VA asking questions on injury background. Warranted?

[Scottish_Knight]

Greetings all,

I served from 1988 to 2009, roughly 18 of those 21 years were as an Army CID Special Agent.  In 2001, I was shot in the leg, which destroy the femur.  This occurred on a US military installation, however I was taken to a civilian hospital for the surgery and was later transferred to a MEDDAC.  The bullet traveled through the femur, so a rod was inserted with two lower and two upper screws.  I lost not only length in the leg (2cm) but my hamstring atrophied.  Since then, I've encountered continued pain in my knee and hip.  All was documented in my military medical records.  Often times, the pain would have me seek medical attention about 2 times per year, which again is documented.

I underwent surgery last year to remove one of the screws (all are now broken) that was pressing against a tendon causing extreme pain.  The surgeon explained the others will need be replaced and I will also need a hip replacement in the coming years.  The pain continues.

My VA exam was in 2009 and at that time the length difference in my legs was disclosed to me for the first time and as xrays were obtained, the screws were discovered to be broken.  The VA Rating Decision gave me 0%. 

Unknown to me was the appeal process.  Last year, I found someone who is helping me with the appeal.  I live in a remote part of southern Germany, so connection to other retirees and vets is nil.

This week, through my appeal representative, the VA has contacted me.  They want all the background information on the shooting.  They require the who, what, when, where, why, and how of this incident.  I am also to supply them with records I have that they don't.  First, they have a copy of my entire medical record.  How am I to know what they don't have?  Second, the Rating Decision states that this injury was service connected and in the line of duty, so why is the background information required?  Had I been shot while in Afghanistan would they be asking the same questions?

Perhaps I simply do not know exactly how the VA adjudicates the claims.  As this is not a presumptive matter, evidence of the injury must be presented.  They have that in the form of my military medical records.  Do the circumstances behind the shooting hold weight on determining the extent of either the injury or the level and percentage of my disability?  Does the background on an injury play some part of the adjudication process and awarded disability to which I am unaware?

Thank you in advance for any insight into this.

Edited October 26, 2018 by Scottish_Knight

[broncovet]

You have 2 choices:  

1.  Provide the VA with all the information they request.  Or

2.  Get denied.  

      It does not matter whether you think this is relevant or not.  They think so, apparently.  One reason they do this is they want to cath you in a lie.  That is the bad news.  

      Here is the good news:  If you submit new and material evidence under 38 cfr 3.156 c (new service records) yur effecitve date can go back to hen you first applied.  Often, Vets think "the VA has all my service records", when, they do not.  And I can testify that VA can/has/does, at least part of the time, destroy your pertinent records.  Alex had a gunshot wound in vn, but the VA doubted it.  He was finally able to prove it with retro back to 1994., after decades of denials.  

[vetquest]

The VA might be looking for line of duty vs willful misconduct.  The rater looking at your case is a desk jockey and has no idea what CID does for a living, unless he watches NCIS and then God only knows what he thinks. 

[Al329]

Sorry cant help with the claim questions.

But there is a retiree group in Garmisch that you might be able to use to connect to other vets.

 

Good luck!

Edited October 26, 2018 by Al329

[GeekySquid]

12 hours ago, Scottish_Knight said:

Thank you in advance for any insight into this.

 

First and foremost get you C-File if you have not done so in the last year or six months.

Get the CID to cough up the reports etc.

Get your commander to write a letter.

If you received a medal or other award for it, highlight it in the records you submit.

Broncovet is right in that if you don't supply the records, the VA will likely deny you, even if they have the records already.

You want to draw a line connecting all the dots for them. Is it galling? yep it is, but you only hurt yourself if you don't do it or get mad about having to do it.

[Scottish_Knight]

@broncovet, @vetquest and @GeekySquid, I understand and appreciate your input.  My assumption was that the VA looks at medical records and makes a determination based upon those records solely.  I was unaware that external factors play a part.

Thank you all.

[GeekySquid]

2 hours ago, Scottish_Knight said:

My assumption was that the VA looks at medical records and makes a determination based upon those records solely. 

@Scottish_Knight

In a perfect world it would be that way. The reality is you are exactly where most if not all veterans are when they start dealing with the VA and trying to get their just compensation for injuries the service caused or conditions service aggravated. You will soon learn how naive that position really is.

The entire system from Military through to VA promotes that naive view. People are led to believe that everything is in their Service Record. That it is always complete. That the VA has the whole thing. That VA raters and Doctors are veteran friendly professionals looking out for us.....the manure just gets deeper.

Just as a starting tip, most VA Doctors and Nurses are not VA employees; they are Contractors. What that means to veterans is that if one of them harms you in the course of treatment you cannot sue the Government, you have to go after the individual and or their company. This is more complicated than it may sound.

