Completed All Required Exams - Now What Happens?

[rootbeer22]

Folks:

At this point it looks like I finished all of my C &P exams last week and I'd like to know what happens next from you seasoned, Hadit.com veterans? Although I'm not satisfied with all of the exams, I did get to retake the one that I was most concerned about and suspect I'll be appealing some contentions? Also, originally, I submitted 13 DBQ's with exams as part of my claims submission package, so that part of my claim is very robust. I'm not sure I would have done the DBQ's again because I retook most of the same exams again anyway and it just cost me more time in the process? That said, I was never able to confirm that all of my hard copy files ever got fully digitized into the VBMS System? I did get a "verbal" from a senior VBA official that they were in fact there? But, like many vets, about half of my service medical records (SMR's) are handwritten by military doctors and I believe they don't get the same attention as the newer chrisp typed records that come out of DOD and the VA Systems today? For me, some of my most important SMR evidence is on these handwritten SMR's. So, I was advised by some seasoned, claims veterans that have turned in claims over the years to provide statements of support and buddy statements to bridge that gap for the VBA claims raters? It's supposed to "tell the full story" so the raters can peice it all together?

One note is that I'm more convinced now then ever after my interactions with examiners that the final outcome of a claim is due in large part to the "luck of the draw" and who works your claim? In one case, I came across someone, whom had their mind already made up before I ever walked thru the door and I suspect that this is more of a "personality type" than the way business is usually done. Just like "global warming", some may have a bias that the whole "Gulf War Syndrome" an in their opinion, it just - does not jibe? However, although there are examination rules, policies, regulations, etc. in place ...many professionals also have a lot of subjective leeway in filling out the forms and personal biases and if you "draw" someone like that, it's like a spawning salmon,( you or me) are swimming against the current to get where you need to go..to get your just due?

[carlie]

Folks:

At this point it looks like I finished all of my C &P exams last week and I'd like to know what happens next from you seasoned, Hadit.com veterans?

Now you just get a hobby or something to interest you and wait things out, until you hear or receive something else.

Although I'm not satisfied with all of the exams, I did get to retake the one that I was most concerned about and suspect I'll be appealing some contentions?

Glad you were able to retake the one of most concern.

Also, originally, I submitted 13 DBQ's with exams as part of my claims submission package, so that part of my claim is very robust. I'm not sure I would have done the DBQ's again because I retook most of the same exams again anyway and it just cost me more time in the process? That said, I was never able to confirm that all of my hard copy files ever got fully digitized into the VBMS System? I did get a "verbal" from a senior VBA official that they were in fact there? But, like many vets, about half of my service medical records (SMR's) are handwritten by military doctors and I believe they don't get the same attention as the newer chrisp typed records that come out of DOD and the VA Systems today? For me, some of my most important SMR evidence is on these handwritten SMR's. So, I was advised by some seasoned, claims veterans that have turned in claims over the years to provide statements of support and buddy statements to bridge that gap for the VBA claims raters? It's supposed to "tell the full story" so the raters can peice it all together?

While it's still fresh - you can, if you want, submit copies of these handwritten SMR's and highlight the portion that would

help connect all the dots for the issue.

One note is that I'm more convinced now then ever after my interactions with examiners that the final outcome of a claim is due in large part to the "luck of the draw" and who works your claim? In one case, I came across someone, whom had their mind already made up before I ever walked thru the door and I suspect that this is more of a "personality type" than the way business is usually done. Just like "global warming", some may have a bias that the whole "Gulf War Syndrome" an in their opinion, it just - does not jibe? However, although there are examination rules, policies, regulations, etc. in place ...many professionals also have a lot of subjective leeway in filling out the forms and personal biases and if you "draw" someone like that, it's like a spawning salmon,( you or me) are swimming against the current to get where you need to go..to get your just due?

I am in full agreement that many times we are pre judged by examiners, prior to even meeting with them for the examination.

IMO - many times,luck of the draw takes place at all levels from the mail room up, all VBA reps, C&P examiners, etc...

IMO - incompetence of following laws, regs, duty and direction is rampant.

We, as individual claimants, armed with knowledge and evidence, are our own best advocates for both VBA claim issues

and VAMC medical care.

