New Evidence After Appeal Started

[Raybob]

I filed an appeal on 3/1/13 for the denial of a compensable claim which had been repeatedly refused numerous times since 2010. I have asked for a personal hearing in DC.

Although the Appeal is dated by the VA as 6/12/13, the eBenefits shows the claim as "Appeal Pending" and "You have initiated an appeal, but at this point your case is still with the local VA office that made the decision on your case. If you have questions about your appeal, please contact that office or your representative, if you have one."

Following telephone confirmation today, next week I will receive new medical evidence that supports my claim -- which adds additional objective detail to evidence already in VA possession (as listed in their SOC).

1. Should I just hold on to this new evidence until I have my face-to-face appeal hearing in DC?

2. Or should I send it into the VARO.

i don't think I want to do anything that will delay my personal hearing longer or start the clock over, but then again, perhaps this could resolve the issue and result in an approval of the claim without the need to wait xxx days for the personal hearing.

Any advice is, as always, appreciated.

Cheers,

Ray

[jbasser]

Never hold it. Send it anyway.

J

[broncovet]

I agree with Basser. There are some circumstances when your effective date will be the date you submitted New and material evidence. Dont delay.

[Raybob]

Thanks for your recommendations, J and Broncovet... I will send in as soon as I get it in the mail.

The initial claim was part of my BDD retirement claim (Dec 2009), so am expecting it to be retro back to my June 2010 retirement date.

It involved a CT scan that was taken in Aug 2010 documenting the residuals of 2 surgeries I had at Walter Reed while on AD.

I just had that same CT scan re-evaluated to get a second, more detailed write up by the Walter Reed Radiology Dept -- all the info and evidence was already in my records sent to VA, but now I have more specific language that "should" leave no reoom for denial of the claim (although, really, there should never have been doubt from the beginning with the medical evidence I submitted -- it is for skull loss, which is hardly a subjective claim).

Cheers

Ray

[Berta]

I would sure submit it and send it marked as Attention to (on the envelope and on the enclosed 21- 4138 or cover letter, and then put the initials that appear in the numeric and initialized code on the VA letter that appears on the right hand side after the RE:

This was the last person (by initial) who worked on your claim at the VARO.

(and send with a Proof of mailing)

[Raybob]

Thank you, Berta!

And I found out something even more shocking today, but am getting the usual VA run around!

Since I was able to go back to Walter Reed and have them issue an Addendum to the original Radiologist's findings on their CT scan, while at the VAMC today, I decided to ask for a copy of the original VA C&P x-ray that had been cited in the SOC and used for all the denials for the past three years.

I had done this once before and was told I could only have the report, so I wanted it noted I asked and they could not supply the x-ray which I would use at my appeal hearing. Well, this time I was told I had to go to Radiology to get a copy! So I did.

I got home, put the CD in my computer opened the x-ray taken of my skull (that was cited as a "normal" skull x-ray) and was shocked! Right there in front of this "layman's" eyes was my skull x-ray showing two separate back circles on the right profile shot of the skull. FYI, I only have one ear!

I called VAMC Radiology to ask if it can be reviewed again, and was told I could not ask and that the Radiologists dont talk to patients. I was told to call my regular VA doctor, but I said he had nothing to do with the C&P x-ray. They then said to call the C&P office. I did, and they said, sorry, we have to be told by the VARO to do something. I let them know that I had two separate C&P exams for this issue in their office and that both had supported my claim, but that the VARO was using the x-ray report to dent it. Well, they then told me to call the VARO, which I expect to also be a dead-end call (hant made that call yet).

Has anyone ever had any success getting VA take a second look at an x-ray? Any advice on how to do that would be appreciated.

Cheers,

Ray

[broncovet]

Generally, the rating specialist is not qualified to interpret X rays. This requires the expertise of a radiologist, whose job it is to interpret Xrays. You might check to see what the radiologist wrote down, and see if you agree with his interpretation. If you do not like the radiologist interpretation, then you can rebut it only with another qualified medical specialist, such as an IMO/IME. If the VA rater did interpret your x rays, that is Cue, as rating specialists are unqualified to make medical diagnosis. Time after time the CAVC puts down raters who attempt medical diagnosis. Even judges are not qualified to make medical determinations and rely on qualified medical personel who are.

Edited August 13, 2013 by broncovet