Denied for lack of diagnosis but wait

[Carl the Engineer]

I just received a decision letter today.  I was granted one increase, 3 contentions deferred, and one denial.  The denial says I don't have a diagnosis for the claimed disability.  But, I sent the diagnosis in with the claim, in person, at my CVSO, and I watched him put in the computer.  Not sure if the rater missed the medical record, or if it was taken out, etc.  Anyway, you can see what I see.

Any thoughts, 

Hamslice

[Carl the Engineer]

1 hour ago, pawmbi said:

At the beginning of the decision, there should be a section that says "Evidence" and it will list all the evidence the rater considered.  Make sure the diagnosis you sent in person is in this evidence list.  If not, supplemental claim and resubmit that evidence as new and relevant.  

That's the rub,

In all of my dealings with the local VA clinic, everything says the regional VA Hospital in Iron Mountain, MI.  As an example, I had a blood test and my annual exam at the local VA clinic, yet in my medical record it says it was done at Iron Mountain.  

The doc that diagnosed me for paravertebral muscle spasm, and where I went for PT, was at my local clinic, which I submitted all the medical records for, but in the evidence section of the decision, it says VAMC treatment records Iron Mountain, for all of the time periods for all of my current claims, etc.

And, as we all know, we don't get to see what the rater is looking at when they make the decision.

Are they looking at what I sent in?  Who knows?

They did take another claimed (diagnosed) disability (lumbar segmental dysfunction) and rolled that up into my claim for increase for thoracolumbar spine degenerative joint disease and DDD.  I could understand if they had done that with the paravertebral muscle spasm, as I am not too sure with these three issues, what overlaps what.

But, it was diagnosed and I did send the records stating such in.  I will wait until the other three conditions deferred come in too see where this goes.

Fun with the VA,

Hamslice

 

[john999]

Ham

All in all you did pretty good considering who you are dealing with and the number of conditions claimed.  Are you at 100% yet? I was at 90% for ten years and it took another 150% to get to schedular 100%.  It should have only taken an extra 50% but the VA threw in another 100% just to kind.......not!

 

[Carl the Engineer]

John,

I'm currently, with the new additional 10 for my left shoulder, at a 92 raw score.  So, with the 3 deferred, I would need a 20 and a 10 or one new 30 to make 95 for 100.  It's definitely doable, just takes time plugging along.  I have no biggie, just a bunch of smalls.  I've been 90 for about 2 years.

I have a theory, and I have a buddy in the same boat, that the powers that be, scrutinize a simple 10 a bit different when the first Veteran is currently 10 percent disabled and when the second Veteran is sitting at 94 raw points.  The first Veteran's 10% increase costs the VA $140.79, while the second Veteran's 10% costs the VA $1277.67, so about $13,833.24 difference in a year, not including extra's and healthcare.  

My 3 deferred claims went to one examiner (RN), and now the VA shipped them off to another (Doctor).  That could be normal procedure, but like I said, working on a theory, and one could surmise that they went shopping for lower rating or denial, etc.  The problem is in the past, when the VA did all my C&P exams, I did have one claim referred and I could see the first exam and then why it was referred (what the examiner failed to address) and for what and then what the referred examiner opined.  Can't do that now with the farmed out exams.

Just a theory,

Hamslice

  

[brokensoldier244th]

13 minutes ago, Hamslice said:

John,

I'm currently, with the new additional 10 for my left shoulder, at a 92 raw score.  So, with the 3 deferred, I would need a 20 and a 10 or one new 30 to make 95 for 100.  It's definitely doable, just takes time plugging along.  I have no biggie, just a bunch of smalls.  I've been 90 for about 2 years.

I have a theory, and I have a buddy in the same boat, that the powers that be, scrutinize a simple 10 a bit different when the first Veteran is currently 10 percent disabled and when the second Veteran is sitting at 94 raw points.  The first Veteran's 10% increase costs the VA $140.79, while the second Veteran's 10% costs the VA $1277.67, so about $13,833.24 difference in a year, not including extra's and healthcare.  

My 3 deferred claims went to one examiner (RN), and now the VA shipped them off to another (Doctor).  That could be normal procedure, but like I said, working on a theory, and one could surmise that they went shopping for lower rating or denial, etc.  The problem is in the past, when the VA did all my C&P exams, I did have one claim referred and I could see the first exam and then why it was referred (what the examiner failed to address) and for what and then what the referred examiner opined.  Can't do that now with the farmed out exams.

Just a theory,

Hamslice

  

There is no scrutinization. The rating is plugged in and its calculated automatically. There also is no 'doctor shopping'- we don't schedule the exam, we send it to the vendor. After that its all on them. We don't know who you see until the results come back, and you can't order another exam unless the returned report is flawed, i.e. missing information or wasn't done correctly. If the boxes are all checked then that is the report that is used. If we send a veteran to another exam when there is already a completed report, whether in error or "on purpose" we are flagged for duplicative effort and under the CFRs for development we have committed a serious error which is then penalized against us (whomever ordered the exam that wasn't needed). As for the vendor reports themselves you can contact the vendor and get the reports from them. 

[Carl the Engineer]

"As for the vendor reports themselves you can contact the vendor and get the reports from them."

LHI Care does not release exams records to Veterans.  According to their site, they are property of the VA and the Veteran has to contact the VA to get them.

QTC from what you have stated before, will have the exams on the Veterans portal, so I will be watching for that when the time comes.  That will be nice.

Thanks for added information,

Hamslice

 

 

 

[brokensoldier244th]

That is true, if they want to really be sticklers about it. I couldn't get the appraisal on my house until my lender was done with it because it wasn't 'my' report. They ordered it, not me, so there was no release for me to have access to it until it was added to my file. Since VA is sending you and you aren't reporting on your own, VA is the client, not you. 

I don't necessarily agree with it, but I can see where they are coming from, legally, I guess.