Flash- Va Told Not To Order Exams

[harleyman]

This is an informational post. I hope it gets into the proper hands, as this will most likely result in many confirmed and continued or denials of claims over the next 4 to 5 months.

As a VA Regional Office employee who processes claims for Veteran’s, I want you all to know I am appalled and EXTREMLY upset about the following information, I am passing on to the HADIT members. This is not B.S., and you will note I have been a HADIT follower for quite some time.

AS MOST OF YOU ARE AWARE:

1. There was a Mandate from VA (spurred by our US Congress to process all claims files older than July 1, 2011 by June 18^th 2013. Basically all other claims stopped being work except high priority special claims unitl these old claims were processed, (there are always exceptions for one reason or another but even the Special Ops team was processing all their older claims.) Basically, the RO’s succeeded in this mandate.(Please remember these were very old claims and most of them had exams in the file already and we were waiting for other information in processing these claims, or the Veteran had added new issues that needed due process be sent to the veteran before a decision could be made.)A lot of technical issues, more than lack of evidence and these claims also took a back seat to the RVN Agent Orange Mandate.

YOU MAY NOT BE AWARE:

1. Approximately the first of July, VA Corporate Offices came out with another Mandate to further reduce the backlog of pending claims. They instructed the Regional Offices to have their VSRs and RVSRs review all pending claims with dates of claim from July 1, 2011 to November 30, 2012, for necessary C&P exams. The exam reviews were required to be done prior to July 15, 2013. (In effect one month to review 1 ½ years’ worth of pending claims). A monumental task to say the least, and I guarantee not all these c-files with pending claims were reviewed). Nonetheless….

THIS PAST WEDNESDAY, OUR REGIONAL OFFICE EMPLOYEES WERE TOLD TO STOP ORDERING EXAMS. RATERS ARE TOLD TO RATE THESE CLAIMS ON THE EVIDENCE OF RECORD OR COMPLETE PROVISIONAL RATINGS.

THIS IS SIMPLY UNACCEPTABLE MY HADIT FRIENDS. WITHOUT EXAMS TO ESTABLISH A NEXUS YOUR CLAIMS WILL BE DENIED. AND YOUR CLAIMS FOR INCREASE WILL BE CONFIRMED AND CONTINUED BECAUSE YOUR TREATING DOCTORS AT VA DO NOT DO RANGE OF MOTION TESTING AND FILL OUT MANDATORY DBQ EXAM FORMS TO DOCUMENT WORSENING CONDITIONS. THEY WRITE SCRIPTS!

I predict from now through December you will see an unprecedented amount of DENIED and CONFIRMED AND CONTINUED claims. I also believe, this to be an opportunity for those Veteran’s who have private insurance or who can afford it, to get their IMO and IMEs to VA , BECAUSE once the word is out that VA is not doing exams, your evidence from your private doctors will be even more important, AND WILL PREVAIL greatly in the INEVITABLE CLAIMS APPEALS process.

I know this is a lot to take in right now. And there is a lot of crazy rationale from Corporate Offices on this, but Veteran’s deserve better than this from our Government.

This in my opinion is an attemp by VA, to manipulate the stats and make it appear to the public Veterans are being served. This is truely an injustice, I pray those of you who have the ability to contact your Congressmen and let them know you deserve opinion and increase exams to support your service related conditions and disbilities. Thank you for reading this.

Edited July 20, 2013 by harleyman

[Valsacar]

I could see this being good, if it was done in this manner:

1. Rate based off of what you have right NOW. Give what you can guarantee the veteran is due based off service records and anything else present in the claim.

2. Give veteran those benefits they you just confirmed they have.

3. Order C&P.

4. Re-evaluate with the new information.

5. Pay veteran back pay for any conditions now SC, or increases to those that were approved in step 1.

If this is how it is done, I would say it's a good step. I get some benefits quickly, and get everything I'm due a little later.

