Just need advice on what to do?

[Dan1865]

Hi All, 

I filed a claim for benefits on Feb 4, 2020 and am still waiting for a decision! Here is what I claimed and will explain.

1. VA 1151- I was diagnosed with appendicitis at the VA hospital. Then said it was an emergency and surgery needed to happen ASAP. Thirty-four hours later they performed the surgery. The student surgeon was allowed to perform the surgery by himself with no attending surgeon present. The student messed up and almost killed me. He ended up leaving almost 5cm of a 6cm organ in my body. Over a 3 month period I kept on getting sick. Out of the blue, I became very ill with high fever, vomiting, and horrible abdominal pains. Went back to ER and they discovered I had appendicitis again. This is when they found out the organ was leaking and in tack. The surgeons tried to say it was a mistake on the CT exam. 

I went into the OR for a second surgery. They had to abort the surgery due to the lack of instruments. 10 days later I had a 3rd surgery. In the end, I now deal with major problems with my colon and stomach due to the constant infections. I have a rare form of chronic colitis. I have submitted everything imaginable to the VA. I have a nexus letters from 2 doctors who are specialists in surgery and GI. I have a Medical Opinion from a highly regarded Surgeon/Radiologist. The IMO clearly defines the many 1151 violations. The attending surgeon was also investigated by the OIG. He was terminated for allowing students to perform surgery without him present. OIG discovered that during surgeries he would not even be in the hospital, but would sign off on the surgery a day or 2 later like he was there.

2. Non Combat PTSD. 

    Everything is clearly documented. I have multiple buddy statements and records from this time period. They have a boatload of information; including, records from a civilian hospital suicide attempt. 

3. Unemployability: I am on SSDI for the GI Issues, Mental Health, Ischemic Heart Disease. and Paraneoplastic Syndrome associated with tumors in my lungs.

I had all exams before May 20, 2020. I figured they would have given me a decision by December. My doctor told me to write my senator; which I did. They told the senators office they were waiting on employment records. I get a call in Jan telling my claim was about finished and he needed a different address for a previous employer. I explained the employer went bankrupt and there is no address. He said my decision would be completed in 30 days. The very next day I get a call from my VSO stating they scheduled me for more exams. Believe it or not, they scheduled me the same PTSD exam I had in May of 2020. It ended up being with the same doctor as the first. He said in 22 years he has never had to do the same exam on someone during the initial Claim. So, for 3 hours we went over the first exam report. He made changes and submitted it the VA. Then in middle of March I get a call from the same guy at the VA. He told me my claim was done and I should have a decision within a week. My wife and I was super excited. The lady at the senators office received a statement stating a decision was forthcoming very soon. The very next day, my VSO calls me and said they scheduled you for PTSD "rework" exam. The same doctor yet again; 3rd time now I have seen this guy. We were able to do this exam over the computer and it was only 8 mins. Then on March 23,2021 they scheduled a new exam. This exam is a record review only. I received a VES overnight stating my record review was completed on 4/8 and it gave me the Physician Assistants name. So, again I sit here and wait. 

Sorry for the long post and thanks for reading. What else can I possibly due to receive a decision? My health is declining and want to make sure a decision is reached to find out what I need to do next. My ultimate goal is to hold this VA system accountable for what they did to my body. They really jacked up my stomach and colon by doing what they did on a routine surgery. My goal is to make sure that the kids are taken care of in the event something happens to me. 

 

 

 

[Berta]

"Then on March 23,2021 they scheduled a new exam. This exam is a record review only. I received a VES overnight stating my record review was completed on 4/8 and it gave me the Physician Assistants name. So, again I sit here and wait. "

 

 

"If you count all of the different exams for PTSD I have had now with the same doctor, this will be number 7 according to my VSO. I now have had 2 in-person exams, 1 tele-health, 2 medical opinions, and now this will be the second *record review only" exam."

 

A physician's assistant should Not be doing PTSD C & P exams, or reviewing them, or is it for the surgical scars?

I will find and post the scar rating criteria here.

[Berta]

In late 2018  the scar rating criteria changed.

This is from a BVA case on remand for other issues but the scar issue was denied. Still, the decisions  holds the new rating criteria- I dont know if that update is here at hadit.

