VA Second Opinion?

[ronnieusmc0311]

Hello, I have been persuing a VA claim for over a year now in regards to Acid Reflex/GERD. I was medically retired from the Marine Corps for Asthma (30%). When I filled this claim, I was trying to Service connect Acid reflex/GERD to ASthma medications. I had a my private NP-C write a letter and added some information that shows connection between my meds and Acid Reflex. I then saw a VA P.A. for an examination. She wrote against me and the VA followed up with a second opinion from a DR at the VA. When I received this decision, I filed a supplemental claim. I had my private NP-C write a stronger letter with more substance to back up my claim. I also had my Asthma specialist DR write a quick note stating my inhaler "may" cause Acid reflex symptoms (I tried to get a substantial letter but he refused). I also typed a letter stating that I do not know (this is why I did a supplemental) if the asthma meds were the only thing causing my acid reflex/GERD. I stated that I also use Lorazepam for PTSD (service connected), I take Acid reflex medication prescribed from the VA, and I have been taking NSAIDS long term for service connected Cervical neck strain/Migraines. I also stated these symptoms manifested during my Sea service deployment to the gulf of Aden. At that time, I was prescribed Advair for asthma and still deployed. I basically connlcuded with, I believe it may be a combination of these medications that have contributed to AcidReflex/GERD.

So, for the second part. I was ordered to see (I spoke on the phone due to COVID-19) with a DR. from Veteran Examination Services. The DR. asked me some straight forward questions then after 5-10 minutes said "I think I heard enough, I have reviewed your letter and I have all the info I need" (he seemed very nice and attentive). Two weeks later, I call the VA and they say that they received the examination notes but my claim was sent back to gathering info because they are going to ask another DR due make an opinion. This happened last time, so I am a bit worried they are trying to find a way of denying me again...Anyone have experience with something like this? Thank you!

[Hucast21]

This seems to be a common tactic by the VA, which is why I immediately sought legal representation when my initial claim was denied.

If a veteran goes at it alone, even with an IMO with nexus, submitting the IMO too early just gives the VA more time to come back with a second opinion. The way my attorney explained it to me was like this:

1. Have a board-certified specialist look at your claims file and render an IMO with nexus.

2. Sit on the IMO and submit until the very last, so the VA doesn’t have time to come back and ask for a second opinion.

3. More than likely, the rater or DRO will uphold the previous denial because the VA wasn’t given enough time to refute the strong probative evidence (IMO with nexus) in favor of the veteran.

4. Appeal to the BVA, and at the hearing, point out the ridiculous decision of how the rater/DRO gave more weight from a NP than a board-certified specialist.

VA disability attorneys/lawyers learned their lesson many years ago when they submitted favorable evidence for their clients too early, only for the VA to turn around and ask for a second opinion.

Edited May 15, 2020 by Hucast21

[1454th Solider]

I am going through this right now, I had a mental health phone C&P with a VHA examiner which I thought went really well, now they sent me letter telling me another doctor from the QTC medical service is going review my evidence and  fill out the VA disability questionnaire. The only way I can see them doing this is to develop to deny. They sent me the QTC examiners credentials and they don't even come close to my private psych doctors experience which my doctor fill out a DBQ also. I hope they are only doing this for rating purposes only and not being sneaky. I will let you know how it turns out.

[Hucast21]

3 minutes ago, 1454th Solider said:

I am going through this right now, I had a mental health phone C&P with a VHA examiner which I thought went really well, now they sent me letter telling me another doctor from the QTC medical service is going review my evidence and  fill out the VA disability questionnaire. The only way I can see them doing this is to develop to deny. They sent me the QTC examiners credentials and they don't even come close to my private psych doctors experience which my doctor fill out a DBQ also. I hope they are only doing this for rating purposes only and not being sneaky. I will let you know how it turns out.

Yea, it’s a common tactic I’ve read far too many times in regards to VA claims.

I am convinced that veterans who received favorable decisions on their claims without going to appeal, are more lucky than anything. 

