de novo Help needed to understand a De Novo Review

[ardodd]

My question is about De Novo Review and how the DRO reviews the evidence.

In my DRO hearing I raised the several questions about the Denial of Compensation.

Question 1)

I addressed the DRO in asking how the VA could change the diagnosis from "Bilateral Patellofemoral Syndrome" to "Osteoarthritis"?

Clearly I was Discharged with "Bilateral Patellofemoral Syndrome" under VA Code 5003-5099

Hearing

Me: 

they're basing on traumatic arthritis...okay.

I'm not 20 years old no more [sic]...

patellofemoral syndrome has progressed from 

that on up and on up until now we've got an

end result of osteoarthritis.

DRO:

Mm-hmm

Me:

So, the medical exam... everything's pointing...

saying, well, we're denying you for the

patellofemoral, but we're gonna give you

arthritis.

DRO: 

No, that's not... that's not the case.

Me:

Well, that's...

DRO: 

(Inaudible)...

Me:

...what it says right here.

DRO:

...you're essentially service-connected for your

knee condition, whether...you know...it's...it

may be called different things, but essentially

that is what you're service-connected for...is

your knee condition. We can't...we don't...we

can't evaluate it by splicing out different

diagnoses or your...you know...involving your

knee. We evaluate based on...like...what we

discussed earlier...you know...your range of

motion...instability...that kind of thing.

Power of Attorney:

They're saying that your patellofemoral

syndrome has progressed to the point where

there's osteoarthritis at this point and that's...

that's what you have right now.

Me:

That's what I got right now...

Power of Attorney:

Right

Me:

...but they're still not warranting...they're...they

were denying the patellofemoral.

Power of Attorney: 

Mmm. They're just saying it's...it's not

patellofemoral...

Me:

Yeah.

Power of Attorney:

...anymore it's...it's arthritis now.

Me:

Well, that's the word they used...they denied it.

Power of Attorney:

Oh, well, they shouldn't have said that.

DRO:

Yeah, and I'm...I'm not sure that that was a...

you know...a completely accurate description in

there, but...

Me:

Well, because...I mean...

DRO:

All right, do you have anything else?

 

And then the DRO closes out by stating that this Appeal is only about the related evaluation of the knee condition. And if I wanted a earlier effective date I would have to file a Claim for it.

My question is if it is a Review of Claim then why is the DRO only going to look at the evaluation and not the complete claim? I mean he is suppose to be bi-partisan and look at all evidence objectively.

Should the DRO of looked at the whole Claim because it was a Reopened Claim ? 

 

[Gastone]

Who wrote your NOD, and specifically what Denied Issues were addressed in your NOD DRO Hearing Request?

What New & Material Evidence did you supply before or at your DRO Hearing to support an Award of your Denied Issue?

Next stop BVA, All Aboard!

[ardodd]

11 minutes ago, Gastone said:

Who wrote your NOD, and specifically what Denied Issues were addressed in your NOD DRO Hearing Request?

The VSO at my Local Office.

Issue's:

1) Entitlement to an initial evaluation greater than 10% for left knee osteoarthritis.

2) Entitlement to an initial evaluation greater than 10% for right knee osteoarthritis.

Issue's Addressed at DRO Hearing:

1) Falsifying a C/P Exam by the NP

2) Why they changed it from Bilateral Patellofemoral Syndrome to Osteoarthritis.

3) Requested a New Impartial C/P Exam.

4) Questioned why they did not consider the medical evidence from the 2010 Denied Claim. Which I submitted the 21-4142 for medical records but they Denied the Claim without them. I pointed out that they did not Notify the RO that I mailed it in and they needed to follow up on my request. I asked them to reopen my Claim later because they never reviewed the evidence. This pertained to the 2010 Claim and I submitted the doctor records in 2014. Because I thought they got them from a 2001 and the 2009 knee arthroscopic was new.

28 minutes ago, Gastone said:

What New & Material Evidence did you supply before or at your DRO Hearing to support an Award of your Denied Issue?

I submitted a 1996 FCA (Functional Capacity Assestment) Test results. Because in the 1999 VA Claim I asked for help in getting the complete medical records for a in-hospital rehabilitation stay. Which they never followed up on. And plain Denied my 1999 Claim without getting any medical evidence I asked for help with. And Denied me a medical exam in lieu of no current medical condition exam.

Which that's why I am asking if the DRO knows about these things is he not suppose to exam the full claim?

And yes they ignored the FCA as the next C/P Examiner all she did was backup what her co-worker wrote when she falsified her C/P Exam report too. She said they do not accept FCA results. I kind of wonder why? Since the medical professional had a license as a Occupational Specialist. Which is more than the crazy C/P Examiner had.

