11 exams in 45 minutes

[GoNavy1775]

Optum Serve performed 11 exams in 45 minutes.  I am going to attach them here.  I am using a lawyer to help with this, but they told me that the only positive exam was for my knees....After reading through it, there are several questions I don't even recall being asked, yet they clicked no on the answer, for example, see attached.  how can I have no flare-ups, but report functional loss or impairment for repeated use?  She never asked that question. Of course I have flare-ups.

If anybody is bored tonight, read through these pages and give me a your thoughts.  If I need to rebut these exams, I need to do it before they make a decision.

By the way, while it's a small amount, I am a monthly contributor to keep this site going. 

I'm at 60% now for the following:

 

10%

tinnitus

Service-connected disability? Yes

Effective date: 01/01/2022

30%

chronic cervical strain

Service-connected disability? Yes

Effective date: 05/29/2019

10%

residuals of a hernia repair

Service-connected disability? Yes

Effective date: 05/18/2002

0%

allergic rhinitis

Service-connected disability? Yes

Effective date: 05/18/2002

30%

asthma

Service-connected disability? Yes

Effective date: 05/18/2002

radiculopathy left upper extremity

Service-connected disability? No

radiculopathy right upper extremity

Service-connected disability? No

bilateral hearing loss

Service-connected disability? No

 

It's funny they denied hearing loss, but they said I have moderate to severe loss in one ear and severe in the other, and they gave me hearing aids.  SMH.

 

 

combinded exams.pdf

[Lemuel]

4 hours ago, GoNavy1775 said:

Optum Serve performed 11 exams in 45 minutes.  I am going to attach them here.  I am using a lawyer to help with this, but they told me that the only positive exam was for my knees....After reading through it, there are several questions I don't even recall being asked, yet they clicked no on the answer, for example, see attached.  how can I have no flare-ups, but report functional loss or impairment for repeated use?  She never asked that question. Of course I have flare-ups.

If anybody is bored tonight, read through these pages and give me a your thoughts.  If I need to rebut these exams, I need to do it before they make a decision.

By the way, while it's a small amount, I am a monthly contributor to keep this site going. 

I'm at 60% now for the following:

 

10%

tinnitus

Service-connected disability? Yes

Effective date: 01/01/2022

30%

chronic cervical strain

Service-connected disability? Yes

Effective date: 05/29/2019

10%

residuals of a hernia repair

Service-connected disability? Yes

Effective date: 05/18/2002

0%

allergic rhinitis

Service-connected disability? Yes

Effective date: 05/18/2002

30%

asthma

Service-connected disability? Yes

Effective date: 05/18/2002

radiculopathy left upper extremity

Service-connected disability? No

radiculopathy right upper extremity

Service-connected disability? No

bilateral hearing loss

Service-connected disability? No

 

It's funny they denied hearing loss, but they said I have moderate to severe loss in one ear and severe in the other, and they gave me hearing aids.  SMH.

 

 

combinded exams.pdf 1.1 MB · 3 downloads

I have a 20% rating for hearing under a CAVC decision that would not let the VA take away the rating based upon a revision of the regulations because hearing aids had improved.  I think I barely met the 5 year rule at the time although it was not part of the requirement to keep my rating.

[Lemuel]

I am at the BVA in remand from the CAVC.  One of the issues is my previous remand by the BVA to AOJ on the tinnitus rating was not looked at (for extra-schedular rating change) because of the limitations of jobs you can get because of safety considerations.  I was denied a Navy operators license for a forklift in 1965.  So the safety concerns is in my record.  You cannot even was dishes with a dishwasher being unable to hear the beeps because of tinnitus.

[broncovet]

The obvious advice is to appeal all the ratings.   You can allege an inadequate exam, alleging they could not have done a thorough job in 45 minutes.  However, be sure to address the reasons and bases for denial.  Dont make it an attack on the examiner, make it an appeal, on the bases that the "reasons for denial" were inapplicable/incorrect.  Example: (Dont use my example)

"While the Nov.4, 2023 VARO decision (cite the decison) denied tinnitus stating that "no evidence of tinnitus could be found", in an exam by Audiologist Cooper, on Jan, 2019, it was noted the exam could not be completed correctly because of ringing in the ears (tinnitus)."  This Jan. 2019 exam directly refutes the VARO decision claim that no evidence can be found.

