Pending HLR, Pending Supp Claim, Closed Supp Claim. Should I call or file IRIS

[JKWilliamsSr]

I am trying to decide if I should call the white house line of file an IRIS claim myself.   I am leaning towards filing the IRIS claim because my understanding is that is what happens when you call the white house line anyway.  So here are where my claims stand.

1.  In September my supplemental for Sleep Apnea and 1 other was closed.   I still have not received a letter or any other type of notification about this other than it is what shows on va.gov.   I am certain they are required to send me notification and by not doing so is a clear violation of 38 CFR 3.103

2. The remaining claims on that supplemental claim are still pending.  I have called them twice already on this for the status.  This is the exam where I had the bad C&P exam but there still should have been some kind of movement.  I had the C&P exam on November 5th and 30 days later I called to request the status and was told they were waiting for exam results.  Called them out on that and they said it was because of backlog.  I called a couple weeks later and they were not gave me any additional information.  Just stated it was still pending.    I personally believe this exam should be in the hands of a rater because it is not an appeal but reopened claims with new evidence.  Unlike new claims or increases I cannot request a decision because I do not have additional evidence like you can on ebenefits.

3. I also have an HLR pending for denials I received an October.   Right now the status is "A senior rater is taking a new look at your case".  It has been sitting in that phase for the last 3 weeks and since no evidence  can be submitted it should not take a rater this long to be looking at this.  I could be wrong but I have seen way too many HLR's being completed within a week or so of a senior rater looking at it.   Maybe it is a good sign maybe not.

Here is what I think is happening.  I have several different types of claims going and I think it is just being swept away.   The last time I called I asked about both my HLR and Supplemental claim and the person I spoke to was clueless and could not give me any information because in my opinion they did not know what the hell they were doing.  I think with an IRIS complaint I can detail all of my concerns and have it listed where it cannot be ignored.  Sure it may not make a difference but it will be on record and can be used in my appeal.

[JKWilliamsSr]

6 hours ago, Miken2c74 said:

Did you challenge this exam ? My examination was done by a German Contract PR and my medical opinion was done by someone else at VES. It is virtually unrealistic to perform a medical opinion if you are not the administering  the exam. You can fight it. You should write a letter.

Yes I did challenge the exam.  As soon as I saw the C&P exam results I called and filed a complaint about it letting them know that I do not feel the examiner did what he was supposed to.  I then followed that up with a letter breaking down each issue I had with the DQB.  The examiner stated things in the DBQ that were flat lies.  Now I did not call him a liar in my statement.  I just point out that what stated was not accurate and did not happen as he stated it. For example the examiner stated that I take motrin for pain.  The problem with this is that we did not discuss medication.  I point that out because for my back I take more than motrin.  I have no idea where he got that from.  On top of that I have a submitted statement in support of claim that discusses my medication and it clearly contradicts what the examiner said.

[JKWilliamsSr]

UPDATE:

So I called the VA this morning to check on the status of my supplemental claim.   They told me once again that they it is still in the development stage.  However, this time they made a request for another C&P exam.  This time it is for my foot issues.  They said the request for a C&P exam was made January 15.  As of today I have not received any word for the appointment.  So I guess I will just wait and see.  I have not idea who I would follow up with pertaining to C&P exams.  

I am going to honest here. I think my HLR may have something to do with the new request for a C&P exam.  My supplemental claim was sent on Sept 22nd and scanned in on October 22nd.   Not long after it is scanned in I get a call for a C&P exam but it was for my back only.  No other exams were requested at that time.  So it is clear someone looked at my claim but probably decided to ignore certain aspects of it.  Now on December 4th I sent in my HLR request.  In this request I pointed out a slew of errors.  In this request I made a number of 38 CFR citations and I also made a number of CAVC Precedent setting case citations and in my HLR I made sure that I pointed out that all cases cited were  3 judge panel precedent setting cases. 

A few weeks after my HLR gets scanned in the request for a foot C&P exam is made.   This is one of the claims they originally denied in 2009 stating there was no complaints in service.   I get a copy of my C-File and in there is an entrance exam that shows normal feet.   A podiatrist visit with a diagnosis of plantar fasciitis and pes planus.  An X-ray report stating flat feet.  An exit exam that has my feet as abnormal with a diagnosis of moderate pes planus.  All of this was in my SMR's and I sent them in with my supplemental claim. 

Edited January 24, 2020 by JKWilliamsSr

[Vync]

With the slow pace a the VARO, I'm not surprised you have not received a C&P letter yet. If you normally get your C&P's done at the VAMC, you might want to call them and ask if they have you setup for an appointment, just in case it got lost in them mail from them to you.

Glad they are at least doing something. I just hope they get it right this time.

[JKWilliamsSr]

3 hours ago, Vync said:

With the slow pace a the VARO, I'm not surprised you have not received a C&P letter yet. If you normally get your C&P's done at the VAMC, you might want to call them and ask if they have you setup for an appointment, just in case it got lost in them mail from them to you.

Glad they are at least doing something. I just hope they get it right this time.

