Veterans Medical Advisor                     

                                                                                drbash@doctor.com

                    

                  Providing Independent Medical Evaluations

Dr. Bash is a veteran of

Veterans Medical Advisor Process

 

TERMINOLOGY

Board of Veterans’ Appeals (BVA) – The Board of Veterans’ Appeals (Board) is a part of the Department of Veterans Affairs (VA), located in Washington, D.C. The Board’s mission is to conduct hearings and decide appeals properly before the Board in a timely manner. 

Buddy Letter Statement of Claim) – A buddy letter is written by someone (who was an eyewitness to the Veteran’s disability claim) and helps to substantiate details about the pending VA claim including, what happened, when did it happen, how did it happen. A Buddy Letter can also be written to substantiate details about how your disability affects your current lifestyle. (See also Statement of Claim and Lay Statement definitions)

Compensation & Pension Exam (C&P) – When someone files a claim with the U.S. Department of Veteran Affairs (VA), for compensation or pension benefits, the Veteran’s Administration may ask the claimant to go to an examination as part of the claim process. This is known as a VA Claim Exam or a Compensation & Pension (C&P) exam. In this part of the claim review process, the C&P exam helps Veteran’s Administration to determine if the claimant’s disability is service connected, the level of their disability, or if their condition should receive an increased rating due to it worsening. 

Clear and Unmistakable Error (CUE) – An error as to the application of the fact or law that existed when the VA decision was made. Claimants have the right to appeal a decision by the Board of Veterans’ Appeals for clear and unmistakable error (CUE). If the claimant is not satisfied with the Board’s decision, they have the following options: 

  1. Appeal to the United States Court of Appeals for Veterans Claims (Court).

  2. File with the Board a motion for reconsideration of their decision.

  3. File with the Board a motion to vacate their decision. 

Disability Benefits Questionnaire (DBQ)

A Disability Benefits Questionnaire (DBQ) is a medical history and physical exam, lab and imaging questionnaire developed by the Veteran’s Administration (VA) in order to assist VA personnel to establish a percentage of disability rating for a Veteran seeking disability compensation.  Disability Benefit Questionnaire’s may be completed under IMO, IME or both depending on the circumstances. If the symptoms of disability are accurately and fully recorded in the Veteran’s claims file medical history, then a DBQ may be based on the medical findings of an IMO (a forensic analysis of past symptoms). During an IME (an in-person personal examination  or exam via tele-health communication), a DBQ is supplied in order document Veteran’s current symptoms for the purposes of establishing criteria for rating of the condition.

Dx – Diagnosis 

Independent Medical Opinion (IMO) – An opinion and is essentially equal to a Nexus.

Independent Medical Exam (IME) – Different than IMO/Nexus because it is essentially a DBQ performed by an independent expert.

NEXUS – A Nexus opinion is the crucial element needed by a Veteran to satisfy entitlement to disability compensation. It is the weighing of the totality of the evidence in order to medically opine as to the theories of etiology of the Veteran’s claimed issue(s); and if justified, to provide the reasons and bases as to how the Veteran’s military service caused or aggravated the Veteran’s claimed conditions. It is the essential link or connection between the current injury and the precipitating disease, injury or event that occurred in-service.

The nexus is based on a complete review of the facts of the record, pertinent medical research, the independent medical opinion (IMO) and/or an independent medical examination (IME) and any criteria necessary to support a probative opinion. A probative (favorable) opinion must reach the threshold of at least as likely as not. In other words, after a thorough evaluation of the evidence, the military stressor was at least as likely as not the cause of the Veteran’s issue. The benefit of the doubt goes in favor of the Veteran. The strength of a nexus opinion is based on sound medical principles, supported by data and importantly – the expertise of the medical professional. 

Dr. Bash is savvy in understanding military injuries as he is a disabled Veteran himself. His years doing investigation of military disability, and the medical knowledge he has in this regard are matched by few. Dr. Bash’s credentials make him a very experienced and knowledgeable expert medical witness.

In order to qualify for VA disability benefits the Veteran needs to prove three criteria: 

  1. Prove eligibility in military service,

  2. Have a diagnosis of a condition(s), and

  3. Supporting evidence that the condition started during your military service, or if your condition was preexisting to your military enlistment, you must prove that it was aggravated by military service. This is called a Nexus.

M-21 – VA low level rating workbook on VA related medical problems  

Medical Expert – Physician with the training and experience needed to formulate medial opinions concerning a long-term disability and its secondary complications.

Medical Expert Opinion – A medical opinion, which is formulated by a medical expert concerning a long-term disability and its secondary complications. 

