It appears they closed my claim not addressing all issues

[Pansy Peacock]

Not sure I worded that title correctly.  Anyhow...

I received a denial on my claim for service connect for death of veteran and burial benefits.  When I filed the 21-534 EZ my VSO had me include a 21P-530 Application for Burial Benefits. Before the denial for Service Connected Death it appeared they had been working the 21-534 EZ as part of the claim.  According to my VSO, one of the claims had been granted and signed off on.  After the denial for Burial and Service Connect there is no information in the VA file regarding the DIC or Accrued Benefits from the 21-534 EZ. Calls to Peggy are no help as the folks are unable to see where I had filed the 21-534 even though at one point they showed not only in ebenefits but in Vets.gov and the program the VSO's have privy to as well.  After the denial for the Burial and S/C death everything just appears to have disappeared.

Here's my question.  I'm filing a Form 9 waiving regional office consideration next Wednesday after running it by the VSO gent, for some reason I'm not sure of.  Am I missing something or someway to expedite this favorably. Is it possible to send it back to the RO and have them pull up the file and see they didn't finish the claim?  Or maybe they did and just didn't put it on the SOC, whatever.  I have little faith that they will do the right thing as the denial for the S/C death essentially stated they should have granted it as secondary for what my husband was already service connected for that they would have known if they had looked in his file.  Also, the DRO signed off on the de novo saying he agreed with the rater, which strikes me as odd, I thought it was supposed to be a "new and complete review with no deference given to the decision being reviewed".  Anyway, if either of them had seen the C-file service connection would have been granted.  Accrued benefits would have not been affected whether his death was service connect or not so it should have at least been addressed.

Any thoughts?

[Berta]

".  I have little faith that they will do the right thing as the denial for the S/C death essentially stated they should have granted it as secondary for what my husband was already service connected for that they would have known if they had looked in his file.  "

DIC claims  are far usually more complex than that-You do appear to have a Denial for SC death-

We can help more if you can scan and attach the denial here- as to the evidence list  they put on the decision and their complete rationale for the denial. Cover C file #,name , address prior to scanning it.

 

 

2 hours ago, Pansy Peacock said:

deleted-other thread- cant find it 

Did the vet rep advise that you might  need an IMO (Independent Medical Opinion)?

We need to see in VA's words why they denied the DIC.

 

Edited August 4, 2018 by Berta

[broncovet]

You posted:

Quote

  I'm filing a Form 9 waiving regional office consideration next Wednesday after running it by the VSO gent, for some reason I'm not sure of.  WAIVER OF RO  CONSIDERATION IS NORMAL WITH A BOARD APPEAL.  It can save a remand, because the Board can remand it or sometimes just decide.  I suggest signing the waiver as it could save an unnecessary remand.    Am I missing something or someway to expedite this favorably.  Ramp may be a possibility to expidite, but I have no idea if RAMP applies to DIC, but I would assume so.   Is it possible to send it back to the RO and have them pull up the file and see they didn't finish the claim? POSSIBLE, yes, but its unlikely to be productive UNLESS you post the decision and Berta can find a CUE.   Or maybe they did and just didn't put it on the SOC, whatever.  SOC's are often "generic" and its not that unusual when you dont get a decsion (for VETS) on all issues.  The Courts even have a name for it, its called a "deemed denial" and that is a whole can of worms.  Best if you can pressure them into a decision on unadjuticated issues.  Try sending an IRIS email, asking the status of (unadjuticated issue).  AND/OR call the white house hotline and ask them for a decision on unadjutated issues.   I have little faith that they will do the right thing as the denial for the S/C death essentially stated they should have granted it as secondary for what my husband was already service connected for that they would have known if they had looked in his file.  Also, the DRO signed off on the de novo saying he agreed with the rater, which strikes me as odd, I thought it was supposed to be a "new and complete review with no deference given to the decision being reviewed".   TYPICAL.  Altho I did win benefits with ONE DRO review, its often a rubber stamp denial "even tho" they call it a de novo decision.  You are likely gonna need to "hunker down" for a long fight with VA, similar to what Berta and most of the VEterans here have been through.  

My RESPONSE is in BOLD.  

Edited August 5, 2018 by broncovet

[Pansy Peacock]

Thank you guys!

Pg 1 Denial SOC.pdf

Last 3 pages SOC Denial.pdf

[Berta]

Broncovet - thanks for trying to help.

There is a LOT to this situation:

Many unanswered questions-----from the last post-the death certificate is not the issue-

Pansy Peacock , Broncovet is right- we need to see the denial of DIC- because I already kow you will need an IMO---

you are going to need an IMO from a REAL doctor- probably someone well versed in Neurology.

Many of my questions went unanswered in the prior post.

I assume there was no autopsy.

