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1. Why VA benefits are denied? .gif)
VA benefits are denied due to a combination of the following three major (BIG 3) factors:
(1a) RECORDS: The patient’s medical records are important for benefits analysis. The problem is that these records are often not available. Many patients have service combat records, private records and VA medical records. These records are not always available to the rater because service records and VA records are not seamlessly transferred and because all outside civilian records are not always available to the VA rater. As a solution, I have seen some patients who hand carry all of their paper records to the VA rater. I've seen some patients who scan and store all their records on a computer then transfer those to the VA via fax or mail. Finally, there is a recent move to be able to upload all records to the internet at a secured location then the patient can just download his records to the VA or his provider by using a password.
(1b) DIAGNOSIS: Military patients get excellent diagnosis and treatment in the battlefield for acute injuries and illnesses but their long term follow up of complicated chronic illnesses is of less quality due to the number of nurse practitioners and PAs used extensively in military and VA hospitals. Many times these extenders are over their heads with the complicated chronic illnesses that are common many older veterans. Solution: Often extra testing and workups need to be done to figure out the primary and secondary medical problems.
(1c) MEDICAL OPINIONS: The patients often do not have access to integrated medical opinions. Many patients send in piles and piles of medical records as discussed above but these records need to be assembled by a physician into a coherent medical opinion that follows general medical principles. The physician should be experienced and must be able to incorporate the VA rules and regulations surrounding the medial diagnosis codes. The civilian codes are about 68,000 in length and these codes need to be distilled into the VAs 2000 codes, which are covered in about 70 DBQs.
2. Why do VA claims take so long to process?
Claims are complex and if any of the above listed BIG 3 reasons for denial (poor records, wrong diagnosis, no medical opinion) are incorrect then the claim goes into an infinite loop of appeals ( The "hamster wheel") RO (Regional Office) - DRO (Decision Review Officer) - BVA (Board of Veterans Appeals) - AMC (Appeals Management Center) -BVA (Board of Veterans Appeals) - CVA (Court of Veterans Appeals) - BVA (Board of Veterans Appeals) - RO...All appealed claims take additional time as they move from venue-to-venue as additional testing and medical opinions are obtained. In other words, the fastest claim to process and decide is the claim that is well organized with a medical opinion on each issue. Each issue by issue focused medical opinion must be supported by medical evidence. In my experience claims without proper documentation flounder in the VA for years.
3. Why use Dr. Bash?
Dr. Bash has testified as an expert at Regional Offices and at the Board of Veterans Appeals. He has worked for years on Veterans cases with success!
Click here to search BVA Decisions!
4. Are you accessible?
I'm very busy. The best way to get me is via email (drbash@doctor.com) and text message or call my phone support person, Skip at 925-381-7561. My electronic consult form on my web site also works well as it goes to my support person who then can call you back as an initial contact (see www.veteransmedadvisor.com).
5. What is the patients’ job?
Each patient’s case is different but the patient can help by gathering and keeping copies of all records and x-rays. It is a must for patients to attend all compensation & pension exams and hearings, if medically possible.
6. Do VA hearings matter?
Yes, all VA hearings formal or informal ARE VERY IMPORTANT. Make sure your advocate has ample experience dealing with VA claims. At the BVA hearing, ask to keep the hearing open for 60 days following the hearing. This allows time for additional information to be added to your record. Ask your doctor to attend the hearing as an expert.
7. Do you attend hearings?
Yes I do.
8. Do Claims and Pension (C & P) exams matter?
Yes C & P exams are essential. These are very difficult to reschedule so do not miss any C & P Exam. If the patient misses a C & P exam, usually the claim is immediately denied (regardless of merit) due to lack of new information.
9. Do DBQs help or hurt the accuracy of the claim?
DBQ (Disability Benefits Questionnaires) can either hurt or help the claim depending on the examiner. Many VA examiners are nurse practitioners or physician assistants. These examiners are assistants/physician extenders are beyond their depth of knowledge in understanding the complicated chronic illnesses in many older veterans and they often do poor/incomplete DBQ exams. A good BDQ by an experienced physician provides the patient with a fair accurate assessment of the patient’s conditions. The DBQ must be followed by a separate report called a Medical Opinion as the DBQ alone does not establish a NEXUS. The NEXUS is documented in the addendum medical opinion, which of course is usually done by a physician. Therefore if a physician extender does the DBQ and a different physician does the medical opinion often there are logical disconnects which hurts the accuracy of the claim.
10. How does the DBQ compare to a NEXUS letter?
As stated above the DBQ is really only a detailed physical exam is does not ask the physician to opine whether the condition is linked to service or not. The nexus letter is specifically focused on any potential linkage to service or secondary to service conditions.
11. What is your recipe for helping veterans?
Dr. Bash suggests that each patient get his claim organized with the best possible set of the BIG 3 noted in question number one above-namely get the best possible:
Medical Records - Diagnoses - Medical opinions
12. What if the VA Compensation and Pension exam disproves my claim?
Unfortunately, the C & P examination system is not designed in the veterans favor. Many times, the VA denies a veterans claim based on the medical evidence the VA itself has provided. The primary care and specialist providers at the VA clinics are restricted in what they can say about your condition. These doctors work for the VA; therefore, they must follow VA guidelines and internal policies.
The C & P examiners are supposed to decide whether you are disabled. Further, they decide just how severe the disability is in your case. The problem is, the C&P doctors usually must see several veterans in one day and do not have time to completely review medical records and do a proper exam. A VA-ordered exam that disproves your claim means it is even more important to have an Independent Medical Examination (IME) that could offset that opinion. If the veteran presents evidence that raises an element of doubt, then, by law, the VA must rule in the veterans favor.
NOTE: If you are notified that the VA has ordered an exam, it is imperative that you show up. Failing to do so can cause immediate denial of your claim. If your health would be jeopardized by any VA-ordered test or procedure, you should notify the VA and send evidence of your doctor's advice against it.
Note: If you have records from an outside (non-VA) doctor, please be sure to pass those on to Dr. Bash, as they are often helpful to your claim as supporting evidence
13. What are Dr. Bash's fees?
Dr. Bash's fee is based on the number of medical problems and complexity of your individual case. Fees will be discussed during your initial phone interview with Dr. Bash.
Click here to see his procedures!
14. How soon should I contact Dr. Bash?
Call Dr. Bash today at 530-925-6081.
His phone support person, Lori, will help set up a phone appointment!
You can first submit an opinion from Dr. Bash when you make the initial claim. If your claim is denied, or if the decision falls short of your expectation, VA allows you time to submit a Notice of Disagreement (NOD). It is in your best interest to submit a supporting medical opinion with the NOD as well. The VA will then respond with a Statement of the Case, an outline of the reasons, and the evidence used in its decision. With an additional medical opinion, it is possible the VA could give you a more favorable decision then.
If the decision still is not in the veterans favor, the DRO will state exactly what evidence is needed to approve the claim. Then this evidence must be taken before the Board of Veterans Appeals (BVA). The BVA will take a further look at all the evidence and decide about the claim. It can decide to approve the claim, remand the claim (send it back to the regional office with instructions about what to do differently), or deny the claim. If the BVA denies a veterans claim, the veteran then can hire a lawyer and go through the courts. At any of these stages, you can have Dr. Bash submit more medical evidence. For further details about this process go to BVA Appeals Process.
Recommendation: Call Lori at 530-925-6081 for immediate help!
Craig Bash M.D. Associate Professor drbash@doctor.com
Call/Text Lori - 530-925-6081
Independent Veteran Medical Opinion (IMO)Veteran Medical Nexus Opinion (VMNO) based on Veterans medical records
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