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Higher Level Review


paulstrgn

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I am filing a HLR for the decision on my hand, I discovered after I received my C-File from the VA that in my opinion the VA did not rate me properly for my hand and fingers.During the medical appointment the individual had marked my right hand range of motion as abnormal, and the gap for my index finger was 5 cm. My current rating on my hand is 10%, I believe it should be at least 20% now (30% might be a stretch if at all possible).

My question is I also need to file a HLR for my knees which were denied, do I file these two together or separately (the decision on the hand is from 7/2018 and the knees 2/2019)?  I believe (which means nothing) that the hand can be evaluated without another medical evaluation where the knees will need a new one (they were not properly evaluated). 

In my mind it is best to file them separately and at different times (the hand right away since the one year is almost up) and the knees once a decision is made on the hand. Should I wait (since the effective date would be the same no matter when I file) or do them both now?

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Paul, I would file both now.  That way you do not lose your date on your hand and you do not wait a year or more for your knees if your case needs to go to the BVA.

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That does make sense Vetquest.  I am hoping they don't need to go to the BVA, but with that said I am probably wrong and will wind up there with an appeal.

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I am going over my C-File again and just realized that the DBQ submitted by the QTC doctor is full of false information. First I will take full responsibility for not calling the doctor out at the the time for trusting him.

I am looking at the DBQ for my knees which shows he did all types of test, he did not perform any tests at all. He only asked he a couple of questions which I answered. I told him the pain I had walking and climbing of stairs because my gait has changed because of my back. I walked stooped over most of the time while also limping to compensate for the pain in my back.  He did a DBQ for my back as well (I was asking for an increase) which is also full of non-performed exams/tests.

I feel like I should call QTC 800 number and report this doctor for all the false information he put in my DBQ (my only concern it might hurt me on future C&Ps). I will raise this issue in the HLR though. 

Plus because of this crap DBQ they are proposing to reduce my back from 20% to 10% because it has gone better (how I wish my back was better)  and to lower my nerve issue in both thighs from 20% to 0% because they have improved. Now mind you my thighs were never examined or even looked at, plus in my C-file they all show "Static" which I thought meant they would not im

As all veterans fully know, it is hard enough getting the ratings for our disabilities as it is, we certainly don't need doctors putting fake information on the DBQ. I am frustrated so much by reading this (it makes me want to scream).

I know at times when I write I ramble on so forgive me for that, I am just so pissed right now. Now I need a drink!!!!

prove.

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You might get better rsults if you call the White House Hot Line    1-855-948-2311.

You will be filing what is called a Provider complaint.

But someone here did file a complaint directly with a contractor regarding their C & P and they got another C & P exam right away.

I posted all of the Provider contact info , for QTC, LHI, and VES her, e available under a search.

I filed a Provider complaint last week with the WH Hot line.

The provider however, was a VA doctor who is actually employed by VA,  but the man who took the complaint said that was the form he had to use.

"Provider" has become a nuanced word the VA uses these days-they are filling their VAMC with non VA health professionals who are under a contract with QTC,VES, and LHI-to provide medical care, called "providers".

While many of them might be excellent doctors, nurses etc- they also might be the same ones who write these lousy C & P exams, and as I mentioned before here- if they cause a VA patient harm or death, they cannot be charged under FTCA, and th VA will deny right off the bat any Section 1151 claim against their negligence. 

Any of you can check the Provider Link from VA I put here, to see if your VA health care professional is really a VA doctor.

 

 

 

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9 hours ago, paulstrgn said:

I am going over my C-File again and just realized that the DBQ submitted by the QTC doctor is full of false information. First I will take full responsibility for not calling the doctor out at the the time for trusting him.

I am looking at the DBQ for my knees which shows he did all types of test, he did not perform any tests at all. He only asked he a couple of questions which I answered. I told him the pain I had walking and climbing of stairs because my gait has changed because of my back. I walked stooped over most of the time while also limping to compensate for the pain in my back.  He did a DBQ for my back as well (I was asking for an increase) which is also full of non-performed exams/tests.

