How To Win Your Claim

[NavyWife]

I can only imagine how difficult the job of a RVSR must be. Even though I was previously a federal worker myself, I wouldn't take that job even if they paid me at the GS-13 rate!!

I think a claim that goes to VA needs to be like a present with a pretty bow on top, everything presented according to their guidelines & rules. Make your claim easy to approve.

What I've learned from reading the VBM is the most important part of your claim is the MEDICAL EVIDENCE. Do not leave the most important part of your claim up to the VA through their lousy, lowballing C&P exams if you don't have to. ( A few contentions do require C&Ps thru VA only). Take control of your claim by controlling the evidence. Then if the rater tries any funny business, you know exactly what the doc said & can prove it.

***Get 2 DBQ IME's for each contention. ***

By getting 2 instead of 1, the RSVR has to dispute 2 doctors opinions & would probably decide that is too much work.

Guidelines for IME/IMO

---Use the DBQ

http://www.benefits.va.gov/compensation/dbq_ListBySymptom.asp

---Refer to the VA rating guidelines

http://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&rgn=div5&view=text&node=38:1.0.1.1.5&idno=38#38:1.0.1.1.5.2.111

---Refer to the VA Clinicians Guide

http://www.vetsforjustice.com/C&P%20Service%20Clinician%E2%80%99s%20Guide.htm

or

http://www.americanbar.org/content/dam/aba/administrative/young_lawyers/project_salute/cc_d1_f1_cp_Pg_1-50.authcheckdam.pdf

Each DBQ must include multiple parts:

1). Diagnosis

2) Statement that Dr. reviewed the pertinent medical records or check the applicable box if available.

3) Nexus Statement from Dr. that says condition X is at least as likely as not due to condition Y.

4) Rationale Statement from Dr. explaining how he came to his conclusion on the Nexus. Must give specific reasons why one condition caused or aggravated the other.

5) Statement from Dr. regarding his medical degree and qualifications--or at least Dr. write up a statement using his official office Letterhead.

On most DBQ forms only #1 and #2 are part of the form. You must have your Dr. write in #3, #4 & #5 if they are not part of the form. I'm NOT saying a DBQ without each of these 5 Items can't be approved. I'm saying these are 5 of the things that if any of them ARE missing, VA has used as an excuse to deny a claim.

Once you get something SC at any percentage, then you can leapfrog to a high rating by putting virtually anything reasonable as secondary to Already service-connected Conditions. For example, any Secondary damage from an injury or traumatic event, any damage Caused by medication for service-connected conditions, any mental health issues Secondary to Service-connected conditions.

Once you get the first claim back, Hold off on filing an appeal as long as possible (up to the 12 month deadline) because appeals can take 4 years. Even a de novo DRO review may take 2 years. Instead file a new FDC for multiple secondary conditions-- with 2 DBQ IME's for each contention.

If an issue you filed for was not rated a high enough percentage then Request an increase and submit new and material evidence. An example of new and material evidence would be a DBQ from a new doctor.

For Direct service connection need to file a Statement of Support listing persistent and ongoing symptoms and stating condition has been chronic. For secondary service connection the condition does not need to be persistent or chronic. Edited to say, "Secondary issues do not need to be persistent or chronic SINCE SERVICE"

For direct service connection doc must state they have reviewed your STR's. For secondary service connection doc does not need to review your STR's--He only needs to review your pertinent medical records and must state that.

Edited October 25, 2014 by NavyWife

[aggie54]

NavyWife,

I just love reading your comments, you make so much sense. I wish my wife was as creative and helpful towards me, as you are to your husband. Your Husband is a very lucky man to have someone like you that looks after him the way you do. Don't get me wrong, I love my wife very much, and we've been married for quite sometime now, but sometimes we need someone with a clear mind to help us tackle the VA with some of our issues. Like the saying go's. Two heads are better than one especially when fighting the VA, you need all the heads you can get lol.

Anyway, I hope everything works out for you and your family :-)

God Bless

Aggie

[NavyWife]

Thanks Aggie--

That's so nice of you to say!

Like any married couple we've certainly had our ups and downs. I guess you get the roses along with the thorns, right? Haha

As far as getting creative, I've seen some posts by Berta and asknod describing the very creative things they've done to get VA to do the right thing. So I'm just following their lead on thinking outside of the box!

I've got some more creative ideas brewing!

Have a great day!

[aggie54]

Thanks, NavyWife, and you are definitely right about Berta, and asknob, they are the Best Of the Best, and a blessing for all of us.

You have a Bless Day also.

Aggie

[Loose Cannon]

Fantastic job on your post...Great guideline for anyone considering starting a claim.

Well done, NavyWife!

LC

[carlie]

I can only imagine how difficult the job of a RVSR must be. Even though I was previously a federal worker myself, I wouldn't take that job even if they paid me at the GS-13 rate!!

I think a claim that goes to VA needs to be like a present with a pretty bow on top, everything presented according to their guidelines & rules. Make your claim easy to approve.

What I've learned from reading the VBM is the most important part of your claim is the MEDICAL EVIDENCE. Do not leave the most important part of your claim up to the VA through their lousy, lowballing C&P exams if you don't have to. ( A few contentions do require C&Ps thru VA only). Take control of your claim by controlling the evidence. Then if the rater tries any funny business, you know exactly what the doc said & can prove it.

***Get 2 DBQ IME's for each contention. ***

By getting 2 instead of 1, the RSVR has to dispute 2 doctors opinions & would probably decide that is too much work.

Guidelines for IME/IMO

Use the DBQ

Refer to the VA Clinicians Guide

Refer to the VA rating guidelines

Each DBQ must have multiple parts:

1). Diagnosis

2) Statement that Dr. reviewed the pertinent medical records or check the applicable box if available.

3) Nexus Statement from Dr. that says condition X is at least as likely as not due to condition Y.

4) Rationale Statement from Dr. explaining how he came to his conclusion on the Nexus. Must give specific reasons why one condition caused or aggravated the other.

5) Statement from Dr. regarding his medical degree and qualifications--or at least Dr. write up the statement using his official office Letterhead.

Once you get something SC at any percentage, then you can leapfrog to a high rating by putting virtually anything reasonable as secondary to Already service-connected Conditions. For example, any Secondary damage from an event, any damage Caused by medication for service-connected conditions, any mental health issues Secondary to Service-connected conditions.

Once you get the first claim back, Hold off on filing an appeal as long as possible (up to the 12 month deadline) because appeals can take 4 years. Even a de novo DRO review may take 2 years. Instead file a new FDC for multiple secondary conditions-- with 2 DBQ IME's for each contention.

For Direct service connection need to file a Statement of Support listing persistent and ongoing symptoms and stating condition has been chronic. For secondary service connection the condition does not need to be persistent or chronic. For direct service connection doc must state they have reviewed your STR's. For secondary service connection doc does not need to review your STR's--He only needs to review your pertinent medical records and must state that.

The VBM is a claimant's best friend - all the answer's are contained within.

[Navy04]

Navywife,

Great info as usual.