Veterans Medical Advisor
Frequently Asked Questions (FAQ)
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1. Why VA benefits are denied?
VA benefits are denied due to a combination of the following three major (BIG 3) factors:
(1) RECORDS: The patient’s medical records are important for benefits analysis. The problem is that these records are often not available. Many patents 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 done load his records to the VA or his provider by using a password.
(2) 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 in 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. Thus, many patients' long term diagnosis are often incorrect. Solution: Often extra testing and workups need to be done to figure out the primary and secondary medical problems.
(3) 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-DRO-BVA- AMC-BVA- CVA- BVA - 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. I predict claims without proper documentation will flounder in the VA for years.
3. Why use Dr. Bash?
I have been doing VA claims for over 30 years and I am likely the only physician to have testified as an expert at regional office, decision review officer and board of veterans’ appeals. I have done thousands of cases with a very high success rate...on the order of 90%. The reason my success rate is high is because I optimize the BIG 3 reasons that claims fail above. I do medical exams/tests to get the diagnosis correct, then I write well supported medical opinion based on all the records.
4. Are you accessible?
I'm very busy. The best way to get me is via email (firstname.lastname@example.org) and text message to my phone 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 C and P exams and hearings if medically possible.
6. Do VA hearings matter?
Yes all VA hearings formal or informal ARE VERY IMPORTANT. The advocate that you take to the hearing also matters. Always ask if your advocate has 10 years' experience and has done 100 or more hearings, as that experience is critical. In my experience independent advocates are often better able to address all issues because often the National Service Organization advocates feel the shadow of their Big VA brother and are thus sometimes are somewhat limited in their ability to advocate for all aspects of the claim. Always ask to keep the hearing open for 60 days following the hearing so that you can add additional information that the Judge/DRO/Rater might require. Ask your doctor to attend the hearing as an expert.
7. Do you attend hearings?
Yes I do, on special request. Hearings I've attended are located in all regions of the country.
8. Do Compensation and Pension (CP) exams matter?
Yes CP exams are essential. These are very difficult to reschedule so do not miss any CP Exam. If the patient misses a CP 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 and their depth of knowledge on the natural history of diseases is limited 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 BDQ 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 specially focused on any potential linkage to service or secondary to service conditions.
11. What is your recipe for helping veterans?
I suggest 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 success rate does Dr. Bash have?
In almost two decades, Dr. Bash has seldom told a veteran he could not help with a claim or an appeal. With those he has assisted, he has an 80 - 90% success rate in helping establish or increase disability compensation and other benefits.
14. What are the fees for using Dr. Bash?
Dr. Bash charges a flat fee (to be prepaid). The fee is based on the number of medical problems and complexity of the case.
15. How soon should I contact Dr. Bash?
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.
16. What if I need him to appear before the board?
Dr. Bash is a seasoned medical expert witness for hearings at the BVA level. If your claim goes to Washington, D.C. on appeal, Dr. Bash is available (with enough advance notice) to attend the hearing and orally present your medical evidence. An extra fee is charged for in-person representation.
17. Fly in Expert Witness at Hearings
I have done many VA hearing as an expert witness concerning complex medical issues because the Judges, DROs, raters (Deciders), service officers and patients are not physicians. The issues involved in any typical veteran claim (that makes it to any level) are usually complex as the medical problems extend often over decades and are thus associated with both primary and secondary complications.
The following is a list of ways that the medical expert can be beneficial at any hearing;
Craig Bash M.D. Associate Professor email@example.com cell 925-381-7561
Independent Veteran Medical Opinion (IMO)Veteran Medical Nexus Opinion (VMNO) based on Veterans medical records
Craig N. Bash M.D., M.B.A.
Neuro-Radiologist and Associate Professor
Uniformed Services School of Medicine