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Higher Level Review


RBrogen

Question

I wanted to share my experience with this new "fast track appeal" option called Higher Level Review (HLR) and see if anyone else has had this experience.

My original claim for IVDS of Cervical Spine and Knee Conditions, Bilateral ( Arthritis in both and have had 2 surgeries on left and 1 on right for meniscus tears) was approved at 10% neck, 10% left knee arthritis and 10% right knee arthritis.

My contention is that all three conditions should be rated at least at 20% each.  First, my neck has "straightened/revers lordosis" which is a qualifying condition for 20%.  On both of my knees, the meniscus are frequently popping out, causing swelling, pain and locking which should qualify each knee for 20%.

I filed the HLR on March 12, 2019.  The form to file the HLR didn't have a place that I could find to submit any supporting information. It only had a section to list the specific conditions to which you wanted them to take another look at.  The HLR form did have an option on the form to request an "INFORMAL CONFERENCE CALL" which I checked off so I could explain my disagreement with the rating given.  About 32 days after submitting my claim, and ironically while I was at VA appointment stuffed into an MRI machine, the decision officer Marcus called and left a message.  I called him back within 45 minutes of his call and the number the give you is out on the west coast and only has a voicemail option.  You can't speak to a live person.  I left a message and told them day/times that I had available.  I waited 2 days and hadn't heard back so I called again and left a message.

I went onto my e-benefits to check something else and noticed that my claims appeal had been closed as of April 15, 2019 and a decision sent ... WTF.  I called the main VA number and let them know the situation and they sent an internal message to the decision office Marcus.  Well Marcus called me back later that day ... and when I picked up the phone he sounded surprised that I picked up.  He then went on to say he was calling to schedule an informal conference call with the decision officer .... UGH WHAT? I told him my availability and he said he'd forward right over to the decision officer and I'd likely get a call in a few minutes.  Guess what .... that call NEVER CAME!  I called back to the main VA number several times and they sent messages and finally one of the people who picked up the phone said just wait for the decision letter.  Well I waited (and am still waiting for the original decision letter), when the required 7-10 days passed I called and had them do a verbal FOIA and fax me the decision letter while I was on the phone with them. 

Yup, you guessed it, the appeal was denied and the reasoning was a cut and past from the original claim decision.  Fortunately, at least I hope so, I have the option of a Supplemental claim, which I put all of the supporting information together in a nice package and faxed it to them, called 3 days later to confirm receipt and hopefully that will address the issue.

Bottom line, it looks like the HLR process is really BS at this point and they are all about making it look like they are processing these HLRs at about 30 days, at least it was in my experience.

Anyone else have HLR experience?

Edited by RBrogen (see edit history)
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I am in the old system so I am waiting for a DRO hearing which is much like the HLR track.  First I will say that your timing is great, DRO hearings are pushed out from 13 to 26 months.  Second, I have not had much luck with DRO hearings.  The Rater listened respectfully to what I had on appeal and set me up for a new C&P, but they set me up with the same doctor I had already seen and another appointment with his supervisor.  So I had two examinations that recommended they sever a ten year old disability.  The new decision stated I was being set up for a reduction of a twenty year old rating and severance of a ten year old disability and C&P's were being scheduled.

I will say that I had much luck with the BVA.  As to my understanding you can request a BVA hearing after the HLR denies you.  I would get that rolling.

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