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      How to get your questions answered. A few observations, and requests of all members. All folks who come here are volunteers who do this on their own time and their own dime.To avoid burning out our best contributors please follow these guidelinesf you are reading a post and it reminds you of a question you want to ask, start a new topic, if you place your question in someone thread it will be difficult to distinguish your question from the original poster, you will get better results posting a new topic with your question. 1. Before Posting please do a search and see if your question has already been answered. If you find the answer print it out and put it in a file to use as a reference file, I find this helpful myself. 2. If you can not find the answer and you do post a question, please print out those answers and refer to them to avoid duplicate questions. 3. Refer to the Frequently Asked Questions4. Duplicate questions will come up from time to time but the keeping them to the minimum will lighten the load on the regular volunteers.5. Respect folks privacy do not request their personal phone numbers for claims help, it is inappropriate and not why they are here.6. Keep the topics focused on veterans issues, in closing Search first Search ... Ask second.it may save a lot of time or at the very least enlighten you.
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    • A bit about Tbird and HadIt.com for those who've asked...

      The following is on my About page, but some have been asking how this all happened. So here is my little story. Tbird US Navy 1983 – 1990 E-6 HadIt.com the website domain registered Jan 20, 1997 the domain is registered and paid for through Jan 21, 2023 at which time I plan to register it for another 15 years Lord willing and the creek don't rise. I guess the best place to start is Jan 1991; I had gotten out of the navy Dec 1990. At my separation seminar, there was a DAV rep Jim Milton he told us to bring our medical records in and he would look through them for us and let us know if we should file a claim with the VA. Well, bless his heart, he opened my medical file, reads the first insert, looks me straight in the eye, and says you will be 50% for the rest of your life and he would file the claim for me. 50% was for surgery I had in the service. True to his word he met with me and talked with me for a long time filled out my paper work and urged me to file for PTSD. I would not file the PTSD claim, nor even discuss it. By Feb 1991 I had moved to the San Francisco bay area and was staying at a friends apartment and pretty much I was just a puddle. In desperation one night I called suicide hot line, I had no job, no idea about going to the VA. They talked with me for a long time and explained to me that I could go to the local VA hospital even if I did not have insurance. Now, I know what you are thinking if I was 50% why didn't I just go to the VA in the first place, two reasons 1, this was Feb 1991 and the 50% didn't come till May and 2, even if it had come through it is unlikely that I would have had the mental acuity at the time to put the two together. I relate this here because it is where so many of our brothers and sisters are coming from, perhaps where you started. Fuzzy and unsure, in pain and sometimes homeless they come to the VA hospital for help. And that is where I ended up. Up to the pysch ward I went, blah, blah, blah, a few days later I was released with a promise of a call from the out patient program, which I would soon be entering. Blah, blah, blah, after many missed communications, and no call backs I was at the Day Hospital everyday M-F. And this brothers and sisters is where I began to learn and formulate my plan for HadIt.com. Veterans, veterans everywhere…I spent a year in the day hospital and about another year at a sheltered workshop before I got back on my feet. So I just talked to veterans everyday waiting for appointments, waiting for prescriptions, waiting for a vet rep and I started to learn the system. While in the navy I was data analyst and had to learn a 5 volume manual and just about anything you were suppose to do was in that manual. So I figured there must be a manual on how to do a VA claim or at the very least regulations. So I found out about the Code of Federal Regulations, United States Code, Veterans Affairs Manuals and so on and so forth. Of course this was 1991/1992 I was living in a tiny studio apartment in a particularly bad neighborhood, working in a sheltered workshop making a nickel per envelope I stuffed throw in PTSD and you will see that it was a difficult task for me to get somewhere where they had copies of these, let alone that they would let me look at. And there was so much knowledge around me, it was like the gold rush in those days, I could just sit on a bench a veteran would sit down next to me a little conversation later I had another nugget, I made copious notes. Phone numbers to call, ask for this guy or that guy he'll give you the straight scoop and they'd slip me a piece of paper with a number on it. You want to read this regulation or that one and another slip of paper into my hand. I spent a lot of time on those benches watching the squirrels they gathered their nuts and I gathered mine :) So I'm thinking I could put a little handbook together print it out and hand it out at the VA. Or perhaps fliers. Still formulating, time goes by, 1994/1995 I am being treated for PTSD regularly and doing and feeling much better and I go to work for a company as a marketing systems analyst and I discover the internet. Well let me tell you that was perhaps one of the most significant life changing events I have ever experienced. And I might add finally a positive one :) It seemed only natural to me that surely there must be a website that contained all the knowledge I wanted, well as it turned out not so much, lots of stuff but I wanted to get straight to the claims information and there was a lot of stuff to wade through to get to it. So taking my lesson from the squirrels earlier I started to gather, gather, gather…and learn HTML and work as a marketing systems analyst and work my claim. 1996/1997 major PTSD cork blows and unemployed. Working my claim, working the website. 20 Jan 1997 register HadIt.com domain name right after getting off the phone with the VA and saying I've had it with this. As fate would have it the old DAV board goes down just as mine opens up and folks start to wander in. So HadIt.com has two main components the website which supports the discussion board with links, articles, research resources etc. The website starts to grow, I can't tell you how many times I had to switch servers for space and features. I continue on a downward trend and in 1998 ended up back home in St Louis living in my sisters basement in therapy and working it, I swear I would have swung a dead chicken around my head at midnight naked if I thought it would have helped. The website continued to do great during this time, I just stayed in the basement bought new software, new books, and learned how to make things work and I continued to use this knowledge to make HadIt.com better. My 100% finally came through from the VA and I had a friend who is an advocate who helped me thru my SSDI claim, he was literally at my side thru the entire process and that came through for me. My therapist and sister continued to try and get me to leave the basement, but to no avail. At some point in 1998 or 1999 I put a counter on the website and was shocked to discover how many visitors we were getting. Time goes by my sister gets married and I move from the basement to the upstairs, there is much celebration that Aunt T is living in the light again. More time goes by and I settle into my life in St Louis and spend more time on the site trying new things, finding more information. 2003 I buy my own home VA loan. For years now I have just considered HadIt.com my job and I get up every morning go to the office and work for several hours, take an afternoon break and see where the rest of day takes me. I have a place in the office to use the computer and a comfortable to place to read journals and articles and take notes. Blah, blah, blah so that is my story and HadIt.com's intertwined.
    • HadIt.com Pass It On Cards

