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]

It means ,if they grant the 1151 claim, they will rate the residuals of the 1151 medical errors and pay compensation for them. The residuals are those disabilities you didn't have before the surgery or VA medical error , that are directly due to VA's medical error.

 

I helped a local vet get 1151 at 100% P & T.

VA had  diagnosed him with  nonservice connected hemorrhoids and they got worse, and very painful so they sent him to a different VAMC, where he was properly diagnosed- with stage 4 colon cancer. He had No hemorrhoids.

He will need to use a colostomy bag for the rest of his life.

It is hard to determine the extent of residuals-one would need to see the entire VA medical record.

 

 

[Dan1865]

Would you assume this as being a good thing for the 1151 claim? 

[Berta]

I would be cautiously optimistic about the 1151 , since they are going to rate the residuals.

But the RO can sure pull some crap on 1151ers.

If you have a strong IMO/IME, that is the best way to succeed under 1151 . 

 

[Dan1865]

Hi Berta,

 

Thanks for the quick reply. After your explanation today, I called 800 number to see what residuals the VA is talking about. I just had the last appt on May 7 in regards to the 1151 claim. 

Before leaving that appt, I asked the PA if there was anything possible the VA would need with the claim. The appt was to measure the scars and it was also a medical record review and clarification. During that appt we discussed the residuals associated with the claim. Beyond the scars the residuals are as follows: 

1. Infections of the colon.

2. Epiploic Appendigitis: multiple bouts with this horrible; painful. Just horrible. All verified thru CT Imagining and blood work. Everytime this occurs, it leads to a hospital stay and medications thru IV infusion.

3. Ulcerative Colitis: I have multiple horrible flare ups every year. I wouldn't wish this on anyone. You feel fine and then bam, out of the blue you get sicker than hell. When a flare up happens it usually results in a hospital stay with IV infusion of this nasty medications. 

I had ZERO problems with my stomach and abdomen until the VA cut me open. The worse mistake of my life was allowing them to cut me!!

Anyway, we discussed this all on the Friday Appt. She was asking me about all of this until she read the IMO from Dr Bash. Before leaving I was asking her to make sure there was nothing we missed and told her what the VA does about having an exam and within a few days requesting the same exam again. She assured me everything was taken care of and answered. Again the same thing happens! 

Why would the VA request the same exam again? Is there anyone I can contact to get this complete and utter nonsense to stop? To keep on having the same exams over and over it just feels like the VA is hoping I miss an exam so they can deny the claim. 

I am not exaggerating on any of this at all. Everything I have stated in this forum is all in my medical records which the VA has. 

[Berta]

Perhaps they are looking for a C & P examiner who has credentials like Dr. Bash's.

They probably will not find anyone like that at VA to do another C & P exam. But they seem to be trying.

My situation was different. 

 

What VARO is this?

I might have contact info for their director and their VSCMs and I can post that info here.

 

 

 

 

 

 

 

 

Edited May 14, 2021 by Berta

[Dan1865]

Hi Berta, 

I hope this note finds you well. Hopefully, you are enjoying the beginning of this holiday weekend!

When you asked a few days ago: "What VARO is this". I do not understand what a VARO is? 

I live outside of Detroit! The guy who has called me multiple times telling me my claim was finished; which was a lie, he was calling from the Atlanta, GA VA Office! 

I wanted to send a quick update. On Tuesday, May 25th I had the appointment for the residuals to the 1151 claim. The appt was at 430 via telehealth. Due to it being done via Telehealth, my wife was able to join me for the appt. She was ready to write down what the doctor said in regards to what we were discussing! In the end, she was ready for really nothing. 

The first 2 minutes of the appt he was telling us about who he was. He then asked me 3 questions about symptoms I experience and he said according to the records you have severe weight loss issues along with all of the other problems. The doctor then paused and said you have a very well written medical opinion that details all of the facts with the associated records. "I will submit everything the VA needs this afternoon. Thanks for your service and have a great holiday weekend"

Not kidding; the appt started at 430 and it ended at 437. 

I went thru the VA claim page today to check the status of my claim. They did an update yesterday and I do not see any new information posted. My wife and I were curious to see how many exams they have sent me too since the submitting this claim. We counted a total of 21 exams since 2/4/2020! Some of these exams in this count were record reviews that I did not attend.

Anyway, the saga continues and we have our fingers crossed on finally receiving a decision!!