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Showing posts with label bay pines. Show all posts
Showing posts with label bay pines. Show all posts

Thursday, October 30, 2014

Once you receive a disability, don't let the VA Medical Center reopen the case.



After a 10 year ordeal,  I was given a disability rating  by the CW Bill Young Veterans Affairs Regional Office (VARO) about 10 months ago. The was after two Board of Veteran Appeals (BVA) hearings, four remands and a Decision Review Officer (DRO) Hearing. 

During the claims period I probably wrote more than 1000 pages of documentation, got 12 letters from board certified physicians and also filed several Disability Benefits Questionnaires. The BVA's Veteran Law Judge described my testimony as a highly credible. Even went through the Social Security disability process at the BVA's recommendation  and prevailed there, too.

Finally got the disability rating I deserved, Oh, what a relief it is!

The lifestyle of my spouse and I greatly improved in the past 10 months. We have been able to do lot more for out three children. Have been helping one of my son's start a salt water aquarium business. 

Thought the disability ordeal was over, but found out on my last appointment at Bay Pines that it was not. The old head of the department had transferred to another location and I was given an appointment with a new specialist.

The appointment was peculiar and conducted more like a compensation and pension (C&P) exam.  Had to provide a lot of background information that was in my claim file (c-file) to the doctor. My wife has a great memory for dates so we were able to provide the doctor a history of my medical conditions including dates. The appointment broke down when the physician wanted an additional MRI scan, another diagnostic blood test and another procedure, all of which had already been completed.

Had i agreed to the tests, it would probably have reopened the claim. Since my disabilities are permanent and total, I viewed additional testing as a fool's errand. Told the doctor he was trying to "reinvent the wheel." Said that wheel was already rolling. The appointment started to "go south" down at that point.

The physician had an epiphany and realized his patient was not a fool and then asked me what my last occupation was. Told him IT and intelligence while i was in the Air Force. At this point we had been in the office nearly 1.5 hours and he wanted to move on to another patient.

Game over! 

After the appointment, checked my medication list on MyHealthEVet. Two of my meds were gone, and one was life essential. It appeared the physicians was being vindictive and had canceled the medications. The next day I checked my medication history and found that the physician had actually deleted four of my medications.

I called CW Bill Young Patient Advocates office the next day and reported the bizarre appointment and the deletion of my meds, one of which is life sustaining. I was refereed to the Assistant Direct of Medical something, by a woman named Danielle. She said she would  file a report to the head of the department in question.

The day after the appointment,I was able get the physician’s progress notes of the meeting. Found a lot of things in the progress notes that were peculiar. Called Danielle again and told her about the four meds that had been deleted and some of the concerns in the progress notes. Danielle said she would add this info to the report that going to the head of the department. Danielle seemed to irritated during the second call.

Was getting ready to fire off a a complaint via the IRIS Inquiry system when the acting head of the clinic called. She was far more polished than the other physician and indicated doctors have their different styles and that my meds really weren’t deleted, the pharmacy  just hadn't "released" the medications yet. One of my meds is refrigerated and my spouse returned a call to the pharmacy about the meds today. The pharmacy indicated that many of my meds, indeed.  had been deleted.

So I opted out of care from that CW Bill Young clinic today. This is not an option that everyone has. Fortunately I have a alternative source for pharmacy meds so i don't need the annual clinic visit to recertify those particular meds.

I still have a primary care doctor at the Palm Harbor Outpatient clinic so I can get most generic meds reauthorized there.

For some vets who have specialists and a primary care provider, you will need an annual visit to both the specialist clinic and the primary care clinic to keep you medicine  current, 

If you are a vet, don't let a VA primary care physician, specialist or clinician talk you into tests that reinvent the wheel once you have been awarded a disability. This could result in you disability being downgraded or taken away altogether. Just politely say 'no."

According the the CW Bill Young VARO senior counselor, it was unlikely that the VA would ever try to change my disability. My disability has been rated permanent and total. Have no interest in enabling a redo nor should you.

Sometimes you just have to say, "No." 


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Thursday, July 18, 2013

Starting a VA Disability claim: To be Pro Se or not to be

When you get ready to file a claim for disability, you have many options.

Many people go to the Veterans Administration (VA) and get a representative called a national service officer (NSO) to handle the claim for them. This would be organizations like the Disabled American Veterans (DAV), or the AMVETS. If you are going his route, the DAV is trained by the VA and has access to some of the VA databases. You have to give the a specific power of attorney (POA) to one of the service organizations.

You can also represent yourself. This is called Pro Se. There are advantages of being Pro Se. Besides having better control of the claim, any veteran proceeding Pro Se gets extra leeway in making his benefits case. Pro Se Veterans' Filings Must Be 'Read Liberally'
See http://blogs.findlaw.com/federal_circuit/2013/01/pro-se-veterans-filings-must-be-read-liberally.html

The bad news is as Pro Se you must educate yourself on the claims process and different strategies you can use. I recommend you start by reading two books: Claim Denied by John Roche and Veteran Administration Claims: What you Need to Know to be Successful by AskNod, The latter book should be used with the AskNod blog: http://asknod.wordpress.com/

I would read the Roche book first because it provides a more general review of the claims process. It also covers a lot of other VA programs you may have little interest in.

The AskNod book is specifically devoted to Disability Claims. You can also submit specific questions to the blog author.

You can file a claim using the old fashioned VA Form 21-526 . There is also an online version called the VONAPP  see http://vabenefits.vba.va.gov/vonapp/main.asp.

The best way to file is a Disability Benefit Questionnaire (DBQ) that is signed by your doctor. The DBQ is in Acrobat format and can be completed online and filed in the VARO's Veteran Center. You can mail it to the VARO by certified mail with a return receipt.

You must write in a nexus staments that connect your medical condition to your armed forces service, Typically you might see a statement like "Mr; Jones medical condition is more likely than not related to his hospitalization in Baghdad, Iraq in 2004 for a leg wound.

The Asknod book will take you through the initial claim, organizing the claim and documenting it. It also address the Decision Review Officer Review. It is the only book that I have reviewed that addresses appeals to the Board of Veteran Appeals (BVA) and the US Court of Veteran Claims (USCAVC) in a comprehensive manner.

The AskNod book discuses filling of Notice of Disagreement, tricks VAROs use to deny the claim , the importance of the BVA Waiver of VARO review, why the the veteran usually gets the higher of disability ratings, Fenderson or staged ratings, and why you need s special statement in claims for Individual Unemployability. It also discusses how vets can get their effective dates for claims pushed back.

AskNod also suggests bringing in an attorney after a denial if you have a well-documented claim at the VARO level. This is where the POA become important.You can not bring in an attorney until the claim has been certified for an appeal to the BVA.

This is another reason why you may want to file the claim Pro Se, Otherwise you will have to rescind POA from the service organization before you can give the POA to an attorney,

AskNod has noted taht the vets are getting smarter and appealing. A BVA appeal can take 3- 5 years. If there are nay open issues, the appeal will be remanded. AskNod also suggests bringing in an attorney to get the claim resolved at the VARO level.

By law, the attorney can take 20 per cent of the claim. This can be expensive but it can avoid extending the claim for years.

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