LHI examiners

[Whodat]

Who out there had bad experiences with LHI C&P examiners?

I would like to share my experience with LHI.

2019, I had filed a claim. A c&p exam was scheduled with LHI. Shortly afterwards, I received a Fedex packet will info to include the examiner info. I pulled up the examiner's info, 3 years of Nurse Practitioner, as well as 3 years with VA system.

I had already been diagnosed with migraines, and had an event or injury that would connect it. The diagnosis was from my Neurologist. 

During my exam with this NP, he kept saying that he doesn't think that my headaches aren't migraines, he thinks that I have cluster headaches.

I am unsure of how the report was written up but I do know that it wasn't good. Denied. 

So of course I had did a HLR. I had gotten  letter from VA duty to assist error and they are returning my claim to the RO for corrections. 

I get another letter from LHI for another c&p exam for migraines. Who do I see? The same examiner. Now things get ugly. He has remembered me and what comes out of his mouth, why are you here again. 

Started the exam, nowhere did he used the dbq, just basically telling me that I do not have migraines, that is clusters. Then he proceeded to tell me that ptsd does not cause headaches.  I feel another bad c&p exam.

Looks like the Department of Veterans affairs has done it again. They claimed to be backlogged,but what do they do? Hire sub contractors with little or no experience conducting bad exams knowing that the Vet is going to appeal. Job security for the contractors just like Brown &Root back in the days. 

The bad thing is that this NP is also a Vet. 

 

[Whodat]

You are right rivet.  

I have file that claim awhile ago. I really can't remember but I do not think when I filed that claim if the headache tab was available.  I think that my attorney cleaned it up for me though. The DBQ was for headaches to include migraines. There is also an IME and buddy statements from combat.  Just waiting on the denial letter. Lol. 

I have have Veterans Law Group and they do not get paid unless they win. They did state that I do have a strong case. I will kick rocks and wait. 

[Berta]

Do I understand this correctly- the C & P examiner stated you have cluster headaches and you expect a denial? This is a recent BVA decision.

"ORDER

Entitlement to a 50 percent rating for cluster headaches from February 10, 2015 is granted."

https://www.va.gov/vetapp21/Files12/21075500.txt

YOu said:

"I had already been diagnosed with migraines, and had an event or injury that would connect it. The diagnosis was from my Neurologist. "

and 

 "Just waiting on the denial letter. Lol. 

I have have Veterans Law Group and they do not get paid unless they win. They did state that I do have a strong case. I will kick rocks and wait."

I feel they -Veterans Law Group- are CORRECT!

If this is a denial please scan and attach it here when you get it-

Cover your C file, name, address, prior to scanning it.

I smell a CUE daisy.   if they deny   !!!!!!!!!!

 

Edited February 27, 2022 by Berta

[Whodat]

Berta, you are the best. I have been following you for awhile. You know your stuff. Even music like Teddy Pendergrass. 

Hopefully I don't get denied, been fighting for years. I just think that the examiner tries hard to give an unfavorable exam. He even asked questions about my employment. I did not see that question on the DBQ. 

[Berta]

Thank you- we have a great crew here of helpers-

The C & P exam is the most important part of a claim in most cases, because what the examiner says, or checks off etc., is how the RO decides the claim, and I bet most of them ,= the examiners,do not take the time to read the most important records ( SMRs, C File etc etc ) to fully give an appropriate medical opinion.

They are paid by VA or QTC, LHI,or VES ,  all ARE paid by VA, for the exams  so obviously it is the fox guarding the hen house-what  A SYSTEM.

 

 

 

 

[Vync]

@Bertais correct about the C&P exam. The VARO often tends to blindly accept what the examiner documented. However, the VARO is supposed to review the exam findings to determine if it is sufficient. If found to be insufficient, they are supposed to send it back for clarification or re-examination.

Keep in mind that the VARO doesn't always catch everything and can cause further errors. As a result, I personally believe it is always a good idea to double-check the decision letter notes and C&P findings against the rating criteria and VA laws/regs.

Example: I filed for SC aggravation of a pre-existing condition. Despite winning SC (eventually), the VARO reduced the rating by 10% because the examiner noted "always had the condition". Years later, I learned that the pre-service level of disability must be put into terms of the rating schedule otherwise they cannot reduce. I filed CUE, VA conceded the error, and the reduction was reversed.

Example: I had a C&P in 2019 for one condition (mentioned previously), but the LHI NP examiner ignored my private nexus letter. Instead, they opined a denial on a completely unrelated and unclaimed. I requested review due to CUE and the denial was eventually reversed.

 

Here's the info about Insufficient Examinations:

M21-1, Part IV, Subpart i, Chapter 3, Section C - Insufficient Examinations

https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000180517/M21-1,-Part-IV,-Subpart-i,-Chapter-3,-Section-C---Insufficient-Examinations

This is an interesting read because it lists out quite a number of factors which could result in an exam being considered insufficient and what should be done.

[deedub75]

If the examiner has checked all the boxes and filled out all of the paperwork correctly, the VARO almost always accepts what the examiners says. I believe they are taught to basically go along with it. Now I believe the DROs have more leeway than the the VSRs when it comes to ratings. 

I remember when I filed for bilateral plantar fasciitis years ago. An ACE exam was conducted and the examiner denied my claim basically stating that I did not see the doctor enough times on active duty with complaints about my feet. There is nothing in the CFRs that states that a person has to go to the doctor X amount of times complaining of something for an in service event to occur. Even though I met all 3 of the Caluza elements, my claim was denied. It made zero sense that a rater would go along with that rationale. I file for a de novo review and the DRO granted the claim along with a few others.