Questions on higher level review

[osidevet]

Trying to get information on a Higher Level Review after Supplemental was denied for tinnitus with what I think are errors in the denial letter. Specific questions about the HLR:

1. Does the reviewer discuss issues, or just listen?
2. How long would the interview last?
3. Can I submit a statement along with the HLR Form to describe the specific items from my denial letter for discussion, or is it only verbal?

Also, the difference in hearing between entry and separation exams is 15-20db, but the C&P examiner stated that no "shift in audiometric thresholds were reported". How can this be? I must be missing something.

Thank you.

[deedub75]

After years of trying to get service connected for knees and back secondary to pes planus, I was finally able to get it done through a supplemental claim in February. It took 10 years of claims, reopens, appeals, and a BVA remand. I opted into RAMP and submitted an HLR and it was denied. I got a nexus letter from my surgeon and submitted it as a supplemental and it was granted. All of this just have a rater put the wrong effective date. The date wasn’t even close. They made it the date I submitted the supplemental. Clearly a mistake. I submitted an HLR to have it fixed so a DRO will now take a look at it.  I’m still waiting for the phone call and I have me evidence ready. If it doesn’t work then back to the BVA it goes. 

[osidevet]

After reading all your input I've submitted my paperwork for a HLR. I think that there are a couple of glaring errors or misstatements by the reviewer. The primary argument for denial is based on information that they say happened during an examination, but the doctor's notes contradict this. I think the best way to correct this is by discussing the issue, hence the HLR. This still leaves open the Supplemental route, or BVA should all go badly.

To those of you moving forward with further reviews, please let me know your experiences and I will do the same.

Thank you.

[broncovet]

When you have 2 doctors opinions, which vary widely and affect your claim, the procedure is to get a 3rd opinion (probably an IMO).  

VA has the discretion to choose "Doc A" over Doc B, but, at the BVA level, they must give a reasons and bases for Doc A's opinion being more probative.  Some good reasons:  Doc A knew you for 10 years, doc B knew you for 10 minutes.  (more thorough exam).  Another reason:  Doc A's evidence "more closely" aligns with the facts.  

But, they mostly only give valid reasons and bases at the BVA, at the Regional office they give BS reasons.  

Example:  My VARO denied hearing loss because "it was too long since military service".  That is bogus.  Reason:  "Time since military service" is NOT one of the rating criteria for hearing loss.  They might just as well said they denied me because I had blue hair, and blue hair just was not natural.  

At the BVA level, since the decisions are reviewed by VA attorney's, you are more likely to get some sort of reasonable reasons for decision.  

Lawyers appeal BVA decisions all the time...if it does not have a valid reasons and bases for decision.  And, they always get a remand.  

[Buck52]

I had a DRO Hearing  and had two different reports  one was NOT favorable one WAS favorable  reports from Dr's

One Dr was a VA ENT  And the other Dr was a private  specialist ENT certified with other medical credentials  who went into further detail about my disability

The DRO used the private specialist report  for a favorable decision. 

Normally when you have two different Dr's reports  or your claim goes into equipoise  they use the specialist 90% of the time.(jmo)

Edited May 14, 2020 by Buck52

[osidevet]

What's funny (not) is that both a private doc (ENT surgeon) and my VA doc wrote that after their exam and reviewing records that it is service connected. I then had a VA audiologist exam, and she told me that she cannot put connection to service into her notes, but noted it as "long standing". 

A C&P audiologist overrides all that, discounts both doctors opinions, and then misstates in writing what is in the written record, twice.  

Edited May 14, 2020 by osidevet