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HLR difference of opinion

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XIbodybag

Question

After filing an HLR I spoke with the senior rater during the informal conference and it updated and opened a supplemental claim stating a "difference of opinion has been asserted for sleep apnea".  A records review was ordered and completed December 14th and now I'm still waiting.  

 

To my questions... does a difference of opinion mean the reviewer believes it is service connected? what leads to a difference of opinion getting sent for a records review as opposed to the reviewer just overturning the previous decision?  I had already uploaded an IMO and completed dbq from a provider so why didn't the reviewer just use that?

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They need to have some sort of evidence or something in your record or your C&P exam that the PA or the Doc said that they are going with.

You will need to find out what it is.  

You will have to see what the Senior person looking at this decides is more credible and or the logic applied.  

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Likely because you have two different opinions, one favorable, one not, therefore that has to be resolved.  A difference of opinion doesn't mean SC, as raters can't make medical based decisions they can only go off of what is in front of them. If there is a difference of opinion between two examiners it has to be resolved, meaning the rater ordered the exam asking the tiebreaker to answer a specific question that wasn't addressed, or that was root of the opposing opinions. 

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Short answer:  We dont know what they are thinking.  

You are just gonna have to wait for the envelope.  You may, however, get advanced notice on ebenefits/va.gov in the "letters" section only.  Most of the rest of ebenefits is unreliable, but, if they let you print a letter that says you are xx percent disabled, you can pretty well count on that.  

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Ebenefits has been in the process of being retired for over a year and I would not rely on it at all unless you are one of the few veterans that have a legacy only appeal going on. Everything has pretty much been moved to VA.Gov. 

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I am one of the ones that likes HLR's. but you have to know how to work them. What I do is when I submit the HLR application. I include exhibits in my C-file that I want the examiner to look at. I put a note at on the extra sheet of paper stating that the exhibits are already in the C-file and do not need to be added in the file. To show you how well this works. I filed for an HLE on 9-28-22 for an EED date via QUE claim. The VA noticed me that they wanted to do the phone interview on 10-7-22. In the phone interview the rater said she would probably have her decision done in a week. I check VA.gov on 10-14-22 and it showed they had a decision. So I called 800-Betty to have them email me the decision. The person on the phone said yes they made a decision and she would email it to me. Then she said you need to check your bank account. I checked the account and the VA dropped 6 figures in my account.

I said the above to make the point that you only put the doc's in front of the VA that clearly proves you point that they screwed up. The same with any claim. People want to through 200 pages at them and want the ratters to "find the need in the hay stack." It just doesn't work that way.

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Legally we are obligated to read through all of it, but ill be the first to say that I really appreciate it when someone sends in a claim with at least approximate dates, seasons, a name of a duty station, or highlights relevant pages of their STR or Capri notes if they have  them. Sure we get that stuff, too, but if yours is marked and/or highlighted, so much the better. I still read stuff but that other info definitely gives me a place to frame it within the context of the original documents so I can mark it there, too. 

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