EVIDENTIARY REQUIREMENTS FOR VA CLAIMS

screwedMany of you who come here seeking advice either do not have access to  the Veterans Benefits Manual or are unaware of the VA’s M21 1MR Manual for adjudicating claims. It’s no mystery how this is done. What most Vets do not know is that Chapter 38 Code of Federal Regulations is an explanation of how to decipher 38 USC on a day-to-day basis. CFRs are dynamic and changes as jurisprudence develops. 38 USC does not change unless Congress so orders it. 

The M21 manual is a how-to for VA raters to conduct their examination of your claim. As such, it becomes the de facto tool for making the actual decision. Nowhere is it written that the VA has permission to do this yet a compliant CAVC has acquiesced to the concept and now allows it.   I attach a small portion here for you to read.

M21 1MR Evidentiary requirements

This proves only one thing. It is written to accomplish claims and is the primary tool for doing so. You will note references to seminal CAVC precedential jurisprudence that supports the chapter or concept. Why they are included is a deep, dark secret or a bald attempt at trying to imply objectivity and thus justice. I have yet to meet anyone in the RO who is even cognizant of the fact that an Article I Court exists above the BVA. VA does not utilize 38 CFR except to justify denial language and give you a rationale for your loss in the Statement Of the Case (SOC). The actual day-to-day adjudication is predicated entirely on the M 21. As such, it is computerized and you merely insert the facts at one end and move to the printer hopper to find out what the Ouija machine has determined. This also takes the angst out of having to deny 85% of the claimants when you know full well that most of them are deserving.

In a more perfect world, we would have a hands-on approach that would catch input errors. There would be an opportunity to spot illogical assumptions. Due to the complexity of the process and the fact that no two claims for the same illness or injury have even close to the same predicate, there cannot be a “one-size-fits-all” computer program that can analyze a finite set of facts and spit out a “if…, then…” scenario. This is why you are inevitably denied the first time out on complex claims. The honchos down in rating, having assembled what they feel is all the info that will be forthcoming, push the magic print function on the WARMS computer and out pops you poorly constructed denial using an antiquated version of Adobe Acrobat 2. This explains the disjointed, poorly constructed sentence structure with incorrect tense and dangling participles. Trying to string these sentences together, they inevitably conjoin two tails and no heads. Three-legged analyses are frequent and rationale for denials is often so incredible that VA has a hard time defending it later. Nevertheless, they do to the point of absurdity. By analogy, I’d compare it to the Thalidomide drug of the sixties- ” Something’s missing. Where’s the arms?”

The CAVC has determined that the M21 is an adjudicative tool and perfectly legal for deciding claims. Why we even have 38 CFR is a mystery if it is unused or unneeded. When you cite to it in your defense, say, on a Notice of Disagreement (NOD), you might as well be speaking Laotian in a little-used Meo dialect. VA DROs will never relate back to these contentions but proceed to merrily develop the original denial language and embellish it at great length. This is one primary reason Veterans fail in a pro se environment. You are busy arguing the apples are red and VA is insisting they are orange and have a decidedly citrus flavor with a big nose.

The M21, from all outward appearances, appears fair and benign. Nothing jumps out at you as being adversarial or anti-Veteran. In fact, every effort is made to calm the sleeping dog and not arouse him initially. In conjunction with willing VSOs, the Veteran is made to feel he inhabits a judicial enterprise exclusively tailored to him or her with adequate safeguards in place to assure objectivity, fairness and arrival at a factually correct decision. In reality, this is far from the truth. The whole ex parte process is founded on your presentation (or your VSO’s failure to present anything) of the evidence needed to corroborate your version of events. Without the service medical records and pertinent documents to work from, you often rely on your memory. Baaaaad idea. VA works strictly from the records. Lay testimony, as you can read in the small M 21 blurb I attached above, is  much ballyhooed in theory but when held up to the light later, we discover VA tends to use every ploy imaginable to denigrate our testimony or that of our buddies in letters of support. I have seen the rationale for one denial based on the bald assertion that no one can remember back forty years clearly as to the inception of a tattoo in Da Nang at 0200 after a few adult beverages. Mind you, the addition of liquor to the story and the early morning hour were purely speculative on the VA examiner’s part and unsupported by physical evidence in the file. This obviously does not deter them from embellishing your denial predicated on their own life experiences when obtaining their own tattoos.

