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

[NavyWife]

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.

I just looked at that DBQ. Only one of the five things needed is part of the form. Only #1, the diagnosis.

Did your Dr. write in the other items?

Did your Dr. Use the exact wording " as likely as not" or "more than likely" ? The words that any regular person would interpret as saying condition X is causing condition Y, are not the same words that VA will accept. I don't know why they are so picky on this exact wording, but they seem to be.

I really hope you get your claim approved. Just curious, did you submit is as a FDC to speed up the processing?

FDC's submitted with (properly filled out & complete) DBQ's are supposed to go straight to rating.

[NavyWife]

K9MAL just posted a list of IME docs

link to post

http://www.imenet.com/content/imedir.pdf link to info

[Berta]

Yes, that made very good sense, Navywife. Thank you.

Your example as to the secondary is perfect as to the seizure- IBS veteran.

A good med site printout of any SC med he/she takes that shows it could cause IBS might be all that vet would technically need for secondary award.

Still the VA would prtobably still need a doctor's agreement with that at a IBS C & P exam, I am sure.

Good work Navywife!

[NavyWife]

A good med site printout of any SC med he/she takes that shows it could cause IBS might be all that vet would technically need for secondary award.

Still the VA would prtobably still need a doctor's agreement with that at a IBS C & P exam, I am sure.

Yes, I agree with you. The VA will still need the nexus statement that the medication taken for the SC condition caused the secondary condition of IBS. But my stance is that a vet stop depending on the VA and their C&P exams. Instead, I'm advocating that a vet get his or her OWN medical evidence from their own doctor, whether a private physician or a certified IME doctor. An IME using the VA's DBQ forms were created to satisfy VA's rating criteria. And to take it a step further, that they get TWO! By getting 2, the rater will have to dispute the word of both doctors and then also order C&P exams that will have to come back against the vet.

The DBQ forms were created by VA to satisfy VA's rating criteria. They conveniently left off a few things, like the nexus statement & rationale statement, so we need to be sure that critical information gets listed in the remarks section of the DBQ.

I read a BVA case last week where the vet had a favorable C&P exam. But the rater didn't like that, so the rater ordered another C&P exam. That 2nd exam AGAIN came back favorable to the vet. The rater dug in his heels and ordered a total of 3 more C&P exams. Only when the last 3 exams came back AGAINST the vet, did the rater finally stop, because he could finally deny the vet. Stories like that scare the hell out of me!

Edited January 17, 2014 by NavyWife

[K9MAL]

I read a BVA case last week where the vet had a favorable C&P exam. But the rater didn't like that, so the rater ordered another C&P exam. That 2nd exam AGAIN came back favorable to the vet. The rater dug in his heels and ordered a total of 3 more C&P exams. Only when the last 3 exams came back AGAINST the vet, did the rater finally stop, because he could finally deny the vet. Stories like that scare the hell out of me!

What a horrible person and very easy to do when the veteran is a faceless stack of paper on their desk. I wish we could confront our raters in person.

[NavyWife]

K9MAL--

I just have to say again how thankful I am that you found that list of certified IME docs. With that information, you have given many vets a fighting chance at actually winning their claims, including my husband. I'm looking through the list as we speak, to see which ones might be a good fit for him.