DRO Hearing

[Jimmer]

Hi Guys, I wan to thank you for all the help you have provided, it has been  great for me!  I have a question.  I will try to make this brief, as possible.  About three years ago, I felt the V.A. was "stonewalling" me on a couple of issues, my back and my lungs.  I call the V.A  line to MacDonald and Hinkley , and within a week, I was contacted by a RO from Phoenix, Az.  She was handling my case, and just need completed DBQ's and Nexus letters, and any recent tests pertaining to my back and lungs.  She said no C&P exam was necessary.  I provided her all the documentation, and she said this was want she needed to finalize everything.  I get a letter for a C& P exam.  I tried contacting the V.A. in Phoenix ,Az,  but no success.  I tried contacting the RO but I found out later she was transferred from Phoenix to San Diego.  I went to the C&P exam, because I know what happens when you don't go.  This is the doctor I think I told you, told me, "wow your in bad shape".  You back is really bad, and you have bad lungs.  The he said "I am probably going to deny you, because that's what I do.  But appeal, and you should win".  He denied, and I sent a NOD.  I had a DRO hearing March 2016.  I provided all the information.  But I neglected to provided the e-mails that I had, documenting from the RO that I did NOT need a C&P exam.  I didn't bring it up in the hearing, because I couldn't fine them. and I thought they might have it in their files. (I know stupid me).  I haven't received a decision yet.  Do I wait until, if I am denied and provide the e-mails, or should I send them now, before a decision is made?  I don't know what to do.  Thanks again,   Jimmer

[Jimmer]

Navy4life, Thanks for your reply.  I had a full blown C&P exam in January 2015.   For Diaphragmatic Paralysis of the Left Lung they perform a Spirometry test.  The original tests agreed with what the Board certified specialists came up with.  I had most recent tests April 2015, with specialists.  When I meet and had this C&P exam in October 2015, the doctor didn't perform any tests.  It was for my lungs and back.  He said "I can tell that you get winded easily".  Then with my back, (I had 4 surgeries) He touched my back, by one of the  scars and I jumped, and he said "boy you back is in bad shape, I'm not going to do anything".  Then he sat at his computer, and talked,  (mostly about himself).  When I got a copy of the C&P exam he stated all these things wrong with my lung and back, but still denied me.  I knew he was going to deny me because he said "it looks like I am going to deny you, ...... but file an appeal.  You have a strong case and should win".   "I deny just about everybody here, that's why they like me".

[Navy4life]

1 minute ago, Jimmer said:

Navy4life, Thanks for your reply.  I had a full blown C&P exam in January 2015.   For Diaphragmatic Paralysis of the Left Lung they perform a Spirometry test.  The original tests agreed with what the Board certified specialists came up with.  I had most recent tests April 2015, with specialists.  When I meet and had this C&P exam in October 2015, the doctor didn't perform any tests.  It was for my lungs and back.  He said "I can tell that you get winded easily".  Then with my back, (I had 4 surgeries) He touched my back, by one of the  scars and I jumped, and he said "boy you back is in bad shape, I'm not going to do anything".  Then he sat at his computer, and talked,  (mostly about himself).  When I got a copy of the C&P exam he stated all these things wrong with my lung and back, but still denied me.  I knew he was going to deny me because he said "it looks like I am going to deny you, ...... but file an appeal.  You have a strong case and should win".   "I deny just about everybody here, that's why they like me".

^^Why would a doctor say this?  Totally unprofessional and I would have filed a complaint with the patient's advocate immediately.  His statement makes no since, that he would say he is denying you but file an appeal b/c you have a strong case....

I am not understanding the timeline....

About three years ago you thought the VA was "stonewalling you" correct?  At that time had you just submitted the claims for your lung/back?

Then you called McDonald/Hinkley in 2015 and that is when you got the C&P exam correct?

You said you had a C&P exam in January 2015 - who ordered that?  

Why was another C&P exam ordered in October 2015? - this is where I am not following...

