ACTUAL VA Rater SECRET When They Decide Your VA Disability Claim
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- Опубликовано: 8 сен 2024
- VA disability claims can be an easy process or a difficult process but there is one factor among veteran benefits that stem from the department of veteran affairs...and that is C&P exams. Compensation and Pension (C&P) exams remain not only the largest variable during the process but is also filled with the most unknowns unknowns from the veteran's perspective.
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TheCivDiv:
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I initially felt guilty about getting money from the government, but after seeing so many veterans with cancer or serious medical conditions or simply can no longer cope, screw the government. I now consider VA disability to be tax on the government for ruining so many lives. This is the cost of war, Uncle Sam. Don't play if you can't afford it.
Understanding the VA Disability Claim Decision Process
Overview:
Navigating the VA disability claim process can seem like wandering through a maze without a map. However, getting a glimpse into the internal workings of how claims are assessed can significantly demystify the process. This insight revolves around understanding what VA raters (officially known as Rating Veterans Service Representatives or VSRs) see on their screens when deciding on a claim and the critical role of 38 CFR (Code of Federal Regulations) in this process.
The Role of 38 CFR and Symptoms Documentation:
38 CFR is the bible for VA disability claims. It outlines the criteria for disability ratings, specifying how symptoms correlate to percentages of disability. For instance, the documentation for Gastroesophageal Reflux Disease (GERD) under 38 CFR would list specific symptoms and their severity levels. These symptoms are crucial for filing a Disability Benefits Questionnaire (DBQ), which is an essential part of the claim process.
The Importance of Medical Evidence:
The strength of a VA disability claim hinges on medical evidence. VSRs value medical records and doctor's notes that corroborate a veteran's self-reported symptoms. For example, if a veteran claims to suffer from frequent migraines, their claim is strengthened by medical records showing they have reported these migraines to their healthcare provider. This principle applies across various conditions, illustrating the importance of informed and consistent communication with healthcare professionals.
How Claims Are Decided: The VA's "Secret" Process:
When a DBQ is submitted, VA software analyzes the information and suggests a disability rating based on the symptoms documented. This process isn't influenced by artificial intelligence or machine learning but is a form of automated recommendation system. VSRs are then presented with three options:
Accept the software's recommendation:
Increase the disability percentage, provided there's substantial evidence to justify the higher rating.
Decrease the recommended rating, which also requires justification based on the available medical evidence.
This streamlined process underscores the importance of detailed and accurate symptom documentation in the DBQ.
Making Your Claim Stand Out:
The VA operates under time constraints, which means VSRs are motivated to process claims efficiently. A well-documented claim that clearly aligns with the criteria outlined in 38 CFR is more likely to be processed swiftly and accurately. Therefore, understanding the specific symptoms and evidence the VA is looking for can significantly impact the outcome of a claim.
For conditions like GERD, detailing symptoms that match those listed in the VA's schedule of ratings can elevate a claim. For example, mentioning heartburn, regurgitation, and weight loss due to GERD during a Compensation and Pension (C&P) exam can align with a higher disability rating, whereas a vague description of symptoms might result in a lower rating.
Tips for Veterans:
-Preparation is Key: Before attending a C&P exam, veterans should familiarize themselves with the relevant sections of 38 CFR and prepare to describe their symptoms accurately.
-Documentation Matters: Continuously document symptoms and treatments with healthcare providers, ensuring this information is reflected in medical records.
-Be Specific: During C&P exams, articulate symptoms clearly and specifically, aligning them with the descriptions found in 38 CFR.
Evidence Supports Claims: The more medical evidence you can provide to support your symptoms and their impact on your life, the stronger your claim will be.
Conclusion:
Understanding the VA disability claim process, particularly how VSRs assess claims, can demystify what many veterans find to be a complex and frustrating process. By aligning symptoms with the detailed descriptions found in 38 CFR and backing up claims with solid medical evidence, veterans can navigate the claims process more effectively and increase their chances of receiving a fair disability rating.
For more detailed guidance on navigating the VA disability claim process, visit the VA's official website or consult with a VA-accredited representative.
This is just a short summary it is best to watch the entire video for all the information.
All vets that are going through the process of being assessed for disability NEED to watch this video. Outstanding job guys!
