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Qtc Exam Question


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8 replies to this topic

#1 Berta

 
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Posted 10 March 2012 - 06:16 AM

On Wednesdays SVR show Dr. Bash discussed the problems some vets have had in obtaining copies of their QTC C & P exam results from the VA before any RO decision has been made on their claim.He had another serious concern as to QTC reports that could reveal additional medical issues which might need immediate medical care. We are trying to find out why this is a problem.

Yesterday QTC told me that, once the exam is done by QTC and approved, it is sent to “ ExamTrack” (probably a VA PC program) and then uploaded to VA and this often takes only 3-4 weeks.At that point the exam is owned by the VA and QTC has no ability to release it themselves to any claimant.

Question:

Has anyone here had problems getting a copy of their QTC exam from the VA?

If so can you tell me what VA sent to you -as far as indicating a reason why they could not release the report?

Were you able, only after a decision had been made on your claim, to then obtain a copy of it?

Has anyone's vet rep here been able to obtain the QTC exam copy directly from VA for you?

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#2 Berta

 
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Posted 10 March 2012 - 06:53 AM

I did a little research here and just found this:

“You can get a copy of the C&P from QTC like this.....

a week or two after your exam, contact your local VSO rep. If they have access to Virtual VA, QTC has to attach a copy of the exam results to the bill that they submitted to the VA. Your Rep can print the exam result from there. At least that is how it worked for me and I was able to get my results, I believe, much faster then most.

Travis “

http://www.hadit.com...dical-facility/

Has anyone else here used this approach as well as Travis to obtain copy of your QTC exam?

#3 broncovet

 
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Posted 10 March 2012 - 06:55 AM

With the VA, its almost always about nepotism. With one particular "ROI" lady, that I had built a good rapport with, I got my medical records released pronto. With others, they usually promised to mail me the copies, after I signed a ROI form...then they never arrived.

#4 #1Cavtrooper

 
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Posted 10 March 2012 - 09:37 AM

I got a copy of my first Qtc C&P exam at the regional office shortly after the exam since I was there for TRP program twice a week in Houston. Until thursday, I haven't been down there since November. A 116 mile commute one way. I went to Varo front desk and she printed copy of my Qtc C&P exam right then.

Edited by #1Cavtrooper, 10 March 2012 - 09:39 AM.


#5 Berta

 
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Posted 10 March 2012 - 10:58 AM

Thanks for that info-

I have been talking to Dr. Bash about this issue but really havent seen too many problems mentioned by vets on the net about it lately.

When QTC started doing C & Ps years ago, there were problems if the vet went to their VAMC to try to get the exam but their VAMCs would not have the QTC exam and as you verified , you got at at the VA Regional Office.

The QTC person I spoke to told me they always direct vets with a QTC question about getting their exam to the 800#.

I will call 800# on Monday to see how they handle QTC exam questions from vets.

#6 Papa

 
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Posted 10 March 2012 - 12:21 PM

I have always wondered if the report that the QTC Doctor submits gets changed by the VA to suit their needs. One exam that I took just did not match what was on the report. Another exam, parkinson, was performed by a GP with no experience in this disease. He had to have an office worker to tell him how to do the exam. My wife thought the office worker was the doctor and the GP was in training.

It would usually take 2 to 3 months to get copies.

Papa

#7 Berta

 
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Posted 11 March 2012 - 08:59 AM

Papa
I have had made SOCs and SSOCs that parsed the C &P exam or simply were medically incorrect when compared to the actual exam.

As i mentioned here before years ago I was so angry at an SSOC that I called the C & P doc up and raised hell with him-only to find out -much to his surprise and mine,that the most critical evidence I had for that claim, a 6 page document that I had sent in multiple times because they failed to address it in prior SOCs and decisions-
had been deliberately withheld from him- and a year later the RO withheld it from the Office of General Counsel too.

