THE PRESUMPTION OF REGULARITY

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It seems Veterans are assailed from every quarter when they file a claim. Denials in this process are endemic and almost guaranteed the first time out. To add insult to injury, the new “Provisional Rating” procedure espoused as the panacea to sweeping out the thicket of old, mouldy claims and cleaning up is nothing more than a wholesale miscarriage of justice to appease Congress. “We’re trying to comply” is VA’s plaint. Unfortunately “trying” implies ultimate defeat or an untoward outcome.

Now comes Ask Nod with a new concept. Most look at a problem like a coin face up on the pavement. I tend to pick it up and look at the obverse side. I accept nothing VA says at face value. For years I have read of the Presumption of Regularity.  I always conceived of it as having to do with the mail which is where I first encountered it in Rios v. Mansfield. See https://asknod.wordpress.com/2011/09/27/cavc-rios-v-mansfield-2007-presumption-of-regularity/

However, I ran across it again and again in numerous mentions regarding medical procedures, IMOs, indeed, everything that VA did. The “presumption” holds that VA is an altruistic outfit with Veterans’ best interests foremost in their endeavours. If you are drinking coffee (or were) I apologize for the brown liquid that just exited your nose and now populates your screen as you read this.

Rios was the prime example of Presumption of Regularity in the mail as was Woods v. Gober (Woods v. Gober, 14 Vet. App. 214, 220  2000). To go back in the anals of  VA history, look at Ashley v. Derwinski, 2 Vet. App. at 308-09 (1993) for inspiration.

VA is asking for a bye on anything it does judicially because, what the hey, they get to ride on the coattails of  the Presumption clause. With this in mind, a glorious hole appears in the fabric of jurisprudence. Overturning or rebutting findings that result in denials is difficult at the VA. Once they make their pronouncement, it is a fact that becomes incontrovertible. Veterans who attempt a Clear and Unmistakable Error (CUE) defense, discover this to their dismay. It looks good on paper but is never realized in Court. Call it Pay-per-view. You pay $50 to get in front of the CAVC to be struck down.

What would happen if you turned the tables on them and used their Presumptions of Regularity in their ratings procedures against them? This is what I am examining. I find it interesting that this blanket exoneration for mistakes seems to gloss over the wealth of errors that VA regularly commits. Driving a wedge in to disrupt a rating decision is the Holy Grail to a win. It should be easier rather than harder to accomplish in a self-admitted “nonadversarial, Veteran-friendly  environment in which to present our claims”.

If constant mention of this presumption is reiterated over and over throughout an argument and demolished by rebutting it, at some point the presumption becomes a fig leaf for VA intransigence and obfuscation- or worse- perfidy, misfeasance and (gasp) malfeasance.

The inception of the Provisional Rating process is showing us the 78 RPM form of pathetic, sloppy jurisprudence VA was renowned for in its former 33 1/3 rpm versions.  I don’t cast aspersions on all the hard workers down in the trenches at Regional Offices. They are constrained by the M21- 1MR denial Bible. Simply inputting the parameters of a claim into the gigantic maw regurgitates a denial 85% of the time. With the marvelous disconnect employed now, a RVSR can be oblivious to the outcome of a case once it has been uploaded and passes from his hands. This 85% denial phenomenon happens, oddly enough, to all claims. All claims encompasses burial benefits, Dependents Indemnity Compensation (DIC), Dependents Educational Assistance (DEA) ad nauseum. From this, all a statistician can ascertain is that 85% of all claims are either insufficient, fraudulent or otherwise do not meet the stringent requirements of the claims process. So much for non adversarial and Veteran-friendly and so much for an honest, provisional panacea for ridding themselves of pesky two-year-old or more claims.