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    • VA Training and Fast Letter Forum Index

      VA Training and Fast Letter Forum Index The following is the index with links to the various Training and Fast Letters plus a few miscellaneous. These letters are not necessarily in the original formatting. I have tried to present them in an easy-to-read form instead of some forms as originally presented. Some of the paragraphs were WAAAAYYY too long. lol - HadIt.com Member fanaticbooks Something to be aware.... Some of these letters may be rescinded, outdated, or otherwise no longer viable. I have still included them because sometimes they provide additional insight or just plain more information than the newest version. Use them wisely. The oldest letters will display at the bottom with the latest letters displayed at the top, all in sequential numbers. Coding of the letters... FL = Fast Letter TL = Training Letter First two numbers = last two digits of year of origin Training Letter http://www.hadit.com/forums/index.php?/topic/40694-va-tl-00-07/ http://www.hadit.com/forums/index.php?/topic/40693-va-tl-00-06/ Fast Letter Number Title http://www.hadit.com/forums/index.php?/topic/44262-va-fl-11-15/ http://www.hadit.com/forums/index.php?/topic/44260-va-fl-11-13/ http://www.hadit.com/forums/index.php?/topic/44261-va-fl-11-11/ http://www.hadit.com/forums/index.php?/topic/44310-va-fl-11-09/ http://www.hadit.com/forums/index.php?/topic/42151-va-fl-11-03/ http://www.hadit.com/forums/index.php?/topic/40957-va-fl-10-49/ http://www.hadit.com/forums/index.php?/topic/40958-va-fl-10-46/ http://www.hadit.com/forums/index.php?/topic/40959-va-fl-10-45/ http://www.hadit.com/forums/index.php?/topic/40960-va-fl-10-42/ http://www.hadit.com/forums/index.php?/topic/40961-va-fl-10-39/ http://www.hadit.com/forums/index.php?/topic/40962-va-fl-10-35/ 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Fighting Bad C & P Exams

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Posted · Report post

Before a veteran files his or her claim for disability, it would be best for them to seek treatment that would establish their medical condition and get a diagnosis. Getting IMOs and IMEs can be quite expensive but having current medical treatment could really help.

A veteran should never let the C & P examiner's medical opinion be the only medical opinion in his or her VAMC treatment records. I agree that IMOs and IMEs are worth the cost but if the veteran can get this from their treating doctors then even if the local VARO denies their claim or low ball their claim, the veteran should win his or her claim on appeal.

Always keep in mind that the local VARO will always force claims to go to BVA. It doesn't matter how much evidence a veteran has in his or her file. If the Rater, DRO, and or Supervisor overlooks or ignores the pertinent evidence then the only thing a veteran can do is file an appeal.

Hope this helps

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8 answers to this question

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Thanks Pete, I hope to someday soon be able to comment in-depth on this subject.

