VA Raters

[5andr01i]

Good Afternoon,

     Does anyone know if the VA raters have wiggle room in regards to judgement calls, or are they black and white when it comes to distributing a rating for a claim.

 

Respectfully, 

[Berta]

Veterans can always appeal a rating that they feel is wrong, based on the medical evidence VA has and the VA Schedule Of Ratings (available here at hadit).

They don't have much wiggle room with C & P results because they are not allowed to substitute their judgement as a rater, regarding a medical opinion. But still, how they perceive (or even ignore) medical evidence could warrant a low ball rating and many here have fought back on that.

We could better answer your question if you give us some specifics.

[Fat]

I respect raters that spell out why the claim is denied; however I have no respect for persons whom purposely overlooks information.

The veteran works hard securing information, getting IME's, and specifically addressing reasons for denials in the initial stages.

Then after a 15 to 24 month wait (NOD), are denied again without the rater considering all new information submitted.

In addition, they conviently leave key information off the reason and basis for denial portion of the SOC.

It is really mind boggling and frustrating.................

Claims should be decided on medical evidence.

Not the laziness of workers, the politics of monthly budgets being met, or a potential bonus for administrators.

It seems the VBA is becoming the preferred way to make sure you have a "fair" appeal.

"NEVER GIVE UP"

 

 

[MarkInTexas]

Y'all correct me if I'm wrong, but I've seen denial letters that were copy/pasted almost verbatim.  Even got a denial for something involving a "muscle" in my initial chronic sinusitis claim.  I think they copy/paste/cut more than actually sit down and examine the record and write a narrative of why they "personally" feel that a denial is warranted.

Just my thoughts on it.

Mark

 

[bluevet]

My C&P examiner opined that my condition was "less likely than not" related to service. His rationale stated " The bipolar disorder is a condition totally unrelated to service. Bipolar disorder is due to advance imbalances in the brain, cause most likely due to genetic conditions." My denial letter cut and pasted this opinion. 

As you can see, this doctor gave his opinion on bipolar disorder, not on me or my medical records. According to this doctors opinion, no veteran qualifies for compensation for bipolar disorder. He never mentioned me or my medical history in this rationale.

Still, the VA rater chose to accept this ridiculous excuse for a medical opinion to deny my claim. Costing me a minimum of 2 years additional delay.

I believe this was because I had filed an FDC and this exam came in very close to the 6 month target time for an FDC claim. So rather than have my claim hurt their FDC stats, he threw me into DRO limbo.

The worst part is that there really is no accountability for VA raters who pull this crap. They basically can do whatever they want and get away with it.

[USMC_VET]

I agree with the above comments.  VA raters technically dont have wiggle room, they can only rate based on the DC in the 38 cfr what the evidence allows them.  they should only be accounting for what the evidence states and whatever % your symtomps and evidence points you MOST towards is what you should get.  however that "technically" doesnt account for the 70% denial rate that is overturned and the above mentioned shenanigans.

 

Have good evidence and always be ready to file a NOD

[pwrslm]

When they have an atmosphere that quantity is a substantial component that overrides quality, its easy for a rater to gloss over information that, if applied in the decision, would change the results.  If a vet submits 600 pages of medical records, 200 pages of statements and history, its not a situation that can be glossed over. 

If the VBA broke out its operation, and put rating officials at the locations where the vets are, and were required to meet that vet, to go over the vets claim, and allow the vet to present the evidence substantiating the claim directly to the rating official at that meeting, the error rates would drop significantly, and I would suspect that the entire process would move along much faster.  When a rater has the opportunity to sit down and explain the in's and out's with the veterant, the veteran would have the ability to point out errors and ask questions directly with the rater that could prevent future conflicts and appeals.

With the rating official at the local clinic, they could interface with PCP's, C&P examiners, and social workers that are also directly involved with the veteran.   Misunderstandings could be solved before the initial rating decisions were complete, and then forwarded to the regional offices for final approval.

Edited August 24, 2015 by pwrslm