A veteran down in Texas writes me to ask if I have ever heard of a “ten day letter” He received it June 26th. In it VA says they are preparing to push “print” in ten days and asks if he has anything else to submit. The letter evinces an understanding that, after 600 days,  it is obvious they do not have all the evidence he has submitted with his Notice of Disagreement. The mad scramble ensues to get it there with an intervening National holiday in between. Thank goodness for FEDEX Purple Label. Is this the much-vaunted Presumption of Regularity- i.e. that it is presumed VA will lose or misplace our evidence and thus produce a flawed decision?

Since the famous Caluza decision in 1995, VA has held Veterans to the standard of three items to win a claim. To wit, a disease, condition or risk in service, a current diagnosis, and a medical opinion tying the two together cogently. The presumption of regularity should attach to a VA doctor writing a nexus letter on your behalf. It rarely does. On the other hand, a VA examiner’s bumbling, misogynistic attempt to deny you almost always has flaws or crevasses wide enough to fall into. This, however, passes the Presumption test. Similarly, private letters from genuine medical doctors drawing a clear relationship between the two are regularly rent asunder by an ARNP or PA-C posing as a VA examiner. This becomes comical when they get out onto the little branches that won’t support them. Unfortunately this doesn’t occur for ten or more years until appealed to the CAVC or the Fed. Circuit.  Whereupon the presumption of intelligence is  finally rebutted.

The Presumption of Regularity is said to attach to all manner of VA processes and procedures according to Woods (supra). Would that it were true. Reality is a far harsher taskmaster and you will find no solace in the presumption that VA is going to adjudicate your claim correctly, let alone in a timely manner. The Provisional Ratings procedure is fraught with pitfalls. In their rush to decide, VA makes no effort to ascertain if the facts, as they are known, are before the adjudicator. In fact, they go so far as to clearly insert a codicil that says “We’re adjudicating this on what we have.” They also assure you that by its very provisional nature, you have a year to disagree but if you so choose, you may proceed immediately to GO! and begin the appeal process. As an aside, VA knows full well that if you are on Social Security, they are required to fetch the records. The Presumption of Reality dictates that they won’t until it arrives at the BVA. Whereupon it will be remanded back to the RO for same.

Haste makes waste seems to have been overlooked in the New VA World Order of claims. Wielding the Presumption of Regularity like a club, they demolish anything that stands in the way of the backlog. Utilizing this presumption against them must be  fine-tuned like a musical instrument. It must be constantly referred to as a Holy Writ that is assumed to be infallible. It must also be shown to be nothing more that a hollow, artful phrase devoid of any regularity. Each facet of your Notice of Disagreement NOD) must assail the precept that there is everything but the presumption of regularity. In this manner, you can make a mockery of their presumption by showing nothing could be further from the truth. This creates a record from which to appeal that will not go unnoticed.

Another Vet, Robert, noticed a Cushman violation of his records. Someone had inartfully handwritten a notation on his VAMC VISTA medical record  and it appeared to obfuscate the clear meaning of what the VA doctor was trying to convey on the nexus. Ruh-oh, Rorge. He presented it as a CUE. I guess you all know where the Presumption of Regularity led to on that one. The BVA VLJ’s Presumption was that it was entered as a postscript by the very doctor who wrote it. This begs an explanation as to why he didn’t just put in an addendum on the VISTA records for posterity and to avoid misunderstanding. The silver lining was that the BVA  VLJ”saw the light” and granted his claim to shut him up.

Never assume that the Presumption of Regularity is a guarantee of a 5 years/100,000 mile bumper to bumper warranty of the correctness of a VA claim. Nothing they do will truly have any legitimacy unless, or until, they become a truly independent trier of fact akin to the Administrative Law Judge (ALJ) model employed by the Social Security Administration. Face it. How can you expect the Presumption of Regularity to mean much of anything if the VA Secretary and his henchmen control the Veterans Law Judges’ purse strings? They serve at his whim as do the hirelings below at VA Regional Offices. Offend him and his agenda at your own peril.

