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    SC MS; Disagree with Rating. What is next step?

    Was granted a 30% SC disability for MS. However, the C&P exam used the incorrect DBQ. They used the DBQ for CNS and not the one for MS. As a result, when the NP checked the box for bladder urgency or right leg atrophy, the CNS DBQ stopped there. With the MS DBQ, it would state "as a result of MS".

    At the exam, the NP checked bladder urgency, right leg weakness, atrophy, gait, permanent numbness, cognative issues to name a few.

    What do you think is the next step? A NOD? My Service officer at the DAV filed an intent to file a claim. He said this is probably the best way to go about this.

    My civilian Neurologist as well as the VSO both agree that 30% is too low.

    Wanting to get opinions on the next step.

    Thanks

    #2
    Irritated! Highly Aggravated!! Completely Furious!!!

    Sorry, but this really irks me to no end. I cannot stand the VA messing over veterans out of sheer incompetence. Many VSOs are no better!!! Did you go with the first VSO you met with??? Something tells me your VSO is incorrect. I would want a second opinion on the "Intent to File" versus a NOD. If your VSO is clueless, interview other VSOs until you find one you are more comfortable with. The "intent to file" is new to me, but it would seem you want to file a Notice of Disagreement (NOD) as located here: http://explore.va.gov/file-disagreement

    Personally, I filed a NOD and that was all that was needed to substantially improve my claim. How in the world was the wrong DBQ used? There is ABSOLUTELY NO EXCUSE for the C&P examiner to not use the correct form. That in itself is grounds for a NOD. Also, you should have been examined by a neurologist and not a NP. That is yet another reason to file a NOD. If your NOD is denied then find out the VARO director and email them. If that fails then email VA Secretary Robert McDonald. I would avoid my Senator unless you get nowhere with Secretary McDonald as they often just slow things up.

    Did you have your civilian neurologist complete the DBQ for MS? http://www.vba.va.gov/pubs/forms/VBA-21-0960C-9-ARE.pdf

    Chances are your neurologist isn't going to want to spend 45 minutes filling out the form. I took a blank DBQ and one that I filled out as much as possible myself. My neurologist took the one mostly filled out and added her information. Keep in mind, that if you lose your appeal(s) you can still request a ratings review and increase. The DBQ your private neurologist fills out can also help with this endeavor. Even though I submitted my DBQ with my claim, I also took a copy to my C&P exam. The C&P examiner copied quite a bit directly off my signed DBQ. It made their job "easier" and you know most of them want the easy way out. Besides, my Board Certified Neurologist has treated me for years and the examiner just met me.

    Never give up, never give in.

    Comment


      #3
      Thx. One more info

      Thanks Marco
      I am meeting with the VSO tomorrow. I have 2 weeks before the year is up, so I need to file the NOD this week. When the VSO talked about doing an intent to file, it did not make sense to me since I have already been granted 30%. Did not understand what filing a new claim would accomplish. Maybe he thought it would be quicker. Will find out tomorrow.

      As for them using the wrong DBQ at the C&P exam, I have no words. Especially since I was claiming disability for MS. I do not know how they did not use the MS DBQ vs the CNS DBQ, which clearly states all CNS EXCEPT MS among others things.

      What surprised me is that she checked boxes for urinary frequency, numbness, rt leg weakness & atrophy (she even measured and noted on the exam the diff in circumference between rt thigh and left thigh. She noted cognative issues as well.

      What is interesting is that the VA did not follow up with exams for these. I made appts after I was given the SC with my primary VA doc for the urinary issue ( which she has me on Meds for) and with neuropsychology for cog issues. I also made an appt with PT for the leg. All came back with Evals that supported the claims in the C&P exam.
      When I asked my primary VA dr why I am being charged a co pay for the urinary freq Meds, she said it is not a disability assoc with MS.

      In my civilian neurologist records that I have for the past few years, it is clearly noted that I have had issues. Also, he has me on Meds for cognative issues. And he also noted the weakness in my leg and my permanent numbers.

      Crazy
      I think the VA should give me another exam using the correct DBQ with a Neurologist and not a NP.
      Do you think they can do this?

      **Edited by moderator in compliance with guideline #4**

      Comment


        #4
        Originally posted by nc37 View Post

        What is interesting is that the VA did not follow up with exams for these. I made appts after I was given the SC with my primary VA doc for the urinary issue ( which she has me on Meds for) and with neuropsychology for cog issues. I also made an appt with PT for the leg. All came back with Evals that supported the claims in the C&P exam.

