Opinion Needed..............

[Fat]

A buddy of mine received his Big Brown Envelope and was highly disappointed.

He filed a claim with the following issues: left hip, left knee, left thigh, and Restless Leg Syndrome.

He was denied for the knee, hip, and RSL.

His wife asked me to look at the SOC and afterwards I was surprised by two things.

In bold letters there was a statement: FULL GRANT OF BENEFITS- the left femur stress fracture (previously claimed as left thigh condition) is currently being worked and a decision will be sent soon.

In addition, the denial for RSL stated: service connection is denied due to condition neither started or was caused by military duty. Also, RSL can't be secondarily connected to service connected left femur condition.

These two statements lead me to believe the left femur condition is going to be service connected when he receives the SOC for that issue.

What do you think?

All comments welcomed.

[john999]

In my opinion he needs  IMO/IME on all issues that will connect and properly comment on severity of his various disabilities.  The initial denial is round one of 12 round fight. Does he have Independent medical opinions for these things or just depending on what the VA says?  They tend to lie , misrepresent the actual facts, laws and regulations, and focus on "How can we deny this claim until the veteran dies or gives up" .  Some people here don't believe that, but after 45 years dealing with my own VA claims I believe it 100%.   I cannot even understand logic of VA when I win a claim often times. When I won TDIU my psychologist and psychiatrist could not understand why I did not get  100% instead of TDIU P&T.   The actual facts support 100% and housebound from at least 2001 and 100% from 1972, but that is a horse of a different color.  To really get all benefits available from VA it will cost some money to get medical opinions and other evidence and help with arguments often times.  This is what disabled vets don't usually have much of in pocket.  When I got P&T I had 4-5 IME's some of which I had to pay for and some I got gratis since I was patient of docs.

[Fat]

The veteran is in good shape (claim wise).

He was injured in basic training, stress fracture of left femur, and the injury was treated by surgery with a pin inserted into the bone.

He was discharged and was unaware of VA disability benefits until 2 years ago.

He filed for left knee, left hip, and RSL without his medical records and knowledge of the VA process.

The denial for the above mentioned disabilities all mention the left femur injury, but he didn't have injuries in the military for those issues and currently isn't suffering residuals for those injuries.

I have to admit the C&P exam seemed very thorough and included ROM measurements and x-rays of the knee, hip, and thigh.

The primary issue is his left femur condition and he is anxiously awaiting the decision for that issue.

In addition, he wants to see if they will address the scar issue from the surgery when they inserted the pin into the femur.

Edited August 21, 2016 by Fat

[MarkInTexas]

On August 20, 2016 at 2:40 PM, john999 said:

In my opinion he needs  IMO/IME on all issues that will connect and properly comment on severity of his various disabilities.  The initial denial is round one of 12 round fight. Does he have Independent medical opinions for these things or just depending on what the VA says?  They tend to lie , misrepresent the actual facts, laws and regulations, and focus on "How can we deny this claim until the veteran dies or gives up" .  Some people here don't believe that, but after 45 years dealing with my own VA claims I believe it 100%.   I cannot even understand logic of VA when I win a claim often times. When I won TDIU my psychologist and psychiatrist could not understand why I did not get  100% instead of TDIU P&T.   The actual facts support 100% and housebound from at least 2001 and 100% from 1972, but that is a horse of a different color.  To really get all benefits available from VA it will cost some money to get medical opinions and other evidence and help with arguments often times.  This is what disabled vets don't usually have much of in pocket.  When I got P&T I had 4-5 IME's some of which I had to pay for and some I got gratis since I was patient of docs.

Amen to that!  They will lie about laboratory test results, mix your records up with those of other veterans then cite them in C&P examination reports, denials and SOC's.  They won't really help you look for your documents, including those that were DOD, and if you do a ton of work to get them, they are great at losing them while not bothering to tell you that they lost them.  If they don't lose them, they still might simply "forget" to use them in the adjudication process.

If you talk to a human, he/she will be polite, but not helpful.  Always polite, but you can tell they can't wait to hang up the phone.

For C&P's , they'll use nurse practitioners, physician's assistants and quack doctors that are on the verge of losing their medical licenses, or who have bellied up in their anti-aging or liposuction practice, and who are forced to either work for the VA, or worse still, for QTC or VES as a contracted "Denier For Hire."

These quacks, who often have no real medical specialty, are considered gospel prophets by VA raters, but the same VA raters will look at IME/IMO reports from actual "real" medical doctors with years or decades of experience in specific specialities, as suspicious and will do everything in their power to discredit them, including simply forgetting to mention their opinions, or better still they shoot them down by "lying to deny." 

And don't forget that they are notorious copy and pasters.....even if it means copying another veteran's information into your denial, rating or SOC.

Keep hitting them, and if you can get leverage, use it.  Don't feel sympathy for them if they screw up, because they won't give you a break if they are given the chance.

Worse still, the longer you wait in the process, the more that your projected retro may grow, which sounds like a good thing.  Right?  Wrong.  The local VARO's hate to grant large retro amounts in the range of five or six figures, so they do everything in their power to deny  to let the BVA sort it out, which adds yet more years to a veteran's claims.

But hey....at least you get a Veteran's ID card that's good for 10% off at Lowe's and Whataburger after it's all said and done.

Peace out!

Mark

 

 

[john999]

Mark

 

                    I forgot about the VA mixing up your records with other vets.  They have done this to me about a dozen times over the years.  The most serious was when doctor at VA did not want to do procedure on me due to my having had a "Stroke" recently.  I never had a stroke.  It was some other vet whose records got mixed up with mine.  Also VA used a dentist's IMO to deny my mental health claim.  They got my IME's mixed up and applied them to wrong claims.   I agree with what you have said 200%.  It is probably worse than what both of us think.  I say they are criminals.

[MarkInTexas]

John,

Don't want to hijack this thread, but yeah.  They are amazing.  Got my third corrupted C-File in June this year, and actually thought it was purged after all of that mess from before.  However, I still found at least one other page of some other veteran's medical records in the file once again.  And it was one of the original ones I told the VA about in 2014!

Nothing crazier than spending over three years trying to tell the VA to purge 95 pages of other veterans' records out of your C-File, and then finding that AFTER all of that, the VA examiner and rater actually still used those records as a negative evidence.  It's a lot of fun reading about some injury your had when you were an adult prior to being in the military, when in reality you either weren't born yet or were just a small child.

I tend to agree that it is criminal.  I really think the VA has gotten so big and powerful that Congress can't even reel them in, or they don't want to.  If too many veterans' claims get approved, there will be too much to pay out in Compensation and too much in medical costs.....so denials keep the budgets down.

As always, evidence and persistence usually can prevail, but unfortunately, they can make up their own evidence, borrow it out of some other veteran's file, lose your evidence, disregard your evidence and when all else fails, stall until you pass away or become so discouraged that you give up.  (The last two are their favorites.)

Mark

 

 

 

[Fat]

Thanks for all the replies...............