Optum Serve, has anyone used them?

[Riplip]

Well i've been waiting for the review of my second C&P for a supplemental claim that started February last year. They denied and I added a IMO from my DR. they sent me to another C&P but it wasn't one I needed to attend. That was for LHI. I've been hoping id have my answer soon. I just received an email from Optum Serve (Formerly LHI) and they will be calling me for another C&P exam. I can't even think of what they need to exam now. Guess I can't hope for an answer soon now. WTF. The system is so terrible I don't get it. So frustrated right now. Hope everyone is have a good New Year so far.

[Sgt. Wilky]

To me, these are the easiest to include on the (almost) inevitable NOD. State in detail your observations and frustrations. If you have private medical insurance (which I know a lot of vets don't) or can get a private medical opinion with a doctor that specializes in the field of your claimed injury or issue, ALWAYS submit their records in your NOD.

Almost every single C&P exam I've had, it was a NP who was paid (I promise to Almighty God) by the VBA to insult and deny my claim. I've had almost every single claim overturned on the basis that my *insert doctor or specialist's names here* render a simple or at times extensive report and opinion. NP's are the lowest on the totem pole of doctors allowed to render an opinion, and I'm glad (in part) the VA uses them because it's easy to trump an NP with a medical doctor or specialist.

Are they truly doctor shopping, or is there a truly obvious reason why they're doing this to you?

Semper Fi,

Sgt. Wilky

[Whodat]

Doctor shopping of course.

I just don't understand why VA is allowed to order more exams. Hold the original examiner feet to the fire. 

Who is allowing the raters feet to the fire?  The question is why did you order another exam? How much money does or will it cost for a new exam?

But it's all in the budget. VA has already paid LHI, QTC, etc. So now if I don't like LHI results, I will send a DTA error to the vet, and contact a different company to schedule a c&p exam.  Right?

[Whodat]

This is a great discussion. This bs has been going on for years. Ask Mr Cue.

We are all vets and are very good at problem solving. We all have identified the problems. We can't change VA regs and laws  and we definitely cannot change stupidity. But we can do research on this multiple unnecessary c&p exams by reading, researching.  There has to be a way to stop the madness. We need to share our experiences.

I am working on a project right now. It's worth a try.

[Sgt. Wilky]

4 hours ago, Riplip said:

Thats the funny thing SGT. Wilky. After the first exam denied I did get a IMO from my private doctor that has been seeing me for years. He has a lot more info on me an is a highly regarded Dr. in my area. Now they are trying to have a NP over rule? Super lame. All it does is prolong everything

Yes, all it does it prolong everything. I'm sorry the VA is doing this to you. I don't know what to do, but I would appeal to the BVA and again, state in short, but detailed comments that the VA has doctor shopped this and your IMO from your PCP has been ignored. That right there is a violation of the "benefit of the doubt" rule and several others.

It doesn't help YOU, but in my case, I spent 12 years fighting through the system, and in 2015 when I FINALLY got to see the VA judge, he actually apologized to me for the wringer I and my family had been put through. The almost six-figure back pay kinda made it worth it though.

Don't give up, keep fighting the fight Brother. Semper Fi.

Sgt. Wilky

[Whodat]

Yes this is what I am talking about. What can we do to overcome the delays? Well file a claim, gets denied. Now choose the 3 lanes. Choose the supplemental if you meet the criteria. If denied what's next? Well VA wants you to do a HLR. Bump that. Waste of time. You can't submit any new evidence. Just an argument. Go straight to BVA in my opinion. Leave HLR alone. Gives them more time to find a DTA error, order another exam or 2, get what they want such as finding a way to break the tie which a tie was supposed to go to the vet. The vet doesn't know that because the vet can not review their c&p exam but VA can. The vet is thinking when they get that letter stating DTA error, the vet thinks that it's in the Vets favor.  Not. That's a tactic to order more exams so there is no tie who wins? Not the vet.

My opinion initial claim. Denied. Supplemental with new evidence. Denied again. Go straight to BVA. 

This might beat unnecessary exams.

 

[Riplip]

Whodat, that is exactly what I plan to do if they deny me with this next exam. Then it'll be a 3 year wait for an answer. Sucks