Odd IRIS response for a C & P exam

[Berta]

I still think whoever wrote this C & P ( as it appears in a 2015  SOC ) is the guy who fills their paper cup dispenser at the RO water cooler-

This is my second response from IRIS:

We have forwarded your Freedom of Information Act request to Intake Processing Center Management.  They will research this issue further and respond to you directly regarding their findings.

 

It was not a FOIA-I am the claimant so the record belongs to me.

They said I could re-open the request but must do that within 14 days, by a response.

I don't like deadlines from the VARO- I said I am giving them until Jan 15, 2019 ( 14 days) to find that C & P exam, or I will file a complaint with the OAWB-

which will have attachments of all of their bogus C && P exams I have received since 1995.

I won the claim under CUE that this pertains to , in less than a month after fiing the CUE- that isn't the point-

The actual claimant is dead- death by VA -24 years ago and cannot speak for himself. So I have been the claimant since he died.

My husband feared the VA would pull my chain if he did not live much longer-(1994) but the VA has a chain to pull as well----

This is the insidious BS  they pull on widows but certainly pull it on Many vets as well.

My evidence, noted in the denial, was available to the "examiner" yet the "examiner chose to ignore a valid ,concise opinion from VA's Top cardio doctor and made up some ridiculous medical stuff ,instead. If the the ROs can find anyone who will try to completely rebutt an opinion from a top VA doctor- whose specialties involved this claim, and get away with it, 

I guess we could all end up in the crapper. 

This is why we still have a BIG appeals  Backlog and why we must rebutt lousy C & P exams with probative evidence-and if they ignore that evidence, a CUE can be filed the same day you get the denial.

I have filed CUE on the CUE above that they awarded.

It has become my favorite avenue of attack.

I have no idea what the Intake Processing Center Management could do. Does anyone here know?

"They will research this issue further and respond to you directly regarding their findings." I named the man who called me from the Buffalo VARO and said they had already picked someone to do this C & P exam-so he knows who did it.I wonder if the "examiner' even works for VA or any contractor- they said he was from the BuffaloVA. I also wonder if it was written by the RO VSO who called me, (who is NOT a medical professional at all.

 

 

 

 

 

 

 

 

Edited January 1, 2019 by Berta

[jfrei]

Have you ever spoken. With The AMO now AMC about your issues (202) 530-9149 or (202) 530-9455 one is the director there who maybe able to answer your issues. Not sure which one it was or if they have been changed since this past June but your welcome to try...

[Berta]

Thanks but I think you mean the Appeals Management Center -this is not an appeal.

I am happy that the VA is giving me the run a-around. I mentioned here somewhere that I am preparing a complaint ,on behalf of all veterans and their survivors, who get a C & P exam that is faulty, and that denies their claim, in spite of valid probative evidence the VA has, to send to the OAWB.

I am building the complaint on my personal experience as well as the established fact that BVA remands often reveal  that a new C & P must be done.In my experience with that, the C & P was not done by anyone with proper expertise , I rebutted it with the BVA, they agreed and I succeeded on the 3 IMOs I had.

It will take time- worthwhile time- to search the BVA site for any decision for any veteran or survivor that supports my complaint about the faulty C & P exams.

Lousy C & P  exams are the main reason I see for the appeals backlog.

Not all veterans and survivors can even attempt to afford a costly IMO/IME. And the cost is worth the money because that will probably be the first time all of your SMRs and VA /private medica reords are actually read by someone with enough medical expertise to fully comprehend what they say.That type of attention to any claim is lacking with the VA.And also is one big cause of VA malpractice.

With OAWB complaints, just ike VA claims, documented evidence is Everything-

I could certainly send them the SOC rendition of the "examiner's" opinion, but one of my claims had an SOC that left out a very significant part of the actual C & P exam...The doctor who did it was shocked to learn what they left out and what evidence the RO failed to give him - his opinion , he told me, would have been far different.

That is why every vet needs a copy of their C & P exam- it is BS that contracted exams are not released until the decision is made.The contractors are in the pockets of the VA, and a proper NOD and SOC cannot be made in time for those deadines ,without the C & P exam itself- 

 

It will take me time because this issue is already before a Congressman, who seems to have prepared a Bill on it-

that will go no where unless his facts are correct.

Also I am hoping some lawyer out there will consider helping with a Class Action- and maybe the new CAVC decision would allow me to file it on behalf of all vets, survivors simiarily situated.

Those veterans and survivors, like me, have been "damaged "by lousy C & P exams, that we had to obtain costly IMO/IMEs for, in order to succeed with our claims.

I have mentioned this Class Action to Bart Stickman of NVLSP -in  email and maybe one of the lawyers who are members here will see this if they have a google alert when their name pops up at hadit: Chris Attig, Matt Hill,

Doug Rosinski, and respond.

( I received a conference call one day with some of the great NVLSP lawyers-due to a donation I had made to them, years ago. We all BSed about claims of course. One of them mentioned the AMC and I said Oh Yeah the Black Hole- they all laughed- my only experience with AMC was minimal- my RO had sent one of my claims there erroneously, after they had sent it to 2 other ROs without any good reason.I faxed the AMC  director with no response, and found out later (when the claim went to the right RO) that their fax machine was locked in a closet at the AMC. Hope AMC has changed by now.)

