Is a cancelled supplemental claim considered a finalized decision that can be reviewed with a HLR claim if you want to challenge/ argue that you did submit new and relevant info and or an ace exam shouldve been ordered to settle any discrepancy? I know cancelled supplemental claims are a different ballgame.
Weirdest Claim On (MY) file
I had an informal conference 2 weeks ago with the St Petersburg Office for a HLR. I pointed out that the c and p examiner made a mistake for my scars. I told him that I have 3 painful scars not 2, that the examiner measured 3 and even described 3 in 1 part and only documented 2 scars. I told him that he can also review my actual surgical notes. Decison letter states upon “thorough” review of my dbq i only have 2 painful scars. Im noticing that these raters are violating law adjudicating claims solely based upon what the contracted c and l examiners put when they’re supposed to look at all the evidence and make the final call. They blindly follow the examiners when it will lowball you when that violates ICARE, the higher of the 2 rule and benefit of the doubt.
Now for Loss of Use
I told the examiner that first of all my ratings for my peripheral neuropathy has the wrong diagnostic code. Whenever all 3 nerves of the hand are involved they’re supposed to use DC 8513 not 8512. I them told him I had severe marked for all three and Lou said wasn’t
Inferred for that. I then told him I had a flail forearm attached and that I didn’t get a musculoskeletal rating for that which clearly would’ve put me at the amputation max which then could’ve forced Lou inferred ancillary benefits. I told the guy to look at my record I have a BVA judge note that I have positive medical nexus letters for Lou of upper and lower extremities which is binding of all subsequent decisions and no examiners check box for the amputation and prosthetic test should be considered because it violates Tucker v west and only the adjudicator can render such a legal determination. I told him the most recent decison I had listed my SSA documents but I’m already being paid for Lou via SSA rule 85-15 loss of manual dexterity and only occasional use of the upper extremities which means up to 2 hours in a 8 hour workday/ majority of the day I can not use my hands.
Major Major Mistakes
1- The Dro changed the diagnostic codes for nerves to 8513 like I said, gave me the severe rating ( still no Lou) but the 20% instead bilateral and by definition the dx change and increase makes it a CUE. They did not lost this as a CUE therefore they covered up the mistake.
2-They once again did not consider SSA rule 85-15 in This decison for nerves.
3- They severed the flail forearm verbiage from my nerve ratings without a proposal to reduce or officially finding a CUE. Now this is is moving from a CUE to a massive cover up by violation of due process and possible fraud. The VA cannot/ or at least isnt supposed to severe ratings, especially Lou level impairments / 50% bilateral issues with already completed c and p exams ordered from the Va with a private medical opinion.
4- To further the cover up they reopened the flail forearm condition but this time deferred both ( right is floating is never never land) and only rescheduled the left. So now they’ve botched a CUE cover up by trying to quickly reopen and reschedule the forearm but now has severed the right and didnt even properly reschedule the right to attempt to cover it up.
5- They VSR ordered an ACE exam for left wrist for increase (reopened) and left flail forearm (reopened) and QTC violated policy and ordered in person exams against the ace only exams that the Va instructed them to do. The Va and QTC has effectively begun to develop the to deny and I will call them Monday to address this. Now I can either not show up or show up with all of this paperwork including prior dbq and inform them of developing to deny and the benefit of the doubt rules.
6- Im also thinking about contacting OIG because us vets complain about these raters purposely lowballing us and lying and covering up stuff and they get on here and tell us it’s just us and they’re everything to help us when if fact they’re just like cops. Supposed to protect and serve us, make the ICARE promise, duty to maximize benefits and benefit of the doubt but will do anything to not file a CUE if it’ll protect their fellow coworkers or other raters performance and fix a vets records to help other raters at the expense of the vet. Ive never seen anything like
This. I might make post number 2 after this about my following decison after that I just got Thats also horrible.