VES Records Review C&P Question

[scooter318]

Recently I posted a question about receiving a records review only from VES. Today I received a call from VES stating that my exam will be a phone call instead of just a records review. In speaking to the VES agent she asked me to fax a copy of my sleep study, the prescription for the CPAP and a copy of the IMO over to the Dr. that's going to be calling me. Is it common for the VA not to send documentation over to the contractors, because I don't understand how the VA can set you up for a C&P with an outside entity and not give them the paperwork that I sent them.

[Whodat]

So when vets needs and imo/IME DBQ etc, there is a statement on the DBQ saying that they have reviewed the medical file/service file. Same with the imo/IME. 

So what I am understanding that there are different standards from an outside source and VA contractors?

[pacmanx1]

18 minutes ago, Whodat said:

So, when vets needs and Imo/IME DBQ etc., there is a statement on the DBQ saying that they have reviewed the medical file/service file. Same with the Imo/IME. 

So, what I am understanding that there are different standards from an outside source and VA contractors?

Don't take this the wrong way, a lot of veterans say they got a bad C & P exam and I know that is true but there are times when the VARO ask the examiner for the wrong opinion. Example: My two most recent C & P exams, the VARO requested an updated status of my current level of disability but I did not file a claim for an increase in rating because I know/knew that my two ratings have been maxed out for well over a decade so I cannot figure out why the VARO would ask the examiner for this type of medical opinion. I filed two separate EEDs. I knew that I could not get an increase in rating but due to VAMC medical records never considered or adjudicated with my current rating would make me eligible for two separate EEDs. Well even though both C & P examiners wrote a favorable medical opinion the VARO ignored both of their assessments and continued my rating as is and failed to even consider these opinions. Now the BVA just awarded me an EED in one rating along with an EED of TDIU, but I still have one appeal still pending. 

There are no set standards at the VAROs, they don't read or understand their own regulations, that’s why one veteran can be granted service connection for a disability at a particular VARO and another veteran may get a denied decision from a different VARO. 

[Whodat]

I do agree. That's why I hired veterans law group. Tired of fighting. 

[Mark D Worthen PsyD]

C-File Review
Question #3 on the VBA Contract Exam Audit Criteria is: “If required, does the report indicate a c-file (e-file) review was completed?”

I don’t know as much about other claim types, but for initial PTSD and other mental disorder claims, a c-file review is required. 

For review exams, the examiner needs to review any new, relevant documents since the previous claim decision. They can review the entire c-file if they wish, but it’s not required.

Make sure VBA has your medical records from private doctors & clinics
As a previous member said, the MDE contract companies connect electronically with VBA and VHA - that's how they obtain relevant records.

If you saw a non-VA doctor, i.e., not at a VA facility and not through VA community care, then (as most of you know) you should make sure VBA adds those records to your c-file. You can: 

(1) ask VBA to obtain the records (after you grant consent in writing - use VA FORM 21-4142)

(2) ask the doctor’s office or clinic to mail VBA the records; or 

(3) obtain the records yourself and upload or mail them to VBA. 

Upload Records to VA
https://www.va.gov/disability/upload-supporting-evidence/

Certified Mail + Return Receipt
Whenever you mail records to VBA, make sure to send them in a way that gives you proof that VBA received them. I prefer US Postal Service Certified Mail, Return Receipt because they have to sign for it, and people tend to treat Certified Mail more seriously. More info on the USPS website:

• USPS: Return Receipt - The Basics
• USPS: Proof of Mailing & Delivery

Mailing address - to send medical records to be added to your C-File:
Department of Veterans Affairs
Evidence Intake Center
PO BOX 4444
JANESVILLE WI 53547-4444

Exam Audit Criteria
The Contract Exam Audit Criteria can be found on pages 25-26 in this VAOIG publication:

• Off. of Audits and Evaluations, Veterans Benefits Admin., Dep’t Veterans Affs., Contract Medical Exam Program Limitations Put Veterans at Risk for Inaccurate Claims Decisions, VA OIG 21-01237-127 (June 8, 2022).

Community Provider Advice
The VA explains how community providers can submit their medical records to VA:

• Community providers: How to submit medical documentation to VA [VAntage Point blog post, 8 Oct 2020]

Edited June 23, 2022 by Mark D Worthen PsyD

[Dustoff1970]

Good reply MarkD.  You know your stuff.

[Richard1954]

Maybe my answer  isn't necessary since Mark seems to have covered all the bases,,, but anyway here goes.

1. The va should have and in all likely hood allowed the contractor to review all of you rmedical records. The contractor should never be asking for copies from you, however, if it were my claim I would abide by the request. 

2. The contractor will be required to state that he/she has reviewed all the available medical records.

3. By you providing the information, you have saved the examiner from spending time looking for the documents in the medical file.

4. When ever I submit a claim, I submit all the medical records that pertain to the claim. This saves the VA from having to ask for them from the VA medical center or from private providers.  It makes the claim move a little faster, and this insures that you have provided all the available evidence for a review, even when they delay the claim asking for more evidence you can go into VA.gov and by checking a box tell them there are no more records and to make a decision on the claim.

5. And whenever I go to any C/P exam I provide all the medical records to the examiner in the form of a book, and tell them the records are for their review and that they should destroy them when they are done. I never put anything on them except my name so that my personal information is not compromised 

BTW you can submit the records directly to the va by going on line and logging into VA.gov, find the claim information and submit the records for the claim.  Or you can do like I do, spend $7.50 on average and send the records by mail with a return receipt request. I do all things by mail because I don't trust computers ( over 40 years expierence with comnputers) and I like receiving the return receipt as assurance the VA received the documents.  Ironically, sometimes I get the return certified  receipt days after the documents were received.

Best of luck with your claim

Edited June 23, 2022 by Richard1954