Scars, Disfigurement Supplemental..HELP

[NCVetGirl]

I will apologize in advance for the lengthy message but I am looking for insight on what may be happening here.

Dec 2019 I filed claim for CCCA - which is a progressive alopecia typically found in certain group of women and very specific symptoms. I combed STR and found first instance of it in 2003 while active duty. I was treated over the years but it progressed (nothing you can do to stop it only slow it down). Based on disfigurement criteria I believe that my records, statements, etc. met at least four of the requirements.
Last 3 years I had been treated by dermatologist and this was her specialty. She wrote medical opinion and completed DBQ (although not correctly) as she had done this before.

I submitted STR, civilian treatment records (over last 10 years), statements(my own, a battle buddy while active duty, hairstylist when active duty, and current hairstylists), and color photos on Dec 2019. I had CP Exam with VA contracted NP in January 2020. We talked she measured and “agreed” or confirmed that she saw what I saw.  Within 30 days of my initial submission, I received rating indicating 3 of 4 had been met additional they described the wrong location (back area of head not middle/front). 

I filed HLR with conference. I had conference on day 123 and he asked what did they miss? I asked should I give you page numbers of submitted docs to support criteria #4? He said no that’s my job. He also said if criteria not identified in CP Exam then not given weight. Result on Day 125 continue current rating.

I then filed a supplemental claim, submitted additional doctors records (last visit had not been submitted), the DBQ that my private doctor completed in Nov 2019 (with color photos)and two additional statements(mine and spouse).

I have now received request for another CP Exam. Is this typical? Anything I should consider? I tried to lay out all of the pieces. Is this CP Exam another opportunity? I am prepared to go to BVA - as I have done my homework. Seems like the CP Exam was given significantly more weight instead of total picture presented. 

I requested January 2020 CP exam and opinions in February 2020 ebenefits shows available 5/2021.

@Berta

@Buck52

 @broncovet

@Tbird

[Tbird]

Bump

[Buck52]

My advise is file the form 9 and head to the BVA, your more than likely  get the same results at this new C&P They have schedule.

 Go to a private Specialist and talk with them/him/her and be up front with these Dr's  let them read your medical records and Also the C&P exam reports.

Let the Specialist know what you need  when he exams you and he needs to use the VA Language when addressing your condition...use the words   in my medical professional   opinion ''likely as not'' and describe your condition and how it would relate to your military service.

This exam with the specialist  can out weigh what the VA Dr's mention especially a N.P.

Have the Dr to put his years experience down with his credentials and what his specialty is.

usually they are on the letterhead.

I believe the BVA will help you, (jmo)

[Buck52]

others can chime in here on this one.

@broncovet

@Berta

@GBArmy

@shrekthetank

@pacmanx1

 

[NCVetGirl]

@Buck52 So should I still go to the newly scheduled C&P? And then file to go to BVA? Also are you suggesting that I go back to my own doctor (who is the specialist in this field) or find another specialist that has never treated me to complete the DBQ (but not in DBQ format)?  There is no dispute about service connection. The dispute is whether I met 3 of the elements of disfigurement or 4 of the elements of disfigurement. 

These are pretty objective elements so I am somewhat puzzled.

Length 

Width

Color (minimum square cm)

Texture (minimum square cm)

 

thank you all in advance!!

Edited August 29, 2020 by NCVetGirl (see edit history)

[NCVetGirl]

@Buck52The reason this is so important to me is that 3 = 30% 4= 50% and 50% equals 100% schedular rating.

[GBArmy]

I think Buck has good advise on this. If you are scheduled for a C&P, you go. If you could get ADDITIONAL evidence that would significantly change the exam , you could get it and down load. If the examiner doesn't have it to review, you can ask him to look at what you had submitted prior to the exam. If he says no, then you are on record and they didn't eval all your evidence. If your claim is a suppl. claim with no additional evidence to submit, then you change it. It will delay the claim but allow new evidence to be evaluated. The new evidence would also be in the claim when you go to BVA.

Edited August 29, 2020 by GBArmy
additional info (see edit history)

[NCVetGirl]

@GBArmy @Buck52 I think I am asking clarification about both of your points. Are you saying following this CP Exam(which is my 2nd CP exam) and will be the 3rd DBQ as this is a supplemental claim to an initial claim that had a HLR that I should then attempt to find additional evidence for a filing to the BVA? 
 

Additionally during this CP Exam, I should ask CP Examiner to review the DBQ that I submitted by My own provider along with the other information that was submitted?

I am not sure that I follow given that I am currently in the Supplemental lane.

