In Ramp Supplemental Information Track

[OldJoe]

Thought it best to start a new post since my other one had become so long and probably fairly confusing with all of the twists and turns that my claim has taken. 

It seems as though the VA is about to deny my NoD for my knees (or has I guess since the DAV rep told me about the Dr opinion).  Should have seen this coming a mile away when the nurse practitioner wrote the nexus connecting for my knees to my back.  I just called her office this morning explaining that I needed a Doctor to basically endorse what she wrote so I could resubmit it. 

In short I interpret this as they simply got a Dr to opine their stance and since a Dr out ranks a nurse practitioner so the VA specialist's word stands.  The DAV from St Louis also mentioned that from the VA that in the Dr's opinion there isn't any medical evidence to support the claim (a quick google quickly proves otherwise, but I know this doesn't mean a hill of beans in their eyes).

Other than that is there anything else I can do?

The other twist to this is that they are combining my CUE with the NoD for my knees.

Thoughts opinions now that this is all new and improved "Ramp Based"?

Backstory:

My side; I have scoliosis (noted in SMRs), I was awarded service connection for back condition (based on records they had in possession at the time of original denial back in 1997 (yes big time CUE).  Any quick google will bring back a plethora of material linking the two, not to mention almost any Dr will confirm that there are links between the two.

My CUE; well after faxing material to Mr. Spickler's office evidently they routed it for a DRO review (included all pertinent documents).  My CUE concerns the fact that they used the information in my SMRs to approve me for my back that they had in their possession at the time of my original claim back in 1997.  My CUE claim is basically a textbook case of what a CUE should look like and how it should be decided.  Instead they didn't even wait for the ink to dry before they denied it (actually couldn't have sat on the raters desk more than a week, this includes time in inbox).  Since I had the other in RAMP I went and had this converted over to RAMP as well.  My thinking is that if they are going to deny me under a DRO review then they might as well deny me quicker under RAMP instead of waiting 6 months to a year.

If you are interested in reviewing the past history of my ongoing claim (now in appeal status) you can find it here (be forewarned it is long and can be quite confusing, though you might glean a few things of what not to do):

 

[OldJoe]

Another question concerning this and the new "RAMP" rules.  Any idea how this is all going to work out?

I already got a feeling from reading other post(s) about this that this seems to be a new way for the VA to stop us Vets dead in our tracks when it comes to fighting them even when (like in my case) the commit an obvious CUE.

[broncovet]

YOu posted:

Quote

It seems as though the VA is about to deny my NoD for my knees (or has I guess since the DAV rep told me about the Dr opinion)

The VA cant deny you because your "doc" was a NP.  Here is why: 

The VA regurarly uses NP's for C and P exams as well as other stuff. That woulld be cutting their own throat.."disallowong" np opinions.  This would cost them a bunch as they would have to replace all the np's with docs.  They use NP's opinions all the time, and they stick, too.  

You see, you are looking for an "expert wtiness", not necessarily a doctor.  An NP can be an expert, when they have training and experience in the applicable field, and are considered an "expert".  

On the other hand, a psychiatrit who has no experience in bones or joints, is not a valid expert on your knee arthirits claim just because he is a doctor.  He is not an expert witness on knee arthirits, unless of course, he has training and experience in treating knee arthirits.  

You need to make a choice:  

You can try to fix what may not be broken now, and get an IMO/IME from a doctor OR

You can wait on the decision, then decide if an IMO/IME is needed.  I suggest you wait on the decision because you can then "target" the VA's reasons and bases for denial..you could get denied for other reasons and waste your money on an IMO that was not needed.  

There is a shard of truth in what your VSO said.  IF you have a favorable NP opinion and the VA has an unfavorable doc opinion, then the bva can deny and give a reason and bases that the VA doctor has more expertise and, therefore they found the docs opinion more probative.  

However, if you did not have a conflicting doc opinion, but only a favorable opinion by a NP, I dont see the VA using that as a sole reason for denial, in no small part because that would open up a can of worms where the va does not want to go.  

If you had a successful CUE, you need to be advising US, not the other way around, since few of us have actually won a CUE.  We need more posters, and would love it if you would answer other VEts questions on CUE.  Cue are the most difficult claims to win, some attorneys wont touch them.  

I will agree, however, that if you have a "negative" doc opionion, dont try to refute that with a NP opinion, as that gives VA a perfect reason to deny alleging the doc had more expertise than the NP/ . 

 

Edited February 21, 2019 by broncovet

[broncovet]

As far as the RAMP, it just so happens I just got a Ramp denial, SCL.  Now, I have 4 choices:

1.  Do nothing and not appeal.  (I wont go that route). 

2. Appeal to the board with hearing.

3.  Appeal to the board with new relevant evidence.

4  Appeal to the board without a hearing and without new evidence.  

     Im currently reviewing my file AGAIN to see if I think I have enough evidence for a board award, without an IMO/IME.  

I think so.  I believe the decision maker (RAMP SCL) top sheeted me, and just plain did not read the evidence which was there all the time.  

      However, I do recognize the value of an IMO, and I have a great relationship with my VA doc.  He has always given me favorable opinions, and I dont see that changing.  He already gave a favorable opinion, but, I may ask him to clarify what may be a minor issue, just in case.  

     I wont be going to any "hearing" because I dont hear well and do terrible in "hearings" which require me to hear!!  Im SC for hearing loss.   I may hire someone to represent me at a hearing, or, I may ask VA for a "reasonable accomodation" to my hearing loss, that is, someone who would "type out" what was said so I could review it.  In other words "closed captions" in person .   I have been to one meeting designed for hard of hearing, where they put every spoken word on the screen, in real time.    It was awesome!!! 

        However, asking for this type of heaing would almost certainly result in delays for me.  

[Buck52]

bronco

what was the RAMP Reason and bases of the denial? was it not enough evidence? or something close to it?

[Buck52]

bump bump up??  broncovet?

[broncovet]

I will quote the relevant part:

Quote

Housebound benefits are payable if the Veteran has a single disability ratable at 100 percent and additional disabilities independently ratable at 60 percent or more or if the Veteran is substantially confined to his or her dwelling and immediate premisis due to disability (specified in 38 cfr 3.350).  .........

.......;lThere is no indication that the claimant is substantially confined to the premisis nor that he has a single disability rated as totally disabling and additional disabilities evaluated as 60 percent disabled.

NOT TRUE.  My doc said I was "homebound", and the decision maker neither read it nor mentioned it.  I have proof.  Its not unusual that VA does not read our evidence.