, the interpretative doubt must be resolved in favor of the veteran. Otero-Castro v. Principi, 16 Vet. App. 375, 382 (2002) (The Court found that Diagnostic Codes 7005 and 7007 were ambiguous when deciding whether or not a veteran should be granted a rating of 60% based on “a separate showing of left ventricular dysfunction in addition to an ejection fraction of 30% through 50%.”).

APPELLANT’S TESTIMONY MAY PLACE THE EVIDENCE IN EQUIPOISE

§ “The Secretary cannot ignore appellant’s testimony simply because appellant is an interested party. [] Appellant’s sworn statement, then, unless sufficiently rebutted, may serve to place the evidence in equipoise.” Cartright v. Derwinski, 2 Vet.App. 24, 25-26 (1991).

BALANCE OF POSITIVE AND NEGATIVE EVIDENCE (RELATIVE EQUIPOISE)

§ “When after consideration of all evidence and material of record in a case before the Department with respect to benefits under laws administered by the Secretary, there is an approximate balance of positive and negative evidence regarding merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant.” 38 U.S.C.A. § 5107(b) (West 1995).

VERY GOOD POST !

[Capt.]

Hello all,,,,,, Yes Carlie ,,, I think I have to do something . My lawyer will not talk or return phone calls. I have to wait for all these new test and new meetings with ways to try and treat this stuff. I am alittle worn out with this stuff. I think I am going to have to go to the VARO. I also can get a copy of the C and P exams and look at the top sheet and Cfile. To check and see if my lawyer has sent material in. I sure hope that other Veterans are paying attention to what is really going on with our VA and can try not to let what is happening to me , happen to them.

Bronco that is an excellant article and this will help so many Veterans here, not just me. Thank you for that. I want to again thank all the folks here for helping me and I am going to continue to NEVER GIVE UP. God Bless, C.C.

Edited January 21, 2013 by Capt.Contaminate

[meghp0405]

As an example of the "Vet is seeking the minimum" rating senario, the VA has a habit of "awarding" 0%. You rarely see this in the "real" world. I mean, gee. Somebody sues you, and the court agrees you are liable for the debt. So, they "award" $Zero.crap dollars. And they call this a "win"? It skews the numbers. You see, the VSO's count an "award" of 0% as a "win". Lawyers wont do this....can you imaging telling your lawyer.

"Ok, you did a fine job winning the case for me. Now, its payday for you. Im going to write you a check for 20% of what we won...who should I make it out to? Ok, Joe Lawyer.

That's $zerodollars and no sense."

Using this method, the VSO's like to make it look like they are as good as the lawyers. The lawyers know its all about the money, and not about zero percent ratings. There is a remarkable amount of Veterans "collecting" zero percent ratings.

what VSO do you know or that you are aware of that counts 0% as a win? First, this isn't a who won and who lost game? Really? I don't know anybody that "keeps score" You keep mentioning "years ago" well, I can tell you that the VA has changed somewhat from years ago. I am not defending the VA at all, I see the mistakes they make all to often. But, I read your comments and all I read is pure hatred. maybe a visit to the ol doc is inorder??

[Capt.]

Hello Megh and Bronco..... I think I know what Bronco is referring to and do know that 0 percent is still service connected. I also know that ...and you would agree ....that we know or have had VSOs that have messed up our claims or someone elses. Megh you are not one of those types and I wish we had several thousand more like you with your knowledge and care....because we probably would not have as many claims backlogged because of faulty initial claims and NODs. You are a breath of fresh air and I wish you would have had my claim when I first filed it. Right now I need both you and Bronco to be on my side as an Advocate, your some of my heros here. And this board needs both of you ......... because you both care and each one of you is able to express ideas , dig for laws , and help with problems.

Just imagine what is going on with our Veterans who have not had the priveledge to be on Hadit and not get help from so many Veterans such as both of you ........that do care here ...who are willing to try. Helping not just Vets like me but others here and those new ones coming aboard. WOW .....have you seen all the new vets coming onto Hadit......its telling me we all have to pull up our boots because its getting way clogged up at the VAROs and BVAs dealing with claims. That means more answering and researching claims for our Veterans.

I also know its STRESSING ALL of us out because it just is getting so bad. Our spirits are dampened, and tempers getting short because we are all so frustrated at trying to deal with this Leviathan called the VA and the lack of care. You both are trying to help in a big way.

I know that is really what both of you are trying to do and I really need it ...more now than ever. So please understand that I am privledged to have both of you as my friends ,,,,,,trying to help..

Right now lets just think about our most important issue.....our Veterans and try to let some of this go as it is not serving anyone much good. I need you and so do alot of other Veterans and alot of new ones coming. Thank you both for NEVER GIVING UP on me. God Bless, C.C.

Edited January 21, 2013 by Capt.Contaminate