Hang in there and keep hopes there are no land-mines to trip you up and start the hamster wheel spinning.

jmho - carlie

[rootbeer22]

Carlie:

Thanks for the help and encouragement...people like you and this site has been truly wonderful. Patience is a virtue that I have yet to masterd? I've learned so much over the last year. I have provide the VBA a copy of the handwritten records at least twice and they are identical to what I provided in the original FDC package. I deal with medical records on a regular basis so I know where they are located and how to obtain them. One of the troubling aspects of the claims process to me is that it's very clear that many examiners don't have a clue of what's in the vets medical file and how it may relate to the exam that a particular examiner is giving a vet? I was told that I could bring additional evidence to the examinations last week- so I did. The first examiner essencially said not to speak until spoken to? Then he made very little eye contact with me during the exam and spent most of his time typing on the computer and it almost felt adverserial? Then on the second examination, the examiner was personable, made full eye contact, reviewed "all" of the paperwork, and asked about the conditions in which I was injured. Frankly, it was 180 degrees out from the first exam. I'm already contemplating an appeal of the contentions for the first examination but I could be wrong? But these exams were a good comparison and contrast - to how it's done differently at the very same facility. Last year, I had one examination in which the APRN actually scolded me verbally for not coming soon after I retired and then talked about her heavy workload- and how someone like me was adding to her burden? When I said that I did put in the original l claim when I retired, she did not believe me until I brought in the actual form that I submitted from 2004. The adversarial attitude from her floored me becuase I had not experienced that before? I complained to her boss because she "guestimated" a lot if the ROM Measurements and they were way off compared to my previous exams? Frankly, I just want the FDC process to be by-the-book and professional without any bias or preconceived notions concerning the exam outcomes? I'm also going to write an article about my Fully Developed Claims process claim experience to inform other vets. My neice works for a very large metropolitan newspaper and is helping me with it. My plan is to put it out once my claim is finalised. I've seen problems with the process but also a lot of good as well and I'm going to be fair. Consequently, most of it could be corrected with examiners just following the rules that are already in place... Thanks again...

Edited March 3, 2015 by rootbeer22

[carlie]

I sure hear you on,

"Consequently, most of it could be corrected with examiners just following the rules that are already in place"

but it all goes so much deeper.

As Berta points out, the 38 USC and 38 CFR are so very important ... BUT the M21-1MR is huge in that it provides

extremely specific instruction to the vba peeps as to when to request exams and how to request them.

Then, to top that part off the 38 CFR Part 4 - Schedule For Rating Disabilities provides further instruction in

many cases, contained within the NOTES of the schedule.

If these are not followed and specifically instructed by the vba peeps -

then even the exams wont be of much help and just continue to add to further delay.

I am pointing this out because the vba peeps are the ones with the authority to request

our C&P exams to be scheduled. They are also supposed to provide specific instructions

to the examiners. There are many, many, many different disabilities that contain secondary

conditions, that in many cases the veteran has not even requested SC for.

You can see this clearly in the last example I post here regarding specific instruction for epilepsy.

The Notes specifically address epilepsy and unemployability, I have highlighted them in red.

If the vba peeps do not specify to the examiner in the C&P request, to opine on the impact the veterans

epilepsy has on their employability - then it maybe decades of the hamster wheel spinning for this claimant

to have their vba disability issues, fully compensated for.

jmho

Here are some examples for anyone that may not be familiar with what I am referring to:

6204 Peripheral vestibular disorders: Dizziness and occasional staggering 30 Occasional dizziness 10 Note: Objective findings supporting the diagnosis of vestibular disequilibrium are required before a compensable evaluation can be assigned under this code. Hearing impairment or suppuration shall be separately rated and combined.

*******************

6839 Mucormycosis. General Rating Formula for Mycotic Lung Disease (diagnostic codes 6834 through 6839): Chronic pulmonary mycosis with persistent fever, weight loss, night sweats, or massive hemoptysis 100 Chronic pulmonary mycosis requiring suppressive therapy with no more than minimal symptoms such as occasional minor hemoptysis or productive cough 50 Chronic pulmonary mycosis with minimal symptoms such as occasional minor hemoptysis or productive cough 30 Healed and inactive mycotic lesions, asymptomatic 0 Note: Coccidioidomycosis has an incubation period up to 21 days, and the disseminated phase is ordinarily manifest within six months of the primary phase. However, there are instances of dissemination delayed up to many years after the initial infection which may have been unrecognized. Accordingly, when service connection is under consideration in the absence of record or other evidence of the disease in service, service in southwestern United States where the disease is endemic and absence of prolonged residence in this locality before or after service will be the deciding factor.