Lay testimony is one of the most often abused of any evidence submitted so it must be carefully vetted to rid it of any taint of stupidity.

VA is renowned for not retrieving that which you give them permission to seek such as civilian medical records.  Unfortunately, you do not find this out until the denial or when you finally extricate an unadulterated C-file from them. You are required (or it is strongly implied that you should) to submit forms allowing VA to obtain those records you identify as being probative to your claim. In reality, they are often not associated with it. Social Security records, quite possibly one of the most probative of all, are rarely associated with your file until it reaches the BVA. When this occurs, two things happen. First, two years of waiting goes down the drain. Secondly, the claim is promptly remanded back to your Regional Office to stand in line again for retrieval of said records and a new adjudication of the claim. This little side trip is good for another one-year delay.  It’s no accident. This gives the VA yet one more in basket in which to stash your claim for a year. Sometimes they send it back up and never obtain the records at all. There is no punishment mechanism built into the remand. If the RO is sloppy (and they all are) this can and will happen. The VLJ can only remand again with an admonition and a set of instructions on how to color inside the lines before returning the crayons to the box.  This is why I have long advocated for what is now called the Fully Developed Claims (FDC)process. Knowing VA is slipshod and prone to this error, it behooves you to take the bull by the horns and do all the fact-finding and development of your claim. It rarely speeds things up but it ensures the record is a lot more probative and complete that entrusting them to accomplish it. Besides, it saves time by depriving them of excuses for failure to get those SSI documents.

While the BVA does not subscribe to the M 21 mantra, they do depend heavily on the C-file the RO compiles (or doesn’t). Thus we often get a rubber stamp denial that merely rearranges a few phrases to make it appear like a new document with much probative analysis and long hours of conjecture involved. Don’t buy it. At the BVA stage, you should have a much more complete assemblage of components rebutting the moronic errors committed below by the Katzenjammer RVSRs.  Each error must be anally documented and a reason why it is factually inaccurate. The operable word here is ‘anally’.

Your win depends on you convincing a Judge who works for the VA Secretary. He is not impartial. He has a crew of munchkins who are paid to be adroit in the art of denial. His paycheck is signed by the agency hired to deny you. Unless, and until we get a truly independent jury to hear our claims, we will always be playing ex parte catch-up and fighting to right mistruths. I will be writing shortly about this on the latest update concerning Keith Roberts‘ long search for justice. His case is so fraught with injustice and outright malfeasance, it is hard to figure out where to start in.

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SOVALDI APPROVED BY FDA

downloadWhat we’ve all been waiting a long time for came true today. The FDA approved Sovaldi for production. Now to convince the government to buy it for me. With my luck and Obamacare, they’ll take the eugenics tack and say it’s simply too much to spend on a 62 year old Vet. 

As for VA coming up with Sovaldi any time soon, rots a ruck. They bought a trainload of Victrelis triple-drug cocktail at bargain basement prices. This was shortly after Gilead revealed they were coming out with a new regimen. No wonder VA got a deal on Telepravir. It was headed for extinction by then anyway. What’s the deal on buying old technology? They sewed Alloderm into me in 2010 even though it had been recalled in 2007. Seems they use up the old before they buy the new. At this rate, Vets can expect to see a generic Sovaldi by 2025.

Posted in HCV Health, Medical News, Sofosbuvir | Tagged , , , , , , , , , , , , , , , , , , , , , | 5 Comments

Update on Minot-area HCV outbreak: From 3 cases to 40 cases from an unknown common source

download (3)This October I wrote about the North Dakota cluster of acute (recently infected) cases of genetically linked HCV from the same geographical region. It can’t happen in Ward County? Well, it did yet North Dakotan journalists must find the subject boring even though the Minot HCV outbreak is already larger than Exeter Hospital’s 32 cases–and where far more people were tested.  (Only 500 people in the Minot area have been screened thus far.)

HCVs are opportunistic little devils that take happy advantage of the endless ways they can slip into new hosts wherever health care is provided.  A nursing home may have been the setting for this transmission.  But they point to the possibility that any of their infected patients may have first contracted HCV in a hospital, prior to admittance to their nursing home.  And that hasn’t been ruled out yet.