Long before my C&P exam for secondary SC of a number of disabling conditions (OSA, lung & heart damage from bilateral DVT/PE, E.D. and a few others) caused either by pain or medications for my SC lumbar spine, I requested referrals, diagnostic tests, etc. that would prove these conditions. I then discussed these conditions with the appropriate doctors/specialists, and the likelihood of them being secondary. I then put together a collection of medical evidence to support my theories of secondary SC, and drafted the opinion (nexus) letters for each.

When I went back to each doctor, I would do the following: bring up the previous conversation, offer them my SMR/STR and private medical records and all of my evidence,, hand them the letter(s) and ask if they agreed and would do so in writing; and made sure to explain the reason I needed such letters, as well as the importance of the phrasing for as likely as not or 50/50, more likely than not , greater than 50% probability, due to, etc.

Here are my results:

Success rate for getting signed opinion letters: 100%.

Number of opinions that cost more than a regular visit: 0

Of these letters, on all but one, the doctor selected the "more likely than not option". I had letters from my regular private PCP for OSA and ED. I had letters from a sleep specialist/lung specialist for OSA and convulsive tic. I had a letter from the pulmonary specialist that treated my DVT/PE. All of these were "more likely". I got one "at least as likely as not", that was from a lung specialist doctor who is also a medical professor at one of the top medical universities in the world.

I have to give credit to fanaticwife and this site, VBN, and VAWatchdog for a number of vital tips including: 1. Do not tell the receptionist or anyone else that you want a doctor's opinion. Nothing good can come of that. They will head you off at the pass. When they ask what is in the folder or notebook or whatever, just say it is some medical info you want to discuss with the doctor, or better yet, stack it in between two sections of a newspaper. If the doctor doesn't want to sign it, he/she should make that decision, not some desk jockey. 2. Feel the doctor out early on in a visit or two BEFORE you spring your opinion letter on him. If he thinks you're out of your mind, try to find what he thinks could be the cause(s) and look for how that information connects with your case. 3. Be really polite. 4. Have the records he/she is signing that they've examined, and have logical, sensible medical evidence from a recognized source or publication. Make sure you have read it and understand it so you can explain it in 100 words or less. 5. Make up your opinion letter with either check blocks beside the different levels of "due to", or better yet, have a copy with each opinion, and find out which one he/she will sign.

All of this is assuming, of course, that any condition you are trying to get service connection for can actually be realistically, possibly, logically connected directly or secondarily to an active duty injury/illness or the meds or consequences of it. Theories won't work, you need evidence, and the opinion letter needs to be supported by facts..

Now, there are some people who can do good research and write a good letter, and there are those who can't. If you can't, GET SOME HELP. Likewise with getting your presentation skills together before you talk to the doctor. The doctor probably isn't going to sign some off-the-wall crap that reflects poorly on his/her professionalism, good judgment, and general intelligence level. If you're trying to connect diabetes to a stubbed toe, it ain't happening. If you're a nervous wreck, or if you simply don't know what you're talking about, you may have a problem getting anything but a polite brush-off.

I've spouted off all of this, and I'm sure it sounded in-depth about 200 words ago, BUT...

I have great opinion/nexus letters from private doctors. I had a lousy C&P by a pathologically dishonest, hateful shrew of a professional VAMC rectal digital diver, a.k.a. N.P. Cratchitt (not her real name, and you wouldn't want me to spell out what words come to mind when I think of her). I'd bet she was a Marine nurse, and the Marines in her unit would rather sandpaper a wildcat's arse in a barroom toilet stall than fall under her evil gaze.

Most of what she "opined" was after the phrase "to state an opinion would require resorting to mere speculation". Funny, mere speculation must be kinda like a mental laxative for her; after she put that phrase down each time, she didn't have any problem speculating a LOT, to the point her mushy speculating seemed to turn into a cesspool of opinion, of which she offered none in my favor, really.

I am waiting with bated breath to see what happens, how much weight is given to her opinions versus those of actual doctors. Supposedly, if the 800 number folks have it right, my stuff finally is out of Development and in the Decision phase now.

Once I've got the results, I will get more detailed in how my evidence weighed against her speculative opinion spewings.

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Posted · Report post

You gave some really good advise here-this s different than what I posted as to Getting an IMO in the IMO forum but that advise was geared to those who need a paid expert opinion. Maybe all this should also be put into our IMO forum.

Great stuff.THANKS!

“Most of what she "opined" was after the phrase "to state an opinion would require resorting to mere speculation". Funny, mere speculation must be kinda like a mental laxative for her; after she put that phrase down each time, she didn't have any problem speculating a LOT, to the point her mushy speculating seemed to turn into a cesspool of opinion, of which she offered none in my favor, really. “

“Mere speculation” has become a VA mantra in the last few years.The BVA disregards speculative C & P statements. They have no medical weight at all.