I feel like I should call QTC 800 number and report this doctor for all the false information he put in my DBQ (my only concern it might hurt me on future C&Ps). I will raise this issue in the HLR though. 

Plus because of this crap DBQ they are proposing to reduce my back from 20% to 10% because it has gone better (how I wish my back was better)  and to lower my nerve issue in both thighs from 20% to 0% because they have improved. Now mind you my thighs were never examined or even looked at, plus in my C-file they all show "Static" which I thought meant they would not im

As all veterans fully know, it is hard enough getting the ratings for our disabilities as it is, we certainly don't need doctors putting fake information on the DBQ. I am frustrated so much by reading this (it makes me want to scream).

I know at times when I write I ramble on so forgive me for that, I am just so pissed right now. Now I need a drink!!!!

prove.

Berta is right.  Buck gave me the best advice and got favorable outcome.  

Go to your VA hospital and talk to the Comp and Pension officer.  Which used to do C&P exams, but now overseas them all!  Talk to them and file the complaint!  I did this at around 9 am later that evening at 3 or 4 I got a call and had an appointment this upcoming Monday.  They can make changes, and they can find someone else to give you an evaluation!.  

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@Berta I will call the White House hotline and tell them my complaint about the C&P I received from the QTC doctor. I honestly wish I could sue this doctor for malpractice and being incompetent. It's doctors like this that give the rest bad names.

@shrekthetank1 I might do that, but to be honest I have only been to the VA hospital three times, once to get an ID (which I could not get since I did not have a utility bill with me), the second time was for an eye exam and the third one for an annual check up. The doctor who gave me the check up never looked at me and only read lab results from a previous annual exam I had at Ft. Eustis. At the end we will see you next year, needless to say I never went back. But if it corrects the issue it would be worth going back to the VA hospital again.

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Thank you Paul! If more veterans would complain about these incompetent C & P exams, something could be done.

I have a lot going on with VA, trying to get a Bill acknowledged and passed-It is with Congressman Roe, and I have another issue with S 221.

When I get ahead on all that I intend to ask the House Veterans Affirs Committee to consider a Bill regarding these lousy ,incompetent, and  medically inaccurate C & Ps ( I also consider them to be malpractice because these are the same "providers" that are taking the place of VA employed doctors these days, and cannot be sued under FTCA, or charged under 1151- that is what my main Bill is about.)

because the VA pays for the C & P ,by contract, and therefore a C & P that denies a claim erroneously -is a guarantee of job security for VA claims adjudicators- it gets the claim off their desk fast and the veteran is forced into the long arduous appeal process. It is a scam. And a conflict of interest. And has been going on for DECADES.

 

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45 minutes ago, paulstrgn said:

@Berta I will call the White House hotline and tell them my complaint about the C&P I received from the QTC doctor. I honestly wish I could sue this doctor for malpractice and being incompetent. It's doctors like this that give the rest bad names.

@shrekthetank1 I might do that, but to be honest I have only been to the VA hospital three times, once to get an ID (which I could not get since I did not have a utility bill with me), the second time was for an eye exam and the third one for an annual check up. The doctor who gave me the check up never looked at me and only read lab results from a previous annual exam I had at Ft. Eustis. At the end we will see you next year, needless to say I never went back. But if it corrects the issue it would be worth going back to the VA hospital again.

It is worth a shot.  The guy was very nice to me and honestly wanted to know what had happened and how he could help fix it.  

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Yes, they satisfied part of my last WH complaint because it went to the Office of Accountability.