[Jimmer]

Navy4Life, I originally submitted claims in 2010,  the V.A. said they need further information.  In 2011, I sent all the information needed, exams, letters, etc.  It was in 2014 (my mistake) I contacted MacDonald/Hinckley about  conflicting information, and I felt I was being "stonewalled".  Then in January 2015 I was scheduled for a full blown exam, which I did.     Then in June 2015 I was contacted by the Rating Specialist, who told me she was working my file.  She said she just needed "updated DBQ's and letter's from the specialists", and she could make a decision.  She stated in her e-mail, NO C&P Exam needed!  I sent all the information, in July-August 2015.   Then I got a call in September for a C&P exam.  I told the Phoenix V.A. office that I didn't need one, and they said they had no record of that.  I tried calling the rating specialist, but I could not reach her, because she had been transferred to San Diego.  I called the V.A. in Phoenix, and they said they had me scheduled to take the C&P exam in October 2015.  I had no choice but to show up for the exam, because I know what happens when you don't show up.  I finally located the Rating Specialist in November, and told her I had to take a C&P exam.  She said that was wrong, and she would contact the Phoenix, AZ office.  Never heard anything further from her, as I tried contacting her several times.  So I got the results filed a NOD, called Washington, said I was really upset about what happen, and I got a DRO hearing scheduled in March 2016.  I went to the hearing, and still waiting............Jimmer

[MarkInTexas]

What I've noticed is that the VARO likes to schedule a new C&P after you submit new and material evidence, especially when it's in the form of an IMO/IME.

They will typically drag along for quite a while after you submit something, and then when you shoot a flare up to a Congressman or President, then the liaisons look it over and low and behold, another year has dragged on since your last C&P, so they schedule a new one for you "because too much time has lapsed since the last one".  Then they try to compound the multiple negative C&P's against your IME/IMO etc, which is developing to deny.....which they are not supposed to do...but still do....or at least attempt to.

Something about the 1 year period that they like to use to pull the trigger.  I don't want to hijack this thread, but during my own DRO hearing last month, the DRO mentioned another C&P, and I brought up the fact that I had already underwent 3 for several of the conditions and he mentioned that the last one must have already been a year prior.  When I dropped the trump card that I had undergone the last one in August, 2016 and it was still under a year, he seemed deflated.

They still scheduled a C&P on me for my hearing, just to stall a while I think, and because it had been 5 years since they had last done a hearing/tinnitus C&P.

But back on topic, I think they schedule multiple C&P's to stall, and to develop to deny claims by compounding them against your own evidence.

Just my two bits worth.  Have a great weekend.

Mark

 

[Navy4life]

16 hours ago, Jimmer said:

Navy4life, Thanks for your reply.  I had a full blown C&P exam in January 2015.   For Diaphragmatic Paralysis of the Left Lung they perform a Spirometry test.  The original tests agreed with what the Board certified specialists came up with.  I had most recent tests April 2015, with specialists.  When I meet and had this C&P exam in October 2015, the doctor didn't perform any tests.  It was for my lungs and back.  He said "I can tell that you get winded easily".  Then with my back, (I had 4 surgeries) He touched my back, by one of the  scars and I jumped, and he said "boy you back is in bad shape, I'm not going to do anything".  Then he sat at his computer, and talked,  (mostly about himself).  When I got a copy of the C&P exam he stated all these things wrong with my lung and back, but still denied me.  I knew he was going to deny me because he said "it looks like I am going to deny you, ...... but file an appeal.  You have a strong case and should win".   "I deny just about everybody here, that's why they like me".

Why would a doctor say that?  If he in fact said that, you should report him.  Secondly, what is the wording in the C&P for the denial?  What is the wording in the C&P exam from earlier that year, 2015 say?  Without knowing what each C&P exam says, I can't really comment but the C&P exam isn't the only factor for the rater to decide.  

You obviously were denied before because you had a DRO hearing.  What was that denial based on and what new evidence did you provide to support the denial was wrong?  

You have to keep in mind a C&P exam can be ordered if it has been more than a year.  I think that is what happened in your case.

[Jimmer]

Navy4life, I do know the doctor is contracted, out of Scottsdale, Az., and is semi-retired (he is supposedly 89 years of age).His denial was "no explicit information, specifically addressing the diaphragm injury exists in the C-file".  I guess is didn't see the medical report from Balboa Hospital, San Diego, Ca. detailing this,  which I have and have submitted several copies to the V.A.   The C&P exam was done in January 2015.  The rating examiner in June 2015, stated no new C&P exam was needed.  They scheduled one anyway, October 2015.  I couldn't get ahold of anyone, so I went to this C&P exam.  I really feel my case would have been approved, without this "phony C&P exam" because I had submitted all evidence supporting my claim.  The latest C&P exam, he did no exam!  He just told me, and wrote in the exam how bad my lungs and back were, and kept on telling me. "Wow, your in bad shape",  "you back is bad", you have severe breathing problems", in then talked about himself.