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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I fired the DAV yesterday

by the Major

Yes, I have had it. Working with the VA Regional Office (VARO) is bad enough, but the Disabled American Veterans (DAV) are  just as bad. What follows in the laundry list of reasons I fired them.

Lets start off by saying something good about the DAV. As service organizations go, it is one of the best, perhaps even the best. It's national service officers are trained by the VA during a two year training period.

The DAV is one of the few organizations that has access to VA claims data. The DAV is automated and networked into part of the VA claims system.That is the good news.

The best the DAV and other service organization can do with service members claims after the second level BVA or DRO review is about 30 per cent success rate. That means less than 1:3 claims are approved by the VA even with DAV or other service organization assistance. The DAV may be satisfied with this percentage, but veterans should not. A thirty percent success rate is hardly impressive.

The DAV seems to be too chummy with the VA. We recently met with  a DAV National Service Officer (NSO) who listened to our complaints about the VA. We strongly hinted we were about to bolt to an attorney, but the NSO suggested attorneys wouldn't have any better luck with the claim. The second time we met him he repeated verbatim the same pabulum we got back from the VA after a congressional inquiry.

The NSO also suggested we were just two retired people who spend all day working on our claim. This was the wrong thing to say to clients, particularly when my spouse works and I am politically active. I spend more time on my FB page and blog than on my VA claim. Perhaps someday that NSO will see this article and get a clue!

The DAV's activities are, for the most part, invisible to the veteran. The DAV rarely advises veterans of actions it takes on their behalf. If you fax or mail a letter to the DAV, you might get a letter back acknowledging the receipt and filing, if you are are lucky. They will also advise you of any hearings with the Decision Review Officer (DRO) or Board of veteran Appeals (BVA). That 's about it.

On well known VA blogger describes service organizations as mail rooms.He makes a good point.   

The NSO's abilities vary widely. There are NSOs and senior NSO's. The senior NSOs are excellent but most of the other NSO's have wide variations in ability. In the case of the St. Petersburg VARO, NSOs rarely last more than a year. In an 11 year period, my spouse estimates we have had a minimum of 30 NSOs. Every 90--120 days, the local DAV changes the NSO for a vet based on his or her Social Security number.

We recently found out that the St.Pete DAV has never been a training facility. This was a cover story for some sort of a management problem in this office for a long time. Of interest, the number two supervisor in the St. Pete DAV had been replaced in the last couple of months. A 17-year senior NSO also resigned.

Not only do the NSOs rarely correspond with vets, it is not common for them to return phone calls either. I can recall perhaps 4 times that the DAV returned a phone call in past 11 years. When my wife thought I was dieing in a hospital, she called 4 times and the St. Pete DAV never returned any of the calls. 

When my wife thought I was dieing in a hospital , she called 4 times and the St. Pete DAV never returned any of the calls. 

In New York, a service officer must have legal training. This is not the case in Florida. The St. Pete DAV has abysmal knowledge of 38USC, BVA and USCAVC rulings.

The DAV has a tough job, my attorney explained, because they listen to sad stories all day long. They function much like social workers.  It is a tough job with relatively low pay, about $48,000 per year.

After the major did a smack-down on the VARO during his last BVA hearing, one of the NSOs suggested at the time he apply for a job there because he was "knew more than anyone" in the DAV office.

Regardless, this would hardly be the kind of job a person with a technical background would want. You need a real people person as an NSO.

In Oct. 20l1 the major suggested the Veterans Benefit Administration (VBA) develop a checklist for veterans who were initiating claims. This was because the new claims process was so haphazard with the local DAV. 

Not long after that the VA developed the Disability Benefits Questionnaires (DBQ) which the major thinks will help more vets develop successful claims. In many respect, the checklist idea was a workaround for vets who are assigned  marginal NSOs.

Most of the NSOs appear to be former non-commissioned officers and some have an attitude toward officers. Others NSO's like to talk about their claims which wastes a vet's time.

The attorney is right. The NOS's are fundamentally social workers. Listening to the laments of vets who have been physically and mentally wounded wears you down over time. It's a tough job.

If fact, it's a job better for an attorney than a social worker. That's why the major fired the DAV. 

An attorney will return phone calls and you can send them email. An attorney will provide an organized presentation to the DRO. BVA or USCAVC something the DAV will not do. An attorney  will also suggest ways you can improve your claim, something that the service organizations rarely do.

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Why the VA sucks

I posted the initial article on the FB page, "The VA is lying."

The VA approves about 15 per cent of its claims overall. If you appeal to the BVA and prevail, about 30 per cent of VA claims make the cut.

If you appeal the BVA ruling to the USCAVC, about 70 per cent of those filings are overturned.. However, only a small percentage of vets who lose a BVA appeal, go to the USCAVC.

About 15 per cent of VA are fraudulent. This means when the dust clears, about 55 per cent of vets just give up. Perhaps the claim is poorly written or lacks appropriate medical documentation. Most vets just tire of the run-around.

