Misread Smr Notes

[Snake Eyes]

In my original denial for sleep apnea in 1992, the letter said by my own statement, I had sleep apnea all my life. They also alleged I did not appear for a C&P exam (which was scheduled after the denial date -- and I appeared.

C&P did not address sleep apnea, so I think they denied it bases on my alleged statement.

I had this reopened in 2012 and received my award letter last month. Basically, what happened was the treating doc was addressing two complaints -- sleep apnea and a rash on my chest. He wrote down notes about the OSA then asked me how long my left side had been larger than the right (to see if it had anything to do with the rash). I replied that I had that as long as I could remember.. And he wrote, "pt says has had all his life", then went back to talking about the sleep apnea.

I won by showing from family and buddy statements that I didn't have OSA early in service but did have the lopsided chest.

Seemed to me it was an honest mistake by the rater in reading my record... VSO agreed, but a doc recently suggested it might be a CUE. Any thoughts?

[Snake Eyes]

Snake Eyes,

Yeah, I thought it seemed similar. Berta is right that more info about the wording/situation is needed to help you further. I thought that BVA claim I linked sounded awfully familiar to your situation. Definitely try to do a lot of research before you commit to moving forward. One thing I learned here is to make sure your evidence is solid, clear, and to the point. Don't give the VA any reasons for them to delay or deny.

Thanks! I posted my decision letter and some of the medical records for the sleep apnea part in reply to Berta's post. I wonder if there is a way of proving whether or not they actually ordered me to appear for C&P exams that I did not make. I'm certain there was none for pulmonary or I would have found a way to make it.

[FormerMember]

Well, you do have a copy of your c-file, right? All appointment activity is in the center pocket with the adjudications and ratings. That's one that trips Vets up. They find out when they read their BVA decision that they were scheduled for a C&P for X condition and the file reflects you never showed up. Instant grounds for denial in a lot of cases-especially for claims for increase. Old VA trick. Mail it to an old address on purpose to string it out for a two to three year remand. The only trick to this is having that file.

a

[Snake Eyes]

Well, you do have a copy of your c-file, right? All appointment activity is in the center pocket with the adjudications and ratings. That's one that trips Vets up. They find out when they read their BVA decision that they were scheduled for a C&P for X condition and the file reflects you never showed up. Instant grounds for denial in a lot of cases-especially for claims for increase. Old VA trick. Mail it to an old address on purpose to string it out for a two to three year remand. The only trick to this is having that file.

a

I requested a copy via FOIA awhile back and got a "we're working on it" letter. I didn't specify a "center pocket" and will probably have to go back and specifically request appointment dates, etc. Either way, if they had sent an appointment notice out, you'd think I"d know. The only "old address" they could have used would be one from when I was on active duty as I had been listed at that address from my retirement date on.

[Vync]

If you requested a full copy of your C-file, they should have sent a full copy. Don't let them slack off. I would be inquiring about once per month. Also, you have the right to schedule an appointment to review the C-file in person. Don't just show up like I did. They laughed at me and it was a long ride home. When you get your C-file in the mail, keep in mind that you might have more records than they have or it could be the other way around. Take the time to go over every page - front and back. When I was in, the docs were notorious for writing new treatment notes on the back of existing notes.

Until the VA starts using certified mail or return receipt to mail out C&P exam notifications, they can keep playing their same old dirty tricks. If they claim they sent it to you, it's legitimate, but if you claim to sent papers to them, you have to prove it.

Regarding the C&P doc recommending a consult for sleep apnea, if the claim is not related to sleep apnea, they might just state that a consult might be needed and expect your primary care doc to write it. It's kind of like they are nice enough to type it in the record, but not notify anyone to act on it.

Zero percent: Unless you receive an award letter stating that you are SC for a condition, the 0% pretty much means you are not SC. They denied a couple of my claims that I eventually won on appeal, but until I won they showed up as 0%.

I remember my last pulmonary exam. They actually scheduled two appointments. The first was to to the full PFT workup in the pulmonary lab with the breathing hose, treadmill, etc... The second was for the doc to examine me. Sometimes they schedule these on the same days, but the last one I had was a few weeks apart.

The VA can request a new C&P exam without notice. They typically don't within a year of SC, but they might. Unless your award letter says 'no further exams', they can request you come back in.

If the VA tries to reduce a rating they must notify you in writing and they send it in the mail. Yes, the same snail mail that they used to hose up your C&P exam appointments. They are supposed to give you time to respond and (usually) prove them wrong. As a result, they might also request additional C&P exams. Ratings most typically reduced in this manner are temporary ratings, like some asthma ratings, and ratings after major transplants or treatments. Regarding the temporary asthma-type rating, the award letter would usually include a statement like 'this rating is temporary because your condition is expected to improve'. In my case, they reduced my asthma rating from 60% to 30% because they did not have evidence from an outside doc. I submitted my rebuttal and included the required records. They ignored it, but I won via NOD after DRO review.

[Snake Eyes]

My zero percent was for SC. It entitles my son to a tuition remittance from any state college in our state. I never got an award letter, so his older brother graduated with a nice student loan. :-)

Found this out when I reopened the claim and got a development letter.

I requested my cFILE by mail as a FOIA request... And it's showing in eBennies as a claim. Supposedly will close in June of 2015. Needless to say, I'll be contacting them well before that.

[FormerMember]

Everything has a recipe. If you want your c-file in short order. I've had the most success with this method. There is the Writ of Mandamus route but it costs $50 unless you want to play pauper. When VA starts to blow smoke up your ass and tell you they're on it, it's time to take it up a notch. Here's how the big boys do it. I've had 100% success in the twenty day window after contacting the OGC (027). If you sit there in gridlock and wait, VA will get the idea you're a Type B personality and try to roll you.

http://asknod.wordpress.com/2013/09/30/getting-your-c-file/

Clear prop! flaps 12%. Departure on 118.9 mhz. Watch out for the gomer with the RPG-2 on rollout.