        In my civilian neurologist records that I have for the past few years, it is clearly noted that I have had issues. Also, he has me on Meds for cognative issues. And he also noted the weakness in my leg and my permanent numbers.

        I think the VA should give me another exam using the correct DBQ with a Neurologist and not a NP.
        Do you think they can do this?

        **Edited by moderator in compliance with guideline #4**
        Yes, they can order a new C&P, but you need to ask for one. I would include the evaluations from the VHA side of the house with the NOD since they support your claim.

        I would still press your neurologist to fill out the DBQ forms. This is how the VA intended it to work -and- they probably aren't going to read all the medical records. I would file your NOD then work on getting this completed.

        You need to make this as easy as possible for the VA to approve your claim. During your next C&P exam, at minimum, I would hope you have:
        • DBQ filled out by your civilian neuro
        • Civilian medical records with highlights supporting your claim
        • Evaluations from VHA appointments that support your claim



        Why did you wait so long? Again, your VSO seems to be dropping the ball. Your VSO might be a nice person, BUT this is your claim and you need to ensure you receive appropriate levels of service.

        Again, I am so sorry you find yourself in this position. It's unacceptable this happened to you and your VSO should have gotten this stuff corrected by talking to the VA (even without a NOD). Thank you for your service. Never give up! Never give in!

        Comment


          #5
          Thx Marco.. One more item

          Met with the VSO this morning. He has over 20 yrs of experience and has been at DAV offices around the country as a VSO. He is very knowledgeable of the current state of affairs and knows some of the rating officers that sit on the floor above where the office is. I guess is is the regional office.

          Anyway, we discussed my case at length. He highly recommends that we go forward with a new C&P exam since the original was clearly incorrect. It also noted my secondary issues on the exam, but did not refer to "as a result of MS" as I had stated previously. He said that following this path would result in a much quicker decision since I will get a new exam in less than 9 months, according to the latest stats.

          If I go ahead with the NOD, it will take 2 years minimum before anyone even looks at it, at which point they could deny or ask for more and more ifo, which could take years and years. He said that filing the Intent to File, will require the VA to give me another C&P exam. He told me some things to have ready for the exam, like having the DBQ filled out by my civilian neurologist (as you had stated). Since I have been getting seen at the VA for my secondary issues which I am claiming, the VA already has a record of these. I also have the records from my civilian Dr. that I will send a copy to the VA which occured after the last time I filed 1 1/2 years ago.

          So, in summary, I went with his recommendation to proceed on this path. I still have a few weeks to change my mind in case something else comes up.

          Thoughts? You seem to know your way around the VA and MS. Based on his logic, I think this might be the best approach.

          ** Moderator's note - Post broken into paragraphs for easier reading. Many people with MS have visual difficulties that prevent them from reading large blocks of print. **

          Comment


            #6
            Many things have changed with the VA and I hope your VSO knows what they are talking about.


            Is there a reason you cannot file both a NOD and a new claim? This is an important question because you want to maintain your effective date of 18 months ago. I am not exactly sure how the VA will treat your new claim, but you want your earlier effective date to ensure you properly get back pay. I would start this claim immediately to try and maintain the earliest effective date possible.


            Don't assume the VA has record of anything. Often the claims people do not have access to your medical records and vice versa. You must submit the information and somehow highlight or summarize it for them. Unlike your VSO, do not assume anything.


            The easiest way to get this accomplished is to go to https://www.myhealth.va.gov and download your records via the "Blue Button." You may need an upgraded My HealtheVet Account to use the Blue Button and that requires additional authentication. The instructions can be found here: https://www.myhealthevet.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_nfto=false&_pageLabel =newsHome&contentPage=ipa/ipa_instructions-anonymous.html


            Once you download your VA medical records review them and highlight important things. I went a step further and made a cover sheet with all the pertinent findings and what page they were on. Again, you want to make this as easy as possible for the VA examiners. A summary might look like this:


            Page 23 | Treatment of Optic Neuritis
            Dr. Jane Doe attributed the optic neuritis to MS. I am claiming this as a secondary condition for MS.
            Page 73 | Treatment for Pain
            Dr. Sam Jones diagnosed my pain as neuropathy secondary to MS. I am claiming this as a secondary condition for MS.