PGY – Postgraduate (medical school) year: number of years of training after medical school (most US residency trained physicians have PGY level 3-4)

Special Monthly Compensation (SMC) – SMC is part of a series of complicated calculations that are assigned in additional to 100% payments given to compensate Veterans who lost, or lost the use of, specific organs or body parts due to military service. The VA pays higher rates, in specific monetary increments, if the Veteran has multiple qualifying disabilities.  The codes for these are alpha numeric (R2/T are only two examples of these types of code designations) above the baseline of 100%. This compensation is added on top of the 100 percent rating to support the most seriously injured Veterans in their homes. It has been estimated (by a VA headquarters DRO)  that only 5 people out of the entire VA employee population (of about 400,000 workers) fully understand the idiosyncrasies of these SMC codes, which pay maximally at about 9000 a month (triple tax free).

SS – Social Security

Statement in Support of Claim (VA Form 21-4138) – Also referred to as a Lay Statement, Lay Letter or Lay Evidence – These are written or typed statements provided by the Veteran (or those familiar with the Veteran’s situation) and helps to give the VA a better understanding of his/her injury, problem or hardship in order to prove their claim for VA disability benefits. Lay evidence, also referred to as lay statements or buddy statements, can be valuable and versatile pieces of evidence to prove various types of claims. (See also above description of a “Buddy Letter).

VA – Veterans Administration

VAMC – Veterans Administration Medical center

VA rating codes – VA uses 2200+ codes, which include both the type of disease 

(analogous to ICD 10 codes) and severity of disease over time, which then translate to a monetary allowance/ancillary benefits ( such as house grant/car grant or educational benefits) and level/priority care inside the VA medical care system.

VSO – A VSO representative (also known as a Veterans Service Officer) helps you with the preparation, presentation, and prosecution of claims. Once your claim is filed, they track the claim through the VA system, act as liaisons between you and the VA, and are your official representative by acting as your Power of Attorney (POA).

Website References – 

www.bva.va.gov

https://catalog.data.gov/dataset/board-of-veterans-appeals-decisions

Find these words “Dr. Craig Bash” or “Craig Bash” or “Dr. Bash”

Select/clear years below “1996-2021”

https://www.index.va.gov/search/va/bva.jsp

EXPERT WITNESS NEXUS OPINION – IMO / IME

An Expert Medical Witness is a physician qualified, by reason of his skill, knowledge, education, experience, or training to testify on a particular medical area. He is a person who has knowledge about the medical and health care profession, beyond that of an average person.

The expert should be able to break down the scientific, technical language and terminology so that someone without any medical training can understand the key issues of a case. A medical expert witness must be able to state opinions with “reasonable medical certainty”. As an Expert Medical Witness in Disability Compensation Claims, Dr. Bash acts to aid a Department of Veterans’ Affairs 

adjudicator (i.e.: Decision Review Officers (DRO), Veteran Law Judge (VLJ)) and/or the Court of Appeals for Veterans’ Claims (CAVC)) in reaching a more valid conclusion about the facts of the Veteran’s disability case, than they would have without the expert’s testimony.

As an Expert Medical Witness, Dr. Bash can provide an independent medical opinion (IMO) and/or an independent medical examination (IME). An IMO is not a physical examination, but rather an examination of the evidence of the record. It is a historical analysis for the purpose of determining a precipitating disease, injury or event that occurred during the period of military service; and/or to document from a historical perspective symptomatology, chronology of a condition, changes in severity over time, and other items that do not require an examination but rather a forensic analysis.  

An IME is performed when an opinion is needed on the current symptoms/medical history of the Veteran and generally requires an in-person examination, but the exam can also be conducted through tele-health communication. An IME would be appropriate for evaluation of issues such as gait, atrophy, range of motion, and other issues that must be personally measured; or to confirm the existence of a condition for data used in a DBQ.

DISABILITY BENEFIT QUESTIONNAIRE (DBQ) PROCESS

The DBQ process takes place via Skype or FaceTime call with Veteran/patient. DBQ’s are initiated at some point after one or more initial verbal conversations with Dr. Bash and only after the Veteran/patient submits the requested supporting documentation regarding their claim. The DBQ timeline will vary depending on individual claim assistance/request for services. Each Veteran’s claim is a dynamic situation, and no two Veteran’s claims are the same. Depending on whether DBQ’s are suggested and/or requested from the Veteran during initial conversations with Dr. Bash, the Veteran will be referred to Scheduler Skip in order to set up video appointment time for DBQ’s. 