As the BVA decision states,  "however, for the period beginning August 13, 2018 the Board will consider both the old and amended version (amended code) of the diagnostic codes and rate based on whichever is most favorable to the Veteran. " Thatis a legal statement by the BVA- I hope the RO's know of this change.

 

Diagnostic Codes 7800 to 7805 pertain to scars.  38 C.F.R. § 4.118.  The Schedule of ratings for the skin were amended effective August 13, 2018.  See 83 Fed. Reg. 32,592 (July 13, 2018).  Prior to August 13, 2018, the Board will consider the old version of the diagnostic codes only (old code); however, for the period beginning August 13, 2018 the Board will consider both the old and amended version (amended code) of the diagnostic codes and rate based on whichever is most favorable to the Veteran.  

As the Veteran’s scar is located on his left hip, Diagnostic Code 7800 which deals with scars and disfigurement of the head, face, or neck, does not apply to the Veteran’s claim.   

Diagnostic Code 7801 provides for a 10 percent disability evaluation for a scar that is not of the head, face, or neck, that is deep and nonlinear (old code) or associated with underlying soft tissue damage (amended code), and that has an area of at least 6 square inches (39 sq. cm.).  Higher ratings are available if larger areas are affected.  Under the old code, a “deep scar” is defined as one associated with underlying soft tissue damage.  The old and amended codes also differ regarding instructions for totalling the area affected when there is more than one qualifying scar.  

Diagnostic Code 7802 provides for a 10 percent disability evaluation for a scar not of the head, face, or neck, that is superficial and nonlinear (old code) or not associated with underlying soft tissue damage (amended code) and which covers an area of at least 144 square inches (929 sq. cm.) or more.  No higher ratings are available under either version of this code.  Under the old code, a “superficial scar” is defined as one not associated with underlying soft tissue damage.  The old and amended codes also differ regarding instructions for totalling the area affected when there is more than one qualifying scar.

Diagnostic Code 7804, unchanged by the amended code, provides for a 10 percent disability evaluation for one or two scars that are unstable or painful.  A 20 percent disability evaluation is assigned where there are three or four scars that are unstable or painful.  A 30 percent disability evaluation is assigned where there are five or more scars that are unstable or painful.  An unstable scar is one where there is frequent loss of skin covering over the scar.  If one or more scars are both unstable and painful 10 percent is added to the evaluation.  

Under the new and amended codes, pursuant to Diagnostic Code 7805, a scar may be rated on any disabling effect(s) not considered as part of Diagnostic Codes 7800 to 7804.

In an April 2015 VA examination, the VA examiner noted the Veteran’s scar on his left lateral hip from the hip replacement surgery.  The scar was not painful or unstable.  It was 20 cm long with a width of 0.2 cm.  The Veteran testified the scar is not painful, tender, or sensitive and it is healed.

Here, the size of the Veteran’s left hip scar does not meet the schedular criteria for a compensable rating for a superficial scar based upon the area affected.  This finding is unchanged under the old Diagnostic Code 7802 and the current Diagnostic Code 7802.  In addition, the Veteran’s scar is not painful or unstable and therefore does not meet the schedular criteria for a compensable rating under Diagnostic Code 7804.  Finally, the medical evidence and lay evidence does not establish any other disabling effects of the scar suggesting rating it under another appropriate diagnostic code.  38 C.F.R. § 4.118, Diagnostic Code 7805.  Accordingly, the Veteran’s nonpainful surgical scar for the left hip replacement surgery is noncompensable under the appropriate diagnostic criteria."

https://www.va.gov/vetapp20/files8/20056066.txt

[Berta]

I need to correct something-I just posted -some PAs can do a PTSD C& P eams per this guideline from the VA:

This worksheet surprised me:

"The following health care providers can perform review examinations for PTSD. a board-certified psychiatrist or board "eligible" psychiatrist; a licensed doctorate-level psychologist; a doctorate-level mental health provider under close supervision of a board-certified or board eligible psychiatrist or licensed doctorate-level psychologist; a psychiatry resident under close supervision of a board-certified or board eligible psychiatrist or licensed doctorate-level psychologist; a clinical or counseling psychologist completing a one year internship or residency (for purposes of a doctorate-level degree) under close supervision of a board-certified or board eligible psychiatrist or licensed doctorate-level psychologist; a licensed clinical social worker (LCSW), a nurse practitioner, a clinical nurse specialist, or a physician assistant, if they are clinically privileged to perform activities required for C&P mental disorder examinations, under close supervision of a board-certified or board eligible psychiatrist or doctorate-level psychologist."

https://www.benefits.va.gov/predischarge/docs/disexm56.pdf

I wonder if the PA is " clinically privileged" working under "close supervision of a board certified or board eligible psychiatrist

or doctorate-level psychologist".

