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

[boomer2]

Navywife

I just filed a claim for prostate cancer and I submitted the pathology report and a DBQ filled out and signed by my Doctor. Also, on the DBQ he put as the cause "agent orange exposure" with ICD code. Now let's see how long it takes them to approve it.

[meghp0405]

depends on how you submitted your claim. I hope you submitted it as a fully developed claim...

[63SIERRA]

++=. For secondary service connection the condition does not need to be persistent or chronic+++

can we hash this out? what does this mean exactly?

[Berta]

Navy wife, you sure are willing to provide good info and insights here....however I am with Sierra ,as I don't find that statement within M21-1MR as to the secondarys.

Maybe I missed it in the VBM?

Thanks for any info on that.

[K9MAL]

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.

Great post NavyWife. This is the first time I've read about using this strategy. Thanks for the info!

[NavyWife]

++=. For secondary service connection the condition does not need to be persistent or chronic+++

can we hash this out? what does this mean exactly?

I read that bit of info in the VBM. I will have to look back through my notes to find out what chapter that was in.

Maybe I should have written it as, "Secondary issues do not need to be persistent or chronic SINCE SERVICE"

Due to it being " secondary", it is an issue that generally will have developed at a later date than the service- connected condition that caused it. For example, if a vet developed seizures in the service, and then he became service-connected for seizures a couple years after getting out, He would need some evidence either medical or lay that he was having persistent symptoms since service. Then say he is prescribed anti-seizure medication, which causes him to develop irritable bowel syndrome, The IBS would NOT need to be persistent and chronic since service.

However, the secondary issue DOES need to be ongoing from the date a person claims it began.

I should have written that in a more clear manner. I can edit my post.

Does that make sense?