Best Way to Help Your Claim - From a Veteran Service Representative

[dajoker12]

 I am a Veteran Service Representative for the Dept of Veterans Affairs for compensation on the rating side. For those unfamiliar with my job, there are two key figures processing compensation claims. RVSRs (raters) and VSRs; they do the medical side and we do the administrative side. Essentially my job is to do everything but rate the claims.  

I have seen some on here disputing the merits of DBQs. That being said, I think that is foolish to advocate that DBQ's for musculoskeletal exams are the only worthwhile DBQs to submit.  One very worthwhile one to submit is Sleep Apnea. Yes, the VA will do it for free, but if you have a decent insurance policy, you can get DBQs done for a $25 co-pay w/ a medical opinion. I get that that not everyone has good medical insurance and that that is a disadvantage for some, but for those that do have it, that is one course of action to take. One might make an argument that you could even essentially write up a medical opinion and save them the legwork and have them edit it to their liking...........don't like the opinion........go to the next doctor and only submit the ones that are favorable to you. 

If you want to really cement your claim, get cross disciplines to and do multiple DBQs i.e. have an orthopedic surgeon and a podiatrist do foot and ankle DBQs and medical opinions. Have a chiropractor and an orthopedic surgeon do your knees, back, neck, hips, shoulders. Want to get sleep apnea, well, get a handful of "buddy statements" from people that you served with on active duty written on 21-4138 forms so that they become affidavits if you have no complaints/treatments/sleep study while on ACTIVE DUTY, submit them so they become part of your "C-file", see a sleep specialist for a sleep apnea DBQ, get a medical opinion for direct service connectedness...........make sure that he sees the buddy statements.........if you legitimately had sleep apnea in service, your buddies will make adequate statements. Then, if you have PTSD, see a psychologist and try to get sleep apnea secondary to PTSD. Double whammy. Lots of studies out there to corroborate that.

Make sure that you have your C-file.  Doctors filling out DBQs are supposed to have access to your C-file to adequately make a medical opinion. If you don't care about the medical opinion, then don't worry about it.

For presumptive issues such as gulf war i.e. chronic fatigue, fibromyalgia, gastrointestinal, I wouldn't even bother trying to get a medical opinion as it will not carry much weight.

Again, DBQs accompanied by medical opinions, especially in number, are in your favor for getting a favorable decision. Don't like the PTSD rating that you just got last month............go right away and get a PTSD Review DBQ and Medical Opinion by a Psychiatrist, Ph.D. Psychologist or a Psychologist under a Ph.D. psychologist. 

Learn about the M 21-2 references.............google is your friend. Learn about the rating references...........google is your friend.............. Don't want your claim held up............take your damn time when filling out all of your paperwork and make sure everything is filled out completely and send us everything from the get-go.  I would suggest doing an intent to file call the 1800 827 1000 number, fax in a 21-0966 form etc.  That way everything will be back paid to whenever we receive that. Take your time filling everything out. If you want to claim dependents, have a 686c form filled out............every damn line that is there fill out.........don't have the information........get it.........I am guessing that you can get it quicker than 15-30 days, so get it. Have birth certificates of your kids and marriage certificate for your wife. We don't need social security cards....just numbers. Have records from private doctors scanned and ready to submit. If you have copies of your Service treatment records, DD 214's, OMPF (Personnel FIle) scan them and have them ready to submit (we still have to send out for them, but if we can't retrieve them, then we have them there ready to use as a last resort. If you are wanting to claim aid and attendance, have those forms scanned and ready to submit. Wanting to claim PTSD, have a 0781 or 0781/a scanned and ready to submit unless you were in combat and it is easily verified. Wanting to claim IU, have an 8940 and 4192 filled out and scanned ready to submit. I would also suggest making a brief (5-6 sentences at most) statement on a 21-4138 for each contention you are claiming; be specific with what you are claiming.............don't say foot pain..........be more specific i.e. pes plan (flat foot)..........when did it start.......was an injury involved.........where did you initially get treated..........where have you continued to get treated............etc...   When filling out the 526ez be specific............ especially if you were in the reserves or the guard..........tell us the name of unit you were with, current address and contact information. If you have a line of duty reports (again, guard and reserves) better believe that you should submit those.  

It pays to take your time. You will be more likely to have a quicker turn around if you take your time and do everything completely.  If you don't like your rating, don't appeal it right away...........that should be the last resort.  Send it new and material (relevant) information. Do not get disheartened. For direct service connected exams, we can generally only send you out for exams if there is a complaint/treatment/injury in your service treatment records for a contention that you are making.  Secondary connected issues are different. This is why it is highly intelligent for anyone wanting to file a claim to actually be in possession of their service treatment records BEFORE filing for a claim.  It would also be intelligent to have a copy of your Personnel records which you can actually get off of DPRIS which can be accessed via va.gov or e-benefits if you got out of the service within the last twenty or so years.  If not, I would recommend downloading an SF 180 form and sending it out.........hopefully the government shutdown won't slow it down too much.  

