Very Sloppy LHI C&P Medical Opinion

[Vync]

For my supplemental heart claim, the VA's RVSR sent a request to LHI to specifically perform a cardiac/heart DBQ and offer an opinion whether SC migraine medication caused any heart condition. An LHI nurse practitioner called me last week to do a phone C&P and asked about atrial fibrillation, my heart attack last year, and the residual impact. They confirmed having received the medical opinion from my non-VA board certified neurologist regarding the heart attack being "more likely than not" caused by my SC migraine medication. Prior to submitting their medical opinion, they said they had to do more research.

This morning, my VSO looked in VBMS and found the LHI medical opinion focused solely on atrial fibrillation, completely failing to opine on the heart attack. Because my claim is still open, an IRIS request was placed asking the VA to send the medical opinion back to LHI due to being inadequate by failing to opine regarding the heart attack.

Fortunately, my claim was still open and the decision letter had not been sent. On va.gov, it still ironically says "We do not know your status", but it has been like that for weeks. I would not be surprised if the RVSR goes ahead and closed my claim based on the sloppy C&P performed by LHI just to get it out of their inbox. If they do that, then I would be forced to send yet another supplemental or HLR to address yet another case of the VA failing to consider evidence and ignoring laws, regulations, internal rules/policies, and it would put my claim back into the 125+ day hopper.

This one should be won via relative equipoise. The VA has a nurse practitioner's "less likely than not opinion" with no medical rationale addressing the merits vs. my board certified non-VA neurologist's "more likely than not" opinion with strong medical rationale. So far, there is no predominate medical evidence against SC, so I am hoping they would at least get this one right at some point.

After thinking about what has happened, I also put in a complaint to the WH VA Hotline. The VAMC C&P contractor I had last year screwed up their exam by failing to consider evidence. The LHI C&P examiner I had last week also screwed the recent exam by failing to consider evidence. It seems like a recurring pattern. If they are doing this to me repeatedly, then they are likely doing this to other veterans.

[GBArmy]

Vync As for receiving a new disability so you can op for the VA insurance by opening up the window to apply, you might consider other options as a intermediate step before your next approval. There are a few other choices for insurance, if you want to get coverage now. The American Legion has a connection with United of Omaha Life Ins. Co., www.mutualdirect-legion.com, or 1-800-867-2953. Their quote chart in the advertisement is very competitive with the VA's disability rates. Now I realize that being at 100%, it cost $ when you could be getting it for free. But if you are concerned about another heart attack before you can sign up with the VA's, you might want to consider. Just bringing up an option to consider.

[Vync]

@kanewnut, I'll have to re-read that section. I haven't filed a CUE since September 2019 or HLR since earlier this year.

 

@Buck52, I am pondering writing my response in crayon. The supplemental was written at 8th grade reading level, which might have been over their reading level. Yep, there is no excuse for not getting this done right the first time. My IMO was only one page in length.
  I called LHI and talked with a couple of people over there. I asked how this kind of mistake could make it past their quality review. I learned that they pretty much don't have a quality review. LHI gets exam requests from the VA and they just facilitate scheduling with their contracted examiners. They pass the request to the examiner who completes it and they pass it back to the VA. There is no mechanism for them to look at anything again unless the request comes directly from the VARO. In effect, LHI is just a middle man. On the bright side, LHI did FedEx me a letter telling me about the examiner. It includes their name, specialties, license number (and state), which I will not post publicly. But I will post these parts publicly so others can get an idea of what to expect:

Quote

Years of medical experience: 12
Years of VA experience with LHI: 4
Examiner training certifications: DMA General Certification, DMA MST and the Disability Examination Process, Gulf War Examination (GWE) Training, DMA Aggravation Opinions, DMA Medical Opinions, DMA Musculoskeletal Examination
Board Certification (when applicable): (none listed)

Service requested (Quantity):
DBQ CARDIO Heart (1), DBQ Medical Opinion - MED: CARDIO Heart (1), Acceptable Clinical Evidence (ACE) examination - Medical (1)

On the bright side, that is a hell of a lot more info than I ever received from the VAMC C&P docs. I had a couple of in-house exams where the letter said it was for one issue, but turned out to be for something completely different (bait and switch). It would have been nice if the LHI examiner at least had some sort of cardiology and neurology training certifications. Had they done their job properly, any examiner would not have missed the target so badly. 
  The LHI call center supervisor did say they would pass my concern over to the account manager, but was not certain if that would potentially change anything. At minimum, I hope this could raise the examiner's awareness that they hosed it up.
 