 

 

 

[propp3]

What I see lacking in current C&P's ?

The dbq's ask about special testing that's been done. Often any special testing, imaging, etc that has been done and is part of the record, was ord'd by a specialist...often in the VHA.

But the dbq never asks is an opinion by a specialist would be beneficial and produce more thorough analysis...often the c&p initially is done by genmed or a NP.

And the BVA often remands back to the RO specifying another exam be conducted by a specialist...often causing years of delay.

[broncovet]

Berta, I agree about bad C and P exams being a major cause of the appeal backlog.  I also think another major cause of the backlog is "top sheeting", where the rater reads only a page or 2 of the file, and never reads the valid nexus statement on page 1135 of the file.  

I also was a "victim" of a bad c and p exam.  I was "examined" by a medical doctor who admitted she had 0 sleep medicine experience in a c and p exam for OSA.  She opined that my OSA had nothing to do with depression/ptsd.  And, of course, my OSA claim was denied.  This means I dont get statuatory SMC S housebound.  The OSA/depression/ptsd link is well established in the medical community.  I spoke with a sleep doc who explained that OSA and depression/ptsd have many of the same symptoms!!  Almost identical!  Sleep deprivation is very depressing!!

  Im still fighting VA for SMC S, because Howell, demonstrates that the VA was overzealous in denying Smc S, because "congress intended" for Smc S to be awarded to Vets "unable to leave the home FOR WORK", instead of unable to leave the home at all.  Since I have not worked since at least 2004, I obviously was unable to leave the home "for work", since that time.  Alex did a great job explaining this: https://asknod.org/2014/08/25/cavc-howell-v-nicholson-what-smc-s-really-says/

All this said, I see your IRIS response as the VA simply passing the buck.  As long as the other person responds within the 2 weeks, then I guess there is nothing to do.  

 

[Buck52]

SO Another Question?

   What can Veterans do to Prevent this from happening?

Other than get in the Appeals Line and just wait wait wait....as the VA Takes their ever loving time....maybe they just do this to see if the Veterans passes away?...and no benefits will be awarded to that veteran...Unless he has a caring family and works his claims after his death  as Ms Berta did.

[Berta]

 I will try to mention anything here in my OAWB complaint , as to any of your personal experiences with lousy C & P exams-

Propp3, I have always thought the DBQs were geared to being inaffective- yet they have helped many vets-

but often only an IMO/IME would work for many other vets.

and as you said "And the BVA often remands back to the RO specifying another exam be conducted by a specialist...often causing years of delay."

You bet- and it might not get to the specialist at all.

BVA remanded my AO DMII death claim to my local VARO for a Cardio opinion.

I had 3 IMOs for the claim, VA had 2 against the claim, and wanted a third VA opinion.

I got a PA's opinion.I rebutted it immediately , to the BVA, but I wonder how many claimants know they can attempt to rebutt any opinion that is Not specifically what the BVA had ordered.

BVA agreed with my rebuttal and the claim was awarded based on my 3 IMOs and other probative evidence.

Broncovet- I do not believe any medical person wrote the C & P -the VA has pulled so much crap on me already, over the past 22 years, that I do not put ANYTHING past them.

As  mentioned- before they failed to send me the 5103 form for each of 2 pending claims.I IRISed them and one 5103 arrived, but for 2 claims.They were pissed already because I had contacted VACO.

For the other claim I have a CUE pending. It is the claim whereby the director called me twice to get me to accept something that is not established VA case law-I hope they dont pull this on any other widow-

My husband's 1151 100% P & T stroke was decared as permanent and total by NYSDept of Hi9gfher Ed, by Voc Rehab, By a former VA secretary, and by other significant documents- Agent Orange settlement fund, many more-and declared 100% P & T by a VA Neurologist ,I was present at the exam-yet VA failed to send me that exam as well....

abovve evidence which I sent in with and again listed on the 5103 for that specific claim, as well as the sole piece of evidence that awarded the other claim, deniedm then CUED and awarded within one month.

Just think- you die with 100% SC P & T, and then the director of the Buffalo VARO (r any RO) tells your spouse you were Total but not Permanent.

Yet they declared my husband , 3 years after he died, as 100% P & T SC for PTSD, and the Permanency was not an issue-

I sent them the BVA's definition of P & T.

"All this said, I see your IRIS response as the VA simply passing the buck.  As long as the other person responds within the 2 weeks, then I guess there is nothing to do.  "

Whether they respond or not, I have plenty to do to bolster my next OAWB complaint.

I will file it with or without that actual C & P.

I do not believe a legitimate C & P opinion exists.If their director can make up some new P & T regulation criteria, , and they already tried to make up a reg in my SMC CUE responses from them, long ago, they can find anyone who would make up a phony C & P exam opinion.

This info is in my White House Hot Line complaint. ( on tape) as to the P & T phone calls.

OAWB received word from the WH Hot line, and contacted me as to another issue I raised- I told the Triage man as well I think-of the Buffalo director's lack of basic VA 101,  but that contact  was regarding the other complaint -against the General Counsel. I sent them plenty of evidence on that, personal evidence and also evidence from the GAO.