As for a HLR? or no?

[Ranmic]

Last Nov I filled two claims, one for an increase in my current SC knees and then I filed a second one for my hips as a secondary to my knees.  The VA combined my two claims and then I got C&P exams for my knees and my hips.  I got an increase for my knees but they said my hips were not service connected.  I'm unsure if I file a higher level review for my hips if they will review my knees also.  All I want is for them to re-evaluate my hips, and not my knees as they are maxed out for instability and knee strain and I don't want that touched.  Below is what I filed for.  Again, I did get my knees increased and now they are maxed out.  I just want to challenge my hips.  Any advice?

• knee condition bilateral (Increase)
• hip condition bilateral (Secondary)

 

[brokensoldier244th]

Secure messages are part of your VHA medical- which is all pulled into your Cfile when someone works your claim, and repeatedly while your claim is pending, and again before sending the claim to rating. They aren't ported over in real time, but if a VSR or Rater does not do a final check of Capri (VHA) before sending to rate, or rating it, its a quality error and we get penalized for it. 

 

Edited October 26, 2022 by brokensoldier244th

[blahsaysme2u]

1 hour ago, brokensoldier244th said:

Secure messages are part of your VHA medical- which is all pulled into your Cfile when someone works your claim, and repeatedly while your claim is pending, and again before sending the claim to rating. They aren't ported over in real time, but if a VSR or Rater does not do a final check of Capri (VHA) before sending to rate, or rating it, its a quality error and we get penalized for it. 

 

thanks for clarifying for me. this is what i meant for those of you that werent aware how you VHA medical records get in your C-file. 

doing this does make a huge impact was my main point tho- showing a real time record of issues reported to your doctor- not just a journal 

thanks again for helping out here @brokensoldier244th

[Rattler]

On 10/23/2022 at 6:48 PM, MilvetHD said:

In my opinion, based upon my own experience, I would say skip the HLR as I don't know of any examples whereby they were turned in favor of the veteran. Secondly, you need not have STR for a secondary condition that is asinine. You need a current diagnosis and in my opinion, most important treatment records. You don't mention the evidence that you submitted but it's not good enough to simply say something hurts, gather objective evidence if you have not already done so. 

I keep seeing this posted and I think it is just wrong.  If you use a HLR right and point the reviewer to the information you need them to look at it will save you alot of time.  Example is the post in the forum below. I filed for an HLR on September 28,2022. The VA did the phone interview on on October 7, 2022. They put money in my bank account on October 13, 2022. So stating that skipping an HLR and going to the BVA will take a lot more time in getting your benefits.

 

https://community.hadit.com/topic/89200-large-win-on-que-claim-high-level-review/page/2/#comment-528706

[Rattler]

I had the same problem with a secondary hip problem that is directly related to my knees. Knees always causes hip arthritis.  I had a crap C & P Exam and they did poor x-rays.  I got about the same thing as you did. My current orthopedics surgeon is my community care doc and I have been seeing his group from 1998. So everything is well x-rayed and documented.  To of set a bad C & P Exam you will need an IMO and DBQ's done by another doctor.  I had this done on October 21, 2022. It will cost you some $$ to do this and my advice is shop around.  I used the site below and found one close to me that charged a good rate. He took his time with me. I was there from 9:30 am to about 3:00 pm.

National Directory Of Independent Medical Examiners 

https://www.imenet.com/

[MilvetHD]

On 10/26/2022 at 10:25 PM, Rattler767 said:

I keep seeing this posted and I think it is just wrong.  If you use a HLR right and point the reviewer to the information you need them to look at it will save you alot of time.  Example is the post in the forum below. I filed for an HLR on September 28,2022. The VA did the phone interview on on October 7, 2022. They put money in my bank account on October 13, 2022. So stating that skipping an HLR and going to the BVA will take a lot more time in getting your benefits.

 

https://community.hadit.com/topic/89200-large-win-on-que-claim-high-level-review/page/2/#comment-528706

Again, I am and can only reference my experience with HLR. HLRs are supposed to be conducted by senior staff, it's not incumbent on the veteran to point them in any direction as the evidence of record should speak for itself and they are required by law to read the file themselves. In my case, I had a HLR official tell me he had not reviewed my file and wanted to speak with me prior to reviewing my claim, initially I took this as a positive sign he would do his job, he would hear me out and then take some time to review my verbal challenges of missed facts. My claim included in total about 80 pages of of information between Buddy statements, Nexus Letter, Peer reviewed research articles and etc. 

We spoke on the phone on a Friday at just before 1400 EST, we were both located in the same time zone, by Monday my denial was already authored and submitted. He either lied and had reviewed my claim or blatantly didn't give a damn about the facts, there is no way a fair and reasonable person could interrupt that much information so quickly and right up a report on such a short turnaround. I don't submit bogus claims. I spent two years researching and gathering information and my private physician spent another 2 weeks reviewing my medical charts and the journals I provided him before he agreed to write a nexus. I don't mind being denied just do so on facts and I think that's what all vets want and desire. 

[Rattler]

On 10/27/2022 at 10:08 PM, MilvetHD said:

Again, I am and can only reference my experience with HLR. HLRs are supposed to be conducted by senior staff, it's not incumbent on the veteran to point them in any direction as the evidence of record should speak for itself and they are required by law to read the file themselves. In my case, I had a HLR official tell me he had not reviewed my file and wanted to speak with me prior to reviewing my claim, initially I took this as a positive sign he would do his job, he would hear me out and then take some time to review my verbal challenges of missed facts. My claim included in total about 80 pages of of information between Buddy statements, Nexus Letter, Peer reviewed research articles and etc. 

We spoke on the phone on a Friday at just before 1400 EST, we were both located in the same time zone, by Monday my denial was already authored and submitted. He either lied and had reviewed my claim or blatantly didn't give a damn about the facts, there is no way a fair and reasonable person could interrupt that much information so quickly and right up a report on such a short turnaround. I don't submit bogus claims. I spent two years researching and gathering information and my private physician spent another 2 weeks reviewing my medical charts and the journals I provided him before he agreed to write a nexus. I don't mind being denied just do so on facts and I think that's what all vets want and desire. 

I don't want you to think I am flaming you but. As an HLR only reviews what's in the file you cannot add any doc's for them to review.  You can not just through doc's at them and expect them to read them all. What got me my win was I made the statement that, "the attached doc's were in my C-File and were presented as reference to the doc's that the VA did not review when they made there original decision.  I framed it as a QUE error.  It sounds like what you have is a QUE error due to the VA error not to review everything in you file. In your decision letter they will list what doc's they reviewed in making the decision. I the doc's you are referring to are not listed than the VA errored in its decision by not reviewing all the evidence.