Aside from the scatological humor of the phrase, the only Presumption of Regularity at the VA is that if you go against the grain, it is presumed you will not be employed there for long.

Attached here is a magnificent BVA decision that illustrates my point about the Presumption. I love this phrase:

The May 2011 VA medical examination report contains no indication that the VA examiner performed an improper examination

As if the VA examiner was going to preface the C&P exam report with the codicil ” This exam is not to be used for anything probative concerning the claimant. If a real C&P is needed for evidentiary purposes, it will require a do over in order to meet the Presumption of Plausibility.” Just because someone tells you the earth is flat, you are under no obligation to swallow it hook, line and sinker.

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COLORADO–ROCKY MOUNTAIN HIGH

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Here’s the perfect story for a Fourth of July. I mentioned it somewhere in one of my posts. I believe Randy sent it to me. Lawbob Squarepants, our esteemed rainmaker extraordinaire, sent me the post game wrap this morning. His observation is spot on:

Like the similar Project Salute case in Texas a few years ago, this was happenstance.  VA was getting ready to grant the benefits. Right.  Ask the Easter Bunny and Tooth Fairy.   They know it is true.

 Bob

One thing in the article you will read is abominable. Kash Alvaro was awarded a 50% rating. You read that right. 50%. The ultimate bitchslap. The one thing you won’t find here is that Kash would still be doing the chicken under an overpass somewhere with no medical help had not a courageous newspaper reporter named Dave Philipps decided to do a writeup on this. VA hates bad PR. To think that they would have been motivated to act without a prime incentive such as an  expose in a small time fishwrap is ludicrous. They moved swiftly in order to prevent this from going viral.

Another anomaly. Absent an upgrade on his discharge to “under honorable conditions” (which he lacked ) due to his misbehavior after playing too close to IEDs, he could not get VA medical benefits. This also disenfranchised him from any VA compensation. So now we have to ask ourselves how the Army managed to ram through an upgrade to “under honorable” in such a short time. I asked to up my General Discharge to Honorable six months ago. I got something back last month saying “Yo. We have some medals here you forgot to pick up before we gave you the bum’s rush out the front gate in 73.” But nothing on the subject of an upgrade. Funny how that works.

Living proof that News and Film at 6 is mightier than the 21-4138 or the pen.

On behalf of myself and the rest of the AskNod Krewe, I wish all of you a happy 4th of July. Since this inherently involves gunpowder and other things like cordite, I won’t be redundant and suggest a safe one. If it’s too loud, you’re too old or lack the patriot’s gene for saltpeter, charcoal and sulphur.

And as a PS, even though we are not responsible for his win, I wish to welcome Bill Acebes to the new ranks of the 100% P&T crowd. It’s good to see him finally inside the wire. Thank you for passing it on to us, Bruce.  Clear Left.

Nod sends

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Not soon enough: health insurance Open Enrollment

Early Rual Clinic

Past– Waiting for Remote Area Medical free clinic to open.

Important dates to remember for you, your family, and friends:  Oct. 1 (Open enrollment); Jan. 1 (Coverage may begin); March 31 (Open enrollment CLOSES!)

Uninsured Americans are counting the days until 1/1/14, when they may actually be covered by health insurance, with pre-existing conditions, at “normal” prices instead of the gouging prices.  I know one person who shelled out $35,000 in annual premiums fearing a recurrence of cancer would bankrupt the family. 

When state marketplaces go online, insurance companies will be competing against each other with their Bronze, Silver, Platinum or Gold policies.  MN’s website has a niffy calculator to help estimate the likely premium for a Silver Plan.

Veterans enrolled in the VHA do NOT have to buy health insurance under the new law.  Their families will need to pick a plan or qualify for a public plan or pay a tax (fee) and pay 100% of any health care costs they incur.  Ouch.

https://www.healthcare.gov/families

A few important things to note:  To get the best price, and get insured, you must buy via the Marketplace your state sets up by March, 21, 2014.   You’ll need a Silver plan for the best savings.  But if you take a lot of expensive meds, or need to see your docs often, you should get a Platinum or Gold plan.  If you qualify for savings on premiums or out-of-pocket amounts, based on income and family size–or a public plan–the Marketplace will advise you based on the information you enter online.