****************

8017 Amyotrophic lateral sclerosis 100 Note: Consider the need for special monthly compensation.

***************

8210 Paralysis of: Complete 50 Incomplete, severe 30 Incomplete, moderate 10

Note : Dependent upon extent of sensory and motor loss to organs of voice, respiration, pharynx, stomach and heart.

***********

A thorough study of all material in §§4.121 and 4.122 of the preface and under the ratings for epilepsy is necessary prior to any rating action. 8910 Epilepsy, grand mal. Rate under the general rating formula for major seizures. 8911 Epilepsy, petit mal. Rate under the general rating formula for minor seizures. Note (1): A major seizure is characterized by the generalized tonic-clonic convulsion with unconsciousness. Note (2): A minor seizure consists of a brief interruption in consciousness or conscious control associated with staring or rhythmic blinking of the eyes or nodding of the head (“pure” petit mal), or sudden jerking movements of the arms, trunk, or head (myoclonic type) or sudden loss of postural control (akinetic type). General Rating Formula for Major and Minor Epileptic Seizures: Averaging at least 1 major seizure per month over the last year 100 Averaging at least 1 major seizure in 3 months over the last year; or more than 10 minor seizures weekly 80 Averaging at least 1 major seizure in 4 months over the last year; or 9-10 minor seizures per week 60 At least 1 major seizure in the last 6 months or 2 in the last year; or averaging at least 5 to 8 minor seizures weekly 40 At least 1 major seizure in the last 2 years; or at least 2 minor seizures in the last 6 months 20 A confirmed diagnosis of epilepsy with a history of seizures 10 Note (1): When continuous medication is shown necessary for the control of epilepsy, the minimum evaluation will be 10 percent. This rating will not be combined with any other rating for epilepsy. Note (2): In the presence of major and minor seizures, rate the predominating type. Note (3): There will be no distinction between diurnal and nocturnal major seizures. 8912 Epilepsy, Jacksonian and focal motor or sensory. 8913 Epilepsy, diencephalic. Rate as minor seizures, except in the presence of major and minor seizures, rate the predominating type. 8914 Epilepsy, psychomotor. Major seizures: Psychomotor seizures will be rated as major seizures under the general rating formula when characterized by automatic states and/or generalized convulsions with unconsciousness. Minor seizures: Psychomotor seizures will be rated as minor seizures under the general rating formula when characterized by brief transient episodes of random motor movements, hallucinations, perceptual illusions, abnormalities of thinking, memory or mood, or autonomic disturbances.

Mental Disorders in Epilepsies: A nonpsychotic organic brain syndrome will be rated separately under the appropriate diagnostic code (e.g., 9304 or 9326). In the absence of a diagnosis of non-psychotic organic psychiatric disturbance (psychotic, psychoneurotic or personality disorder) if diagnosed and shown to be secondary to or directly associated with epilepsy will be rated separately. The psychotic or psychroneurotic disorder will be rated under the appropriate diagnostic code. The personality disorder will be rated as a dementia (e.g., diagnostic code 9304 or 9326).

Epilepsy and Unemployability: (1) Rating specialists must bear in mind that the epileptic, although his or her seizures are controlled, may find employment and rehabilitation difficult of attainment due to employer reluctance to the hiring of the epileptic.

(2) Where a case is encountered with a definite history of unemployment, full and complete development should be undertaken to ascertain whether the epilepsy is the determining factor in his or her inability to obtain employment.

(3) The assent of the claimant should first be obtained for permission to conduct this economic and social survey. The purpose of this survey is to secure all the relevant facts and data necessary to permit of a true judgment as to the reason for his or her unemployment and should include information as to:

(a) Education;

(b) Occupations prior and subsequent to service;

© Places of employment and reasons for termination;

(d) Wages received;

(e) Number of seizures.

(4) Upon completion of this survey and current examination, the case should have rating board consideration. Where in the judgment of the rating board the veteran's unemployability is due to epilepsy and jurisdiction is not vested in that body by reason of schedular evaluations, the case should be submitted to the Compensation Service or the Director, Pension and Fiduciary Service.