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How To Win Your Claim

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NavyWife

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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 by NavyWife
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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.

You're very welcome and I'm really glad I could help!

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Hi,

I was looking at the IME list. I have some IBS issues and there are no GI doctors on there. Are internal doctors the same?..thanks in advance for the reply

I may be wrong… But, I'm pretty sure you'll need to get blood work and a colonoscopy for an IBS rating. A gastro doc would have to to the procedure and give his opinion. From my understanding, IBS is diagnosed after all other avenues have been exhausted like Chron's, Colitis, etc.

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Hi,

I was looking at the IME list. I have some IBS issues and there are no GI doctors on there. Are internal doctors the same?..thanks in advance for the reply

My understanding is that VA does not require the licensed medical professional to be a specialist for any of the DBQ's. If it does require a specialist, that information will be listed at the top of the DBQ form. The only exception is for mental health. The mental health DBQ or IME must be done by a specific type of doctor, basically a psychiatrist or PHd level psychologist and a few other types. But for all the others I've reviewed so far, there is no requirement that you need a specialist. It seems like for general health issues, a primary care provider, just a regular M.D., is qualified. Granted, the better credentials your doc has, the more solid your case and the harder it will be for the rater to dispute your DBQ IME.

I'm basing this off what I've read on the VA website here http://www.benefits.va.gov/COMPENSATION/dbq_FAQS.asp

"Asking your primary care provider to complete a DBQ is no different than asking your provider to write a letter or note providing medical evidence of a medical condition in support of a claim."

 

 

I think it's important that we carefully read over the DBQ's for each issue and see if it requires any specific testing. Many of them do not. Plus of course carefully read over the rating guide for each issue before asking a doc to fill it out.

And thank goodness, no colonoscopy required for IBS DBQ!!! ouch!

from the last page of the DBQ ---"no further studies or testing are required for this examination"

http://www.vba.va.gov/pubs/forms/VBA-21-0960G-3-ARE.pdf IBS DBQ

 

Edited by NavyWife
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