The Marketplace Youtube Channel is directed to millennials who realize that they’re not invincible: https://www.youtube.com/user/HealthCareGov?feature=watch

For the fortunate veteran, a private plan in addition to VHA enrollment  offers excellent  security.   And if the Virtual Lifetime Electronic Record (link below) between private and VA facilities is implemented nationwide, veterans will have superior customized coverage.  Call it the Titanium Plan.  Not as good as the Federal Plan, but very good.  One wouldn’t need to vacation near a VA hospital–although Orlando VA does look spiffy.

http://www.va.gov/opa/pressrel/pressrelease.cfm?id=2159

I think it’s important to remember what no health insurance looks like in America as seen by the volunteers of the Remote Area Medical teams.  The populations they serve don’t eat  healthy diets or have access to any health care.  This is one reason I support allowing family access to VA facilities that are in danger of closing.

What will these metallic plans include and cost? Well, it’s going to be a surprise on October 1.  No doubt some state websites will crash; no doubt everyone will be totally confused and fearful for a while.  No doubt the swindling insurance companies will find new ways to swindle us.  But it sure beats what we have now.

In the 70s, I met a young woman who told me a shocking true story.  Pregnant, she was traveling across country with her boyfriend when she went into an early labor.  They drove to the nearest hospital and the staff delivered her baby.  They had no health insurance.    The nurses wrapped her baby in paper towels and discharged her immediately.  Yes, you read that right.  Paper towels.  They wouldn’t even wrap a precious baby girl in a $2.00 cotton blanket because she was a charity case.

Posted in Guest authors, HCV Health | Tagged , , , , , , , , , , , , , , | 21 Comments

FIELD OF DREAMS REDUX

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This is priceless. I just received it from soon to be Washington State citizen and neighbor Mark. Remember the red-headed puke (brother in law?) on Field of Dreams who suddenly discovers all those 1920s baseball players wandering around on the field? That’s what this feels like. Fox News just came to the belated revelation that Vets have a hard road to hoe getting any traction on claims. One hundred Forms? Say it ain’t so, Barrack. Numerous Federal agencies? Get out of here. When did all that happen?

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ROUND UP THE ROUNDUP

HELPS BUILD CANCEROUS

downloadBOOBS 12 DIFFERENT WAYS

Bummer. Just when you thought it was safe to come out of the bunker, we find out our favorite soil sterilizer is metastasizing into AO. This just in from Law Bob Squarepants on a great Jamie Reno article.

Perhaps they should do some PR and label this a “tactical herbicide” rather than get all that unwanted media attention. Wait a minute. What media attention?

Posted in AO, Medical News, Porphyria Cutanea Tarda, Vietnam Disease Issues | Tagged , , , , , , , , , , , , | 2 Comments

BVA–GOING FOR THE EARLIER EFFECTIVE DATE

WHAT?

imagesME RATE HIM?

He’s not dead yet.

Here’s a smart Vet. Get a good law dog and go to appeal. He did just that. He hired Daniel Krasnegor. Danny boy is a past master at HCV claims. You’ll see his name on quite a few. Here, he took the VA on and positively smoked them. His Vet gets 100% and now the inevitable Fenderson staged ratings dance ensues. All this over a 10% rating. The VA raters  at the Cleveland RO must be kicking themselves in the ass for not tossing him a 60% bone. He probably would have just gone home to die.