The ND state epidemiologist, Tracy Miller, is still investigating but hasn’t released much information.  Administer Kirby Kruger doesn’t sound worried. He stated:

“It’s important to remember that hepatitis C is not spread through the air, but instead through blood, and it is not spread easily,” said Kirby Kruger, director of the state Health Department’s Division of Disease Control. “At this point, we do not believe the general population to be at risk for hepatitis C related to this outbreak.”

Someone needs to clue him in on just how virile HCV is since the rising numbers of known cases doesn’t alarm him. The ND Dept. of Health press releases report these numbers:

August 12: 3 cases; October 16, 7 cases;  October 17, 28 cases (revised to 27); October 30: Testing expanded again; November 12, 35 cases; Nov. 19, 40 cases.

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Image is not of the actual victims.

Not spread easily?  They know that 40 people were infected with HCV in a relatively short period of time from one common source in ND.  The house is on fire.  We, the general public, need to know what happened in Minot as soon as possible. 

 

Posted in Guest authors, HCV Health, HCV Risks (documented), Medical News | Tagged , , , , , , , , , , , , , , , , | Leave a comment

ANOTHER VA SECURITY BREACH

2If you haven’t heard yet, the VA has once again stepped on their collective necktie. When not busy leaving expensive laptops in plain view in vehicles in high-crime areas, they now have been busted for all but printing out our SSNs on our VA ID cards. Yeppers, folks. Spread the word. 

download (1)While I’m not very prone to drag out my VA ID and proudly wave it around, if I lose my wallet, there’s a high probability that a motivated criminal with a bar code reader app in his cel phone can pull it out without much fuss. That, along with your DOB and a few other metrics like an address off your driver’s license is just about all that is needed to buy a new car on your brand new credit card you didn’t know you had yet.

images (1)Be aware. It’s a new world out there and some of the people inhabiting it are not your friends. The good old days of stamping it on your dog tags is gone. The new VA card will be out next year so protect the one you have. What the hey. Take a pair of shears and cut the bar code off. If  the VA weenies down at the VAMC blow an ass gasket, give them your opinion of their intelligence. Go ahead. Be brutally honest but do it with a smile. They’re already batting .1000 on stupidity as it is. This just confirms it.

By the way, google VA ID cards on the ‘image’ setting and you can view any of the above cards. I do hope they are merely facsimiles of real ones. And if you know any of these guys, tell them their images are published there (at Google).

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HCV LONGEVITY @ ROOM TEMPERATURE

USS Mayflower

USS Mayflower

Wowser. Just the right calibre ammo for that HCV claim where they say everything is pristine clean and HCV is not a “robust ” virus such as it’s close cousins HBV/HAV on the other side of the sheets. This will poke a hole in one of VA’s prized arguments that HCV can barely survive on a needle for sharing drugs but dies left out in the open to it’s own devices. My advice is to download and print it for inclusion of a general nature to show the VA you were not on the original Mayflower manifest. This will defeat many an argument by making it a nonstarter conversationally. A warm thank you to Patricia for putting this one out there.

Posted in HCV Health, HCV Risks (documented), research | Tagged , , , , , , , , , , , , , , , , , , , | 3 Comments

UGLY STATISTICS ON DISABLED VETS BEING HIDDEN

This hardly surprises me. ‘Pop’ Smoke sends us this news flash which should hardly come as a surprise but does. In the early stages of World War II, this us-veteran-disabled-texas-pic-2-getty-imagewas commonplace. Roosevelt did not want America to lose heart at the outset when our casualties were enormous in the South Pacific. He ‘sat’ on them for years and the truth did not out until after the war. I think we’re all big boys and girls now and can stomach the truth- however unpalatable it may be.

Here, we have the enigma of a self-described ‘open, transparent administration’ which suddenly has become opaque.  Suddenly glasnost from the C in C, who promised to extricate us from Iraqistan, is in short supply.

Winning a military engagement is pursued with gusto. Half-measures result in unnecessary casualties. A three-to-one force majority, in conjunction with air superiority is employed and a guaranteed outcome ensues. This fact is tried and true. It has never been otherwise. Yet we have embarked on a policing mission that is anathema to troops in place. Look no further than the type and number of the injuries. It mirrors the carnage of the sixties and early seventies in Southeast Asia. Amputations and loss of limbs once again lead the statistics.

