I Am So Irritated With Ineptness! Update.

[kate7772]

Filed a reconsideration for percentage of disability in my husband's mental health claim. Was awarded 50% and we think it should have been 70 due to the symptoms. In the decision, they listed the symptoms required for the next higher level. My husband has at least five of the seven listed but since the C&P examiner failed to fill out the symptom part of the C&P, the award was based on his opinion which was at the 50% level.

In the reconsideration, we asked for a new C&P due to the incompleteness of the first one. A new one was scheduled but the new examiner instead forwarded it back to the original doctor to complete. When he did complete it by listing symptoms, I swear he just went in and fit the symptoms around his original opinion. He said he reviewed my husband's VA treatment records but that is highly unlikely since those symptoms he missed are all through the records for the past 18 months.

Now, the claim is in pending decision approval and DAV says they are denying an increase due to the symptoms not fitting.

How do you get through to these people something as simple as "do it right?"

I don't want to wait another three years or so for an appeal.

Thanks

Kate

Edited April 10, 2015 by kate7772

[kate7772]

I see what you mean now, with the TDIU...

TDIU for the kidney problem and then 60 % or more for an additional independent SC disability ( the MH disability that I believe solely stemmed from his service and is not due to his kidney problem)

would warrant SMC S.

A kidney problem rated that high , in my opinion, also might meet the Housebound criteria,without another additional 60 %.

But one thing about MH ratings......symptoms do not count as much as how the manifestations affect one's ability to sustain and retain substantial employment.

Has he applied for SSDI yet?

I don't think he would be eligible for SSDI. He started collecting regular SS when he was 64, I think. He did this because of his illness and we needed the money because he had to cut back his work hours to about 18 a week. But, he made over the amount SS says is required for SSDI.

[john999]

I do think the fact they sent your C&P to the same doctor who mishandled the first C&P exam is the basis for an appeal. The thing is I think you should get an IME/IMO. You can go round and round with VA C&P exams. I appealed a claim based on a biased exam and two years later I got an even worse exam from the VA. Then I wised up and hired my own doctor. I would never trust the VA alone to give a good exam.

John

[kate7772]

I do think the fact they sent your C&P to the same doctor who mishandled the first C&P exam is the basis for an appeal. The thing is I think you should get an IME/IMO. You can go round and round with VA C&P exams. I appealed a claim based on a biased exam and two years later I got an even worse exam from the VA. Then I wised up and hired my own doctor. I would never trust the VA alone to give a good exam.

John

Not sure they will accept an outside opinion for mental health?

[georgiapapa]

It is my understanding they will not accept an initial outside diagnosis for PTSD. The initial diagnosis for PTSD must be made by a VA psychiatrist or psychologist. The VA will accept an initial outside diagnosis for all other mental disorders. The VA will accept outside medical opinions for all mental health disorders,including PTSD (provided initial PTSD diagnosis made by VA). This is my opinion but others will correct my info if it is wrong.

GP

[Berta]

I agree with that.

[Navy04]

Sorry to hear of your issues. I have had 4 FDCs with over 30 C&Ps the last 2 years, and honestly the majority of them sucked, Including a Civilian VBS Doc that had me sit in his cold office for almost 3 hours, did not ask a single question but look at my shoulder. Guess what he denied everything but the R Shoulder, only because he would not read one single part of my record. Just look at a little computer screen, no hi or bye, just get the heck out of here. Truly so sorry for your Husband, but happy that he has you to ride along on the VA Roller Coaster of Crap!!!