Higher level Review phone CALL

[USMCNEVERFORGET]

I just had my phone call from HLR person last week (not the same office who did the denial) .  I'm seeking service connection for sleep apnea as a secondary condition. I have everything documented EVERYTHING I mean EVERYTHING. My question is about the phone call experience. I was suppose to have it with my representative present but this wasn't the case due to DAV office being in-operational.  So I had it and was asked for the reason of my seeking  service connection. I explained my side and the person conducting the call agreed and also pointed out evidence that was over looked and not written in the denials.  My question is about what was said afterwards. "I'm going to channel this claim to the right place and you may or may not have someone call you or need another exam not sure how they are doing things now, during places being closed up."  Does this mean they made a mistake and need to correct it? Does this mean another C&P exam for sleep apnea?  Has anyone ever experienced the HLR phone call with the caller saying what was said to me?  What does this mean to you???

Below is what transpired since July 2018.

Filed fully developed claim July 9, 2018

Had C&P exam October 1,2019

Denial October 7,2019

NOD/Supplemental Claim filed on October 25,2019 with more evidence. More evidence filed on October 26,2019.

Denial November 6,2019 

Higher Level Review (requested informal call ) Submitted November 15,2019

HLR call June 4,2020

 

[GBArmy]

Sounds like it is favorable to me. If the caller told you specifically what things were missed or mistakes made, that is a very positive sign. The suggestion you may need another C&P is because he feels that in order to correctly rate you, the original examiner left some important info off your exam. So, it is often the case for a new C&P. If you ckeck your claim status on VA.gov, it says that it is possible base on the findings of the HLR. I would expect you will be getting a call to schedule a new one within a few weeks; but, who know with the coronavirus thing and getting back to normal piece by piece.

[deedub75]

I wonder where they are going to channel your claim.  I assumed the person making the call would be the DRO but I guess it's possible that they have a VSR make those calls.  If you talked to a VSR then I could see an exam being ordered if necessary and the phone call notes sent to the DRO to complete your claim.  It's hard to say if it's favorable or not.  If a DRO told you this then I would say it's favorable but if a VSR told you this then it could go either way.  

It took someone a LONG time to call you.  I filed a HLR in March and I'm waiting for a call.  I guess I'll be waiting for a while.  

[USMCNEVERFORGET]

2 hours ago, deedub75 said:

I wonder where they are going to channel your claim.  I assumed the person making the call would be the DRO but I guess it's possible that they have a VSR make those calls.  If you talked to a VSR then I could see an exam being ordered if necessary and the phone call notes sent to the DRO to complete your claim.  It's hard to say if it's favorable or not.  If a DRO told you this then I would say it's favorable but if a VSR told you this then it could go either way.  

It took someone a LONG time to call you.  I filed a HLR in March and I'm waiting for a call.  I guess I'll be waiting for a while.  

Your right on "channel my claim" I wish I knew what the person meant. The person was at RO in Minnesota and gave me a number to call in St Petersburg FL the day before in a message to schedule the call because I missed the call the first day. The very next day the call came in from Minnesota again, I answered and we went over my HLR call.  Just to give everyone a heads up write down what you want to say and make sure to point out the reason for upgrade or service connection.  By now we should all have these things memorized but good to have notes.  If they have to schedule a new C&P exam does the claim go back to the original RO where the claim originated??? Will the original RO will be making a new decision based solely on a new C&P exam??? Does the HLR person have the final say after the exam if they schedule one???

[kanewnut]

2 hours ago, USMCNEVERFORGET said:

If they have to schedule a new C&P exam does the claim go back to the original RO where the claim originated???

I think the VA is now using the NATIONAL WORK QUE. It is my understanding that any RO can work on a case. 

 

3 hours ago, USMCNEVERFORGET said:

Does the HLR person have the final say after the exam if they schedule one???

It is my understanding that you can’t submit new evidence with a HLR. I don’t know if an HLR person can request a C&P exam and then use it in their determination. If the HLR person can do that then they would have the final say before you get your decision. If the HLR person can’t do that then I think it would go back into the NWQ for an RO to look at and if you weren’t satisfied with their decision then you could request another HLR review.

[deedub75]

27 minutes ago, kanewnut said:

I think the VA is now using the NATIONAL WORK QUE. It is my understanding that any RO can work on a case. 

 

It is my understanding that you can’t submit new evidence with a HLR. I don’t know if an HLR person can request a C&P exam and then use it in their determination. If the HLR person can do that then they would have the final say before you get your decision. If the HLR person can’t do that then I think it would go back into the NWQ for an RO to look at and if you weren’t satisfied with their decision then you could request another HLR review.

There is an appeals management center (AMC) in St. Petersburg, FL. I’m not sure if that’s the only AMC. Before the new appeals process went live they hired a bunch of people to work appeals down there. The person who conducted the phone call from MN was likely a VSR and the DRO is likely at the AMC. They can order new exams or medical opinions as they see fit. Back to back HLRs aren’t allowed. The next step would be a supplemental a then on to BVA. 

[Buck52]

FYI

What should I expect if I request a call with a senior reviewer?

If you request an informal conference with a senior reviewer on the Higher-Level Review option, they’ll call the phone number that you or your representative provided on the Higher-Level Review form to schedule a time to discuss your case with you. The senior reviewer will try to reach you or your representative by phone twice. If no one answers, they’ll leave a voice mail.

During the call, you and/or your representative can talk about why you think the decision should be changed and identify errors. There won’t be transcripts of this call.

What should I expect if I request a hearing with a Veterans Law Judge?

You have the option to request a hearing with a judge. A video conference hearing will take place at a VA location near you.

At your hearing, you and the judge will have a conversation. The judge will listen to your testimony. The judge may ask you a few questions. Your representative, if you have one, may help you at the hearing.

The hearing will be transcribed and added to your appeal file. You can add new and relevant evidence within 90 days after the hearing, but it isn’t required.

What if I want to choose a different review option after I’ve already submitted a form?

If you’ve submitted a form and want to change your review option, you can send in a new decision review request form within 1 year from the date on your VA decision. You must include a letter that says you want to withdraw your existing review and switch to a different option.

If you requested a Board Appeal and want to switch to a different appeal option, you can send in a new Board Appeal form with a different option selected. You can switch appeal options within 1 year from the date on your VA decision or 60 days from the date you submitted your original form. You can’t select a different appeal option if you’ve already submitted evidence or had a hearing.

How do I opt in if I want my legacy claim or appeal to be considered in the modernized system?

You may be able to opt in to the modernized review system after receiving a VA Statement of the Case (SOC) or Supplemental Statement of the Case (SSOC).

For an SOC dated before February 19, 2019, you must continue with the legacy appeals process.
Return VA Form 9 (PDF) to the VA regional office within 60 days from the date on the Statement of the Case to continue your appeal.  

For an SOC dated on or after February 19, 2019, you have 2 options:

• You can continue the legacy appeals process.
  Return VA Form 9 (PDF) to the VA regional office within 60 days from the date on the Statement of the Case. 
• Or opt in to the new decision review process.
  You have 60 days from the date on the Statement of the Case to opt in to the new decision review process. 

For an SSOC dated on or after February 19, 2019, you have 2 options:

• You can continue the legacy appeals process.
• Or opt in to the new decision review process.
  You have 60 days from the date on the Supplemental Statement of the Case to opt in to the new decision review process.