            It seems like you have already been worked over by the VSO and the VA so get busy. No one cares more about your claim than you do. Put yourself in their position. They have a stack of claims to work and they don't want to search through 100s of pages of records to find an important sentence or two. Assemble the information, organize it, summarize it, highlight it and then spoon feed it to them. Fortunately, you are already service connected so now you just want to emphasize the degree of your disability.

            I hope this help ....

            Comment


              #7
              Originally posted by Marco View Post
              Many things have changed with the VA and I hope your VSO knows what they are talking about.


              Is there a reason you cannot file both a NOD and a new claim? This is an important question because you want to maintain your effective date of 18 months ago. I am not exactly sure how the VA will treat your new claim, but you want your earlier effective date to ensure you properly get back pay. I would start this claim immediately to try and maintain the earliest effective date possible.


              Don't assume the VA has record of anything. Often the claims people do not have access to your medical records and vice versa. You must submit the information and somehow highlight or summarize it for them. Unlike your VSO, do not assume anything.


              The easiest way to get this accomplished is to go to https://www.myhealth.va.gov and download your records via the "Blue Button." You may need an upgraded My HealtheVet Account to use the Blue Button and that requires additional authentication. The instructions can be found here: https://www.myhealthevet.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_nfto=false&_pageLabel =newsHome&contentPage=ipa/ipa_instructions-anonymous.html


              Once you download your VA medical records review them and highlight important things. I went a step further and made a cover sheet with all the pertinent findings and what page they were on. Again, you want to make this as easy as possible for the VA examiners. A summary might look like this:


              Page 23 | Treatment of Optic Neuritis
              Dr. Jane Doe attributed the optic neuritis to MS. I am claiming this as a secondary condition for MS.
              Page 73 | Treatment for Pain
              Dr. Sam Jones diagnosed my pain as neuropathy secondary to MS. I am claiming this as a secondary condition for MS.


              It seems like you have already been worked over by the VSO and the VA so get busy. No one cares more about your claim than you do. Put yourself in their position. They have a stack of claims to work and they don't want to search through 100s of pages of records to find an important sentence or two. Assemble the information, organize it, summarize it, highlight it and then spoon feed it to them. Fortunately, you are already service connected so now you just want to emphasize the degree of your disability.

              I hope this help ....
              Marco,
              Thx for the tips. I have been downloading my records from MHV since last spring when I got my SC rating. Highlighting the VA appts for the secondary conditions is excatly what I was doing along with the records from my civ Neurologist.

              Since My VSO and I already submitted for a new C&P exam, do you think it will cause an issue if I file the NOD as well? Was not sure, from a paperwork standpoint, if they saw both that it would cause confusion..

              As I previously stated, the basis for a new C&P exam is that the VA used the wrong DBQ and missed highlighting the other conditions as a result of MS. At which point, they should have scheduled appts to address at the VA. It just so happens, that I took this upon my self to start that, which are in my records. Also, after almost a year of going back and forth with my primary Dr at the VA and different prescriptions for bladder issues, they finally set me up with a Urologist at the VA hospital. To be fair to them, I believe there is only 1 urologist at the VA hospital and it takes a while to be seen. Either way, I have an appt and it will be documented with the issues, etc.
              The other coditions of permanent numbness, leg weakness, fatigue, and cog issues are also documented with my civ neurologist and VA medical personnel, so I will pull those from the records and attach to any future paperwork.

              The real question is whether I should go ahead and file an NOD even though we already sent in the paperwork for a new claim. Just worried that it will create a lot of confusion at the VA. Maybe I am being too pesimitic and should give them more credit.

              I still have a week or so to file. I have done the work, so it is a matter of going back downtown and visitiing with the VSO and mailing.

              I agree with you on the effective date issue. By filing an NOD, the effective date remains. Getting a new exam does no gaurantee, but the VSO is highly confident that they will back date since they were in error by giving the wrong exam and not taking into account the other conditions that were noted, but not attributed to MS by the NP giving the exam. Plus the follow on appts and documentation from the VA as well as my civ Neurologist make for a solid case. And, by rehgs, the RO should look favorably upon the veteran in these cases.

              Thoughts?

              Thanks for your help Marco! You are a wealth of info! If I were in San Antonio again, I would buy you lunch! I went to some training at Brooks AFB in the mid 90s for school. Nice area..

              Comment


                #8
                More info

                In addition to the reply I made a few minutes ago, Marco. Here is some info I forgot to post.

                From the original Decision from the VA.