 

The C & P problems are explained well here:

"Veterans Health Administration:

Greater Focus on Credentialing Needed to Prevent Disqualified Providers from Delivering Patient Care

GAO-19-6: Published: Feb 28, 2019."


https://www.gao.gov/products/GAO-19-6


 

This one is even worse:

https://www.nvlsp.org/news-and-events/press-releases/nvlsp-dismayed-over-gao-report-on-va-disability-exams-and-the-need-for-impr

That report is here:

https://www.gao.gov/assets/700/695476.pdf

 

I contacted Ms. Curda asking if the GAO ever actually considers information from veterans or their survivors ,in the VA claims system, whose claims are denied solely due to faulty C & P exams.

This is her reply:
 

Dear Ms. Simmons,

 

Thank you for your email and I am very sorry to hear about the difficulties you have experienced.  Unfortunately, GAO is not in a position to look at individual claims issues.  We do work at the request of Congress and focus on broad program effectiveness and efficiency issues.  We look at cases that have been carefully selected to meet our study objectives.  That said, it is helpful to hear about the types of problems veterans and their survivors are experiencing.  We may do some work in the future looking at the quality of C&P exams and your information might help shape our thinking about areas to look at.  So thank you for taking the time to share your experiences with me.

 

Regarding a lawyer, unfortunately I don’t know any lawyers off hand who can help with that.

 

I wish you well,

 

Elizabeth Curda

Director | Disability Issues

US GOVERNMENT ACCOUNTABILITY OFFICE

441 G Street, NW | Washington, DC 20548 | 202.512.4040
Fax: 202.512.5334 | curdae@gao.gov | www.gao.gov

 

I had briefly explained my personal experience with posthumous C & P exams,done regarding my dead husband, and also what I see as a veterans advocate, in this growing problem.I also mentioned that erroneous C & P exams also force the claimant to have to obtain independent medical opinions, that are often very costly, but this is the only way they have to overcome deficient C & P exams, and the first time their actual medical history with VA is actually read in total..

 

I said I was seeking a lawyer who could sue the VA to recover ,as damages, the cost of any C & P exam IMO/IME fee ,that any veteran or survivor , was forced to pay, and that resulted in a proper VA award, solely in order to get a real doctor read their medical records.

Anyone can contact Ms. Curda- her email is above- but as she said, they can only react to requests from Congress,so I am collecting evidence to prepare another Bill.

This Congressional  stuff takes up a lot of my time but I sure would like to see something done.I would like to retire from all this VAOLA  someday, and spend my time at the local river, full of trout,-which  is only 350 feet down the road.

 

 

 


 

Edited by Berta (see edit history)
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4 hours ago, shrekthetank1 said:

It is worth a shot.  The guy was very nice to me and honestly wanted to know what had happened and how he could help fix it.  

I will contact the Hampton Roads VA next week and see what they say, after all the worse thing they can do is say "sorry" we can't help you. Thanks @shrekthetank1

 

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@Berta I did contact QTC about the doctor who put false information on my DBQ. When I call QTC at 800-682-9701 and they gave me an email address to email my concerns which I have done. That email address is Incident.Report@QTCM.com. 

@shrekthetank1 I did not contact the Hampton Roads VA because I had email the Regional Director in Roanoke, VA ( @Berta - I thank you for posting her information on Hadit) about my complaint, she had someone from her staff call me and they are now going to have a new C&P performed on me. I spoke with this person for more than 1 hour about the issues I have with this doctor. I am not 100% pleased with the outcome because they will only give me a new eval for my back and also two nerve issues in my back (I am pissed that they will look at these two nerve issues I had never asked for an increase for this issue. It is because of this doctor). The doctors DBQ triggered a proposal in reduction for my back 20% to 10% and two Femoral nerve issues in my legs from 20% to 0% (they say because the DBQ shows these issues have improved which is false). I will also have a hearing about this proposal to reduce. Every time I think about this I want to scream!!! 

On the bright side the person I spoke to at the VA gave me his phone number and said to call him 1 - 2 weeks after the DBQ is completed and he will tell me what it says so I will know prior to the hearing.