 

[GoNavy1775]

On 2/2/2024 at 8:33 PM, GoNavy1775 said:

Does anybody have a contact in the Wilmington, NC area that I can go to with these exams for a 2nd opinion?  I really can't believe she said there is no connection to sleep apnea, the va did a test and gave me a cpap...the guy in the va told me all signs point to my service connected issues as to why I have it. These companies get $100M contracts and then deny deny deny all they can to keep winning contracts. 

 

 

I received the results. Only a 10% increase from 60% to 70% for left and right knee, all other claims were denied.  
 

I need a good appeals lawyer.  Anybody know any?

[pacmanx1]

5 hours ago, GoNavy1775 said:

Does anybody have a contact in the Wilmington, NC area that I can go to with these exams for a 2nd opinion?

Your claim your call but veterans do not need an attorney until his/her appeal goes to the CAVC (Court of Appeal for Veterans Claim). You could possibly win your own claims at the BVA. If not, you would have about 120 days to file an appeal to the CAVC.  The EAJA will pay for your case if you appeal to the CAVC, but you will have to pay if you hire an attorney at the BVA level. Either way you will have to sign a fee agreement. In this day and age of technology, you do not have to get a local attorney.

A Federal law called the Equal Access to Justice Act (EAJA) permits an appellant, in some instances, to ask the government to pay his or her attorney fees and expenses. You will be awarded attorney fees only if you are represented by an attorney and if you "prevail" in your claim. Your attorney is responsible for filing the EAJA claim with the Court. An EAJA award does NOT reduce or otherwise affect the money that you might receive from VA. This money is NOT part of your VA benefits, nor is it intended to be compensation for you. It represents payment to the attorney for the work that he or she did on your appeal. In addition, a pro se appellant who prevails may sometimes receive an EAJA award for certain expenses such as photocopying and mailing.

Common Errors in VA Decisions That Veterans Can Appeal | Nolo

US Court of Appeals for Veterans Claims - Finding a Representative (cavc.gov)

Edited March 28 by pacmanx1

[Lemuel]

6 hours ago, GoNavy1775 said:

I received the results. Only a 10% increase from 60% to 70% for left and right knee, all other claims were denied.  
 

I need a good appeals lawyer.  Anybody know any?

I agree with Pacman with the following stipulation.  You need to make sure the facts of record are pointed out in writing to the BVA.  The BVA is the only factfinder.  In the instance by Bronco.  By putting your facts in writing from your medical records to the BVA then the BVA has to find something to counter your references to the record instead of just accepting and copying the facts from the rating decision.

The attorneys do not do the work needed in going through the record to often.  That was true of every attorney I have had so far.  I made it easy for CCK because they have my previous brief and motions to work from.  There may be issues, that because of the law, they will not be able to bring up.  You cannot challenge a medical report without another medical report.

So you are right to seek an independent medical examiner.  The adds online to help you usually just make you do all the work of going through the record and unless you have medical training, you will not have the knowledge to compare medical reports and find the contradicting reports like the one Bronco found for his tinnitus.

There is a new CAFC case, Thomas v. McDonough 2022-1504 that will open up challenges of EED.  And another case on PCAFC that opens challenges of VA medical reports up also.  But you need to get the facts decided at the BVA to get there with either precedent with attorneys.

If your medical file is less that 500 pages, an attorney may do O K with it.  But you need to get all the duplications out of your C&P file and all of the things that have nothing to do with compensation in order to get the clerks that work for attorneys and the attorneys who are clerks that work for the judges to pay attention to your brief.

Your brief can be informal to the BVA, as in a letter and ask for a Legacy Appeal hearing so the judge can question you on your documentation.  Best to provide the BVA a copy of your favorable documents.  The Rating Decisions usually do not reference specific documents.  Rather the reference the record as a whole which they are supposed to have reviewed as a whole but they take short cuts to please their supervisor and make statements like the one Bronco noted that are flat out false when you look at the actual record.

If you want a good firm, CCK is one of the best.  They are working on SMS-T paid as R2.  So my case was easy for them to take.  If you want a good attorney that will go all the way with you to the CAVC and CAFC then you need to write a good letter to them with cited copies of documents or an independent medical evaluation if needed.

Also look at the winners of CAFC cases for the best because they are admitted to the bar all the way up to the 2nd highest court in the land.

Sorry for the length.  Sometimes I get carried away and do not go through it to make it shorter and more succinct.