Clarification – Veteran/patient often makes a first contact with Alice or Skip based off the website instruction. Veteran/patient’s may talk to Alice or Skip several times before making contact with Dr. Bash as they have questions regarding the claim process. Alice or Skip will schedule a phone conversation with Dr. Bash and give the Veteran/patient the contact information. Processes and procedures are adjusted to meet the individual need of each Veteran based on their unique situation. For example, one Veteran/patient may not need DBQ(s) to for their claim development. Another Veteran/patient may only request medical nexus opinion and then, only after reviewing patient/Veteran’s entire file (which also may come in bits and pieces over several months-time) Dr. Bash may consult with the Veteran to suggest that DBQ(s) may further assist the Veteran’s successful outcome of their disability claim. Yet another Veteran may seek additional referrals from Dr. Bash for outside medical opinions for mental health evaluations where further diagnostic testing and DBQ’s will be performed and this additional medical data will then be forwarded to Dr. Bash for integration into his Nexus opinion. 

Dr. Bash uses the VA’s DBQ forms. Dr. Bash completes the exam portion of the DBQ form during telehealth video with Veteran/patient and further develops the DBQ(s) as needed during his review of patient medical record and/or additional correspondence with Veteran/patient through phone conversation or via email.  Dr. Bash then sends the original DBQ(s) form(s) to Veteran/patient via USPS.

Although the completed original DBQ’s are sent to the Veteran/patient, Dr. Bash takes detailed notes throughout the telehealth video exam as he is filling out the DBQ’s for use in development of and integration into the Veteran/patient’s medical data, which would also include Dr. Bash’s medical expert witness nexus opinion. As well, he also takes exhaustive notes during all conversations with the Veteran/patient and anyone else that is involved with claim process, including spouses, caregivers and buddies. Veteran/patient’s lay statements, pertinent medical research, VA regulations and medical testing to corroborate, substantiate, validate the claim opinions are also integrated into the medical expert witness nexus opinion which is necessary since the VA often looks for consistency across all data in order to assign a VA rating code.

FEES

Every claim is unique, and the amount of time and development needed is dependent upon several dynamic variables including medical complexity of claim, number of primary/secondary disabilities claimed; status of appeal(s); number of other medical opinions in the records (probative and negative); number of years claims have been pending; amount of research and medical development needed, etc. 

During the free initial consultation, Dr. Bash will have discussion with regards to what the Veteran/patient’s goals are as it relates to their specific claim needs. Discussion includes Nexuses, DBQ’s and suggestions for additional medical outside opinions (i.e. mental health referrals, additional medical testing etc.) and all discussions revolve around type of claim the Veterans seeks and necessary process for development of such claim. 

Should the Veteran choose to utilize Dr. Bash’s services, a mutually negotiated fee is decided with respect to the complexity of the requested claim assistance. 

Invoices are included when payment(s) are made through Square and if the Veteran/patient pays by check, an invoice is forwarded to the mailing address on file.

CLAIM DEVELOPMENT PROCESS OUTLINE

1. Veteran/patient makes initial contact via email or website contact. First conversation is usually with either Alice or Skip. 

2. After Veteran/patient’s questions are answered, Veteran/patient is scheduled for conversation with Dr. Bash and is also given instructions with regard to information that Dr. Bash will need during initial phone call, including but not limited to   

    a. List of disabilities and medical issues
    b. Current rating
    c. Availability of in-service records, medical records, etc.

3. Phone appointment with Dr. Bash – Initial conversation with Veteran/patient includes topics including but not limited to:

    a. Current medical issues and disabilities, Veteran/patient’s goals for desired outcome of disability rating and action plan going forward – which may or may not include additional advice on referrals for diagnostic testing/consults/ corroborative nexus to support/aid with development of disability claim.
    b. Explanation is given regarding review of their available medical record (in-service/post-service) to establish service connection and produce complete expert witness medical nexus opinion. Veteran/patient’s VA physician generated C&P exams reports may also be reviewed for any new VA medical information and to help establish whether accurate ratings codes were applied.
    c. After Veteran/patient is fully instructed on above details and mutual expectations as to the claims process, fees are negotiated based on individual claim development complexity and number of primary/secondary disabilities. Other fee considerations include but are not limited to type of claim processing assistance requested (i.e. new claim, supplemental claim, higher level review, BVA involvement and/or expert witness appearances, CUE review, etc.)
    d. Following fee determination, Dr. Bash emails a sample statement in support of claim (also called a lay letter or lay statement) to the Veteran/patient which outlines the procedure for writing a draft summary statement (to the best of their ability) which should describe all the medical problems/injuries and disabilities they are seeking for VA claim. Dr. Bash also sends a copy of his resume/experiences. 
    e. Veteran/patient is referred to Alice (925-408-7984) for payment arrangements.