 

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I know -it is Crap that no veteran needs.

Thank you for being so proactive on this-

I was going to ask my Congressman to support a Bill on these lousy C & P examiners.

Someone already did- it is in the House- but I have not had time to deal with it-

It is also mentioned in my Bill, that I hope Congressman Roe will support, and was part of my OAWB complaint.

These "providers" as VA calls them are replacing VA health care employees all over the country-

because the VA's malpractice payments are so high, and if a contractor from VES, LHI, or QTC commits malpractice on a vet- they have to file directly in a Federal district court because they don't fall under FTCA or Sec 1151.

Someone griped here yesterday or today that I give too much confusing "information" here with links I use.

But I am again posting a link-

https://www.accesstocare.va.gov/ourproviders

Your VA doctor, if you search for them by name , at this link, might not even be a VA doctor.

If a Vet or their survivor has to file a malpractice case in a Federal district court against one of them, the VA's malpractice stats will not show the results of that settlement, if they are successful.

VA is hiding their malpractice stats as it is. My Bill might prevent them from doing that in the future.

I think it is malpractice when any doctor , VA or contractor , deliberately manipulates a C & P exam to be in VA's favor. Because if they cannot handle a C & P right, how many VA patients can they harm?

Some of the contractors are former VA doctors- that info stunned me----but then again one of the contractor sites touts "low" liability- yeah- they believe vets or their survivors will never file in a Fed District Ct...if they are harmed or killed by one of them.

 

 

 

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@Berta All I can say is I really appreciate all the information and guidance you provide us, I find it very helpful. I must admit I am very envious of your knowledge of VA issues!

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That's really cool Paul.  I filed for an EED and wound up with the VA looking again at my nephropathy.  Everyone knows nerve issues do not get better.  I have to wait and see with the DRO does.

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It really does drive me crazy Vetquest when the VA does these things. I hate it since there is nothing to track since it is an internal process.

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I received a call from VES setting me up for a new C&P with a Dr. Pinnaka in Virginia Beach for the May 24. I am a little confused (more than usual - 🙂 ), the women told me I was being evaluated for an increase for my back, the radiculopathy in my lower legs and my cervical radiculopathy. This stems from proposal to reduce on my back and radiculopathy in my lower legs. I am not understanding the cervical radiculopathy part, I have never claimed this so I do not know why I am being evaluated for this. When I asked about the cervical radiculopathy she said the VA has requested it.

Should I ask the VA why or just go with it?

 

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I would just go with it and go to the C&P.  You might have surprised somebody by calling into question your C&P.  

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I will go for sure. I just confused about the cervical nerve issue. But I will surly go and see what exactly they are looking at. If for some reason they say I have issues there great. I am not sure how they will service connect it is all.

i will take copies of my MRI and latest x-ray results. 

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Good, I wish you luck.

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On 5/10/2019 at 6:44 PM, paulstrgn said:

 

I feel like I should call QTC 800 number and report this doctor for all the false information he put in my DBQ (my only concern it might hurt me on future C&Ps). I will raise this issue in the HLR though. 

1st - write up a 4138 right now and get it into the record or call or submit a statement through eBenefits.  Don't wait for the review.

2nd - do you get care at a VA medical center?  You can take a copy of a DBQ in and have them fill out that DBQ ASAP.  It will carry more weight if it's done by VA docs and the closer in time to the contract exam the better.  It will be obvious what happened if the VA exam/DBQ shows very different results from the contract exam.

3rd - you can take a DBQ to a private doc as well.  Those forms (most of them are downloadable) are available to the public with a few exceptions.  

By the way, if you do get another DBQ to turn in, you want to submit it with a VA Form 20-0995 - Supplemental Claim.  HLRs are "closed" records so no new evidence after the decision you disagreed with.  You can file a Supplemental any time as long as you have "new and relevant" evidence.

 

 

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