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 ? 

 

[ardodd]

13 minutes ago, broncovet said:

In other words if you are getting paid for the symptom of "pain and limit of range of motion" for OA, then you wont get paid for pain an limit of range of motion for PFS, because "pyramiding" is prohibited for the same joint. 

Thank you @broncovet. I feel the same as you do about that.

By definition Patellofemoral Syndrome is considered Painful Motion of the patella. And osteoarthritis is the result of wear and tear in the knee.

To try and clarify what happened is the VA RO put that I did not have Patellofemoral Syndrome when they Denied my Claim in 2015. After arguing with him for close to 30 minutes he said he would go back and see what he could do. That was on a Friday, then on Monday he called me back and said they decided to grant me osteoarthritis. Which technically it is the current condition, but they still denied the PFS in the first C/P exam.

And in the second C/P exam which they granted me after we exposed the NP lying about doing test when he did not. The examiner lied on most of her assessment also, but at the end she was trying to get them to reverse their decision to SC osteoarthritis and deny it. But in the process she admitted I had PFS and Osteoarthritis which is a big deal since they have been denying the PFS for 27 years.

This why I must keep bugging everyone so I can make sure I fully understand and can explain it in a manner that is also understandable. 

[Gastone]

Well, as you stand now, all your New and Increase Claims have been Filed or Filed again (as in missed BVA I-9 Filing).  All your Supportive EOR (Evidence of Record from prior Awards and Denials, as well as any New Directly Supportive Material Evidence, has been supplied to the RO Rating Authority.

All C & Ps for Increases and the New shopping list of Secondary Conditions have also been completed.  Your immediate Fate rests with your RO Rating Dept for now. Just be sure to have the NOD Locked and Cocked. If Denied, it might be time to proceed directly to the BVA.

[ardodd]

**UPDATE**

Dated: February 02, 2018

From: DVA.VBANOL@VA.GOV

New Orleans VA Regional Office communications with DAV (Disabled American Veterans)

@Berta

Albert received this letter from the New Orleans Regional DAV Office yesterday. It was dated February 02, 2018 which was just over a week now. But it does have some good news about his claims, not everything good but it has all going in a better direction.

Upon final approval from VA he will be increased to 100% for both PTSD and Temporary Total Disability. He also qualifies for SMC based on housebound criteria.

There are other issue's like the VA RO has asked that he be ruled as Incompetent. Which will help with getting him the correct health professionals. 

I have attached the letter that he received. If you may notice something that I have missed or may not understand I would appreciate your input greatly.

Thank you 

DAV-BVA 2018 Decision.pdf

DAV-BVA 2018 Decision pg.2.pdf