This matter comes before the Board of Veterans’ Appeals (Board) by order of the United States Court of Appeals for Veterans Claims (hereinafter “the Court”) in October 2007, which vacated a July 2005 Board decision and remanded the issue of entitlement to a rating in excess of 10 percent for additional development. The appeal arose from an August 2003 rating decision by the Cleveland, Ohio, Regional Office (RO) of the Department of Veterans Affairs (VA). The Board remanded the issue in February 2009 and in an April 2011 rating decision an increased 100 percent rating was granted for the Veteran’s service-connected hepatitis C disability effective from November 13, 2008. In subsequent correspondence it was asserted that a higher rating was warranted prior to November 13, 2008.

VA immediately takes the position that it has been more than a stand up agency in caving in. The only problem is they fought Johnny Vet tooth and nail all the way up to the CAVC before they got caught cheating and caved in. Now, ten years after beginning this, they’re haggling over when he should get a compensable rating commensurate with his illness. This is so VARO. Here he is back at the BVA being saddled with the inevitable remand (again).

Although this case has been previously remanded for additional development, the Board finds that in light of the receipt of a recent statement from the Veteran’s attorney, further development is required for an adequate determination. In a January 2013 statement in support of the appeal, the Veteran’s attorney asserted that the record showed the Veteran’s employment at the Louis Stokes VA Medical Center was terminated in July 2008 and requested that employment records pertinent to how his disability affected his employment be obtained. It was further asserted that the available record showed he complained of being weak and fatiguing easily upon VA examination in February 2000 and that upon VA examination in May 2003 he complained of malaise, lack of energy, decreased appetite, and abdominal pain. It is maintained that the Veteran met the criteria for a 30 percent rating under the provisions of 38 C.F.R. § 4.114, Diagnostic Code 7345, effective prior to July 2, 2001, and a 20 percent rating under the current criteria.

They’ll quibble for another five years in this penny poker game all the while keeping watch out of the corner of their eye to see if Johnny keels over and dies during the pendency of this latest appeal.  Old Danny boy might look wet behind the ears but don’t let that fool you. He carefully cultivates that look to assuage VA’s law dogs. In truth, he was raised by legal wolves and and still bites like one.

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The meek, mild-mannered
Clark Kent look

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BVA– PTSD=HCV–COMBAT MADE ME DO IT

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From the VARO with the fringe on top (Muskogee, Oklahoma) comes this sweetie. We have seen a few of these cross the table over the years and some bear fruit. This one did. The Vet was ably represented by the Oklahoma Dept. of Vet Affairs, a stand up group of VSO reps much like their neighbors south of them (Texas Veterans Commision). Seems those folks care about their Vets.

Johnny Vet here smartly used the law to his advantage and got a win. You and I know this would never occur at the RO in Muskogee. No one wants to get out onto the little limbs and risk saying this. Read his testimony at his hearing and it’s easy to see how he did it. Well done, hoss.

 

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DBQs AND CLAIMS FILING

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Lawyer Bob and his stalwart crew up in large mosquito land have sent me some interesting news. As often as I inveigh against using the DBQs (disability benefits questionnaires), I have now been told there is a silver lining to the beast. No, don’t get your hopes up. Undersecretary for Benefits Allison (in Wonderland) Hickey has not yet added a porthole for your nexus from your doctor. What has transpired recently is that with the switch to electronic records, you can speed up your adjudication exponentially in VA time. Here’s how…

Here’s the skinny. File your claim on line using the new portal on Ebenefits called VONAPP. Separately file the nexus letter from your doctor or health professional in the same manner. Make sure it is typed rather than hand-written in order that the .PDF word-searchable programs can recognize it. What then transpires is an electronic decision generated by the computer (VBMS). The nexus letter will be perused by a Rating Service Veterans Representative (RVSR) to ascertain it meets the three requirements of  current disease, disease in service (or risk factor) and medical assertion of connection between the two. He/she then uploads confirmation into the VBMS that this has been accomplished.