If the VA makes an award, the award comes out of the local VA claims office's (VARO) hide. This is really a conflict of interest and may explain why the VA is so stingy.

About 40-45 percent of claims from Iraq and Afghan vets are being approved. Not bad.

However, if you are Vietnam era vet, it's about 2-4 per cent.

Is this a dual standard for vets? You betcha!

Essentially if 100 vets were to file claims, about 20 would be approved at the the VA Regional Office (VARO) level. If you are an Iraq and Afghan vet, a Purple Heart recipient, paralyzed or paraplegic, your odds improve. 

If you appeal to the Decision Review Officer (DRO) or the Board of Veteran Appeals (BVA), another 20 per cent of those appellants get approved. 

Keep in mind the DRO is bound by it VA Manual, M21-1. It does not consider precedent rulings from the United States Court of Appeals for Veterans' Claims (USCAVC) , the 38 CFR that is the VA directive or 38 USC that is public law.

The BVA will consider USCAVC precedent rulings that require a three panel judge, 38CFR and 38 USC. The BVA is legal administrative proceeding. the BVA will also consider the opinions of private practice physicians in letters and Disability Benefit Questionnaires. 

The VARO will gloss over private practice evidence if it conflicts with the Compensation and Pension (C&P) clinicians findings. Keep in mind that many of the C&P examiners are nurse practitioners and physician assistants. A board certified physician will hold more weight in front of the BVA. 

Make sure your key physicians have conducted record reviews of you military service records. This is important to the BVA.

However, the DRO or BVA base is smaller. Let's says that 50 of the 80 claimants who were rejected appeal. Only 10 would prevail at the DRO or BVA. At this point about 30 per cent of the claims have been approved. However, the BVA may only approve one of your 4 claims and remand the other three back to the VARO for development.

You are now playing remand ping pong with the your other three claims. 

We now have 40 claimants left who didn't make the cut at the DRO or BVA. These appellants can apeal to the USCAVC. If 10 appeal, about seven will prevail. 

These examples are hypothetical and based on limited data the VA has provided on claims. Much of this information was harvested from congressional testimony.

Of the 33 remaining claimants. about half (15) are fraudulent. If you file a fraudulent claim, you will most likely receive a quick reject. You can also be prosecuted.

It behooves the vet to appeal if he/she have a well grounded claim. The writer recently discovered he was very fortunate to prevail in front of the BVA without an attorney. Generally, once you get into appeals, you should probably hire an attorney. 

Refine your claim based on the attorney's advice and bring in new substantial evidence at the DRO and BVA levels, 

Once you appeal to the USCAVC, the claim is locked. You cannot introduce new evidence.

What do these statistics suggest. Appeal, young person, appeal!

Your odds of winning are highest at the USCAVC level, but you better have a solid claim. You cannot introduce new evidence once the BVA hearing is over. 

graphics: courtesy of AskNod blog.

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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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Filing Veterans Administration claims data

The Major found out that the VA actually has two Freedom of Information Act (FOIA) offices. 

At Bay Pines there is the main FOIA office where veteran's can get copies of C&P progress notes from physicals and also from your VA physicians.

There is also a Privacy Office in the VA Regional Office (VARO) that has a similar information function.

Doctor's enter data directly into the Computerized Patient Record System (CPRS). However, some data has to be scanned into the system using Vista Imaging,

For example, if a Veteran submits a Disability Benefit Questionnaire from to his primary care or VA specialist,  The doctor would manually fill in the form an his/her nurse would take the form to the Veterans Administration Medical Center FOIA office. The FOIA office would then have the document scanned into CPRS.

Most veterans take  medical calims to their Veteran representative. The Major uses The Disabled American Veteran (DAV) and has worked with an assortment of DAV National Service Officers (NSO).

In general, claims are submitted to the VA representative. The Major has submitted medical documentation related to the claims to the Veteran's Center. The VA Regional Office (VARO) rep there will copy your document and stamp it.

Data submitted to the VA rep or the Veterans Center will go into the veteran's claim file (c-file). Data submitted to the VAMC FOIA office goes into CPRS.

Rightardia's advice is that if you have important medical documentation, take it both the FOIO office and the Veterans Center. If you want you VA doctors to be able to see the documentation, take it to the VAMC FOIO office so the document can be scanned into CPRS.

The Major does not give documentation other than the initial claim to the DAV NSO because he knows the typical NSO handles the claims for 300 veterans.

It's better to file the documentation in the Veterans Center which will take the administrative burden off of the NSO. In addition, the Veterans center will return a copy of any documentation you provide it with a date stamp.

In summary, take important claim documentation to both the VAMC FOIA office and the VARO Veterans Center. The FOIO office will scan your document and have it entered into CPRS which doctors and clinicians in the hospital use.

Any data submitted to the Veterans Center will go into the Veterans c-file.

The Major recommends that key documents be entered into both CPRS and the c-file.

http://benefits.va.gov/TRANSFORMATION/dbqs/ListByDBQFormName.asp

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