Once you have all of that done, sit back, relax and have a cold one.  Believe it or not, people sending out original claims (first time claims) that have everything put together and in which the claims are not overly complex i.e. 35+ contentions w/ aid and attendance, IU, 4142/4142a etc ad nauseum, are actually having exams ordered for them within 2-3 weeks of the claim being received. 

Best of luck. 

[dajoker12]

2 hours ago, Buck52 said:

''One other thing that I would like to touch on is the value of your rating narrative that you get in the mail.............whatever you do, do not throw it away...

Question?

Do you mean the explanation of benefits letter we recieve the first part of a New Year?   stating our  current rating status?

or the award packet letter? the decision? reason and bases of What We Decided?

 

The decision and what we decided. That is what is called the rating narrative. On most, not all, the rater will put down what is required to go to the next higher level. 

[Buck52]

dajoker12

Roger that buddy.

[acesup]

Sounds like some excellent advice, it is great to see a VSR here helping us to better understand the process!  Thank you!

 

[dajoker12]

10 hours ago, acesup said:

Sounds like some excellent advice, it is great to see a VSR here helping us to better understand the process!  Thank you!

 

You're more than welcome

Edited January 26, 2019 by dajoker12

[63Charlie]

Does your official job(VSR) require that you render decisions for service connection for claims after C&P exams are performed?

If so, maybe you can offer more advice.

How do you suggest a vet proceed when a C&P examiner's rationale, with an unfavorable opinion for service connection, is directly contradicted by favorable evidence in the service treatment records and other medical records that was ignored by the examiner?

What would you do?

After this happens, the VSR has always denied service connection for my claims.

I'm not feeling any professionalism by the raters.

MY next question to you is, are the VSR people too busy to weigh in ALL of the evidence instead of just what an examiner opines, or is this Standard VA Protocol to deny vets like this?

I'm starting to wonder if my claims are flagged for denial by a VSCM or RO Director, because if I swallowed a horse and had the tail hanging out of my mouth, a VA TEAM of C&P examiners/raters would say it isn't so. I have no evidence of this being true of course but it is based on the  way my claims are being handled.

Meanwhile, the wheels on the VA bus go round and round, round and round.........

Waiting four years for a DRO decision, w/ no hearing, on a NOD, with no decision, is a bummer.

My final question is this ,explain how to get a DRO to render a decision so my appeal doesn't keep on sitting dead in the water?

Edited January 31, 2019 by 63Charlie

[dajoker12]

19 hours ago, 63Charlie said:

Does your official job(VSR) require that you render decisions for service connection for claims after C&P exams are performed?

If so, maybe you can offer more advice.

How do you suggest a vet proceed when a C&P examiner's rationale, with an unfavorable opinion for service connection, is directly contradicted by favorable evidence in the service treatment records and other medical records that was ignored by the examiner?

What would you do?

After this happens, the VSR has always denied service connection for my claims.

I'm not feeling any professionalism by the raters.

MY next question to you is, are the VSR people too busy to weigh in ALL of the evidence instead of just what an examiner opines, or is this Standard VA Protocol to deny vets like this?

I'm starting to wonder if my claims are flagged for denial by a VSCM or RO Director, because if I swallowed a horse and had the tail hanging out of my mouth, a VA TEAM of C&P examiners/raters would say it isn't so. I have no evidence of this being true of course but it is based on the  way my claims are being handled.

Meanwhile, the wheels on the VA bus go round and round, round and round.........

Waiting four years for a DRO decision, w/ no hearing, on a NOD, with no decision, is a bummer.

My final question is this ,explain how to get a DRO to render a decision so my appeal doesn't keep on sitting dead in the water?

The individuals either granting, denying, discontinuing, decreasing, etc SC for contentions claimed are RVSR's aka Raters. 

How would one combat an unfavorable opinion? Did you read my initial post? New and material evidence. Combat one unfavorable medical opinion by offsetting it with one that is favorable....better yet, two that are favorable. What were the qualifications of the C&P examiner that gave you the unfavorable opinion? A nurse practitioner? A Physician assistant?  All too common, especially if done by via a vendor examination. How do you combat that? Well, an MD trumps a PA or an NP, especially one that specializes in the field of medicine governing the anatomy you are wanting to get a DBQ on. For instance, go to see an ENT for ear issues, not an internal medicine doctor aka general practitioner aka family doctor. Go to see an orthopedic surgeon for anything to do with your skeletal system, though a podiatrist would be more than sufficient for anything dealing with your feet or ankles. The most ironclad case that I ever saw was a Veteran that clearly had a ton of time and money on his hand, and was clearly smart enough to do the research or knew someone that was able to point him in the right direction.  He turned in DBQs w/ Medical Opinions from an orthopedic surgeon, podiatrist, and a chiropractor for all of his musculoskeletal issues, and then had a radiologist (not sure how he pulled this one off as you aren't treated by them)  write up medical opinions covering every single issue. This guy was covered head to toe (literally)........foot, ankle, knees, hips, back, neck, shoulders, wrist. He had at least two medical opinions for every anatomic part that he was claiming, three for several, and four for some. He claimed PTSD, headaches, and sleep apnea and he was at 100% with his first claim, and SC for everything but sleep apnea. 

Edited February 1, 2019 by dajoker12