If our troops are injured, so be it. Let’s get them help. Shuffling them into a backwater corner of Walter Reed away from the prying eyes of the media is not what we need. Honesty is. A frank assessment of what the needs list is and prompt attention to these troops to get them help is in order rather than getting reelected on broken promises.

I personally do not care what the Agenda du jour is anymore. I cannot change the bellicose nature of nations nor can I incite my own nation to do what’s right. Somewhere, we made a decision politically to abandon reason and press on with appearances. As usual, the ones who lose are those who can ill afford it. This is not an argument about ‘Bush lied, thousands died’. I note Reagan was not repetitively  blaming Jimmy ‘the peanut’ Carter for getting him into a jam economically five years after he was elected a second time. Neither was Clinton overly inclined to take Bush 41 to task for America’s malaise.

The parallels to the Vietnam War and the familiar, concomitant fallout now are striking. Using CIA logic (if we don’t discuss it, they won’t come bitch), the VA and the military are quietly burying this in the backwaters of VAMCs and military hospitals everywhere.

Honesty is what drives future decisions in government. Cooking the books or worse- simply removing whole chapters and secreting them out of sight in hopes no one will notice- is disingenuous and self-serving. Are we so driven by our political beliefs that we are content to obscure the truth about our injured Sons of War? To what possible purpose? Winning the next election? America deserves better. We, as Veterans deserve better.

Since writing your congressman is not the panacea it once was, I strongly suggest we use that lovely lever of democracy called the vote to effect change in the next election. I do not, nor will I ever, suggest who might be the more adroit at accomplishing this task. I don’t rightly know. Both sides seem more consumed with keeping their jobs than keeping America strong. You’re all adults. I leave that determination to you. PFC Josh Stein and his buddies demand we do something rather than bury him and his statistics at the bottom of a trash can. We tried this after Vietnam and it didn’t work very well then, either.

Posted in Food for thought, Future Veterans, Gulf War Issues | Tagged , , , , , , , , , , , , , | 3 Comments

FACE HUMOR AGAIN

training fluffyTime life is coming out with their new book on Teaching Your Old Cat New Tricks. You probably don’t want to miss this one. Hundreds of new ways to get Fluffy to dance and even retrieve like a Labrador. A bargain at $29.95

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VA BACKLOG IN DECLINE?

VA ratings machine

We decided to take the Ric Shinseki ‘Find a needy Vet’ challenge and see if we could find even one sick needy Vet falling through the cracks this Christmas. Turns out we didn’t have to look very far. Our very own Hepsick, Mark, got hornswoggled into a DRO review down in Oakland’s Puzzle Palace back in February of this year. For any of you who don’t know how they are manipulating the backlog, gather around and let me illuminate you. 

Entering the VA jungle, you may not notice that you often lose the first time out. That is a 5 month fast-track claim or something fully developed. I am not referring to Presumptive AO diseases. They are in another office and do not count. They’re an automatic gimme but still take a year. No, I’m talking about a bad back, busted up knees or some good old-fashioned bent brain disease with a side of IED-shaken not stirred.

The glorious process only moves forward like a merry go round because there are just so many seats on the ride. The journey actually begins back in the line waiting to get on. After a period of time ( a year or two) you get off and have traversed the diameter of the merry go round circle and no further. You then get in line for the next merry go round and wait for your shot at the appeal or DRO review. This lather, rinse, repeat begins anew at each stop along the way to the Court of Veterans Appeals. Hurry up and wait. Sounds horribly familiar.

The Board of Veterans Appeals, in 2004, invented yet another VA Regional office in which to conduct Kangaroo justice and print up SSOCs to speed up the denial process. They call it the AMC and its located over on Eye Street near Vermin Ave.

download (1)To visualize this as a parody, think back on Lucille Ball in I love Lucy. Remember the hilarious scene in the bon bon factory where the chocolates overwhelmed the gals? Now picture them as VA raters yelling down the hall ” Yep. Got it. We’re on target to pump a bunch of ratings out here. Stand back.” Unfortunately the filing cabinets are stuffed, the storage areas are swamped, the building is being structurally tortured and the claims pile up.

downloadWhen it begins to look like they may get hoist on their own petard come Monday Morning, they merely  create a new file or column and label it “Fast Track Claims” When it begins to overflow, they’ll bifurcate it again or another one similar.