In my opinion, these “mere speculation” statements mean the C & P doc didnt read the entire clinical record, or they simply didn't understand the medical aspects of the disability, or lacked the needed expertise in the field of the specific disablity - Or all of that..

I had 3 solid IMOs from real docs at the BVA along with my own medical rationale and I used my past VA matters as proof of my medical background.They threw out a PA's C & P as he said he would have to “resort to speculation” to opine on a claim that was clearly substantiated by all of the Medical evidence and the IMOs.

These statements are geared in C & Ps to pass the buck as they know these statements can either set up a long remand or if the rater buys what the C & P is selling- the rater can use the speculative nature of the opinion to deny the claim and then not properly weigh other medical evidence under the BOD regs.

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Posted · Report post

Another thing-

if a VA doctor says they would have to resort to "mere speculation" to medically opine in a C & P exam-how the heck do they give their patients proper care?

I personally think some of these C & P opinions reveal negligence or complete lack of medical knowledge.

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Posted · Report post

Berta,

I find it disturbing that for a exam for PTSD you need to have a psychiatric physician but for IHD the VA can use a Nurse Practitioner. Now I have nothing against NP's but this just seems wrong. They are using the opinion of a NP over surgeons, cardiologist and physicians to make the rating decision.

As I discussed with you in another forum, I put in a claim for IHD, PTSD, IU and other items which I just received a decision on. When putting in the claim, I submitted a lot of medical records from years of treatment from physicians for my particular diseases particularly IHD. Included in those records were reference to SSDI determination for permanent total disability and have been on SSDI since 1990 for IHD.

Now I have a C&P exam for IHD and IU conducted by a Family Nurse Practitioner who at the end of the exam findings uses the phrase "…conditions do not prevent you from securing or maintaining LIGHT duty employment, including sedentary employment".

Without any reference to any of the doctors opinions that I submitted or any of the SSDI files, the rater used that exact phrase for the denial. "The VA examiner indicated that your service connected conditions do no prevent you from securing or maintaining gainful light duty employment, including sedentary employment."

Just starting to work on my plan of attack for either a NOD or CUE and the information about the IMO letters from doctors you and acesup will be very valuable. I'll be meeting with my VSO next week to start my appeal. Thanks for the great information.

Another thing-

if a VA doctor says they would have to resort to "mere speculation" to medically opine in a C & P exam-how the heck do they give their patients proper care?

I personally think some of these C & P opinions reveal negligence or complete lack of medical knowledge.

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Posted · Report post

Does the VA know you are on SSDI????

Geez-

"have been on SSDI since 1990 for IHD." That evidence might put you into the 100% IHD criteria ,making her TDIU statement there having no probative value.

"They are using the opinion of a NP over surgeons, cardiologist and physicians to make the rating decision." When the H VAC hearings schedule is posted- vets have got to bring this crap to the attention of the H VAC.

Even when the BVA orders a Cardio or Neuro opinion -the vet can end up with a PA.

Nothing wrong with PAs except they dont have MD after their names.

I guess if a vet had a real good IMO from a PA -then the VA would sure find a VA doctor to go against it.

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Yes, they knew I was on SSDI. Evidence shows that they requested and received the SS records.

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bump

Before a veteran files his or her claim for disability, it would be best for them to seek treatment that would establish their medical condition and get a diagnosis. Getting IMOs and IMEs can be quite expensive but having current medical treatment could really help.

A veteran should never let the C & P examiner's medical opinion be the only medical opinion in his or her VAMC treatment records. I agree that IMOs and IMEs are worth the cost but if the veteran can get this from their treating doctors then even if the local VARO denies their claim or low ball their claim, the veteran should win his or her claim on appeal.

Always keep in mind that the local VARO will always force claims to go to BVA. It doesn't matter how much evidence a veteran has in his or her file. If the Rater, DRO, and or Supervisor overlooks or ignores the pertinent evidence then the only thing a veteran can do is file an appeal.

Hope this helps

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Berta,

I find it disturbing that for a exam for PTSD you need to have a psychiatric physician but for IHD the VA can use a Nurse Practitioner. Now I have nothing against NP's but this just seems wrong. They are using the opinion of a NP over surgeons, cardiologist and physicians to make the rating decision.

handler,

I'm not Berta but wanted to throw in my dollar's worth (inflation).

If we take the time to look the C&P results over real good, you will most all times find somewhere

that a doc signs off on the NP or ARNP's work.

Sometimes it's a bit difficult to find as some are printed on both sides of the page, the pages are sometimes out

of order and many times 1/2 of some progress notes can be mixed in with the actual C&P, along

with pharmacy records, MRI's, EKG, Echo's, etc...

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