I assume he ever claimed or was diagnosed with a TBI ?

 

You had stated:" Multi-compartmental hemorrhage with midline shift. (I researched this and one of the main worries for physicians prescribing blood thinners is hemorrhaging)."

That is a possible cause- however, there might be many more causes, and  I believe the only way this claim an succeed is with an IMO and it has to be re-characterized as a Section 1151 claim....if all of his treatment and health care came from the VA.

We have considerable info here on 1151 claims.

Was this a sudden emergency situation? Was this a surgical death?

When was th e first MRI done-

You dont have to answer my questions-you need a real doctor to determine those issues to see  if VA should have treated this situation differently than the "Usual and Standard" Medical Community, and through that failure, did the VA cause your husband's death.

The IMO format is here at hadit- I suggest Dr. Bash because he knows the VA lingo and IMO  format and has extensive expertise in any condition that has involved past CT scan s, X rays, and MRIs.

A Section 1151 DIC award does NOT bring the benefits of a direct DIC award, but I dont see any potential here  for direct DIC death.

Perhaps ( maybe) the accrued claim would----but that is just a guess- I don't know what that claim is for.

Al l  vet reps got the same training I did for 1151 claims...... from NVLSP.

Dr Bash is very expensive. I won my 1151 death claim without a IMO and also a FTCA wrongful death claim.

I have had four theories granted for my DIC, over the past 23 years but  only one check-

The most important claim was for malpracticed AO DMII.I paid 4,000 to Dr Bash for 2 IMOs in  2005- and believe the cost would have beeen MUCH higher, but I had laid out my lay medical opinion quite well, and I knew he would give me 2 great IMOS and he did.Within a very short period of time.

An IMO doctor will need a copy of the C & P exam and will need to have copies of all of your husband';s medical records.

You are still within the 2 year Statute of Limits to file a FTCA claim against  the USA.VSOs dont handle that type of claim- lawyers do-

I suggest, if you get a favorable IMO for VA malpractice - file a SF 95 Immediately- the info for that is in the FTCA/1151 forum and you can file 1151 as well-but you need to read over all the info there-----

Dr Bash's contact info is here somewhere and he has done some recent shows on our radio blog.

There are other Neuro docs I am sure who could help- I got a free IMO from a neuro-but already explained why somewhere here. Others will chime in. Maybe there are vets here who could recommend a good IMO doctor-

maybe it would involve an expert in Hemotalogy-re: Brain.

Even if you proved he had a nicotine dependence (Allen V Principi)

that stemmed from his service and caused his CPD- there is nothing on the death certificate to show COPD as a contributing factor.

It seems there is far more to your husband's medical situation -in his lifetime-than we could possibly know here-it wuld mean reviewing his entire medical history- but that is what IMO doctors do.

 

 

 

 

 

 

 

 

 

 

 

Edited August 5, 2018 by Berta

[pwrslm]

Was there an existing claim in prior to the Vet's passing?

[Pansy Peacock]

Yes, I still have not received the amended death certificate, so that should help, although I'm going to send in the Form 9 now and will send the amended death cert. when I get it.  Seems they'll only amend part 2  with the anticoagulation, PD, hypertension and PTSD but hopefully that'll be enough.

I hope the accrued benefits part of the 21-534 is not going to be "deemed denial" BroncoVet referenced and that they just jumped the gun.  Whether he was service connect for his death isn't relevant as to whether I should get his accrued benefits.

Except for his Primary Care Physician and his medication I kept him away from the VA hospitals.  He had had a not so good experience and he would not know who his surgeon would be as he wouldn't know when his veins/arteries/heart were going to be an issue so it was almost always emergency situations.  We were lucky that we found a local surgeon who would be there for my husband when we needed him. Good man! Because of him and his efforts my husband still had all his limbs and he knew how to get the VA to pay for his non-VA hospitalizations.

I didn't ask for an autopsy. At the time the thought of him being cut on again just wasn't something I could do to him. Seemed kinda wrong after all the BS he had had to deal with and I was pretty much a "nut job" at that point. Not a good decision maker.

He was service connect for PTSD and IHD and had claims in or on appeals for COPD and PAD secondary to his PTSD related smoking, and AO related Stage IV Parkinsons Disease. Before his file disappeared from my view it showed him service connected for COPD secondary to his PTSD related smoking, I used VAOPGCPREC 6-03; 69 Fed. Reg. 2517 (2004) as reference when I filed the claim and since the "medical examiner" opined that my husbands tobacco usage was likely the cause of his cerebral hemorrhage this would also apply to VAOPGCPREC 6-03; 69 Fed. Reg. 2517 (2004) and that would have made it a contributor to his death. I'm guessing that's why it's not addressed.

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Pg 1 Denial SOC.pdf

Last 3 pages SOC Denial.pdf