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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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Berta

Read First before claiming Section 1151

Question

I have posted extensive here  on this type of claim.

Here is a brief run down from the VA.

http://www.benefits.va.gov/COMPENSATION/claims-special-1151.asp

VA says they have a 1151 form on line now:

But this is all I get from VA and this separate link:

https://www.pdffiller.com/en/project/81839399.htm?f_hash=d9744d&reload=true

What form?

None appears at any link. I never used a form for my 1151 claims .

The Order of the Purple Heart gives a clear explanation of these types of claims:

http://www.purpleheart.org/serviceprogram/Training2013/10-M--1151 Claims-Maria.pdf

There are many nuances to 1151 issues, so best to  read all that is here in this topic.

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To add to this topic:

I recently stated here that 99% of 1151 claims need an IMO but I changed that to 98%.

I have already stated the 2 key ingredients for a successful 1151 claim here many times, but here it is again:

1.Documented medical proof of a ratable disability or death directly due to VA malpractice.

 

 

2.Documented medical proof of the malpractice/negligence that caused the additional disability or death.

 

 

If anyone with what they feel is a basis for a valid 1151 claim, does not attempt to get a strong IMO/IME, then they will be part of the 98% who will be denied.

If anyone however is willing to practically become a doctor themselves, then there is a chance they can succeed. Been there done that…...It is a lot of work and time consuming.

The basis for any FTCA or 1151 claim is simply this……

Would the “standard and Usual” medical community ( the non VA medical community) have taken the same steps to diagnose and treat the veteran?

If the answer is No that becomes a basis for malpractice.

I am repeating what I posted here before over the years as to FTCA and 1151 issues.It might help someone these days.

 

 

In Early 1995 I filed a FTCA case. VA did what they were supposed to do and referred the claim to the VA Regional Counsel in Buffalo.

Regional Counsel then referred the claim to a doctor for what they call a Peer Review.

This was a VA doctor with expertise in cardiology and he was also the director of one of the VAMCs I charged with malpractice.

In May 1995 the RC called me to tell me he needed to begin negotiations with me because the Peer Review found the veteran’s medical care, along with the evidence I sent in with the FTCA claim, was substandard and in no way complied with the ‘standard and usual care’ in the usual medical community and cited documented examples from the medical records and within my statements, as to how the VA care was inappropriate etc etc etc and that it caused my husband’s death.

It was about 4 pages long.

Then odd things happened ( they don’t seem odd now after dealing with VA for decades since)

The RC disappeared, the Peer review doctor disappeared and also the Peer Review report disappeared as well.

Within a year I found out where the RC and the Doctor went but the VA told me the Peer Review report had Never existed.

At that point my FTCA case went to the VA General Counsel in DC. That was a battle too to get it there.

I had to continue my case without the Peer Review that the VA RC wanted to start negotiations on.

That’s OK. I had a valid case and fought it aggressively.

In 1997 I won. The VA had done another Peer Review , it was far worse than the original one….

Worse for VA, not for me.

But  it bothered me that the original Review somehow disappeared……but it didn’t……

When I re opened my claim for death due to DMII AO, I got a copy of my file and the Peer review was right at the bottom of the C file.

I used it since then for the DMII claim and a few other 1151 claims I had.

It was dated May 1995 and was by then New and Material evidence....since the VARO had never acknowledged it before ( I found the RC and the doctor and they assured me the VARO had it)

My long point here is that when we advise getting an IMO for any type of claim and specifically for 1151s, we know what we are talking about.

Of course if you want to practically become a doctor yourself , you can take a chance without an IMO/IME.

I proved without an IMO the VA malpractice on “multiple deviations in a usual standard of care, all of which hastened the veteran’s death” ( quote from my 1998 1151 DIC award.)

Those deviations included heart disease, multiple transcient ischemia, major CVA (Stroke) , and HBP, but I didnt have an MD after my name so I had no idea they also were negligent in not diagnosing or treating DMII as well…

 

 

I had to study medicine again. Endocrinology. And when I knew my DMII  claim was solid , I got 3 IMos this time and even ordered a fourth that I didn’t need.

I was tired of dealing with incompetent VA doctors and their ridiculous C & Ps.

So I am giving advice that I took myself, when I reopened my claim for direct SC death.

The IM0s fees were nothing compared to the ancillary benefits that my husband wanted me to have if he died and VA even had to (after a battle), refund to me the FTCA offset I had agreed on,pay me the REPS benefits, and even refund some of my college tuition ( about 6 thousand) I had paid to AMU after my original DEA date ran out.

We are unable to fully assess most 1151 and FTCA issues here.

We can only offer advice as to what we read here or what is attached.

That is the job of professional non VA doctors to do if they are willing to provide an IMO/IME, that fully conforms to the IMO/IME criteria here at hadit.

Even if their IMO/IME does not reveal any malpractice, then the vet has paid for Peace of mind.

And Peace of Mind has value.

 

 

Edited by Berta

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