                "An evaluation of 30percent is assigned from July 28, 2013.

                We have assigned a 30% evaluation for your Multiple Sclerosis based on:
                - Miniumum evaluation assigned for ascertainable residuals.

                Higher evaluations are based on more severe residuals.

                This is the highest schedular evaluation allowed under the law for multiple sclerosis."

                Now: I did not receive this document from the VA, I received from my VSO, who printed from his system. Not sure why.

                So, another question: I read where I can file a FOIA form to receive all documentation from the VA. I already have all of the medical stuff. Is there typically more info that comes along with the decision from the VA and the Rating Officer?

                Thanks!

                Comment


                  #9
                  I would do all these things through your VSO, so they are not blind-sided.

                  1. Based on what you have said, I would write a letter to the VA stating your VSO has advised you to file an "Intent to File" instead of a "Notice of Disagreement." That you are following the advice of your VSO. That your two goals are to receive a fair ruling on your original claim while maintaining your original effective date. This should provide you some cover should you eventually need the Board of Veteran Appeals.


                  2. Have your VSO inform the VA that you have never received your rating letter and request it. Again, seems like your VSO is dropping the balll.


                  3. Did the VSO print you out the entire decision or just the small blurb? A FOIA might give you some additional information, but the entire basis for their decision should be in your award letter.
                  The VA provided me more information than I needed in their rating decision.


                  4. Prior to your new C&P we need to go over a few things so please remind me ...


                  No need to thank me, just kick some VA rump and that will be satisfaction enough. It sounds like you are doing all the right things. Never give in! Never give up!

                  Comment


                    #10
                    MArco

                    My rating decision from my VSO was two pages.

                    Decision:Service connection for MS is granted with an evaluation of 30%, effective 28 July 2013.

                    Evidence:
                    *VA 21-526EZ, Fully Developed Claim
                    *Exam Request

                    Reason for Decision:
                    Service Connection for multiple Sclerosis.
                    Service connection may be granted for specific diseases or conditions which are resumed to have been caused by service if manifested to a compensable degree following military discharge. Although not shown in service, service connection for multiple sclerosis has been granted on the basis of presumption.
                    We have assigned a 30% evaluation for your multiple sclerosis based on:
                    *minimum evaluation assigned for ascertainable residuals.
                    Higher evaluations are based on more severe residuals,
                    This is the highest schedular evaluation allowed under the law for multiple sclerois.

                    References:
                    Title 38 of the CFR, etc, etc..

                    That was the rating letter I received. Does that look like it has enough info in it?

                    Also - Getting back to the NOD. I filled out and am taking to my VSO tomorrow. Since the C&P exam administered the incorrect exam, do you think I should still attach all of the pages from the VA where I was seen for the items I am claiming on my NOD.. IE, leg weakness, cognative, urinary, etc... Since they can see in my records, do you think I should still attach?

                    Thanks!!

                    Comment


                      #11
                      Originally posted by nc37 View Post
                      Also - Getting back to the NOD. I filled out and am taking to my VSO tomorrow. Since the C&P exam administered the incorrect exam, do you think I should still attach all of the pages from the VA where I was seen for the items I am claiming on my NOD.. IE, leg weakness, cognative, urinary, etc... Since they can see in my records, do you think I should still attach?
                      The Benefits team CANNOT see your Health records and vice-versa. Even if they could, you still want to separate out the most important information and highlight it for the raters.

                      It's not just that they conducted the incorrect C&P examination, but you were examined by an unqualified rater.

                      Comment


                        #12
                        New C&P Exam

                        Hi Marco,

                        Got a call from the VA late Friday wanting to set up a new C&P exam. I am giving them a call tomorrow morning with the times that work best for me. Obviously, I am going to get the earliest date that they have.

                        In addition. I had an appt with the Urologist at the VA regarding my bladder issues. He says that I have some serious issues. He wants to see how my medication is doing and for another full eval in two months. If things are not improved,he may move to having me use a cathedar at times when I can not completely empty. This is obviously a big surprise to me and one that I was not prepared for. I am relatively young (in my low 40s) and to hear this news is a little depressing,to say the least.

                        My primary care Phys and the VA also has scheduled another appt for a check up and to do a physical with labs, etc..

                        lastly, my VSO said that this was the best approach and it looks like he was correct. Within a month, I got a call for another exam. An NOD may have taken years. The date of the intent to file was May 25 (which he filed last year) even though we did not submit the form to the VA until late Feb. If I do get a new rating, they will definately go back to May, and the VSO said I could file an appeal if they did not back date to the original effective dat in late 2013.