We absolutely have to be proactive, and sometimes aggressive in getting our evidence read by the VAROs and only by having copies of the actual C & P reports,whether from QTC or VA, do we even have a chance to combat a negative decision if it is based on medical inaccuracies in the RO decision.


Dr. Bash mentioned something to me today- what if a QTC exam reveals breast cancer that should be medically treated right away.Say the vet didnt claim this and this was the first diagnosis of the cancer. It could certainly happen during the course of a C & P that other disabilities arise.

The exam then goes to the Regional Office but when does the veteran's PCP get it, and what triggers them to even follow up on it or does it just become part of the medical record stack that , as I well know from personal experience,
the PCPs often ignore. When does the vet even find out they have cancer?

NVLSP is reviewing my EED for my AO IHD claim.

When the lawyer called me she focused on the issue I had raised in my prior email to her.It falls under this same type of problem.

The VA ,although I proved my husband had IHD back to 1988, never diagnosed or treated him for it.
I found it all in the med recs from Bath VAMC and then discovered a cover up at Syracuse VAMC when I started asking too many questions.

VA at any point could have saved my husband's life over a 6 year period.

What surprised NVLSP and me was that the decision I got with IHD retro back to 1988 stated a VA exam in late Nov 1988 had revealed the heart disease but this exam was for my husband's PTSD.The VA had proposed to reduce his comp.

All I recall on that claim is AMVETS called us and the rep told me that VA had turned on the NOD I prepared and the check was in the mail (Rod had requested them (VA) to lower his comp immediately so that if he lost his appeal he woudnt have any overpayment. which he feared)

I never saw any rating sheet at all and dont even seem to have copy of the reinstated comp decision.His comp did go back up to where it had been.

My long point here is this is why these QTC exams or any C & P exam can be critical not only to a claim but even to the veteran's medical situation.

I wrote to the Nehmer RO last week to try to get copies of the documents they used for that 1988 exam.

This stuff doesnt happen often but when it does it could become a fatality. of a veteran.

VA did not acnowledge my husband's fatal heart disease in his lifetime, only doing that when I FTCAed them.

But someone apparently in 1988 at VA DID realize he had IHD, certainly within a time frame that shows his Stroke and his IHD death could have been averted.

and NVLSP sure wants to hear more on what I find out on that.

It is the C & P exam results that mainly controls our claims.

SOCs and SSOCs are not written by doctors, they are written by raters with as much medical backgrounds that most of us develop in working on our claims. If even close to that.

We must argue with medical evidence in responses to SOCs, SSOCs, to anything we disagree with as to disparaities between the SOC and the actual exam results.

And rebutt the exam results as well if they are speculative or medically inaccurate.

Or get a real doctor to do that for us ,with an IMO.

#8 Hoppy

 
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Posted 11 March 2012 - 03:36 PM

Berta and others,


“We must argue with medical evidence in responses to SOCs, SSOCs, to anything we disagree with as to disparaities between the SOC and the actual exam results.

And rebutt the exam results as well if they are speculative or medically inaccurate.

Or get a real doctor to do that for us ,with an IMO.”



This is how I won my claim. The denials made no sense at all and were based on misinformation and unsupported by any medical evidence. I was awarded by a DRO without submitting any new evidence. It was just a question of properly interpreting the evidence of record

I was recently helping a veteran who provided me with the medical reports used by the rater as evidence against his claim. The claim was for a secondary condition to a previously service connected condition. There is known statistical research that establishes a statistical linkage between the service connected condition and the secondary condition. The veteran submitted his own IMO referring to the statistical linkage. However, the rater gave greater weight to the VA examiners report that the secondary condition was due to post service intercurrent events.The doctors statements that the veterans condition was due to post service events were arbitrary and did not explain in any detail how the statistically known linkage was over ridden by the post service events. The fact that the post service events could have caused the veterans disability was plausible. However, the determination the condition was caused by post service events was speculative and unsupported. The doctor could only make a bare determination without supporting logic. This, is due to the fact that there was no road map establishing the post service events as the cause of the veterans secondary condition.