Think of it this way, I injured my back in service. They can tell from my records that I have a herniated disc (diagnosed in service) with pain. They can give 10% for that, ROM could make it higher but we're not waiting for that before awarding benefits. I also have sciatica down the right leg, records show that it's severe pain, but no mention of muscular atrophy. We can say that's at least a 30%, it might be more so we'll give it 30% provisionally.

Now I am able to go to the VA hospital and get treatment I need for these conditions, treatment I may not have been able to afford before. I'm happy, I'm getting my treatment and if it takes them 2 years to give me what I truely deserve (with back pay) so be it. The most important part of this whole system, in my opinion, is I can get treatment without going bankrupt doing it.

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Now, that said... I have zero faith that this is how it is being done.

[harleyman]

Valsacar says;

I could see this being good, if it was done in this manner:

1. Rate based off of what you have right NOW. Give what you can guarantee the veteran is due based off service records and anything else present in the claim.

2. Give veteran those benefits they you just confirmed they have.

3. Order C&P.

4. Re-evaluate with the new information.

5. Pay veteran back pay for any conditions now SC, or increases to those that were approved in step 1.

If this is how it is done, I would say it's a good step. I get some benefits quickly, and get everything I'm due a little later.

Think of it this way, I injured my back in service. They can tell from my records that I have a herniated disc (diagnosed in service) with pain. They can give 10% for that, ROM could make it higher but we're not waiting for that before awarding benefits. I also have sciatica down the right leg, records show that it's severe pain, but no mention of muscular atrophy. We can say that's at least a 30%, it might be more so we'll give it 30% provisionally.

Now I am able to go to the VA hospital and get treatment I need for these conditions, treatment I may not have been able to afford before. I'm happy, I'm getting my treatment and if it takes them 2 years to give me what I truly deserve (with back pay) so be it. The most important part of this whole system, in my opinion, is I can get treatment without going bankrupt doing it.

Now, that said... I have zero faith that this is how it is being done.

Response:

I appreciate your optimism. And your hypothetical is good. However: there are so many variables involved in rating cases, I predict a high percentage of denials and C&C’s. Because,

Most Veteran’s prior to the recent OEF/OIF did not file a claim for benefits within one year of discharge. That is the magic number for presumptive to service conditions ( AO, or Gulf War syndrome claims notwithstanding).

Claim for a New condition Example One:

If a Vet files a claim within one year of discharge, per RO policy, the Veteran receives an automatic General Medical Exam for any and all claimed conditions. And service connection is easier, because you have a condition in service, the exam then shows the condition remains after service, which this shows chronicity and service connection is warranted because it was found within the one year of discharge or it was documented to still exist during the one year following discharge, no opinion is needed. This would be a likely grant, as no opinion to link in needed, unless the exam shows the Veteran does not have the currently claimed condition.

Without an exam it would likely be a grant at “0” percent. As you have to have subjective findings on exam to warrant a percentage. The “0” percent could be claim as a new claim for increase if the Veteran knows to request an increase in a new claim. It has been my experience that when a Veteran’s get a grant of “0” percent, they think it was denied. Most Veterans are not as smart about VA has those who are members of HADIT.

Example Two:

If a Veteran files the same claim more than one year from discharge, he does not get the automatic general medical examination for his condition. In this scenario, let’s say, he does not have recent treatment for the claimed condition, he will not be afforded a C&P exam, so there is no chronicity of treatment and no NEXUS as there is no opinion, hence the claim is denied.

Example 3:

If a Veteran files the same claim more than one year from discharge, and he had treatment in service and he has received sporadic treatment since discharge, but he does not get a current exam, he does not have an opinion stating the condition while in service and the currently diagnosed condition is a continuation of the condition while in service, thus no nexus, the claim is denied. The examiner has to opine saying the condition is as likely as not related to the condition while in service. No exam means a No opinion, the claim is denied.

