Camp lejeune appeal hearing

[marinevet61]

On Thursday oct. 6 got a call from Louisville. The person wanted to know when would be a good time to set a date and time for a hearing. They wanted to know if I wanted formal or informal hearing by phone. He said informal DRO can make immediate decision and informal would take 2-3 months. Got another call today time and date was set. 

I requested informal hearing. This hearing is on an appeal for Camp Lejeune from 2014. I hope I made the right decision requesting informal hearing. In the initial phone 

Call the person talked briefly about some of the evidence that they had and I brought up the Nexus letter from my oncologist. She stated that the word could was used by

My oncologist. I felt that she was trying to tell me that the word could is not very strong. The dictionary defines "could" (To show a possibility.) Can anyone comment on 

this? My original claim was rated and denied by an SME. I found out that the SME is only a PCP.( Primary Care Physician) who is not an expert in oncology. As I have never

Been through a DRO hearing I am asking for any advice as to what to expect. 

Thanks to all of you 

 

 

 

 

 

 

 

 

 

 

 

[Berta]

She was right.... the proper criteria for an IMO/IME is here under read First before getting an IMO/IME.

"Could" is too speculative...did the doctor bolster their opinion with some sound medical texts and a full medical rationale?

Your oncologist certainly should outweight the PCP opinion, but VA looks for the minefields in these private opinions. ..and they found one already...the word "could."

Maybe your oncologist would be able to look over the IMO criteria here and add an addendum to his opinion.

 

[marinevet61]

Berta he did not speculate or add a rationale. I was lucky to get what I did get from him. None of

My other docs would take the time or just Flat refused. I have asked again and he says that this is

All he will do.

[Berta]

I assume this opinion did not cost you anything.

I have had multiple claims but needed an IMO for one of them, actually I got 3 IMOs and even ordered a third one I didnt need..

It was one of the best investments I ever made....but costly.

Many years prior  to that I had won a FTCA  VA case by myself..wrongful death , 1151 award too.......no lawyer, no independent medical opinion...I did all the legal and medical work myself. I just had mailing fees and PC ink, paper costs

But the difference is that, unlike my RO,  I was dealing directly with VA General Counsel lawyers in DC... and they can read.

Lawyers not only LOVE evidence, the VA lawyers know 38 USC,and 38 CFR  to the letter.

I am on my RO's crap list since winning the FTCA so I didnt take any chances and got those IMOs for the next claim.

You asked what you could expect and maybe the VA will find your doc's opinion of equal value probatively to their med opinion  that denied the claim...... maybe .....That means you would possibly win the claim under Relative Equipoise.(Benefit of Doubt)

However as a hardcore claimant myself, I sure would not depend on that , on what you stated here, that the DRO said.

Remember who owns the Benefit of Doubt Scale.

 

 

 

Edited October 13, 2016 by Berta

[marinevet61]

Berta you are correct, I did not have to pay for the Nexus letter from my oncologist. I have thought about

What you said about who owns the benefit of the doubt. I have made up my mind to get through this hearing

and whatever I need to do if I am denied again I will get it done as long as I have the strength to keep going.

Thank you for your time and all of the information. Will let you know how it turns out.

 

 

[Berta]

I mentioned above I had ordered and paid for a 4th IMO but the BVA awarded before that IMO doctor completed it.The company (forensic specialists) refunded about half of what I paid.

I ordered the 4th C & P because I didnt know if the BVA would accept my rebuttal to the VA's last C & P exam, but they did...I jumped the $$$ gun.;..so I hesitate to tell you that you need an IMO.....but I think you do, because of what the VA  said about the word ":could."

Did you already post the denial here at hadit? If so, I will search for it...and I hope others chime in.

 

Long ago I  helped a local vet years ago who got a free IME from his private doc but his doc got pissed off at the vet and me , because I also had included a healthgrade run down on him with the documented evidence I found in the veteran's SMRs. This was before I even knew Dr Bash and could prepare the IMO/IME posts here.

This Doc, a well known NY Endocrinologist,  thought everyone in NY and at the Buffalo VAR0 knew how good he was. His healthgrades run down was excellent and detailed his experience etc.Maybe VA did recognize how prominent he was ,  but they didnt give a shit because their lousy C & P exams were done by nurses, with no clue at all on diabetes, and this endo doc's first IMO was awful.

I have dealt with Buffalo RO for over 20 years so I know how difficult they are to deal with.

I paid 4,000 for 2 IMOs from Dr Bash and then the next one was almost 2,000 as well but they refunded about half when I called them and told them I just had received the award letter.

I do not regret at all these fees ( and not all IMO docs would charge this much..but some might charge more)..You already have an IMO from your doc that could bolster another one ,from an oncologist, that conforms to the IMO/IME criteria I posted the link to,  to overcome their C & P exams.....

Maybe someone here has had a good experience with this type of oncologist IMO/IME, from a real doctor ...which you have , but VA, in my opinion, will consider his opinion as too "speculative" and deny the claim again.

BTW The above vet's endocrinologist doctor did comply with another IMO giving a full medical rationale this time for his opinion,reading the SMRs and all of the time consuming work I had already done on this claim. The vet had been denied multiple times by then because no one else would read his SMRs  and figure out what they said.

I had attached copies of many handwritten SMRs, I had to decifer them all,hard to read...to support my lay diagnosis of diabetes, while the vet was in service. The military had diagnosed and treated him for VD...which he never had, and which his documented inservice symptoms did not support. He had diabetes, not VD.

He won the claim when they got the 2nd IMO/IME from the Endocrinogist..

 

 

 

 

 

 

 

 

Edited October 16, 2016 by Berta

[marinevet61]

 Berta I tried to scan the denial and other info several times. As I said in the past I am not very savvy at

Technology. It just would not work. My brother says it is the "Operator" not the scanner. This is the claim

That was denied. The SME did this on February 13 but my evidence was not uploaded into the system until

February 19. So my question to them is how can this be fair to the veteran if a decision is made without

Reviewing ALL of the evidence and how can they do this without notifying the veteran. My oncologist is

The one that wrote the Nexus letter, but as I stated earlier he refuses to write another one. I have no idea

how this will turn out and I am very nervous but I will do the best  I can 

Thanks Berta