hypertension Senseless Denial And Forced To Use An Attorney ! Unbelievable. !

[DocNyger]

Hello fellow vets, I hope all is well and still in the fight. I am new to the site and welcome any and all comments please... I served for 12 years , I've been involved in 3 wars. I separated in August 2003. In March 2005 I filled a claim for 4 contentions. I finally heard about my denial in Nov 2008. The reasoning that VA stated my denials were that even though the QTC doctors documented favorable statements , he didn't state it was from the military. ( I read the exact notes and he did state back issues, knee issues, hypertension, and depression were from my time in the military ). I also stated the locations on my original claims and sent in multiples documentation via hand delivery to my Regional office, faxing my VSO, and certified mail with Return Receipt. In the denial section the Va stated that there was nothing in my medical records. I filled a NOD in Feb 2009 and to date that appeal is still on phase 1...:(. I started to wonder if it's just me or does the Va really denies veterans for no reason..) So I'm waiting !!!!!

In Mar 2011 I filed for PTSD , and PFB (shaving). I've submitted documentation for both the same vehicles that I did before. I received countless messages from VA stating they need sudden information... The same info I sent.... So I called my VSO again, met with her and gave the same copies I sent in, she supposedly walked it up and personally put it in my C -file. Well later I finally got scheduled for a c and p for PTSD. Nothing for PFB. My initial exam was by a mental health doctor at the Va who verbally told my the she was new to the field and after the exam was over, she diagnosed me with major depression and hypertension, she stated that there were multiple symptom for ptsd but unsure if they meet criteria 1 for PTSD and referred me to a Va contracted mental doctor. My treatment started in the beginning of 2012. During his ignition evaluation, he diagnoses me with probable ptsd. He explained to me why, because he just met me and wanted to spend time with me. Well on Apr 25 2013 I was diagnoses with PTSD have severe symptoms. Now all my records were sent to Va and I once again hand delivered them and got the regional acceptance stamp. In the end of October I received a letter stating that the Va wanted me to go to another c and p for PTSD. I called my VSO and explained what was going on and she just stated " I guess you need to be there" ... Why do I have to go through four different evaluations.!!! I truly thought this was crazy. Well I reported to the c and p examination and I experience a very rude ,biased, and incompetent person I have ever dealt with in my 41 years of living. He asked me two question. Do I drink and how often? And how much do I spend on alcohol a month. That's it !!!! Nothing about PTSD symptoms or nothing. I filled out a form asking what are my symptoms which I stated everything from my treatment records. This guy didn't put anything that I verbally stated or written. He had this ( what ever attitude). Not even 10 min later he stated it's done. You probably won't get it... And left the room.

Well I finally left 5 minutes later when he didn't returned, later in Nov 2013 I received a denial letter stating I was denied because I don't have a current diagnosis of PTSD, even though my treatment notes states probable ptsd the recent ptsd exam did not diagnosis me with PTSD. I was floored !!! I ordered I copy of the exam to find out that the examiner diagnosis me with substance abuse... What !!! No one even looked at my records. I went to my regional office again and spoke to another VSO. I showed him the diagnosis from the contracted mental doctor for PTSD back in April and he supposedly walked it up to the raters. He came back and told me that they said there wasn't a signature from the doctor. I pointed out the electronically signature that many doctor uses, then the VSO stated that it does stated that it's a diagnosis, I stated and showed him in the right corner where it states Confirmed Diagnosis ptsd 309. Etc and severity of symptoms., then I was told that the raters said that they would challenge the diagnosis... At that point I said I'll get an attorney because this is not right and the VSO stated " why would you want to do that, they will take all your money" .. Of course I left and found a good attorney who took my case and was shocked how the Va handle my case. The attorney stated that the Va is famous for creating bad evidence to out way the good .. Is that true? What do you think about my case? I'm sorry for the long message .. Just need to vent and my wife is getting tired of the nightmares, isolation, and me talking about it... Thank all of you in advance for your comments and advice !!!

Edited May 19, 2014 by DocNyger

[Notorious Kelly]

Sounds like a strong case, Doc - hope you get a positive resolution sooner than later!