[ardodd]

Please help me understand why the RO that initially rated the 2015 Claim. Called me on Friday June 22, 2015 and explained to me that my Claim was Denied. As I cursed him from one side to the other asking how they could fail so miserably at identifying a condition I was discharged with.

On June 25, 2015 the same RO called me back and told me that after careful consideration they got another opinion from a Orthopedic doctor. And that doctor said I did not have Bilateral Patellofemoral Syndrome, but had Osteoarthritis instead. And that it most likely was not service-connected.

Then the RO stated since my X-rays showed evidence of "Traumatic Arthritis" that they were going to give me 10% for both knee's.

That is why I asked or sent in a NOD, but the VSO just put down I disagreed with the rating and it should be higher.

I have also noticed that the RO and DRO only Rated me for Painful Motion. Since the C/P falsified her report to show that the range of motion was not affected.

I did not receive a Rating under VA Code 5257 for Instability as the C/P examiner stated I had never experienced any kind of instability. Which contradicts the Medical records that showed I had 2 arthroscopic knee surgeries. I guess i am not a NP and I don't my own body as they tell us what happened to us when we were 10 years because they have special physic powers only C/P can poses.    

[Berta]

DROs are not doctors.They hang onto anything a VA doctor says.

I feel you will definitely need an IMO/IME for this claim- they re -characterized the initial disability and it will take a non VA doctor to tip the scales in your favor.

Gastone always makes good points----what did the NOD cover and what additonal evidence did you bring to the hearing?

"I had 2 arthroscopic knee surgeries" amd that should have been claimed , as to any residuals, (if any) as secondary to the original diagnosis-

but their re-characterized diagnose will follow you until a Real doctor is able to determine what the initial disability was, and what has affected you from it , since leaving service.

I think you have had a P TSD Exam recently ?

If that awards you SC for PTSD and retro, the retro could help you obtain an opinion (based on all medical records you have) from  an IMO/IME doctor, whose expertise is beyond that of the C & P examiner.

There are three different threads here on this issue...I am going to respond in the future to your wife's  comments because she is try so hard to simplify these issues.

Others will chime in on this new thread.

 

 

Edited December 8, 2017 by Berta

[Buck52]

 Since your case has under continue prosecution ,you need a certified VA Claims agent  such as  hadit member Asknod (Alex)  to help you on this.

if your still in your appeals time limit?

You will need a New IMO/IME from a specialist to rebute the NP C&P and also a DRO can't make a medical decision simply because there not medical Dr's  but they do rely on medical Dr's reports in making a decision,  so if you have a specialist that will state  that he/she has examined you and read  your medical records and use likely as not in there opinion  that you do have 

''Bilateral Patellofemoral ''  and its condition as worsen and give the dates  and and the reason the condition has in fact got worse, this will surely help.

The specialist must put all his/her credentials down and years of expertise.

This Case will take a medical specialist to help you.  and you need a VA Certified claims agent to lay it all out for you.

sounds like to me you did not hit it off right away with the DRO, and when this happens its not going to be in your favor, you never speak loud or yell at a DRO NEVER NEVER NEVER,(NO MATTER HOW MAD OR PISSED OFF WE GET)

You can point out your medical evidence and have your say, but you need to remember the DRO is not a Dr and they only rely on medical evidence that a Dr reports...and your not a Dr either, but you can state your opinion   which  has hardly has any clout what so ever, & never agure with a DRO if you disagree then just simply disagree and state your opinion as to why and what your medical evidence  reports.

A Board certified specialist in this field of medicine is your best friend to help you.

Making sure the specialist uses the VA guidelines and uses the correct tools for his/her examination such a the tool for ROM (Guiometer)  <ms, ect,,ect,,,

if the VA Dr's failed to use this tool  then its already in your favor  to the plus side.

they will be other factors to be considered but you can win this...with medical evidence from correct Medical Experts.

do some research 

Ask if a NP has the right to give an expert medical opinion? and also the right to be Qualified  as  a  C&P Examiner in this field of medicine?

if not then base this C&P as an Inadequate Exam. Request another C&P

 JMO

[Gastone]

I would certainly reconsider having this same VSR handle your BVA Appeal.

Appears you and your VSR attended the DRO Hearing with a shopping cart of issues other than those that were part of the Original Claim. The Knee Ratings @ 10% were the only NOD Issues that the DRO could address.

Any subjective testimony on your part as to Falsified Reports (DBQ's or Clinician Treatment Notes), especially regarding issues that are not part of the Award Appeal can not be addressed by the DRO.

You might be well served to have a set down with your VSR and his Boss, seems like someone wasn't up to snuff regarding DRO Appeal Hearings.