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Varo Swamped

Guest jangrin


Guest jangrin

Good Morning,

When a doctor is certified by a state,e.g. (california) to do a QME/IME, the doctor has to abide by certain guidelines. If he doesn't he will loose his certification to perform the examinations and then he will loose money.

Depending on the amount of time the doctor spends with the patient doing the exam and the complexity of the case, how many body areas or systems are involved, how many patient records ( and by how many, they measure how thick in inches the file is,determines how much the doctor is allowed to bill for his exam and opinion services. They can bill from $300.00 to $1200.00 and more for one exam and report.

This is for workers compensation. Social Security contracts with certain facilities for doctors supposedly by the doctors area of specialty. They are also compensated by complexity on a case by case basis.


The way I understand the VA system, the VA raters or claim determination person is paid the same, no matter how complex the case is, how old, how many body systems, how many doctors involved, how many records there are, an on and on.

If I remember right, I think I read somewhere that the raters are given 4 to 5 new cases a day!! Now that doesn't seem like much when you think about it on the surface. But if we look at it a little closer I think we will find that this can be a very difficult kind of work load, if they are expected to do a fair and just review of records and research and then render in writing a determination for the veteran.

One thing over the past few weeks that has sort of stuck with us was, when Dr. Bash gave my husband the QME to mail in to the VA, he told us to only mail the copies of my husbands records that he (Dr. Bash) had attached to the report. I asked him why-I said you reviewed all the records wouldn't we want all the records with the report? His reply was, we want to keep it simple and we don't want to confuse or overwhelm anyone. He expressed that the feedback he had been getting lately is that the claims people are just over-the-top with the work load on some of the claims and to try to simplify things, is better.

Now I'm not a doctor, but I worked in a doctor's office for a lot of years. And the doctor I worked for did those QME reports for the state. I will tell you, as the doctor got older and lets say less motivated about "saving the world" and being human and wanting to have a life away from being a doctor, things have a way of changing over time.

Those QME exams, they still happened, and reports were written. But, in all honesty, the less complicated exams and reports got done first. The complex, well, they sat on the shelf for awhile. And the ones that were over 5 inches thick. Well, they sat and sat and sat, because the review of records and sifting out duplicates and figuring dates of when who saw who and diagnosed what, well they got so complicated that it would take hours and hours.

The point is ...some of the reports just didn't get done because the records were overwhelming. And you knowwhat else, those records came in before the exam usually by about a week ahead of time. But they didn't get reviewed sometimes until just a few minutes before the exam. He would read the request and what needed to be evaluated but the records themselves, they really didn't get reviewed until after the exam.

Now if the report didn't get written for a few weeks after the exam then maybe things weren't quite as fresh or vivid as they might have been in the doctors mind by the time he got around to writing the report. Had the records been organized before hand by the insurance company to make it easier to render an opinion I think those reports would have been out alot faster.

I believe that this is what may be going on at the VARO. The BVA, maybe not, because it is reviewed by the judge and the clerks have to organize the file before hand. But at the VARO I think the claims people have that responsiblity, if they do it at all. The reason for no VCAA letter is because they are having a hard time deciphering the veterans multiude of medical records.

I think my husband got VCAA letters becaused my husbands medical records file for the last 38 years consisted of about 35 sheets of paper. Alll records with the exception of radiographic reports were from the VA. Even though he claimed multiple systems to DMII, his records were "thin".

I don't know what the solution is, maybe someone else has some ideas in trying to organize the C-file somehow. Maybe you all have some imput on how each of us could get our c-file and index it or make a table of contents or a timeline-anything to aid in simplifying the records organization, I believe could make a big difference. ANY SUGGESTIONS--What do you all think? Could this be a valid problem in long waits at the RO?

Just my personal thoughts on this.

Jangrin :D

Edited by jangrin
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Guest jstacy

Jangrin, I like your idea about organizing the C File.

I have done ecactly that but it took about 7 months.

The first thing that needs to be done is to obtain a complete copy of the C File and service record.

Go to Kinkos and make 2 additional copies, ( kinkos is cheaper than burning up 4 of 5 40 dollar cartridges on printer at home.)

If you have excel make a cover sheet and a second sheet.

Outline and number each issue on the cover sheet and hand number each page of corresonding evidence from the C File, Servide record, Med record.

The submit the entire package to the VSR and the RO. Explain this is not new and material evidenc just a tool to assist the VA in the adudication of a claim

Keep coies in 2 places. One at a desk and one in a fireproof safe. If you are applyinf for IU explain you did the work and not the Veteran because if the Vet can do this, Then they will deny the Iu for being able to comprehend the complex issues and summarizing and will label you as employable.

Hope this helps and if you need assistance, Please feel free to shoot a personal message.

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