Wow. Groundhog Day already. Shut the front door. If I were five years old, I’d of figured a year had transpired already. At almost 72, it feels more like New Year’s was a week ago. I had a kickass Higher Level Review  with a nurse as the reviewer this AM. It was a situation I never ever thought I would have to fight for. Imagine you have a brand spanking new BVA decision granting you your long fought (2019) Hep C with residuals and F4 Metavir cirrhosis. You’re expecting ratings commensurate with the level of your debility. And then some goombah rater hands you a 0% for the hep and denies the cirrhosis the BVA just gave you. Welcome to the new, improved AMA circus merry-go-round. We used to call it the Hamster wheel. 

 Chuck is a Vet who did Army until he realized it was more comfortable to fly than march. He transferred to the Air Force and finished out his 20 as a light colonel. Wise man, he.  Unfortunately, he’d picked up the hepatitis from jet guns or dental work along the way. Doesn’t take much in a herd setting like the military. Remember them jars of blue juice in front of the barber’s mirror they put the straight razors in? How about that skanky old leather strop hanging off the side of the chair? In spite of the obvious, VA wasn’t having any of this hooey and denied. I don’t know how you’d get hep anywhere else but in the military if you spent most of you life in it. VA felt he might be less pure than the driven snow and somewhere in the time right after retirement, began the cherchez la femme noire or snorting the white lady. The aspersions were subtle but firm. Ewwwwww, Chuck. You have a ‘dirty’ disease.

That’s when he came to me and asked for the secret password and the Caluza handshake. I scooped the entire file and shipped it off to my IMO outfit. I filed at the local Fort Fugetaboutit a month or so later. They flat out blew it off as useless and denied again. Because it the dawning of the Age of AMA, I filed the NOD and let the BVA VLJ’s common sense prevail.  It paid to get it in front a knowledgeable Judge as long as s/he was pro-Veteran. And we sat back to wait. And wait. etc. And then the pandemic hit. And more waiting.

Chuck says while he was at the VAMC on Valentine’s Day 2022 , he sashayed over to the DAV table and asked the Bozo a few questions about the new PACT act and what the parameters were going to be. Mr. DAV was more than obliging and said sign here and I’ll give you the briefing. Chuck asked if it was kosher to have two POAs going at the same time and Mr. DAV assured him it was legit. Boom. POA cleanup on Aisle 5.   I knew I was missing a client but couldn’t find him because it takes a lot of time to find out which guy is AWOL.

So Chuck calls up around Father’s Day and said what the hey? Weren’t you gonna call me and tell me we won? He was flatass speechless that DAV purposely would lie and pull a stunt like that. I’m not. I’ve read of a NSO that argued to reduce a Veteran with a rater in a DRO hearing transcript. And he had the balls to do it with the Vet right there in the room sitting beside him no less.

redact HCV BVA win

Redact RD 6.1.2022

So anyway, Mr. DAV whips up a four-page Appellant’s brief  right before the decision without even discussing this with Chuck. Remember, I already had mine in for a year by now. Shucks. Chuck thought they were working the future PACT burn pit gig for his sinusitis. Hey. VSOs are what they are. They suffer from too little training and two huge egos each. Their mother organizations refuse to give them too much info like SMC and concepts like CUE. Never heard of it. §3.156(c)? No such thing. The game ends at 100%. Trust me. I do this for a living. Go home.

Having access to the system, I can see the BVA decision hit CASEFLOW at exactly at 14:18:16 Eastern on May 31st. The completed rating decision was uploaded at 08:23:49 Local (Pacific) here at the DROC in Seattle. 0% for hep confirmed and continued. Cirrhosis denied. DM2 denied. Gall bladder removal denied. The teaching moment when you read it is the deadpan giveaway. “He didn’t have cirrhosis in service and has no history of it until after service so it can’t be service connected. The VA c&p clinician held that it was less likely as not you’d  get cirrhosis from hep c if you’re cured. Thank you for your service.” Better than that, the RD says boy howdy did we stay up all last night reviewing your records in order to be able to share your brand new rating with you bright and early this morning.

Not to be outfoxed, I had Chuck round up every private medical record he had since we’d filed the appeal. I submitted them all with a supplemental figuring that would clear the air. I even went into the tool box in Adobe 9 pro and used the call-out boxes with arrows and pointed to words  like “cirrhosis, gastritis, hepatic encephalopathy, malaise, arthralgias, nausea and vomiting”. Once again, I drew a zilch. My final legal gasp when dealing with mental Lilliputians is one last stab at finding competence in a field of stultifying gomers. I decided to try a HLR before setting sail for Washington D.C. At least I could honestly tell a VLJ I tried to reason with these shit-for-brains below at the puzzle palace.

Redact RD 11.10.2022 RD

I quickly filed the 996 to get it over with and sure enough-about that time the HLR instant Informal conference program ended. Used to be, you filed the 996 and the phone rang about an hour later with a reviewer asking you if you were ready to rock and roll. Now, all of a sudden, you file  for it on line at scheduleconference@vadotcom and get crickets. I filed 11/15/2022 and finally got in today. The St. Petersburg DROC may have been eager to put this to bed. Maybe they thought they were still dealing with the DAV chowderhead. I dumpster-dived that VBMS all day yesterday and pulled up all kinds of rich quotes. I had four pages worth including the actual regs to quote from. The gibberish from Nursey Nurse Ashley the VES booth bitch was priceless. She tried to sound like a Nobel Prize winner. Even better, the BVA judge had discounted VA’s two prior c&ps exams for being bogus and used my hired gun’s. The RD they were trying to pawn off on us now, in 2022, still relied on the bogus opinions in the evidence section like they were gospel. Sorry Charlie.

The icing on the cake was that my Reviewer this morning was a bonafide Nurse. She didn’t say which (APRN/PA etc). but at least she understood the concept that you didn’t need an acute case of Hepatitis C to qualify for the residuals. That’s the problem now. These c&p factories of QTC/VES/LHI/Optum teach their own folks how to do this. They’re using VA’s manuals They’re indoctrinating them in certain incorrect beliefs such as once you cure the Hep, you’re good to go… like the flu or a cold.

redact HLR 2.01.2023

All in all, it was a good Groundhog Day. Another Vet is saved from the machinations of the evil VA Goliath. Now, wait for the merry-go-round to fire up all over. Murphy’s law posits if it can get more screwed up than this…. it will. Honestly, herding cats might be easier.

 For some reason, VA has begun denying IMOs written by Board certified surgeons using nurse practitioners barely dry behind the ears. Their rationale borders on the incredible and they aren’t above citing to Wikipedia. I had one recently where an optometrist called bullshit on a noted ophthalmological surgeon 30 years his senior. Yep. The VLJ cut him in half and decided in my client’s favor. But this just begs the question of how we arrived here. Riddle me this. Since when does VA get a bye on medical opinion superiority? I could see a pissing match between two neurologists and in fact just went through that. But why?

The whole VA justice system is tilted ever so slightly in the Veteran’s favor-or was. The benefit of the doubt is a powerful tool but it only kicks in at the end when all the goodies are stacked up on the justice scale. If everything is in approximate equipoise then you win.  If your doctor disagrees with VA’s doctor, then it’s a tie and you win. Since the advent of the new Administration, that rule seems to have been turned topsy turvy. You can’t win fairly on a big claim-especially one with a big retro- at the local fun house. It’s almost guaranteed these days you’ll be sitting on the Group W waiting bench with Arlo and the gang for a lot longer than they promised us when they sold us this new system.