Possible CUE win?

[SPO]

So after some prompting from some friends I got an appointment with the DAV to look at what I thought would just be a new claim to ask for in increase on my psoriasis claim (10%).  After the DAV reviewed my records, including my C-file it looked like the VA had ignored some evidence that would have given me 30-60% rating for psoriasis, which is based on the use of immunosuppresive medication.  We couldn't find a copy of my civilian dermatologist medical records in the file, but we did find where I provided them with the information to locate the records and a note asking them to retrieve them.  No where in my C&P exam did it state the I told them I was on that medication, but in my decision letter the cited the use of immunosuppresive medication to treat the condition (information only available through my private doctors records.)  Also I believe that the VA did not fulfill its duty to assist in accordance with federal regulation under title 38 CFR 3.159, which states they must provide notice as to the identity of the records they cannot obtain, as well as what efforts they have made to obtain them.  No letter of that type exists in my file.  The only letter is a generic letter asking if there is anymore evidence I would like to provide (no specifics included). 

Using these medications for 6 weeks or more in the last 12 months (at the time the application was filed) can lead to a 30% or 60% rating.   My decision noted other items to justify the 10% but did not mention the immunosuppresives in the paragraph that tell you why you got that rating. The DAV reps submitted a CUE for me, so if we are right I should be back dated to December, 2009. It could possibly take me from a 30% overall rating to 50-70% overall depending on which criteria they think i meet.  Any else seem like this should be one for the veteran win column?

Edited October 21, 2016 by SPO

[Berta]

I think I 'inputted' all I could think of....

the very fast timeline concerns me....they should have all of the prescription info etc etc you mentioned 

You mentioned you were concerned about this:

" Is there anything I can do to ensure that my prescription records for the Humira are properly interpreted."

This is not politically correct for me to say, but I have prayed many times for VA to have the ability to read my evidence. Sometimes the prayer was answered in years and sometimes in a few weeks.

But it got answered. It was the only thing I could think of to do,once all of my evidence was in their hands.

I don't see what, at this point, you can do...but they might even kick it out of the decision phase, and do something else with it....ebenefits does not always seem reliable. They might have the C & P exam there by now at your ebenefits account.

 

 

 

 

 

 

 

 

 

 

[SPO]

My C&P exam (which was favorable to me, the doc actually added additional info to help) did show on Ebenefits about the same time it changed to preparation for decision.  The only thing I can hope for is that their error was so clear an unmistakable that they gave in immediately.  Doesn't exactly sound like the VA's way of thinking but maybe I'll get lucky.

[Berta]

WOW that is great news---- it is the C & P exam that determines the outcomes .....

yes, this might well be a case of the VA doing the right thing, sooner than later.

I sound negative here a lot SPO but only because I am a hardcore claimant and they made every mistake they could on all of my claims....but the VA , here at the local VAMC ,employs some of the best people I Know

and I sure have met many VA employees outside of this VAMC community as well, who do a good job and put vets first every day.

But if the VA claims process was without all of it's negative nuances, we would not even need to have the hadit site. In the past 20 years , the fact that this site has grown so much shows that not every vet gets a fair shake right from the git go.

If you mentioned the good C & P before here ,I sure missed it.   This is very good news!

 

[SPO]

I just realized something else. They gave me an initial rating of 10% for using uvb treatment.  I don't remember when I ever got that or how they would have gotten record stating that. The records I requested they retrieve didn't mention it. I can figure out where they got that info

[FormerMember]

I'm somewhat like Berta. VA short-sheeted me so many times I became accustomed to the negative expectation. In this case, I suspect, short of some major reason like homelessness or medical exigency, a feeling that they are lip-whipping together a quick denial unless it's an open-and-shut case of VA dumb. For every 85 claims they screw up, we know they get 15 right statistically the first time out. Yours may be one. 

[Berta]

I bet it might have been a NSC rating ...NSC = no comp...but the expected decision could now take that into account....or 

be the basis for another CUE.

What I mean is once a vet gets a SC rating for something they denied in the past with a NSC rating, there is always a good potential to file CUE on the older decision...if the NSC rating was at least at 10%.

It just makes sense..if something is now SC ,after denials, it was SC when it was initially claimed,if they made a NSC rating on it...