Higher Level Review

[msvj3]

Hi,

I pray that someone can give me some answers because I feel distraught.  I filed for a higher level review.  The decision came back saying, it was returned for correction of a duty to assist error in the prior decision.  The Va Medical opinion was not sufficient for rating purposes.  What happens now?  Do I have to go for another exam?  I called and was told that no exam was scheduled for me.

[vetquest]

If they say you are not required to go to another exam they have most likely contacted the doctor for clarification.  If this is the case there is nothing for you to do right now.  Good Luck.

[Vync]

@msvj3 The VA regional office has a set of minimum requirements for what is considered an adequate exam. Sometimes the doc may fail to provide sufficient information or additional clarification is required. 

At this point, there are no plans to bring you back in. Once they get the information they need, they may either proceed and make a decision or bring you back in. Currently, there's no way to tell which way they will go. 

I have been brought back in for a follow up C&P exam once, but it was 20+ years ago. The documentation from the first exam was misplaced, so I had to come back. Ironically, I found the misplaced documentation in my claims folder some years later.

[Buck52]

I agree wit hthe above members  but this don't sound to good

''The Va Medical opinion was not sufficient for rating purposes.  What happens now?  Do I have to go for another exam?  I called and was told that no exam was scheduled for me.''

[Vync]

This should be very helpful. Please note that there is much more to this article. Click the link to view the complete article.

M21-1, Part III, Subpart iv, Chapter 3, Section D - Examination Reports

3. Handling Examinations Reports That Are Insufficient for Rating Purposes

Quote

A VA examination report submitted to the rating activity must be as complete as possible.

 

Any missing, required information on the report makes the examination report insufficient for rating purposes.The following are examples of deficiencies that would render an examination report insufficient:

• The examination report is unsigned.
• The examination report does not address all disabilities for which an examination was requested.
• The required question(s) on the DBQ is/are unanswered.
• The required review of the claims folder was not accomplished.
• The report is missing information pertinent to the specific disability under review, such as the impact of musculoskeletal pain on the functional loss of an affected joint.
• A medical opinion is not properly supported by a valid rationale and/or by the evidence of record.
• A requested medical opinion was not furnished.

Note:  If the rating activity determines that a necessary examination was canceled without a valid reason, it must submit a new examination request to the examining facility and specify why the previous cancellation was inappropriate.

  

Example:  An examination requested in connection with a claim for a knee condition was not completed because “the claimed condition was not documented and diagnosed in the service treatment records on examiner review.”  If the rating activity determines that such examination is needed, the existing report or cancellation notice should be returned to the examining facility as insufficient for rating purposes.

  

Important:  There are instances where missing information in an examination report does not make the examination itself insufficient.  However, claims processors must seek and obtain the missing information via communication with and clarification by the examiner, as discussed in M21-1, Part III, Subpart iv, 3.D.3.c, before issuing a final decision on the underlying claim.

  

References:  For more information on

• inadequate examinations, see 38 CFR 4.70
• circumstances under which further development may be needed, see M21-1, Part III, Subpart iv, 5.A.7
• weighing evidence, see M21-1, Part III, Subpart iv, 5.A.9
• partial rating decisions and deferred issues, see M21-1, Part III, Subpart iv, 6.A.1
• resolving inconsistencies, see M21-1, Part III, Subpart iv, 3.D.3.d, and
• descriptions of pain affecting functional loss, see Floyd v. Brown, 9 Vet.App. 88 (1996).

 

[Guest]

IMHO, this is more of a good thing than a bad thing.  The good thing is instead of denying your claim, VA is taking more time to do a better rating decision.  The bad thing is you may still be denied.  Good thing more weeks/months versus bad thing months/years.

[Buck52]

Great Infor Vync   glad you put this on here...hopefully this Veteran will read it.