Under Administrative Review

[Scout Swimmer]

I was denied recently on a depression claim. I noticed on the denial letter that they based the decision on direct service connection. I am 40% TBI with 50% mixed headaches as a secondary. I assumed it would be automatically rated as a secondary condition to my TBI as my submitted medical evidence clearly state in my progress reports.

I immediately submitted a letter of reconsideration to rate my claim as secondary to TBI, as my DAV rep advised. I am now under Administrative Review.

I'm still not clear on how long this process takes, or what it exactly is. I called Peggy and she informed me that it has nothing to do with my claim and it is closed. I didnt get much out of her as she was unwilling and a bit hostile. I am considering retaining an Attorney but should I wait and see where this goes? Is this a thing that could last a year forfit my right to appeal?

Any suggestions would help

Thanks

[daklander]

Unfortunately I think you are right. I asked my VA psychologist to write something up for me. Just to be more detailed in her already documented diagnosis. She said it would be a conflict of interest because ultimately, her boss is the VA. I am learning the awful truth as you suggest as I go along.

There is a document directing doctors & care takers to write those letters.

I'm going through a major website move so I can't get to the files. Maybe someone else here has that document.

[FormerMember]

Golly doggies. Finally. I have been preaching this for the last 4 years. A DRO review is nothing more than another in-basket for a claim to sit in. Absent any true constructive evidence, a DRO Review is nothing more than a holding area that prevents you from advancing to the BVA and a fighting chance at a win. Think of it like this, Veterans. The VA Bus has X # of seats. From 2004 to 2012, the same basic number of Vets have been rated exactly the same. In that 10-year time, we have experienced innumerable catastrophic injuries (read paraplegic, etc.) yet something is immutable. Virtually the same number of Vets are 0%-100%. Statistics tell us a fixed number of 100% Vets have to get off the VA bus (read die) in order for an equal number to board. Same metric for Vietnam in the 60s-70s. Amazing, huh? Didn't anyone wonder why we get a 10% rating when we should be P&T? And then we have to fight up the ladder for each increase for 10 years to finally attain our due? It's called managing the costs via controlling the ratings percentage. No mystery here in my book. It's precisely why the backlog will plague us for decades even if we never wage war again. VA cannot afford us.

http://asknod.wordpress.com/disabled-vets-statistics-by-state/

Edited March 5, 2014 by asknod

[GatorNavy]

There is a document directing doctors & care takers to write those letters.

I'm going through a major website move so I can't get to the files. Maybe someone else here has that document.

The letter says that it is ok for the VA doctors to do a nexus letter although all hell will break loose if they don't do it right. Of course the VBA keeps those "rules" like a guarded secret, so the VA docs are hesitant since it could cost them their job or at the very least their next raise. I got a nexus letter from a VA practitioner and she was harangued by the VBA to the point that she is no longer working in that capacity. My VA shrink wouldn't give me one. He told me that it was the responsibility of the VBA. He is Japanese and his little spiel sounded too well rehearsed for him to come up with it on his own. When I claimed the bent brain syndrome, they didn't want to give a C&P for 7 months. I told them that won't pass muster and I needed one sooner. They scheduled one sooner but I had to drive 100 miles. Luckily, he was a famous shrink with a published reputation and took the exam on because he found my case interesting. He didn't fall under the spell of the wicked witch of the West (VSCM) and I got a decent rating out of it. Even a blind hog finds an acorn once in a while!

Edited March 5, 2014 by GatorNavy

[daklander]

The letter says that it is ok for the VA doctors to do a nexus letter although all hell will break loose if they don't do it right. Of course the VBA keeps those "rules" like a guarded secret, so the VA docs are hesitant since it could cost them their job or at the very least their next raise. I got a nexus letter from a VA practitioner and she was harangued by the VBA to the point that she is no longer working in that capacity. My VA shrink wouldn't give me one. He told me that it was the responsibility of the VBA. He is Japanese and his little spiel sounded too well rehearsed for him to come up with it on his own. When I claimed the bent brain syndrome, they didn't want to give a C&P for 7 months. I told them that won't pass muster and I needed one sooner. They scheduled one sooner but I had to drive 100 miles. Luckily, he was a famous shrink with a published reputation and took the exam on because he found my case interesting. He didn't fall under the spell of the wicked witch of the West (VSCM) and I got a decent rating out of it. Even a blind hog finds an acorn once in a while!

May well be that I'm a lucky one in getting Nexus letters.

My current primary Oncologist kind of hesitated for a while because he said he couldn't prove my cancer was caused by Agent Orange. Once he understood he didn't have to prove it but opine it was as likely as not caused by Agent Orange he wrote the Nexus.

The secondary Oncologist I used for a couple of years in another VA system didn't pull any punches and stated straight out the cancer was caused by Agent Orange exposure.

The third, a psychologist, didn't hesitate either, in writing up a letter for another condition.

[GatorNavy]

It's always worth a try to get a nexus letter from a VA specialist. I got one. The C&P examiner can give a favorable nexus also. I think it is more likely to get a favorable nexus from a mental C&P exam simply because they have to be board certified psychologists or psychiatrists. For any other type of exam they could get a part time nurse who just finished their AA degree. They could just as well get a young, inexperienced, family practice MD to opine on chronic liver disease for example. Back to the mental condition, even though there may be multiple diagnoses, there can be only one rating. I pulled the DBQ from the C&P and compared that to the schedule of ratings. This is one area where the rater can twist and turn with a low-ball. However a low GAF, can't be ignored as well as documented suicidal or homicidal tendencies. It will be a looong time before the VA moves to the next higher DSM.

[GatorNavy]

My evidence I submitted originally will be reviewed for this as well, won't it?

For a reconsideration there needs to be "new and material" evidence to make a difference. Technically it is a re-opening of the claim. The reasoning behind that process is because conditions can worsen or new evidence can be found in the time it takes to process a decision. A reconsideration (re-open) is not an appeal and was never meant to be. The administrative review will look at all evidence used in the decision and beat that against the new evidence submitted to re-open the claim. Hang in there, relax, take it step by step.and everything will get straightened out.