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.

[Berta]

This shows the change to M21-1MR re:  CUE in action:

 

https://community.hadit.com/topic/78007-supplemental-claim-approved-hlr-for-effective-date/page/6/#comment-493502

A few other vets here have had the HRL find CUE prior to their decisions being finalized.

The M21-1MR info from Kanenut, re: the change regarding CUE, is here:

https://community.hadit.com/topic/78864-cue-and-bva-2020/page/6/

I think it is on Page 2. 

[Vync]

@Berta Thank you very much for reviewing this. I will start working on the HLR.

It stinks having to wait four to six more months despite the VA being notified about the problem before the decision was made. I wish there was some recourse to reopen/kick it back to the adjudicator without having to wait, such as the old reconsideration option that is no longer available. I used it frequently and got fast results almost every time.

 

 

[Berta]

Everything has slowed down due to Corona-

I asked a question of the VA Survivors Office and was shocked to get a reply the next day. In June I asked a question in email to the General Counsel- asking if they could accept something by Priority mail.

It took a few weeks maybe even more than a month, for reply and they  stated  than due to the Virus they could only accept the documents via pdf.  in email.

VACO has been hit by the Virus as well as the ROs etc....in the case of the ROs, I do not believe it is legally possible for the raters  to handle claims decisions, by working from home. Maybe they can-but I know they are not allowed to take claims documents home with them. ( that is a VA employee got caught doing that so I think that is illegal) Maybe they can access RO claims info from their personal PCs .