The problem is just because one takes medication, or procedure to help live with an issue, doesn't mean they aren't injured.
Not true - for example you get one rating which is low if you have diabetes, but then you get the higher rate if you’re taking medication to control the diabetes.
Also, for sleep apnea, you will get a higher rating of 50% if you actually use the CPAP. People really do need to read the schedule of ratings.
I am from the Cold War pre internet days. I never reported my PTSD or the incidents (1988-1989). I also never reported my shoulder, back, neck and knees. I was a tanker. Heavy lifting and jumping on and off that machine caused many issues. I am 60 now. I doubt I can do anything about it now.
😅😅😅😅😅😅😅😅😅😅😅
@chillwill5080 I was a worker for local county government since 1993.
2 of the most humblest knowledgeable Veterans that continue to help and give back to veterans! Because of you both so many veterans have received what we deserve. I salute you both
Great job guys. Veteran A reminds me of us old 1990 plus vets who had no internet or education outside of taps class. Its no wonder so many of us are under rated now compared to younger vets. Your videos give us hope.
This is the best video you have put out since I started watching several months ago. You finally got through to me on HOW to prepare for a C&P exam. In a perfect world, a rater would always give the veteran the benefit of the doubt. Alas, this world is not perfect. Thank you.
It only makes sense that the Veteran would need medical evidence for 6 plus months to get rated a disability. Why would anyone get disability money monthly when they haven’t been to the doctor and there’s no proof of their health issue. I think the 38CFR is very fair & if a vet would read it & see the rating then he/she would have understood the process from the get-go.
It's not fair if it is incomprehensible to the reader. It's about as clear as common core math. Many of us can only dream of being as smart as you. @@60eyewatcher
Thank you for this video. I work woth vets alot and we especially marines don't always have the right words to explain these aches and pains in a very embarrassing moment.
This info is EXCEPTIONALLY illuminating, thank you!
You guys are good together. Keep going
Notes are super helpful in preparation for the C&P. The C&P examiners I’ve had like that you’re prepared and makes their day.
I liked that regurgitation pun! I might regurgitate it elsewhere. That is, if anyone around can stomach it.
Gets me every time
i just got decision back today and the denied my non combat ptsd moral injuries, and granted tinnitus at 10 hearing zero and deferred my lung cancer and others. there is no place on the entire 9 pages that they saw in the record I am not claiming active lung cancer my right lung was removed in 1988, total pneumonectomy and my left lung is under surveillance twice a year with cat scans wi contrast.. the report confirms my exposure to TERA and although my lung function test shows under 50 fev1 they deferred copd which is due to having only one lung..there is a note in my va med records that rescue bronchodilators have no effect but to continue to use and I wont even go into fellas the removal of my bladder and prostate last year... and this is all under favorable items... i knew the video ptsd exam with a sports phd was a loser from the first minute. she was pd off that i did not drive the 60 miles each way. i had va waiver to i have a urostomy pouch and would need a private place to cleanup and put on new bag at her office and qtf called me back and said provider cannot accommodate do video.... have to keep fighting
This is awesome! This information is priceless!!! Thanks!!!
Rooster man speaks so much more succinctly when he speaks directly from his brain instead of reading from a VA news brief👍good job🤗
Good Video...but I still believe raters use a dart board, because way too many vets are given lower ratings based on their strong evidence and C&P exam evidence. We all know you need strong evidence, that's common sense, but that doesn't always give a veteran the proper award for some reason. Software recommends? there must be human interaction even with software. I am glad you explained this, but it's even more aggravating that the Veteran suffers because it's easier to just push a button. All the veterans who sincerely suffer and wish to be properly awarded aren't. I'd rather have them use a dart board
This is good and needed channel because brings a lot of vet comments to
Last time was “stand up straight, turn to your left until you can’t anymore or pain is overwhelming…same with the right side.” I thought I was being evaluated for GERD and or gastric problems. They looked through my records and picked out the back issues, the apnea, the other stuff and set me up with/ P&T. I was and am ever grateful. My PCP on the other hand went BSC and started trying to disprove or reassign conditions to different/non rated conditions, particularly in the MH arena. Basically, there’s nothing wrong with you, you’re “crazy” and it’s all in your head. I have had a terrible relationship with the VHA ever since. Echoes of an internal battle where people keep trying to inject personal values and ideology into treatment, which is a horrific experience. and now the network expands beyond the VHA, and community health providers see disparaging remarks in your records. Thoughts?