Edited August 29, 2020 by NCVetGirl
Added content (see edit history)

[GBArmy]

The CP examiner is not likely going to look at your new DBQ unless it is already submitted as evidence. The more favorable evidence you can present on a previously denied claim the better IMHO. As long as they aren't contradicting each others, it would be favorable. You said you are missing one element or symptom and I assume the new DBQ covers that. If the supplemental claim is fdc, fully developed claim, and you submit new evidence, it is no longer fdc but regular. I don't know what you filed as. If you are denied again, you can then go to BVA as fdc, no additional evidence, which would be a  "quicker" trip, as your new evidence was submitted.

[NCVetGirl]

I filed a  VA Form 0995. The denial from HLR stated I could only request Decision Review Request Supplemental or go to BVA. I submitted 0995 with DBQ, additional medical treatment records and two buddy statements. I then received a call to schedule this CP Exam.

@GBArmy

Edited August 29, 2020 by NCVetGirl (see edit history)

[Buck52]

 Do you mean you filed a 21-0958? NOD form.?

Never miss a C&P Exam.

You can try to have it cancel before the date of the exam.

But if not  Definitely go to that exam.

We had an Elder HADIT Mod/Admin(THE LATE BELOVED CARLIE CASH)

RIP Carlie,

 She wrote a letter to the VA under Secretary  about a nonsense C&P Exam  she had got ,and she got  the C&P Canceled by writing this letter 

https://community.hadit.com/topic/61871-im-sc-100-smcs-over-10-yrs-varo-just-requested-a-cp/

Failing to show up at a scheduled C&P will result in benefit reductions. (MOST OF THE TIME)

 As for as getting a medical opinion  I would use a Different Dr  and explain this to this Dr what you need let him read your denial and the reports of your Dr and VA Medical reports.

you need to fix why you were denied.  and that will take another Specialist to do this, because  the Dr 's   you have used obvious is not favorable to you.

''  The Dr needs  to...>met 3 of the elements of disfigurement or 4 of the elements of disfigurement. 

or what your claiming.

Remember they have what evidence you have already submitted  this is to rebut what the other Dr's have stated after they examine you and read the pertinent records.

Its called a  (IMO) (IME)Independent Medical opinion & Independent Medical Examination.

You may want to contact Dr  C Bash/Dr out of California, Dr,Ellis out of Oklahoma  (The Ellis Clinic) or of course a Dr of your choice,

Edited August 30, 2020 by Buck52 (see edit history)

[NCVetGirl]

I have successfully cancelled a CP Exam in the past (not this claim). I called and stated I had already submitted a DBQ submitted. The VA rep took statement sent to RO to cancel. Per manual must cancel and consider DBQ when notified of existing DBQ for consideration. 
 

I guess if I cancel this one and say I have submitted a DBQ for consideration with supplemental claim and DBQ are inconsistent in any way, then doomed right?
 

Filed initial claim 12/2019

VA CP exam 1/2020

Filed Form 21-0996 Decision Review Request (Higher Lever Review)  2/2020

Filed Form 21-0995 (Decision Review Request (Supplemental Claim) 6/2020
 - included provider DBQ completed 11/2019
 - buddy statements

- additional dr files

CP Exam - TBD

 Can I add additional evidence after the CP Exam but before this decision (ex. IMO/IME)?  Or will I simply need to wait for decision and then file another supplemental claim?

[deedub75]

Go to your exam. It’s possibly the new exam was ordered because something was missed on the previous exam or they want to verify the information on the DBQ that you submitted.

I submitted a supplemental claim with a nexus statement from my surgeon. A new exam was ordered and everything was finally granted after 10 years of fighting for them.

If denied on your supplemental then got to the BVA. 
 

 

Edited August 30, 2020 by deedub75 (see edit history)

[NCVetGirl]

Thank you

[NCVetGirl]

All - I wanted to close the loop on this and thank everyone for all of the input. I had my C&P exam. The doctor seemed knowledgeable, took notes, and seemed to agree that one of the elements of disfigurement was present (that had been overlooked) in addition to pain. She also pointed that she needed to look at prior notes and C&P exam from January.  The previous examiner works in same office and happened to walk by when I was exiting the exam room. Well I was very surprised that she did not include the element of disfigurement that she seemed to agree was present (so 30% rating continued instead of increase to 50%) but she did identify painful scars which resulted in an additional rating of 10%. I am flabbergasted but then how can you say your colleague got it totally wrong? I am reached 100% scheduler but not P&T. I have an insomnia claim pending. Maybe a rating on this issue will result in a P&T. Thoughts?

@Tbird

@broncovet

@Buck52

@Berta

Edited October 19, 2020 by NCVetGirl (see edit history)