4. Veteran/patient calls Alice.

    a. Alice sets up payment arrangements either through Square or via personal check. 
    b. Veteran/patient is instructed (based on their individual situation) regarding payment schedules/payment dates and amounts, including number of equal payments expected to pay balance. 
    c. Veteran/patient is instructed to gather and make copies all available medical records to send via USPS or email. 
    d. Veteran/patient is reminded of the importance of a written statement in support of claim (also called a lay letter or lay statement) which should be emailed to Dr. Bash upon competition.  
    e. Alice explains to Veteran/patient that Dr. Bash offers no guarantee that his expert medical consult/opinion will produce a favorable outcome for patient’s disability claim (VA disability and/or Social Security disability). 

5. After fee deposit is received, Dr. Bash sends a follow-up email to Veteran/patient including: 

   a. written advice for further testing/consults (if required) and if needed, email referral to support staff for assistance with additional questions including but not limited to, lay statement development, claim process questions, timelines etc.
        • Each person’s case is individually unique and therefore cost for services is tailored to individual claims/cases.
        • Recurring payment amounts may be individualized to meet each person’s needs and/or requests. 
        • Veteran/patient is expected to pay their balance over time in equal payments as arranged and agreed to.

6. Veteran/patient sends/emails available medical records and their written statement in support of claim summary (also called lay letter or lay statement) to Dr. Bash which is used for development of claim and DBQ’s.

7. After receiving pertinent medical data and notes from initial conversations and discussion of Veteran/patient’s disabilities, Dr. Bash determines which Disability Benefit Questionnaires (DBQ’s) will help facilitate development VA claim and is referred to Scheduler Skip to schedule tele-health video conference with Dr. Bash for DBQ completion

8. Dr. Bash sends completed and signed DBQs to Veteran/patient via US Mail.

9. During claim development process, Veteran/patient completes any advised consult referrals recommendations/testing and forwards completed results to Dr. Bash

10. Dr. Bash begins development of his expert nexus opinion using notes from Veteran/patient’s conversations, video DBQ exam, available medical records, VA claims file, lay statements, testing, consults, image reports, VA C&P exam, VA decisions and any other available data/records. Dr. Bash also performs a detailed literature search including research of peer reviewed medical-legal literature to help support and substantiate his Nexus opinion. 

11. A completed Nexus opinion is emailed to Veteran/patient for their review. Review should include all claims that were requested and accurate review search of pertinent dates and other proofreading errors. Requesting that the Veteran/patient review a draft version of the Nexus helps all parties validate expectations. 

12. If the Veteran/patient does not have assistance from a VSO rep, Dr. Bash and/or support staff offers instructions to the Veteran/patient on process to submit claim package to VA and/or Social Security. 

   a. Claim package includes:
        • Expert witness Nexus opinion
        • DBQ’s 
        • All medical records referenced in Nexus medical opinion, including any new records since last VA decisions such as test results/consult reports.
        • Statement in Support of Claim (Also referred to as lay statements, lay letters and/or buddy letters)
        • Dr. Bash CV (resume)
        • Any other additional information Veteran/patient wishes to include such as their own research articles.

WEBSITE DISCLAIMERS

WEBSITE DISCLAIMER: Veteran/Patient/Client understands that Craig N. Bash, M.D. makes no guarantee of results for services rendered that his independent expert medical opinion and/or nexus and/or supplemental medical opinions and/or disability benefit questionnaire (DBQ’s) and/or medical opinions written as a result of a referral from Dr. Bash, will produce a favorable outcome to your disability claim. 

In the event the Veteran’s Administration or Social Security Administration or Employment Medical Disability or Worker’s Compensation denies any and/or all of your disability claim(s), no refunds shall be granted. 

In the event you have a specific mental health claim which requires separate referral for an Independent Medical Opinion by a mental health specialist professional which may include additional testing, you understand and agree that you are responsible for paying for this additional IMO and/or testing. 

You also understand and agree that at any time during the claim development process, you have the option to choose your own private medical provider. At all times during the claim development process and until competition, it is your sole responsibility to obtain copies of your own medical records including but not limited to in-service records, C&P Exams etc. to forward to Dr. Bash for review.   

Nothing posted on this website forum constitutes legal advice.

Craig N. Bash M.D., M.B.A.

Neuro-radiologist 

Associate professor--Cell 240-506-1556

drbash@doctor.com

Dr. Bash in 2021

Dr. Bash in 1986

drbash@doctor.com

______________________

Craig N. Bash M.D., M.B.A.

Neuro-Radiologist and Associate Professor

Uniformed Services School of Medicine

NPI/UPIN-1225123318

4938 Hampden Lane
Bethesda, Md 20814

Cell/Text 925-381-7561
Fax 301-951-9106