A rater that would go against the recommendation and give someone a lower rating is a total douche
It would be completely based on evidence.
Glad to see this dynamic duo of two veterans putting it down 💪🏾
I filed for VA disability benefits back in.April. for low back issues and tinnitus and hearing loss. I had a c@p for the hearing loss.. but no c@p for my back issues I do have xrays in my medical file, and was diagnosed with ddd and also have it documented multiple times over the years with my VA doctors I'm also seeing a chiropractor at the VA. I was told I have enough medical evidence in my file that a c@p was not needed for my back issues. I still waiting for a rating etc. But I'm assuming that due to them telling me I didn't need a c@p that I will get a rating for it.
I wondered about that. I have mental health documentation of PTSD/MST, they have my medical records, the LOD, and I've had C&P exams for minor things, but have not heard a word regarding my mental health claim. I filed in January, it's mid-August now. The radio silence regarding my claim is insufferable
Thank you for all you gentlemen do for our fellow comrades.
Good job!
It’s not a big secret that I tell some of my friends that are still serving. I tell them you better have a big book size medical record before you get out. My medical record was 5-6 inch thick when I ets. I made them print me out physically and waited just to tell them i would like another just as back up. I did this also knowing I had my med records on electronic form as well. Back in 07 when they said “ they lost my med records in what happened with my back” in Iraq the previous year due to system switching to electronic form. That was the day I made sure to double check that everything was documented when I was still in. My thinking on my SC is that my folder is so damn thick and has so much shit in it that when a rater had to rate me they are just overwhelm and just said “f it” just gave me 100% 😂. Or at least that what i always tell myself.
Great video, feeling confident now!
You guys are awesome! I had questions to ask, but you covered the solutions so completely! Thank you so much!
Word. Glad we could answer those!
This definitely explains why there are SO MANY issues. I am not a fan of automation and believe that all claims should be looked at with more than one step of human eyes. It os rodiculous having to keep doing supplemental claims. I have three in right now thatni had TONS of evidence for and yet was denied benefits. Any of these 3 would put me at and/or over 100% P&T. 5 out of the six claims ive done have had to have supplemental claims filed. Every one of them was approved in supplemental with the same evidence. I always use the 38 CFR to make sure the wording is correct. I always take the part of the 38CFR with me and every single one of the C&P examiners pushes me off and writes their own mess and that's is the major issue.
Really? Thats the "major"mess? And you know this based on your personal years of experience practicing medicine and conducting C&P exams??
@@tfinn2700 I know this from my 20+ years of dealing with C&P examiners and knowing who is good and who is not. I have plenty of medical professionals, including nurses and Doctors, in my family.
As long as I been keeping up with these videos across RUclips that’s the first time I’ve heard this and obviously then explained.
This is incredibly helpful, I'm currently waiting on getting my C&P appointment booked and will use this video as a reference
I went to a C&P for vertigo. When I was called back I had a pretty intense Vertigo episode just as I was standing up to go. The exam we saw the event. I think I got my 30% right then.
Continuing: to visibility. Read them!
What the VA does or doesn't do, is very important. Being rated by someone who isn't a doctor,
And isn't necessarily
An educated Person,
Could be inaccurate
And unfair.
Great video, keep up the good work! 😊
For my headache C&P I didn’t take any chances & told the examiner that from what I would track in my headache log/journal i get completely prostrating headaches 5 days a week 3 times a day & greater than once a month since the DBQ question asked. I told them the same at the VA clinic when I went to tell them about it
Why do they rate Gerd and ibs together when they are completely 2 separate conditions? Gerd is worse than bad heartburn lol. It's painfull, you can't eat, can't sleep, vomiting and it hurts like he'll on the left shoulder. One c&p exam I went to the nurse practitioner did not know what Gerd really was and reported that I had a cracked rib without an xray. It took them 8 months and I got a response from the VA stating that they made a mistake on my Gerd rating and they increased it from 10% to 30% and that took me over 100%. I'm still suffering from agent orange Exposure and I have cancer in my abdominal area and the VA is paying for the treatments but they refuse to let me claim it even with the pact act. They just keep telling me I need to show proof where I served in Vietnam, I wasn't even born then. I was Exposed when I served 11 years on Gulfport Mississippi CB base.