                        Marco, you wanted me to get back with you when I got a new exam. What advice did you have for me??

                        Thanks for your help Marco!!!

                        Comment


                          #13
                          The VA uses C&P examinations to help determine diagnosis and whether something should be service-connected. The VA also uses C&P examinations to determine degree of disability for rating purposes. Thirty percent is the minimum rating for MS, so if you are currently at 30% you can only improve your rating during this process. Moving from 30% to 50% will more than double your monthly VA disability check.

                          Bring the urologist notes as this should be listed as secondary to MS. You need to have information of all of your secondary conditions and hope the C&P rater will list them as secondary to MS. To get the highest rating that you deserve you need to be prepared for your C&P examination.


                          To do this you need to prepare like a lawyer for a big case. You need to collect as much documentation about your medical condition as possible. Do not expect the C&P examiner to know anything about you, have any relevant medical records or even know much about MS. It's your job to present them with the information they need to rule in your favor. I made a 3-ring binder for my MS C&P and had all of my medical records, a summary of my condition in chronological order, what secondary conditions might apply and the pertinent records for those, etc. I had two copies and let them keep whatever they were interested in. I did not want to burden them with the entire folder, but wanted them to have anything that would help them. You are not trying to overwhelm them with information, just provide relevant information to help them.


                          Familiarize yourself with the DBQ form for Multiple Sclerosis. Besides having specific questions the examiner will most likely use the DBQ to get an overview of your medical condition. The direct link to the MS form is located here: http://www.vba.va.gov/pubs/forms/VBA-21-0960C-9-ARE.pdf. If that doesn't work go to http://www.benefits.va.gov/compensat...BQFormName.asp and select the MS form under the Neurological section (Form# 21-0960C-9). By reviewing the MS form you will have a decent idea of what the examiner may be asking you and what documentation you might need.




                          Make a list of all of your signs and symptoms.
                          You are not a lawyer or doctor so do not try to use big terms. Tell the doctor about your symptoms and your limitations. Estimate the number of days each week or month you have those symptoms and qualify them.

                          For example: At wake up, I have vertigo 5 days/week. The vertigo episodes last normally 2 hours and during that time I am unable to shower, reliably walk and I am a fall risk.


                          This gives the examiner the best picture of what you are dealing with. Do not answer all of the questions in just the present tense. If you have a headache 300 days/year, but do not during the exam don't say, "I do not have a headache." Your answer should sound something more like this, "I have headaches 6 days per week and often times the headaches run 2-3 days at a time. The pain level reaches up to 8 and during this time I am unable to drive, sleep, etc." You are NOT trying to lie. You are trying to paint the most accurate description of your problems. You are NEVER "fine" in a C&P exam or you shouldn't be at the examination.


                          General notes
                          • Be polite to the examiner. This is one time when you want the medical professional to work with you and not against you.
                          • Know what medications you are on and what medications you have been on.
                          • Have a list of any, and all, therapies you have tried (PT/OT/ST, etc).
                          • Be able to give examples of what your life was before and how it has changed after MS.
                          • Example: Before MS, I ran half-marathons, but now I can barely walk 25 feet without falling down. This really depresses me and I feel worthless because I can no longer rung.
                          • Where possible point the examiner back to medical records so they realize your response is part of your record.



                          Consider taking someone with you to keep you on track and answer any questions you may not know the answer to.

                          Let me know if you have questions and I'll do my best to answer them.

                          Comment


                            #14
                            Thanks Marco! I started doing most of what you recommended over the weekend. I have notes in Chrono order with applicable Dr. Notes to support.

                            The one thing I did not get a chance to do, since they scheduled the exam so quickly, was take the MS DBQ to my civilian Neurologist and have them fill out. My next exam with her is next month, and that took a lot of luck since she is usually scheduled out 6 months in advance and my original appt was not until June. Unfortunately, the only slot they had was early next month. Oh well...

                            Having been through this once, I have a much better feel for the exam, exam questions, etc. I feel much more confident since I have all of the documentation from my civilian Dr. as well as all the info from all of the VA Drs.

                            Exam is Thursday Morning. As I prepare, I will write you again if I have any more questions...

                            Thanks Marco!

                            Comment


                              #15
                              Please let us know how the C&P examination went.

                              Comment

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