The thing that bothered me most in this case is I have seen BVA cases in which the raters remand the case back to the doctors and require that the doctors read each other reports and comment on each other reports before they decide the claim. I thought that given the complexity of this claim such a remand would have been appropriate in this claim.

The veteran was at a loss as to what to do next. So I gave him the exact advice you mentioned above. I told him the minimum he can do is write it up explaining in detail how the reports used as evidence against his claim lacked support and were bare conclusion without supporting logic and that the claim should have been remanded in order for the doctors to comment on each other reports. I told him the best thing to do is get yet another doctor to read all the evidence and comment on the reports used as evidence against the claim.

Long story short I told him to do exactly as you suggested above.

A bare conclusion, even when reached by a health care professional is not probative without a factual predicate in the record. Miler v. West,

11 Vet. App. 345, 348 (1998).







#9 Berta

 
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Posted 12 March 2012 - 08:27 AM

Hoppy said:


"The thing that bothered me most in this case is I have seen BVA cases in which the raters remand the case back to the doctors and require that the doctors read each other reports and comment on each other reports before they decide the claim. I thought that given the complexity of this claim such a remand would have been appropriate in this claim."




Yes- I even asked the BVA to remand my 2003 claim.They remanded in 2008 and awarded in 2009 due to the fact that none of my 3 IMOs had been even mentioned by the RO as evidence from 2004 to BVA transfer in 2006 and their opining doctors didn't mention my IMOs.
Plus I had a major VCAA problem and this too is why I asked for remand.


The VA agreed with me,in the remand, but that was years ago and I certainly would have handled this differently if it happened to me today.


I even got 2 DRO reviews because I asked VA to CUE itself on their initial DRO decision in 2005.The second review happened very fast and my former vet rep stood in for me at that review.
He called me up after it and said although he presented the IMOs to the DRO formally, she said she didnt know how to read them.
He was surprised that he asked her for another C & P opinion and she agreed.He thought he had done a great job doing that-

I asked him-wait a minute----if she cant read my 3 IMOs how the hell can she read a VA opinion?

He didnt answer that one but assured me the IMOs were put into my C file for their next C & P doctor to consider-but that never happened. He has been demoted.


Hoppy- you work hard for veterans and will surely agree that this stuff can truly become a war game.
Oddly enough this above all began when I started courses in tactical warfare at AMU in 2003 and being the only civilian these USMC profs had ever taught, I had to prove myself to them as well as prove myself to the VA, as a claimant because of the wording of the initial denial of that specific claim
.I think I lost focus on my claim as the courses were quite tough but it has helped me immensely in playing their war of the words game -when I made them CUE themselves this past Dec 2012 for my IHD claim and I got my award in January 2012. One month after I asked for them to CUE themselves.


When I say we need to be aggressive, I sure mean that- I dont mean getting angry or nasty,I mean hitting them with their own regs and all the evidence you have and demanding that they read it.
Often even attaching highlighted M21-1MR excerpts to our stuff can help remind the VA what they are supposed to do.


PS this is funny now but I was furious at the time-
It took me almost 8 months to get my money from VA on my 2003 claim.I had an usual situation not noted in any past VA claims at BVA or CAVC.
It might have been the first of it's kind.
However 38 USC and 38 CFR explicitely stated why the payment I expected was a valid ,legal request, in some old regs that VA doesn't use much at all.
I ended up dealing with emails to the Regional Counsel up here and making multiple phone calls andsending letters to the General Counsel and when they saw I would not go away some big deal at OGC finally sent the RO the same regs I had been sending them and told them to pay me.
I know I gripe about my past VA problems a lot here- but they are were resolved to my satisfaction.
If I had not taken aggressive actions, ALL of my claims would have ended up in the crapper.
38 USC,CFR and M21-1MR gives us as many tools to success as they give the VA tools to deny.





What is the actual current status of this vet's claim you mentioned?
Was his VCAA letter fully concise as to what evidence they needed for the secondary?




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