What's Best Recourse To Address Falsified Medical Records?

[OldSkool33]

Hey, y'all I'm the new kid. Yes I tried searching. I had trouble finding my answers. Now I'm drowning in data and could use some help. If the topic already exists, a point in the right direction would be awesome.

So here's the situation. In the middle of processing a claim, the C-file finally arrives and there's an entire C&P exam in there that NEVER happened. And it is not just the fictitious exam, but a whole chain of communication and DBQs pursuant to it. Its insane!

In terms of processing the actual claim, I think I'm OK. But in terms of the falsification of records, I'm not OK. The question I have is, what next? I can deal with the claim separately. I want to see punitive action like going for medical licenses and facility accountability. I'd also like to know if there's recourse for malpractice since the illegal activity has done financial harm.

They would crucify us for fraud, can't I at least poke them in the eye or something?

Edited May 13, 2017 by OldSkool33

[OldSkool33]

6 hours ago, Buck52 said:

The VA goes out to get evidence to help deny the claim when everything in the record says that the claim should be granted.

 

This is system wide, isn't it? Thanks for the references, will look into it. Hopefully, future legislation and policy changes will address these issues. I hate the thought that many of our brothers and sisters in crisis were driven there by the system they had turned to for help.

[OldSkool33]

4 hours ago, broncovet said:

 

This is an ongoing problem, and your's is not the first records falsified by VA in order to deny.  

 

 

I'm becoming painfully aware of this fact. The more I look into our own files, I'm realizing this isn't the first or last time they've done it to me. Add that to the probability that every one of us may have the same problem and OMG, its mindblowing. 

In terms of getting away with it, I don't know exactly how to respond. Is it possible that Mr. Cushman's primary interest was in his claim? I'm sure the case was stressful enough. You would think that the regulatory authorities would grab something like this without the need for prompting. Maybe you have to actually file those charges with the appropriate agency to follow through with it.

[Berta]

The vets and NSOs, VSOs, reps,even vet  lawyers used to call it a "fishing expedition"when VA would seek enough VA negative opinions to deny with.

This has happened to many of us hardcore claims, and that is why we advise many to get IMO/IMEs.... I had 3, a freeby from a Neuro, and 4,000 bucks for the other two  and I  figured that was good enough, but I asked for a remand because the VA did not give me my VCAA rights. They remanded instead for a Bogus opinion and I knocked it down myself and sent my lay medical opinion to the BVA. I had paid for another IMO but got the decision before the doctor had time to prepare it.

 

The 3rd opinion they got was not from a Cardio, as they had requested.

It was from a PA . I got the C & P and I stated he had speculated on the opinion because he did not have expertise in cardio and besides, the BVA wanted a cardio opinion, not one from a PA. I then laid out my own lay medical cardio opinion.

The BVA agreed that my VCAA rights had been violated, but that it was a moot point because of all of the evidence I had ( (much more than the 3 IMOs , and as I always say here, unlike the ROs, the BVA can read and will read everything they get.

This issue is not a FTCA/1151 issue. If you go to our FTCA forum here you will see the criteria for FTCA/1151 claims that I have put there.

The VA has a new office of accountability....I havent read their email yet, and I assume it has contact info or will.... This is where vets should be writing to the VA, because Shulkin was hired to "reform" VA, not maintain the status quo that no one has done anything about yet.

Veterans have to reform the VA by letting themselves be heard. SecShulkin and POTUS as well need to hear from them.

I did feel, with flashbacks to the 1980s and 90s with VA that  the BVA was on a 'fishing expedition with me, until I realized why they had to ask for one more opinion.

I am waiting for my baby girl to call me. They screwed up her very first application to the VA.

7 Year USAF Intel. Mommy got that error fixed in 3 weeks. She said I wrote a CUE and a NOD for her to sign and mail back to them.She was really angry but all I could say was "Welcome to my world."

It was a Chap 35 award for one month. They had her DD214 and every thing they needed.

The new award letter was for 7 years of extended entitlement. She served 7 years. The regs were right on the application she signed, when she sent them her DD 214.