“The three scenarios I mention here are why I said this might be a good opportunity for Veterans to get their IMO and IME in as evidence”. Veterans are going to need someone to provide the link/ nexus. Since VA won't a private IMO, IME will fit the bill and hold up in court.

Since these claim are older claims, I would venture to guess, most of these claims or claims which were opened after more than one year had passed since the veteran’s discharge. They will fall under the number two and number three scenarios above.

These are very basic examples. Having an examination to determine the extent of a disability, and to have it linked to service if it “should” be linked to service, is a right the Veterans should not have to lose because Corporate Offices want their stats to look good. We owe our Veterans more than that. We need to do it correctly the first time. - JMO

Edited July 20, 2013 by harleyman

[harleyman]

Another example,

Five years following discharge, a Veteran notices his hearing is getting worse. He never went to the doctor for a hearing exam, he knows his hearing is worse because his wife says he is talking really loud and she has to ask him to turn down the TV all the time. Currently he works in an office and is not around loud noise. He thinks his hearing problem must have been do to the gun fire and loud noises he was around while in service, and he suspects he does have a hearing loss due to service.

The Veteran never went to the doctor or audiologist about this, as he was not in pain and he has been able to work, and as it was not really a problem unitl recently. He files a claim for hearing loss with VBA, but has no treatment records to submit in support of his claim. The VA looks at his claim, and sends it to the rating board as ready to rate. (remember no exams are being allowed). The rater gets the claim, there no evidence of chronicity of treatment, no evidence of a currently diagnosed condition, so the claim is denied.

You be the judge, is this right? Because this IS what is being done to Veterans with this new policy. Granted this is a very simplistic scenario, but keep in mind most claims at the VA include hearing loss and tinnitus. How much money is the government going to save by prematurely processing claims without affording Veterans examination for thier claimed conditions.

Edited July 20, 2013 by harleyman

[OSC]

Of course the jury is still out on both my appeal and claim but if it had not been for a new C&P the VA had ordered for me, I would never had stood a chance for approval because this is where my Nexus finally was done.

If no new exams, then the decision will be made with the evidence at hand, in the Vet’s record with no chance of an exam being added that might SUPPORT that claim.

Hopefully this is just a temporary move.

OSC

[harleyman]

The examination policy currently being applied to claims that have a date of claim filed July 1, 2011 through November 30, 2012, are already being affected. I guess the only way to judge will be by the number of denials, c&c, "0" grants we see over the next 5 months. I believe if this policy is allowed to stand, it will become the standard, rather than a temporary policy to clear pending claims.

Alot of Veterans will not re-file thier denied claims because they figure whats the use. It's certainly will save the government alot, by not having to pay compensation payments to deserving Veterans.

If this policy continues, Veterans trying to become service connected for service related conditions will have to hire and pay for private exams and reports in support of thier claim. Usually, Veterans do not have the income for that kind of medical evidence and usually Veterans are "ill" and cannot work to pay for such evidence, such reports of findings with medical opinion can cost upwards of 2, 3, 4 thousand dollars.

And don't be fooled by one minute and think the government officials don't already know Veteran's incomes are limited.

Edited July 20, 2013 by harleyman

[Berta]

Harleyman! THANK YOU!!!!!! You sure assessed the ramifications of this new crap well.........

Is this in a Fast Letter or Directive that us advocates can get a hold of?

I wonder how soon this info is going to get to the lawyers out there who represent vets, let alone the major Vet orgs like AL,DAV, VVA, VFW......

This is absolutely absurd.

Sometimes I think I have seen it all, but then the VA surprises me with something else....

This isn't Due Process,

it is a Denial process.

"Hopefully this is just a temporary move.

OSC"

I have no optimism like that at all.

Where was this bogus VA idea in the Federal Register for Public comment?

Arent they (VA) supposed to propose changes this radical ,to amend 38 USC and CFR, publically, in the FR so that we can comment on or gripe about them... even if they are "temporary"?