@GBArmy Yeah, I know about requesting a different VARO (i.e. de novo review) because I have done that before. I am not concerned with taking the pressure off employees who work in the same VARO. If they are actually being called out on errors like this, the pressure would perhaps educate them so they don't make the same mistake twice. They need these kind of errors to be called out at a high level so they can't just fix one claim and sweep the error under the rug.
  I do like the idea of the national work queue vs. the old regional system. We are led to believe everyone is working with the same set of rules and work standards. Before the AMA, I would get calls from the VARO's quality review team to go over the claims before they were finalized. Given what happened on this claim, I wonder if the VA did away with that team completely.
  I know that the HLR cannot include new evidence, but they had all the evidence to process this claim correctly from the beginning. After filing the CUE last year, the VARO working it wasted six weeks requesting copies of medical records from my VAMC. Here's the catch. That request was for the period between 1995 and 2000, but their request was for all records from 2000 to 2019.  I kept telling them repeatedly that the relevant records were already present in my claim file because that's where I got them. After six weeks and a couple of calls to the WH VA Hotline, they finally realized that the request was made in error.
  I talked to a couple of insurance companies. They quoted me about $100/month for a no medical exam Gerber policy for $10,000. I really appreciate the info about the company you provided. Do you know if it is exclusive for members of the American Legion? I was thinking about just filing an application for S-DVI with the VA anyway and getting a quick rubber stamp denial. Once I get the new SC disability, then they can just retroactively approve it in case I am not knocking around any longer.

[Buck52]

Vync

I would request another exam on this with a different examiner because this examiner fail to read all your evidence which results in a denial.(Inadequate)

You might want to call the C&P Chief at your VAMC or R.O. and request a new exam  I am not sure as to why this LHI Examiner never read all your evidence or even got to that part....this is an inadequate exam.

those can be rescheduled  show the C&P CHIEF YOUR REASON THEY DENIED YOU and he should set up another C&P.

.HOWEVER BEING THIS IS OFFICIALLY DENIED YOU MAY HAVE TO GO THROUGH THE NOD rout  which has GB  Army mention  that would be the HLR

Yeah  below  in paragraph it seems its always  this way with any outside contractor QTC is the same  but fortunate for me QTC examiners have always be pretty fair to me.

''They pass the request to the examiner who completes it and they pass it back to the VA. There is no mechanism for them to look at anything again unless the request comes directly from the VARO.'' 

[Vync]

@Buck52 It may be worth a few minutes to call my VAMC's C&P clinic and ask. Given the circumstances, they will likely say they can't do anything because it was closed.

[GBArmy]

Vync I'm not sure about the client has to be a American Legion member, but it was implied. Give them a call. For what it's worth, annual dues is $35.00. I don't use them at all, but the main reason I joined up is a good friend was made the commander of the post, and I just wanted to help his membership numbers. Actually, any of these VSO groups don't do enough for Veterans IMHO so I don't have much use for them. They are ok if you need a VSO to help for paperwork and VBMS but from my experience, they usually are under trained , overworked or lazy. They could spend more of their millions on more and better trained VSO's.

[Berta]

I would go with the HLR option, if I were you-Vync and Kanenut posted the entire M21-1MR regulation here on that.

If the HLR does not pick up a CUE , then you can file a 38 CFR 4.6 CUE immediately.

I wish I saw this sooner in the week- I spent many hours researching ,off the board for two members here recently- before giving them an adequate reply- and so far they have not returned. 

If the VA has probative evidence and they choose to ignore it ( the cause of every denial I have ever received)

they have committed a bonafide CUE.

The HRL regulations were changed by Secretary Shinseki due to a letter I had written to him-I have seen the HRLs in action here, by finding CUE, prior to the final decision.

Former Sec. Shulkin's office called me to tell me my suggestions ( there was another one regarding NOD deadlines,) had been incorporated into the AMA.

I gave the Secretary  personal evidence and comments as an advocate in regards to other claimants similarly situated as well, that  VA  could and should seek CUE in every decision before the veteran gets it and might be on the Appeal Hamster wheel for years, adding to th backlog of appeals. I gave him evidence of my CUEs awarded in mere weeks, during the appeal process, no need for a NOD ,and evidence of my SMC CUE that sat at my VARO for over 7 years before it was set for transfer to the BVA- but the Nehmer RO, per my request to them for my AO IHD claim, considered the SMC  CUE I had pending prior to  Nehmer- AO IHD court order ,and  awarded that CUE in a heartbeat.

The other CUE I consider as an open issue, from 2004 , that my current CUE issues will consider.

I will try to find Kanenut's post or the actual M211MR link and post it here.