VA Claims reviewers deferring claims involving IMO support??? Anyone see a pattern?

[Corwin]

I recently (March 2) put in a claim for OSA secondary to CAD and tinnitus. I included an independent medical opinion (IMO). I received a minimally worded denial on April 11. It contained no opinion or even reference to the  contents of the IMO. A C&P was never asked for nor did the reviewer even mention the tinnitus part of the claim. The reviewer also stated that they reviewed the most recent 18 months of medical records and stated as a fact that my OSA was DX'd ..." Your VA examination conducted on March 8, 2022 confirmed an active sleep active diagnosis".   "Active sleep active"??? 

No surprise I am sure to most,  but I was  never  at the VA on that date which was  after I actually submitted the claim. My OSA dx was given to the VA in June/july 2012 and I have had several subsequent appointments with their sleep physicians since then . Those original DX records were included with my claim.

My feeling is, when they saw the IMO, they punted. Their claim response certainly seems counter intuitive to their  supposed 'responsibility" to  assist. Has anyone else had this experience? I am considering addressing this issue with the VA directly through the Inspector General office with copies to Congressman. After several error filled claims experiences, I am, at this point, a little tired of dancing.

Best, Nick

[Dustoff1970]

Unfortunately this is a situation normal pattern for VARO denials of initial claims even those with important/extensive medical support evidence including a favorable private doctor's nexus opinion (MO) and then the vet will very often win the same claim on appeal to the professional fair minded lawyers and judges of the BVA.  I have been there and done that many times since 1985.  "Delay and Deny" is their cheer leading VARO sector chant.  Good luck going forward.

P&T 100% Scheduler (Formerly P&T TDIU) since 1998.

My comment is not legal advice as I am no lawyer, paralegal or VSO so do not contact me for more info folks and I remind 3 of you are on my ignore list. 

[Vync]

@Dustoff 11is correct. The VA is required to review all evidence, not just 18 months of it. Most over half the claims I filed since 1995 has had one common factor: not all evidence was considered. On the bright side, I have won on appeal and review on almost every claim. While we can appreciate people being hired to process our claims, it seems that they are pressured to spend as little effort as possible to do. Quantity over quality. I even had a DRO tell me that the person who processed my initial claim (five years earlier) made a lot of stupid mistakes. 

Please let us know how it turns out.

[john999]

The first claim I filed in 1972  the VA ignored or failed to consider all my private doctors evidence.  I did not know that at the time because VA was not required to list all the evidence they had.  They would just "say" they did consider it all.  I believed the VA did consider my doctor's evidence and that I had just lost.   I filed a CUE on that basis many years later because it was obvious to any unbiased person that the VA ignored my evidence.  Of course ,  I lost.  Most Cue claims are pipe dreams. I have won one over the last 50 years.

[Mr cue]

The VA pick a choose what they use from each medical report and exam.

Like I can't get the VA to even address there own bva decision from 2001 or 2012.

For smc benfits.

I would believe there own decision could be used as evidence in your case. But if it's favorable they will not address it. Smh.

Law is the VA is to address all evidence favorable and negative on a decision.

This is how you get benefit of doubt.

 

As far as cue claims I can't say they are pipe dreams.

. Because I was rated under a rating code for a gunshot wound.

I don't have a gunshot wound. I was pay 90.00 a month under this rating code. From service could work due to my injury.

An i had the vso American legion at the time. I was 23 24 I didn't understand how the VA work.

This why I have trust issues lol

 

2001 I apply for tdiu and 60 for my neck condition.

Granted by ro first time.

I feel that was to easy. So I cue the 1993 claim from service.

Find out my claim from service was in appeal status for 8 years.

Granted extra scheduler tdiu from 1993-2001.

So I believe in the cue 

 

 

[john999]

Mr. Cue

             For my CUE I had a lawyer and we went to Court of Vet Appeals.  We both thought I had a slam/dunk case.  We found out that according to the VA we could not prove the VA disregarding my evidence.  How do you prove a negative?  So we lost after 6 years of appeals.  Bad taste in my mouth for the rest of my life.  Cue just has to be black and white.  No thought process or judgement. A joke since the VA uses nothing but subjective judgement and bias.