HERE WE GO AGAIN

[blahsaysme2u]

here we go again. someone please help me. i know this has been talked about already but serious guys i am so fed up and i dont know what to do!

i have a favoable exam from 2020 showing SC from a C&P exam(by VES) that the VA sent me to.

 

last year they attempted to have me re-examined over and over again but kept scheduling for my right leg and foot...the claim was for the left leg and left foot...finally the cliam was denied beacuase the last exam i attended after comfirming that the exam was for my left leg with the VA, i found out from the doc upon arrival that it was in fact for the right leg again and was told to leave. the VA said i refused the exam and denied the claim.

i reopened the claim. now they are sending me back for re-exam, when there is already an exam on record, in my favor along with medical evidence showing nexus. 

HELP! this has got to stop! 

[asdf]

What does the decision letter state as the reason for denial? That is the exam but they could be denying for something else.

[blahsaysme2u]

depends on which denial you are talking about...i have had several...

the one from 2008(again later i was SC for my right Knee/foot/ankle but not my left)- 

2008/10/15

2008/12/06

i didnt try to re-open or fight these claims until 2012 when i was awarded my SC for my right knee, foot and ankle as well as my left ankle but not my foot or knee. 

2012/12/14

for some reason we didnt appeal this denial and keep the trail going- i was working with the DAV at the time and was very confused on the process and they convinced me i won and should be happy...it was not until i found Mr. BEBE at the Virginia VSO that we tried reopening this claim and when i found the new medical records- and obviously there were many in my C-file that were ignored that i printed off and took with me to the exam in 2020. then the VA started playing games with me- they kept sending me to exams over and over...and when i would call peggy i was told it was for my Right leg. after explaining 3x for 3 different rescheduled exams(which btw the excuse i was given for the re-exam for my left leg and foot is because the dbq was too old to be used- i bought this at first-now i know better) i was finally told on the last exam it was for the left leg by peggy and that i could attend and this was all behind me. 

as some of you know the story now- i attended this exam, the doctor explained it was for the right leg and foot again! after discussing with the doctor he told me to leave and he would send the exam back to the VA since my claim is not for the right leg or foot and the exam is not needed and a new exam needed to be rescheduled. next thing i know i receive in the mail the denial

below is the denial from the re-opened claim in December 2019 as a result of "not completing" the exam.

2021/07/30

so here we are- and they are trying to schedule me again for more exams- i just dont get it!

Edited October 11, 2022 by blahsaysme2u

[Vync]

 

 

On a side note regarding your SC right knee/ankle, keep in mind that if the VA denies SC because they claim your medical records are incomplete, but later grant SC after you found those same records which the VA was in possession of all along, they should grant the effective date of claim back to when you initially filed. Check 38 CFR 4.2, 4.6, and M21-1MR, Part III, Subpart iv, Chapter 2, Section B (4).

X.ii.5.A.1.c.  Identifying a CUE

https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000177971/M21-1-Part-X-Subpart-ii-Chapter-5-Section-A-Revision-Due-to-Clear-and-Unmistakable-Error-CUE?query=undefined

Quote

Exception:  A failure to consider VA medical records, which were in VA’s constructive possession at the time of the prior decision, may constitute a CUE, if such failure affected the outcome of the claim.  See VAOPGCPREC 12-1995.

I was under the assumption that once an examiner writes an opinion in favor of granting SC for a disability, then you are solid (unless fraud can be proven). Any subsequent exam for the same condition would be merely to determine the rating percentage.

With the VA using contractors for C&P exams, the VARO will send them a letter instructing them what they are supposed to examine. When I had my heart claim, they outsourced it to LHI and simultaneously sent me a letter which detailed the purpose of the exam, the person performing the exam, their curriculum vitae (i.e. qualifications), and any other special instructions as to what the VARO needs them to do. I don't know which contractor is doing the exam for you, but this same information is available to Peggy. Call and verify exactly what is on that form. I know you are beating a dead horse, but if the information is still not correct, simply ask them to compare the claimed disability with what was on your claim form. You can also send an IRIS request and ask them to communicate with you by email. I did that a few times, but sometimes I simply never got a response.

For what it's worth, I did get a letter from LHI telling me all the info I described above. It matched exactly what I had claimed (heart attack secondary to side effects of SC migraine medications). While talking with the LHI examiner, they decided to ignore a lot of that. It's an odd situation because I was initially SC for TMJ, then secondary for migraines. The LHI examiner opined negatively on a heart condition causing TMJ instead of what I actually claimed. Have hope though because I got it overturned on appeal and because I had a "more likely than" IMO from a specialist who actually read my records and cared.

With respect to the VA saying you refused an exam, if necessary, ask for evidence proving that vs. your lay statement where you descibed the situation to the examining doc. That could be worth exploring...

 

[pacmanx1]

My advice is when contacting the White House Hotline is keep in mind that they are a part of the VA and was created to try to fix problems. Make sure you explain that you are already service connected for your right leg and foot and you filed a claim for your left leg and foot, and you have a favorable C & P examination, but the VA has been scheduling you for your right leg and foot and denying your request based on the wrong leg and foot which are already service connected. Try to be polite, respectful and calm. They are in a position to either help or not help but they could really get the ball going on the right track.  Since your current exam is well over a years’ old, the VA may still try to request an updated C & P exam, but it should be on the left leg and left foot to try to determine the severity of your disability/condition.

As stated, even though you have a favorable medical opinion, the VA still has the authority to schedule you for an update medical exam to determine the severity of your current disability, so don’t freak out if they do. Your other option is to file an appeal/Cue or disagreement and that would take some time.

 

[Whodat]

Pacman is absolutely correct. And like all of us say, never refuse an exam. I am sure that the VA will want an updated exam although you had already had that same multiple times for the same thing but this is where the incompetence of the exam can come into play.  

[blahsaysme2u]

20 hours ago, pacmanx1 said:

Try to be polite, respectful and calm.

best advice! i will certainly try my best

20 hours ago, pacmanx1 said:

Since your current exam is well over a years’ old, the VA may still try to request an updated C & P exam, but it should be on the left leg and left foot to try to determine the severity of your disability/condition.

well i havent claimed the condition has gotten worse since that C&P exam- i have only filed NOD/appeal in regards to them ignoring the evidence that has already been presented...i cant understand how this would be fair to the veteran in any way. 

if this is the argument, lets go with it for a second- 

- i go to the new exam..the doc finds me not SC, which is in opposition to the original exam that was favorable. with the line of reasoning you have presented all the VA has to do is say, "maybe he was SC but now hes not because hes better so 'Denial of SC' award letter"...even though conflicting evidence is supposed to go for the veteran, they could spin this to say its not conflicting, just an "updated exam showed improvement and no SC"

this is all BS to me and shoudlnt be allowed at all- there should not be a reason to keep sending veterans to exams if favorable evidence is found from an exam- the case should be closed and move on to someone else that needs help...look how much time they have wasted on my claim when they could be actually helping someone else/working another claim- i re-opened this claim in 2019 and the exam in 2020 should have finished it....now 3 years later im still fighting over this junk