If they are doing all of these multiple C & P exams for your PTSD it seems they do not have a clue. and might have no expertise or clinical privilege at all, or any board certified supervision.

I imagine you do not have the results of any of those exams?

I am assuming the PA did the PTSD exams and I might be wrong.

You could  file a complaint at IRIS, asking them for proof of this PA' s  ' clinically privilege' and who is working under "close supervision of a board certified or board eligible psychiatrist".

We have members here who could probably perform a valid C & P for PTSD ! 

This is all we need - the VA going to the bottom of the list above ,to get an 'examiner"instead of getting a real PTSD doctor to do the exams.

Maybe the PA is in training for these exams and you are the guinea pig.

When a VA doctor gave a bizarre opinion some time ago, on my husband's 1151 HBP, she stated that it was an " in person " exam.

He had been dead by then for over twenty years so I raised Hell with the White House Hot Line. 1-855-948-2311.

It had something to do with a 1151 HBP CUE I filed. They reversed that denial to an award in 3 weeks. They didn't even need a posthumous C & P exam because my evidence was from the chief cardiologist at VA Central, as part of my FTCA case...documentd as improperly treated HBP that was contraindicated by VA prescribed  Sudafed for a sinus condition ,that I proved he didn't even have-the 4th malpracticed condition that contributed to his death.FTCA and 1151.

 

 

 

 

 

 

[Dan1865]

Hi Berta,

 Sorry for the confusion in my post a few days ago. All of this PTSD exam nightmare from the VA is going thru a board certified Psychiatrist; not a P.A. The exam for the surgical scars is with a physician assistant. 

There was a massive investigation done by the OIG a few years ago when it comes to exams for disability ratings with the VA. The OIG came to the conclusion that the VA was wasting millions of dollars a year on these exams that were not needed. They took a huge sample from VA C-Files and discovered that veterans with more than enough medical evidence on their claims were still being sent thru C&P exams. Not only was this contributing to wasteful spending, it was also creating an unnecessary backlog of cases. 

My question is what happens at the VA when a claim goes past the stated goal of 128 days? Everywhere you read online is the VA will take a claim from start to finish in 128 days. When the claim exceeds that threshold, what happens internally? Do people start getting in trouble? Are they held accountable in any way? 

A good friend filed a claim with the VA about a month before me. He claimed 6 different things. So, within a few weeks of filing he was scheduled for some exams. He went to one of the exams and about a week later he had his decision for that one claimed contention. He literally received decisions on each condition separately. How did he get so lucky to have it done like that? Is there a way for me to request a decision on some of the claimed conditions while I still wait for this other part to finish? In his case, they denied 2 of his conditions and rated him for 4. The entire process for him was 5 months. We talked a few days ago and he doesn't understand why I am still waiting and he isn't!

[Berta]

Thanks for the correction-I do not understand why a Board Certified VA  Psychiatrist is having a problem with-the exams.

Noncombat PTSD requires a strong nexus and you mentioned the buddy statements and MH hospitalization.

I hope it falls with VA's definition of a stressor. There is an article here available under Search on how VA defines a stressor.

All claims are unique to the claimant- some go fast and some go very slowly.

They fight 1151s aggressively as well.

 

 

[Buck52]

Just a quick question reguarding the mal practice Suites FTCA

What about the old electrionic signuture we have to sighn before any type of surgical procudure? known better as the ''CONSENT FORM''

Does that stop any law suites  because we were ask to sign?

My reason for asking  I get ask that question a lot from Veterans spouse at my VAMC

Also asking for my self  I am or need a surgical procdure done at the VAMC for a lower abdomen herinia  that has already pusing down into my privates.

I am still trying to figure out rather or not to let the VA Doc's touch me  or ask for the choice care and be outsourced?