Supplemental Claim Denied w/IMO, High-Level Review Next?

[lawbro]

Hi All

To make a long story short, last year the VA granted my right-knee tendinitis 10% but said my left-knee was NOT service connected. I reached out and obtained an IMO from Dr. Anaise whose IMO opined that either my left-knee tendinitis WAS service connected or that it was secondary to my service connected right-knee. 

I filed a supplemental claim at the end of June and just received the decision back that they stuck with the original decision to not grant me anything for my left-knee tendinitis, stating that it was still not service connected. 

How should I go about the next step in the process? I seem to read a lot that High-Level Reviews are a waste of time and perhaps go straight to BVA. Also, should I also look into getting an attorney for the High Level Review or just wait to see if it goes to BVA or not?

What do we believe is the best way to go about this?

[Berta]

They put it to the right hand side of the initial decision letter, frist page ------------that is---- I hope the VA didn't get wise to my past suggestions here- and decide to eliminate it-

If there is no alphanumeric, I don't know what you could do to get it to the person who made the error.

But the RO should know who that would be.

 

 

[lawbro]

Thank you all for the responses and amazing advice!

I filed for a HLR in November and finally received my informal conference call with the rater today. I told her about my concerns that I felt like the IMO from Dr. Anaise was not considered or was not reviewed in its entirety. She was very friendly and told me she had my entire file in front of her that included the IMO from Dr Anaise. She said she couldn't say one way or another if the previous rater read the entire IMO but that she would review it. 

She also said one of the issues that the current system faces is that once you get an Opinion from an outside VA doctor and submit it for an appeal or supplemental claim, if they schedule you for another C&P exam they don't provide that Doctor with a copy of the evidence that you have sent to the VA, so basically whoever is doing the C&P is just going off of the documents that were already in your C-File. So if you have documents from the last C&P where the doctor says "I don't believe this is service connected" then the new C&P Doctor sees that as well.

She told me that she would take today and tomorrow to review my entire claim but that if the documentation/evidence in the IMO meets the criteria a rating then that would most likely be the decision that she went with. I'm trying not to get too excited about the decision because the VA has let all of us down multiple times. She told me that they should have a decision to me sometime next week.

This claim/appeal process goes back to Mayof 2018 so the plan is to donate 10% of my backpay to Hadit if it goes through. This site is amazing and has amazing people that take time out of their busy days to help us weave through this bureaucratic nightmare. 

Edited February 7, 2020 by lawbro

[GBArmy]

lawbro If she means what she said then you certainly have a fighting chance. And at HLR, that really is all any of us can ask for. You want a fair shake at having all your evidence look at and considered. We all wish you the best; sounds like it will be coming down the road fairly quickly. 13 months back pay minimum would help it along too!

[JKWilliamsSr]

42 minutes ago, lawbro said:

She also said one of the issues that the current system faces is that once you get an Opinion from an outside VA doctor and submit it for an appeal or supplemental claim, if they schedule you for another C&P exam they don't provide that Doctor with a copy of the evidence that you have sent to the VA, so basically whoever is doing the C&P is just going off of the documents that were already in your C-File. So if you have documents from the last C&P where the doctor says "I don't believe this is service connected" then the new C&P Doctor sees that as well.

I think the reason for this is that it is not a requirement of the C&P examiner to review another doctors opinion.   The only reason this would be necessary is if the rater needs an opinion of an outside examination report and this is something they would need to request.  C&P examiners do not make rating decisions. They make the determination of they believe the condition is service connected or not.  This is done via the submitted medical records in conjunction with the examination. C&P examiners have access to your entire C-File and can see all the information that is uploaded.  They can see lay statement as well as reports from other doctors this is not necessary to be provided.  They can just look it up themselves. 

It is the raters responsibility to review the outside doctors report and determine it's weight not the C&P Examiner.  Where it can become tricky is if the rater decides to give the C&P examiner more weight than your examiner. Then the requirement is for the rater to state the specific medical reasons why.  They cannot simply say they believe one over the other.  On top of that most C&P examiners are either NP's or PA's.  So it can be tricky for the VA to state why they gave their examiner more weight when most of us that use outside doctors use actual MD's. I have yet to have a C&P examination from an actual MD.  

[Oceanbound]

My HLR review was a waste of time. (you can read the post in my thread) Still got denied, wasn't given my correct rating of 60%, stayed at 30% since the C&P examiner had to be sent it again plus couldn't read my weight changed from point a to point b over this period of time and that my GI doc said it wasn't from that, which would have pushed me into 100%. So now I wait in line for the BVA.

[El Train]

2 hours ago, JKWilliamsSr said:

It is the raters responsibility to review the outside doctors report and determine it's weight not the C&P Examiner.  Where it can become tricky is if the rater decides to give the C&P examiner more weight than your examiner. Then the requirement is for the rater to state the specific medical reasons why.  They cannot simply say they believe one over the other.  On top of that most C&P examiners are either NP's or PA's.  So it can be tricky for the VA to state why they gave their examiner more weight when most of us that use outside doctors use actual MD's. I have yet to have a C&P examination from an actual MD.  

This happened to me.  HLR still went with the VA C&P NP opinion over my outside MD well written nexus and diagnosis stating records review and the whole nine yards.  I would win in an appeal, but why do I have to go this route?  I'm 100% P&T so I won't.  But I hate losing when it's a solid claim.