Some immediate things you need to know about the claims process.

To process a claim successfully there needs to be what is known as the Caluza Triangle

https://www.hadit.com/caluza-triangle-defines-necessary-service-connection/

As you might guess from the word triangle it has three elements or legs.

1. Current Diagnosis.   (No diagnosis, no Service Connection.)
2. In Service Event or Aggravation.
3. Nexus (link- cause and effect- connection) or Doctor’s Statement close to: “The Veteran’s (current diagnosis) is at least as likely due to x Event in military service”

When you file, a whole bunch of records requests are issued to collect all the federally held files, like your service records, service treatment records, etc. If you told them you had been to an outside doctor they  will ask you for a "permission slip" to get those records if you did not provide it with the claim.

This takes time and frankly not all locations have complete files, will find complete files or will get to your files in any speedy time frame. Be prepared to wait.

This is also part of why you want to have your C-File handy. You can submit docs from your C-file with your claim and take them to the C&P Exam with you.

As for the C&P exam.

In theory the Examiner is a well qualified and experienced profession in the particular area of medicine you are claiming to have a problem with. That is absolutely NOT accurate or representative of reality with the VA. You may need to or want to challenge the decision based on the  C&P examiners qualifications.

The Examiner is supposed to review your entire file. The raters send out a request to have an exam and "tab" the files they feel are relevant. The Examiner has to look at those but is required to review the entire file. You might be able to guess how this plays out, and it is not always in your favor. To be fair these folks are human and make honest mistakes. It is just difficult to fathom the shear volume of documented mistakes before you conclude there is a lot of slack in their view of professionalism. 

The Caluza Elements "should be" in your record. Note the scare quotes they are there for a reason. The raters are not Medical Doctors, and really have no medical training at all. They are likely as not not veterans, so will have zero idea what your job in the CID entailed and in fact may not know or care what CID means. The same goes for the C&P examiners.

The raters and C&P examiners are human and may have biases, known and unknown, about you and or your job. For example since you were CID they might have a buddy or relative that was arrested and jailed by the CID. This might or might not affect how much care the rater put into your claim. You will never know if that is true or if they are just sloppy or inexperienced.

This post could go on forever but you should get the point that you need to prepare and submit your claim to include all the documents and proofs you want them to consider. You literally have to make yourself into your own best advocate for your claims.

You tell them a detailed story and include the documents that prove your claim. That highlight you in the most favorable way. The point is to lead them by the nose to conclude you deserve the highest rating possible for your particular injury.

On that last point. When you speak to your va doctors, nurses and C&P examiners DON"T do what most people do and try and put a 'bright face' on your problems.

You don't get points for "dealing with it", "getting by" , "doing for yourself", "working it out" or any other way of proving what a "man" you are in how you deal with life. Not being insulting, but the stark reality is most people are taught to put their best face forward. It is why when someone says "how are you today" people invariably say "okay" even if we have a broken bone sticking out through our skin.

In practical terms what that means is that you tell the truth to those people. In the case of the Exam they will ask you about levels of pain, harm, difficulties, etc. associated with your injury. You want to relate to them the WORST incidents, pains, and problems your injury causes. If for example you limp. remember the time that climbing stairs took you 2 hours to get  up 4 floors because the pain was so bad. Don't lie, but don't make it seem like you dealt with it like Superman.

You will want to get very familiar with the DBQ for your particular claim. You can find them on the VA website. Just google VA DBQ and you will find them.

There is specific language in the DBQ that the raters will be looking for to determine the percentage and service connection. Each is different but the Examiner has to offer the opinion that your injury is at least 50% more likely than not cause by your in-service nexus event. Since you were CID you understand how stilted official language can be, particularly if it is mandated language.

You may have or need an Independent Medical Opinion or Examination (IMO/IME). That doctor must use the VA phrasing for the VA to accept it. They must answer the DBQ like the VA raters are trained to read it. You will learn that somethings cannot use an IME/IMO for the initial claim, most can, some can't. You should be fine, just be aware of this when research similar claims. 

You will need learn terms and form names like NOD and VA Form 9. IF you disagree with the VA decision on your initial claim you want to file a NOD. You have 1 year from the decision date to file that, but don't wait that long.

In short get them the documents you believe will lead them to get you the highest award, and then prepare for the roller coaster of getting the correct rating from the Earliest Effective Date (versus what they try to pay you from). It is a long ride for most.

In short make yourself a expert. There is a site run by an attorney named Attig, and you will see posts and articles on here from his site. He has several training manuals and videos that will help you if you can afford them. The expense may be worth it to you so your claims are done right from the start.