[1454th Solider]

16 hours ago, ronnieusmc0311 said:

Hello, I have been persuing a VA claim for over a year now in regards to Acid Reflex/GERD. I was medically retired from the Marine Corps for Asthma (30%). When I filled this claim, I was trying to Service connect Acid reflex/GERD to ASthma medications. I had a my private NP-C write a letter and added some information that shows connection between my meds and Acid Reflex. I then saw a VA P.A. for an examination. She wrote against me and the VA followed up with a second opinion from a DR at the VA. When I received this decision, I filed a supplemental claim. I had my private NP-C write a stronger letter with more substance to back up my claim. I also had my Asthma specialist DR write a quick note stating my inhaler "may" cause Acid reflex symptoms (I tried to get a substantial letter but he refused). I also typed a letter stating that I do not know (this is why I did a supplemental) if the asthma meds were the only thing causing my acid reflex/GERD. I stated that I also use Lorazepam for PTSD (service connected), I take Acid reflex medication prescribed from the VA, and I have been taking NSAIDS long term for service connected Cervical neck strain/Migraines. I also stated these symptoms manifested during my Sea service deployment to the gulf of Aden. At that time, I was prescribed Advair for asthma and still deployed. I basically connlcuded with, I believe it may be a combination of these medications that have contributed to AcidReflex/GERD.

So, for the second part. I was ordered to see (I spoke on the phone due to COVID-19) with a DR. from Veteran Examination Services. The DR. asked me some straight forward questions then after 5-10 minutes said "I think I heard enough, I have reviewed your letter and I have all the info I need" (he seemed very nice and attentive). Two weeks later, I call the VA and they say that they received the examination notes but my claim was sent back to gathering info because they are going to ask another DR due make an opinion. This happened last time, so I am a bit worried they are trying to find a way of denying me again...Anyone have experience with something like this? Thank you!

They maybe deciding your claim through ACE (acceptable clinical evidence) due to COVID-19. Your phone examination was done by a VHA examiner for DBQ information and the VA contracted doctor is assisting in the DBQ but not service connection opinion, the rater may have already established that, but the VHA doctor's DBQ wasn't fully filled out or they didn't know how to rate it so they need a second opinion.

The ACE process involves C&P clinicians completing Disability Benefit Questionnaires (DBQs) using the medical evidence currently in existence and a Veteran's claims file or medical records, supplemented by a telephone interview with the Veteran if necessary, instead of requiring some Veterans to be examined in-person.

https://www.navao.org/wp-content/uploads/2017/01/DMA-Fact-Sheet-16-005-ACE-Process-12-16-16.pdf

[ronnieusmc0311]

6 hours ago, 1454th Solider said:

They maybe deciding your claim through ACE (acceptable clinical evidence) due to COVID-19. Your phone examination was done by a VHA examiner for DBQ information and the VA contracted doctor is assisting in the DBQ but not service connection opinion, the rater may have already established that, but the VHA doctor's DBQ wasn't fully filled out or they didn't know how to rate it so they need a second opinion.

The ACE process involves C&P clinicians completing Disability Benefit Questionnaires (DBQs) using the medical evidence currently in existence and a Veteran's claims file or medical records, supplemented by a telephone interview with the Veteran if necessary, instead of requiring some Veterans to be examined in-person.

https://www.navao.org/wp-content/uploads/2017/01/DMA-Fact-Sheet-16-005-ACE-Process-12-16-16.pdf

Make sense, Well I guess I'll know soon enough, I have 3 other things that need upgrading in terms of service connected disabilities, so its only a matter of time for me to rate 100% (i am at 94%)

[ronnieusmc0311]

On 5/14/2020 at 5:21 PM, Hucast21 said:

This seems to be a common tactic by the VA, which is why I immediately sought legal representation when my initial claim was denied.

If a veteran goes at it alone, even with an IMO with nexus, submitting the IMO too early just gives the VA more time to come back with a second opinion. The way my attorney explained it to me was like this:

1. Have a board-certified specialist look at your claims file and render an IMO with nexus.

2. Sit on the IMO and submit until the very last, so the VA doesn’t have time to come back and ask for a second opinion.

3. More than likely, the rater or DRO will uphold the previous denial because the VA wasn’t given enough time to refute the strong probative evidence (IMO with nexus) in favor of the veteran.

4. Appeal to the BVA, and at the hearing, point out the ridiculous decision of how the rater/DRO gave more weight from a NP than a board-certified specialist.

VA disability attorneys/lawyers learned their lesson many years ago when they submitted favorable evidence for their clients too early, only for the VA to turn around and ask for a second opinion.

WHo do you suggest I speak to? in terms of Lawyers, I think they did what you just said, the guy on the Phone (VA) kinda hinted to me my claim was denied, even after everything was in my favor... Man, I never had trouble with claims back in washignton state, as soon as I moved to Arizona, DENIED DENIED DENIED!.