1. Why VA benefits are denied?
VA benefits are denied due to a combination of the following three major (BIG 3) factors:
(1) RECORDS: The patient’s medical records are important for benefits analysis. The problem is that these records are often not available. Many patents have service combat records, private records and VA medical records. These records are not always available to the rater because service records and VA records are not seamlessly transferred and because all outside civilian records are not always available to the VA rater. As a solution, I have seen some patients who hand carry all of their paper records to the VA rater. I've seen some patients who scan and store all their records on a computer then transfer those to the VA via fax or mail. Finally, there is a recent move to be able to upload all records to the internet at a secured location then the patient can just done load his records to the VA or his provider by using a password.
(2) DIAGNOSIS: Military patients get excellent diagnosis and treatment in the battlefield for acute injuries and illnesses but their long term follow up of complicated chronic illnesses is of less quality due to the number of nurse practitioners and PAs used in extensively in military and VA hospitals. Many times these extenders are over their heads with the complicated chronic illnesses that are common many older veterans. Thus, many patients' long term diagnosis are often incorrect. Solution: Often extra testing and workups need to be done to figure out the primary and secondary medical problems.
(3) MEDICAL OPINIONS: The patients often do not have access to integrated medical opinions. Many patients send in piles and piles of medical records as discussed above but these records need to be assembled by a physician into a coherent medical opinion that follows general medical principles. The physician should be experienced and must be able to incorporate the VA rules and regulations surrounding the medial diagnosis codes. The civilian codes are about 68,000 in length and these codes need to be distilled into the VAs 2000 codes, which are covered in about 70 DBQs.
2. Why do VA claims take so long to process?
Claims are complex and if any of the above listed BIG 3 reasons for denial (poor records, wrong diagnosis, no medical opinion) are incorrect then the claim goes into an infinite loop of appeals ( The "hamster wheel") RO-DRO-BVA- AMC-BVA- CVA- BVA - RO….). All appealed claims take additional time as they move from venue-to-venue as additional testing and medical opinions are obtained. In other words, the fastest claim to process and decide is the claim that is well organized with a medical opinion on each issue. Each issue by issue focused medical opinion must be supported by medical evidence. I predict claims without proper documentation will flounder in the VA for years.
3. Why use Dr. Bash?
I have been doing VA claims for over 30 years and I am likely the only physician to have testified as an expert at regional office, decision review officer and board of veterans’ appeals. I have done thousands of cases with a very high success rate...on the order of 90%. The reason my success rate is high is because I optimize the BIG 3 reasons that claims fail above. I do medical exams/tests to get the diagnosis correct, then I write well supported medical opinion based on all the records.
4. Are you accessible?
I'm very busy. The best way to get me is via email (firstname.lastname@example.org) and text message to my phone 240-506-1556. My electronic consult form on my web site also works well as it goes to my support person who then can call you back as an initial contact (see www.veteransmedadvisor.com).
5. What is the patients’ job?
Each patient’s case is different but the patient can help by gathering and keeping copies of all records and x-rays. It is a must for patients to attend all C and P exams and hearings if medically possible.
6. Do VA hearings matter?
Yes all VA hearings formal or informal ARE VERY IMPORTANT. The advocate that you take to the hearing also matters. Always ask if your advocate has 10 years' experience and has done 100 or more hearings, as that experience is critical. In my experience independent advocates are often better able to address all issues because often the National Service Organization advocates feel the shadow of their Big VA brother and are thus sometimes are somewhat limited in their ability to advocate for all aspects of the claim. Always ask to keep the hearing open for 60 days following the hearing so that you can add additional information that the Judge/DRO/Rater might require. Ask your doctor to attend the hearing as an expert.
7. Do you attend hearings?
Yes I do, on special request. Hearings I've attended are located in all regions of the country.
8. Do Compensation and Pension (CP) exams matter?
Yes CP exams are essential. These are very difficult to reschedule so do not miss any CP Exam. If the patient misses a CP exam, usually the claim is immediately denied (regardless of merit) due to lack of new information.
9. Do DBQs help or hurt the accuracy of the claim?
DBQ (Disability Benefits Questionnaires) can either hurt or help the claim depending on the examiner. Many VA examiners are nurse practitioners or physician assistants. These examiners are assistants/physician extenders and their depth of knowledge on the natural history of diseases is limited and they often do poor/incomplete DBQ exams. A good BDQ by an experienced physician provides the patient with a fair accurate assessment of the patient’s conditions. The DBQ must be followed by a separate report called a Medical Opinion as the DBQ alone does not establish a NEXUS. The NEXUS is documented in the addendum medical opinion, which of course is usually done by a physician. Therefore if a physician extender does the BDQ and a different physician does the medical opinion often there are logical disconnects which hurts the accuracy of the claim.
10. How does the DBQ compare to a NEXUS letter?
As stated above the DBQ is really only a detailed physical exam is does not ask the physician to opine whether the condition is linked to service or not. The nexus letter is specially focused on any potential linkage to service or secondary to service conditions.
11. What is your recipe for helping veterans?
I suggest that each patient get his claim organized with the best possible set of the BIG 3 noted in question number one above-namely get the best possible:
Medical Records - Diagnoses - Medical opinions