Denied Increase

[ArmygirlRJ]

I recently received my letter of denial for increase on the grounds that I needed to have more than one prostating migraine in 2 months and even though my VA medical records never mentioned the word prostrating the Neurologist does say on multiply times that the patient is unable to work during attacks and he has also stated that I needed to lye down in a dark room. The only problem is that it is a teaching hospital so each time I see a different resident and maybe a different attending also. I have become a test dummy for the Neurologist because I have been on multiple medications and have failed therapy but I still try. My attacks can be from 2-5 headaches a month with each one lasting at least 2 days the only reason I haven't lost my job is that the neurologist filled out a Family Medical leave paper which allow me to miss periods at work without being fired but believe me my job is ready to dismiss me if they can find the loophole. With everything in my medical records I thought I would at least get 30%. Can anyone help me understand what to do? At the C&P the ARNP asked me all the questions and said that she could only write what was in my doctor notes the only thing I could think is that she read the resident notes without reading the attending notes. I have sent back my NOD already highlighting what the attending notes say in my VA medical records for the last two years. Also I have no idea what the C&P notes say because they did not send me that and I can not find it in my medical records. Please Help

[broncovet]

This is my recommendation.

First, get your cfile if you have not yet done so. Read what the docs said, and dont take VA's word for it.

Next, read and understand the "reasons and bases" for denial. Finally, look up the criteria necessary for your desired increase. When you respond with a NOD, cite evidence showing how you met the applicable criteria.

Did they cite favorable evidence? If not, then you can appeal on that bases, that the VARO decision failed to consider Dr. XXX favorable evidence on a medical exam of dd-mm-year.

If VA was incorrect, and misinterpreted or lied about what the medical records, then base your appeal on this evidence.

If you had a C and P exam that was unfavorable, then you can dispute the credentials of the examiner, such as do they have expertise in your malady.

In short, you want to refute the "reasons and bases" for denial with solid medical evidence to the contrary.

If a rookie doc gave unfavorable evidence, you can ask the BVA for a C and P exam.

Edited June 28, 2015 by broncovet

[Buck52]

Most all VA Hospitals are teaching Hospitals!

You need to go get a Private IME/IMO and give the Dr your history and ask him to give his opine to your disability and use the VA guidelines here on hadit

Its good you filed your NOD you have one year, to re-gather your evidence or New & Material Evidence

You should receive a SOC from the VA ''Statement of the Case''

You need to get your last C&P report usually you can get that at the VAMC where your exam was.

And like broncovet mention you NEED to get your C-File.

There's other ways to prove your claim but we need to know what the reasons and bases of the denial.

if you can copy & paste that here on hadit and be sure to cover your name and SS No. be sure there's no personal ID on it.

Remember if your SC disability precludes you from working or doing any type of sendetary work you will be eligible for the 100%TDIU Rates. and SSDI

Thank you for your service and I'm glad you came to Hadit, things will get better for you now.

.....................Buck

Edited June 28, 2015 by Buck52

[Chuck75]

The VA usually needs "in your face" documentation that makes it more than obvious that the severity of a condition is sufficient to grant the rating sought.

The question at the heart of your problem is how to get the medical provider(s) to generate it.

It sounds like you will need to coach the provider as to what is needed. An option is to get an independent medical opinion that backs up and summarizes

your condition and it's severity in language that the VA accepts. From what you wrote concerning the VA's refusal of an increase, you have an understanding

of what is needed, but not exactly how to obtain it. We all have this sort of problem at times, since most doctors and providers have a limited knowledge of what the VA wants to see.

Explaining your VA related problem to the provider(s), along with what you need, is usually effective. Occasionally, I've had to go back to a provider, and explain why the provider's

statements need to be re-worded, or amplified to meet the VA's druthers. In one case, a provider originally agreed to write an opinion, then wanted to back out. I pointed out that

they had agreed, and that was a significant part of why I chose the provider, and made it clear that I expected them to fully honor the commitment if they wanted to retain me as a patient..

Many veterans face the provider "only game in town" issue, due to cost, or other considerations. When this happens, the veteran must deal with the problem, and often be politely persuasive.

"The only problem is that it is a teaching hospital so each time I see a different resident and maybe a different attending also"

Based upon this, it sounds like you will need to talk to the supervising physician, and explain the problem/difficulty you are encountering. Since this is evidently the VA,

it may be easy or not to accomplish. In a private setting, the physician would usually cause a more complete evaluation to be made from the individual inputs of the various

providers you have seen. Who knows what the VA would do, but it's worth a try.

[Buck52]

Here are some older post from the elders of hadit, read them to get a better insight.

.............Buck

[ArmygirlRJ]

Thank you to everyone for responding and providing me with help. Reason for Descision: We have assaigned a 10 percent evaluation for your migraine headaches based on Characteristic prostrating attacks averaging one in 2 months over the last several months. A higher evaluation of 30 percent is not warrent for migraine unless the evidence shows characteristic prostating attacks occuring on an average once a month over the last several months. When you mention C-file would that be my VA medical records? If so I enclosed them with my NOD highlighted with the Doctors stating that my migraines does not allow me to work if that is not my c-file how do I attain it?

[lotzaspotz]

Your neurologist would not have completed your FMLA paperwork unless you had a chronic health condition that warranted it. You should include your FMLA paperwork as part of your evidence and if you could get an IMO from the neurologist, have him/her discuss the circumstances that justified the completion of that paperwork.

There is no "loophole" in FMLA. That's not to say that employees are not harassed for taking advantage of FMLA, but an employer's interference in an employee's right to access FMLA will be very costly to the employer. Short of a reduction in force that includes other people, the employer would have a very high hurdle to clear trying to defend firing someone who has not exhausted their FMLA leave.