Mr. Hepsick has been riding these merry go rounds now for seven years and has won. The next merry go round he boarded gave him a 20% rating in spite of his painfully obvious condition. There’s a reason for this. If he goes away, they have less Mark work to do. If he files a NOD for a higher rating, that is an appeal and Mark has to go get in the appeal line. While standing there, the VA asked him if he was a real glutton for punishment. He answered in the affirmative and signed up for a magic 585 day DRO review. They promptly sent him out for the C&P that they should have done before rating him and had him move over to the Group W bench. And no, it wasn’t named after a guy from Texas. W stands for Wait. As in A Long Wait.

Back in the days, the old, senior raters would see one of these come in and pull it out of the stack. Off Mark would go to the VAMC for a checkie-checkie and bingo- home again, home again. Instead, with a limited number of seats, he will get on several more merry go rounds and eventually get off at 100% Permanent and Total. He knows this. VA knows this. It’s a game. Unfortunately for us, the game is getting longer. We are assured that the corner has been turned and a new dawn is just a year or less away. Yet Mark gets bushwhacked with a knowingly lowballed rating forcing him into an appeal posture to protect himself. Welcome to merry go round number 2 -your very first post-BVA win appeal for a real rating.

In case none of you recognize this, it is the VAMC version of a DBQ for Hepatitis. They are only now doing it post-appeal. This should have been done before the rating in February.

Mark’s C&P DBQ

How is it then that this is allowed to happen? February 2013 to approximately August-December 2014 for a DRO decision on whether the Markster gets a full ride? This must be some kind of heavy reading. Why you’d have to wait until Hell freezes over to get someone to give this the once over and a rubber stamp is crazy. That is the depths unto which we have now subsided. Just think if we didn’t have VBMS or Veterans Service Organizations. You wonder how long it would takes then, huh? Naw. I’m not gonna go there.

Posted in C&P exams, VA BACKLOG, Veterans Law | Tagged , , , , , , , , , , , , , , , , , | 8 Comments

ILP GREENHOUSE UPDATE

DSC00610

Organic, gmo-free, green heat. Click on picture 

Here’s the latest from CBS. VA Vocation Rehabilitation Counselor tells Veteran to man up and heat his own greenhouses. Veteran, In vain attempt to protect what’s left of his liver and keep organic food on the table, enlists help of local power company and his horses. Veteran signs pact to only buy “green” electricity generated by wind in eastern Washington and thus reduces global warming. Horses sign mutual trade agreement to deliver “green heat” for apples, rolled oats and leftover carrots.

DSC00612

Green electricity imported from eastern Washington. Like they say, it costs more if you’re trying to save the world.

Being space-challenged because Broccoli is rude makes it difficult to walk into my smaller greenhouse. Lettuce is on track  to be ready by Easter if we don’t have a cold snap.

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DSC00615

Gee, I may get my ILP appeal certified and  sent to Washington for a BVA decision sometime in 2015 or 2016.  Good thing this backlog business is over.

Posted in Food for the soul | Tagged , , , , , , , , , , | 2 Comments

GEN. MOSES & THE PONTOON BRIDGE

Yo! 14 cubits wide. Got it?

Yo! 14 cubits wide. Got it?

From the seasonally festive Battle Creek Law Offices of Law Bob Courtpants comes this endearing Army version of the story. I had no idea. It’s from a former Airborne weenie, so you have to take it with a grain a salt. A very large one, in fact.

Nine-year-old Joey, who tended toward drama, was asked by his mother what he had learned in Sunday School.

Well, Mom,  our teacher told us how God sent  Lt. General Moses behind  enemy lines  on a rescue mission to lead the Israelites out of  Egypt . When they got to the  Red Sea , he had his army build a pontoon bridge  and all the people walked  across safely. Then he radioed headquarters for  reinforcements. They sent in bombers to blow up the bridge. In the meantime, after the fighters achieved air superiority, they strafed and naped the Egyptian Forces. The A-10s took out the chariots and dropped CBU-26/49 delayed to impede their withdrawal.  It was a complete route and the Israelites made a brilliant tactical retreat into their homeland.’

‘Now, Joey,  is that really what your teacher taught you?’ his  Mother asked.

 ‘Mom. If I told you the teacher’s version,  you’d put me on restriction for a month and make me start seeing a shrink!’

Pontoon Bridge02

Israelites crossing the Red Sea

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