VA EDU dept is an oxymoron at times...I didnt have any real problems with them at all.

Edited May 14, 2017 by Berta

[OldSkool33]

1 hour ago, Berta said:

I asked for a remand because the VA did not give me my VCAA rights

I'm not very well educated on the finer points of the VCAA. I get the jest of it. But maybe I can find an immediate application for it?

I'm trying to be as generic as possible because it isn't my claim. So I have to ask in general terms. I have a letter of intent to reduce disability ratings. The letter itself contains some medical blah blah blah about why they reached their conclusion. They also listed every document and source of information they claim to have used in making their decision.

The C-File has been like pulling teeth to get, but a disk with some of it arrived about a week ago. It is incomplete and contains none of the documents that were declared  Any of the potential information found with the "Blue Button" is reported with a message similar to, "You may not view this record".

The intent to reduce gives us a 60-day window before they take action. But without the records in question, how can I give a knowledgeable response?

The difficulty is compounded because among the documents listed is another problematic C&P exam. The exam in question was incomplete because the Examiner actually caused injury to the Veteran who immediately left the C&P office to go to the ER.

WTH is in that report? And they based an intent to reduce benefits on that? So my question is, would the veteran be able to request a stay against the reduction based on VCAA in order to get the documents needed to properly evaluate the intent to reduce? We all know those records will take more than 60 days to get if they ever show up.

I know this gets tricky because it ventures into the fuzziness of the NOD and appeals requests and so on. But I'm just wondering if there's something in the VCAA that might leverage a stay on the reduction.

[Berta]

" The exam in question was incomplete because the Examiner actually caused injury to the Veteran who immediately left the C&P office to go to the ER.'

If they caused a ratable disability ( meaning the veteran was 10% or more disabled when this happened,due to the injury), and all of that is documented on the ER certificate, that might be basis for a Section 1151 claim.

If you are waiting for the medical records, they might give you a copy of that ER cert right away if you go to the Privacy Act/FOIA  person at your VAMC... maybe....right away.....

"So my question is, would the veteran be able to request a stay against the reduction based on VCAA in order to get the documents needed to properly evaluate the intent to reduce? "

Maybe if they violated the VCAA The entire Act is here somewhere but still this claim will need in my opinion an IMO/IME  for a proper resolve and that would be mandatory anyhow  for a Sec 1151 claim or FTCA claim or both.

I know how absurd that sounds ---disabled vets have to pay a real doctor to get a fair shake for sacrifices they made in service, in most cases where the C & P goes against the claim. 

Have you googled the C & P docs?  To see if they have any expertise at all to opine on the disability?

We had a vet here, I think for a foot condition and he got a C & P from a gynecologist.

As I mentioned I got a PA when the BVA called for a cardio specialist.

Another vet here recently got a C & P that went against him, but he never went to this C & P at all.

The VA is SNAFUed and FUBARed up the ying yangs. 

 

[OldSkool33]

11 minutes ago, Berta said:

"So my question is, would the veteran be able to request a stay against the reduction based on VCAA in order to get the documents needed to properly evaluate the intent to reduce? "

Maybe if they violated the VCAA The entire Act is here somewhere but still this claim will need in my opinion an IMO/IME  for a proper resolve and that would be mandatory anyhow  for a Sec 1151 claim or FTCA claim or both.

 

The injury only aggravated an already rated condition. We did get the ER report from Release of Information. And they erroneously labeled the cause of the injury as 'exercise' ... it was the VA ER, IDK why I expected anything different when filing a complaint on VA C&P, but I digress. I think you're right about the IMO/IME. Its a little difficult finding someone to do that. Primarily the concern right now is, I can't give the Doc the records to review in order to reach an opinion. I need the VAs assistance in the form of 'give me my records, please'.

12 minutes ago, Berta said:

We had a vet here, I think for a foot condition and he got a C & P from a gynecologist.

That's too funny. Actually, the Doc who signed off on the original C&P exam in the OP was an Ob/Gyn opining on ortho conditions.

13 minutes ago, Berta said:

The VA is SNAFUed and FUBARed up the ying yangs. 

This is unfortunately true.