If they sent a letter out last week there is a possibility I may get it in the next few days.  I have not checked my mail this week so in all fairness one could sitting there.   I guess i think it odd because they called me for my last appointment and sent the letter after.  I guess in this instance they may just schedule it this time and just tell me when and where to show up. 

This time I am not taking any chances.  I think I made critical errors on all of my C&P exams and that is by not giving the examiner all the information for my claim.  In each of my exams they would tell me that they did not need the information I had because they had access to my C-File and I went along with it.   Every time I was screwed in the end because any evidence I submitted has never been included in a decision.  This time will be different. 

I have already started preparing my packet to hand to the C&P examiner at my exam. 

1. My entire Independent medical examination report with the disabilities that pertain to the appointment highlighted as well as the Nexus Statement highlighted.
2. Entrance Physical with the annotation that my feet were normal highlighted. 
3. Exit physical with the annotation that I had flat feet at separation highlighted.
4. Sick call visit for foot complaints
5. The referral to podiatry where the podiatrist diagnosed plantar fasciitits and pes planus diagnosis highlighted
6. The X-Ray report with the confirmation of flat feet diagnosed.
7.  VA 21-4138 from myself and spouse that shows continued symptomology since service
8. Private medical records that show treatment for plantar fasciitis.  It has gotten to the point where I need to get cortisone shots. 

The fact that I highlight the important part in my SMR's may annoy the examiner but to be honest I do not care.  I have been getting screwed over repeatedly and I am making sure the see everything important. 

[broncovet]

Mr. Williams...

    If I have not mentioned this earlier, ebenefits/VA.gov is notoriously unreliable.  Just because it says, "gathering evidnece" means nothing.  

122 days is not unreasonable, be it a reopened, new claim, or HLR or SCL.  Its actually rare to get them faster than that.  Now, VA has this new RAMP, aka AMA going on, and frankly they dont know what they are doing and it slows stuff down.  

    I know you are anxious, almost all of us have been there.  I lost my home waiting on VA benefits which took them 4 years, and they still did not get it right.  That was in 2002, and Im still in appeals, now "with judge" at the BVA.  Of course, that is what ebenefits says, so I know that is probably in accurate, or not up to date at best.  Its just not worth fussing over what ebenefits says...we know its unreliable, so we just dont count on it.  Like everyone else, you will have to wait for the envelope, like it or not.  I have been doing this more than 10 years on hadit, and I have learned not to worry about what ebenefits says.  Many Vet advocates recommend NOT checking ebenefits because of this:  Its not reliable and it gets vets get anxiety attacks over it.  

    There is simply nothing we can do about it, and I have long since given up trying to figure out what ebenefits means when they say "_______" because you are better off trying to figure out what draft picks each time will do in the NFL draft.  Most people dont know, and those that do arent talking.  

[JKWilliamsSr]

9 minutes ago, broncovet said:

Mr. Williams...

    If I have not mentioned this earlier, ebenefits/VA.gov is notoriously unreliable.  Just because it says, "gathering evidnece" means nothing.  

122 days is not unreasonable, be it a reopened, new claim, or HLR or SCL.  Its actually rare to get them faster than that.  Now, VA has this new RAMP, aka AMA going on, and frankly they dont know what they are doing and it slows stuff down.  

    I know you are anxious, almost all of us have been there.  I lost my home waiting on VA benefits which took them 4 years, and they still did not get it right.  That was in 2002, and Im still in appeals, now "with judge" at the BVA.  Of course, that is what ebenefits says, so I know that is probably in accurate, or not up to date at best.  Its just not worth fussing over what ebenefits says...we know its unreliable, so we just dont count on it.  Like everyone else, you will have to wait for the envelope, like it or not.  I have been doing this more than 10 years on hadit, and I have learned not to worry about what ebenefits says.  Many Vet advocates recommend NOT checking ebenefits because of this:  Its not reliable and it gets vets get anxiety attacks over it.  

    There is simply nothing we can do about it, and I have long since given up trying to figure out what ebenefits means when they say "_______" because you are better off trying to figure out what draft picks each time will do in the NFL draft.  Most people dont know, and those that do arent talking.  

I agree with you that 122 days is not unreasonable for a claim but at the same time I cannot allow them to just sit on their behinds either.  I filed for increases and new secondary claims at the same time I filed my supplemental claim.  The increase/new claim was a fully developed claim and was  completed in less than 30 days and that was with a C&P exam.  My supplemental claim was reopened previously denied claims and to be honest off of VA errors.  They denied claims by saying they were not in my SMR's so submitting the SMR's with additional evidence to further support the claim should have made it straight forward. 

My concern is the amount of time from my C&P exam from my supplemental claim was so long when the first part of my claim was less than 30 days completed.  With that said I was lied to when I called and asked for an updated.  I was initially told that they were waiting for exam results.  Well I called them on that and was told it was because of the backlog.   Then the next time I call it is in the gathering evidence phase and 2 months later there was nothing.  Did did not request any additional information from me not that I had any to give because my claim was FDC so it was just sitting there. So i was just checking on movement. 

When I call the VA I am never angry nor am I point fingers at anyone. I merely ask for an update on the status of my claim.  I have learned that every time I  make an inquiry some movement takes place. I normally would only call once every 3-4 weeks and that seems to work.