[TiredCoastie]

You might want to double check the rules on PTSD and how the VA determines SC and rating. I haven't had to address this condition myself, but have read a lot about PTSD being an "in house" diagnosis for disability purposes. Hopefully your lawyer knows how to get around this or at least push it in the right direction through an IME - maybe proving that both the VAMC and RO did you wrong by showing an outside opinion and pushing for a new C&P? I don't know... Really hope it works out for you!

[DocNyger]

Thank you for your response... I have been dx with PTSD chronic from a contracted psychologist also, it was in my file that got over looked. I'm not sure how the VA would look at it but that 3 c and p exams where one said MDD, two stated PTSD severe exams and the hosed up recent 2013 QTC exam( dx with substance abuse)... With this kind of documentation it's seems dry cut.. Since I've been on the site, I have become knowledgable of PTSD a-z. As soon as I figure out how to include the actual reports.. I really pray I get spared with having to go all the way to BVA...

[NavyWife]

Good for you on getting a lawyer! I find it ridiculous that people do not want to give up 20% to a lawyer. Without the lawyer they likely end up with nothing, and they get to keep 100% of $0

Many many vets in your shoes would have given up at this point. That is exactly what va counts on.

Does your lawyer think a DRO hearing could help move it along faster? I'm only asking about A DRO hearing, not a DRO review.

Or is he just asking for a reopen with your new & material evidence of IME?

Edited June 26, 2014 by NavyWife

[FormerMember]

New and material evidence

I've written about this several times but allow me to reiterate it again. Look closely at 38 CFR § 3.156(b). At any time during the course of your claim at the Agency of Jurisdiction ( AOJ aka your Regional Office), a Veteran submits new and material evidence (NM&E) to the claim (such as a new IME/IMO), it requires a de novo (brand new) adjudication in conjunction with all the previously submitted evidence of record (EOR) in your c-file. The submitted information may also be EOR in that it is pertinent (material) to the claim and clarifies or enlightens/alerts the rater to a possible brain fart on his part. This graciously allows everyone to pat themselves on the back and right the wrong without anyone’s ego being bruised. I'm also sure it's why they invented yellow hi-lighter pens.

Ratings personnel (usually GS-11s or 12s aka RVSRs or Rating Veteran Service Representatives), once they have made a decision on your claim and obtained the needed three signatures (to deny or grant), are removed from the process. Any submission of NM&E must automatically be given a de novo review by a superior-either a Senior Rating Veteran Service Representative (SRVSR - GS-12 or 13) or a Decision Review Officer (DRO - GS-13 +). This is, in essence, a mini-DRO review of sorts. Most Vets do not know this. It also takes less than 585 days.

You are only allowed to submit that new and material info that is needed within one year of this decision in order to keep it at the AOJ. I have helped one guy who milked out the N&ME game by continually feeding in more contemporary service medical records (SMRs) all the way into the BVA after his hearing. He was a pecker checker in the Air Force and wisely snagged his own SMRs when he left to “preserve” them. And yes, he won. I’m sure the RO was wondering where he was coming up with them but they continued to deny-something I feel is almost cast in stone on really contentious cases like Hepatitis C and PTSD. If they deny, you’re generally headed to DC no matter what. It’s because they don’t want to take responsibility for a political or medical hot potato. Far, far easier to punt on 4^th and long. That's often why SSOCs sound a lot like the SOCs. You could submit a NM&E buddy statement from Jesus and still have to appeal. And that's all I'm gonna say about that.

[DocNyger]

Thank you NavyWife, I just spoke to my attorney and I believe he doesn't have any faith at the RO level, he states I have a great case with great evidence. ( I personally think he just wants to go to court) .. Lol. I am hoping that someone can see that there was a mistake and grant it. Listening to the pod cast on IME and CUE's , I thing I could have went the CUE route also...

Also thank you asknod, my question is " is it really new evidence when it was in my c file the entire time?". I had to get an IME to offset that crazy QTC exam ... The original dx was always there....