From there the nexus box gets checked off and the claim enters the maw of the computer. The computer can pull out the salient facts on the DBQ and grant your claim much faster with no human interaction (i.e. no VA Examiner). Knowing the VA, this will still result in an inordinately high number of denials but this is a vast improvement over what we’ve been dealing with. Besides, computers don’t get tired and grumpy and spill coffee on their keyboards. They are impartial within the parameters preset by VA. This is a vast improvement over idiots arbitrarily denying you based on nothing more than a whim and the glowing approval of their bonus-awarding superiors.

Look above at the top in the black area for  VA Forms or if you’re lazy like me click this. It will give you all the downloadable DBQs needed for your claims. You can also give this link to your provider (be specific for the DBQ http://) so he can type it up on the form electronically and then print a copy for both of you. This will help tremendously. Remember, if the doctor hand writes the DBQ, the whole thing slows back down to a crawl. VA’s VBMS cannot decipher handwriting-especially doctor’s handwriting. Hell, neither can I for that matter.

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HCV testing upgraded to a “B” service just in time for Affordable Care Act (ACA)

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Image credit: CDC infographic

A lot of positive changes will be coming to millions of under-insured and uninsured Americans in 2014.  One change is that the U. S. Preventive Services Task Force has upgraded (6/25/13) 1-time HCV testing for baby boomers from a “C” to a “B” preventative service.  That means that insurance companies will have to cover the screening when ACA takes effect.

http://www.uspreventiveservicestaskforce.org/uspstf12/hepc/hepcfinalrs.htm

The CDC has published the above simple infographic in preparation for the change: http://www.cdc.gov/vitalsigns/hepatitisc/.

This resource also provides useful background about the implementation of ACA and HCV.

HCV could NOT have been detected prior to 1989, because the HCV protein hadn’t been identified.  NOD has discussed Dr. Edwin Southern’s Western blot test for HIV versus the Northern Blot which detects HCV here.  Almost 25 years later, HCV testing will become part of routine preventive care.  That’s cause to be happy because this clever sturdy virus is going to be infecting humans for a long time.

HCV is the most common chronic bloodborne pathogen in the U. S.. Among veterans, HCV is endemic and we explore the reasons why this is so on this weblog.

Soon everyone will be able to find out their status through their private or public health care coverage if they chose too.  Remember hearing about HCV for the first time?  It’s an emotional time.  Thousands of patients newly diagnosed with HCV will ask new questions and demand better and more truthful answers from their government.

Posted in Guest authors, HCV Health, HCV Risks (documented), Uncategorized | Tagged , , , , , , , , , , , , , , , , , | 1 Comment

#40 WEIGHS IN

Win or Die

From the Wilmington, Delaware VARO:  Jules just emailed me last night to let us know he has met the beast and won. I have no qualms sharing the limelight with Hadit.com. I’m actually the FNG on the block. T-bird set up her site at Hadit at the turn of the century. We’re the newbies.

I just wanted to drop you and all the other VA Hadit.com elders a line to thank you for your remotely shared knowledge, comradeship and encouragement during my four year four month struggle with the VBA. With the assistance of my Congressman, Senators, including the late Frank Lautenberg may he rest in peace, ask nod and Hadit.com.   I was able to have the long awaited 100% schedular confirmation letter printed out for me at VARO Wilmington, DE this morning. I think in many respects the past four years of attempting to convince the VBA that Psoriatic Arthritis, Psoriasis, Asthma, COPD and skin cancer were disabling was as trying as some the 21 years spent in the Army.Please keep up the good work that you do. Your wit and insight help to sustain and encourage many of your fellow vets. Win or die trying.

Regards,

Jules

MAJ, MS, AUS, Retired

Jules, as I mentioned in my email, this is what we live for. Both the sites encourages all to never give up. The vision of the frog attempting to strangle the heron is synonymous with Win or Die. Too bad there aren’t more sites for Vets to visit that truly engage in “hands on” help rather than try to dissuade them or beat them to death with their lips.

Congratulations on a battle well fought.

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