Good thing I'm at 100% now though
May 19th these will be separated.
Have Gerd IBS etc from a different toxic by not Pact Act CB base, how do we prove that.
This secret only works if a VA rater uses the correct starting point. I have a asthma claim that according to the schedule of ratings is rated at 30% because of the medications I am on. Emphysema was detected on the same CT-scan that the Asthma was. The pulmonary doctor I saw diagnosed me with moderate asthma. I applied for a asthma rating through the PACT Act and they rated me at 0% for Emphysema with asthma. What a joke. And my only recourse is to appeal for a rater's blatant error. Since I have a denied respiratory claim with an effective date of October 1991, I know exactly why this happened.
I’m the same but only with emphysema. I do have some shortness of breath issues but the ratings are all about the FEV. When it comes to respiratory. Brother in law has severe asthma and uses an inhaler daily 0%, but has 50% OSA that was diagnosed in service.
I’m a never smoker BTW so I was surprised on the emphysema find.
Call a VA attorney and have them appeal it for you probably with a high probability of success. Time is ticking now.
MY CP EXAMINER PUT DIFFERENT INFO WHAT I TOLD HIM. HE PUT EVERYTHING IS NORMAL EVEN IF I TOLD HIM IT AFFECTED MY DAILY LIFE. HE LOW BALLED ME AND CHANGE THE DBQ INTO A NORMAL RESULY EVEN I HAVE TOO MANY ISSUES.
This is why we ALWAYS stress evidence instead of relying on C&P examiners.
Same thing happened to me. I’ve been going to the VA and having the symptoms noted. Also the VA is paying for Chiropractor care. I’m having an outside doctor and my Chiropractor write Nexus letters. Trying again. Gotta keep fighting for your benefits
@@chadperrizo135Is that the way ? I'm wiped out and confused by the process now, getting worse.
I gave them medical evidence of being put in a splint and crutches that happened from a training exercise on active duty. 1 year after that incident, I needed a hip replacement. Denied. I have no faith in our system.
I don’t know about the system it looks like raters are blatantly ignoring evidence and denying claims. I am service connected for Chronic Hives at 10% off the rating schedule. I filed for an increase which would give me 60% for that condition and got a proposal to severe the disability. After reading the denial letter and the 38 cfr for this condition the rater completely ignored the new evidence and twisted 38 crr
This “secret” adds to my theory that C&P contractors are making decisions as if they’re USG employees. Sure the VSR “accepts” the system recommendations but this also explains why HLRs & appeals are SO successful.
Lets remember that your primary care doctor leaves and the veteran goes through a half a dozen primary care doctor, then let remember that if the veteran doesn't wants to be rated Non employable, rather needs to be rated selected, or handicapped, becausewe still should be able to work, even if its for four hours a day, for two or three days a week.
Thanks❤
Great video gentlemen
Great info! Thank you!
Have a question:
I have been diagnosed (again) with a burnpit registry cancer. I never was in the sandbox in 91 or Afghanistan post 9-11;
But I was in Honduras in 89 and was a 51M Firefighter. I am in the burnpit/asbestos registry.
Will I be ok due to the exact cancer that is on the VA list or will deployment location knock me out?
This would put me at 100%. I’m currently 70% for PTSD..
Thanks Brothers for taking care of us
If you can show your condition came from your exposure, sure.
VA been doing this for years, the system learns from all the valuable information communicated by veterans, this is why the rules change all the time, you get close, the goal post moves...
What is insufferable as waiting for the VA sooo long. I filed in January, had C&P exams in July for a couple of minor things, but my psychiatrist diagnosed PTSD from MST..
. With an LOD on file, tons of medical records... And I have heard nothing from them regarding this. I have not got a rating on the other ones, I'm not sure if they're waiting to do it all at once, but with the PTSD issue... Suffice it to say, it's hard not to conclude a lack of urgency, which takes the brain to bad places
If you’re a veteran and you’re able to talk to your VA healthcare team. You’re very lucky I’ve been able to talk to VA employee in five years which means no medical no travel no clothing allowance.. tried to file for housing grant. Not allowed.
What does it mean when they say getting info from other government agencies…?
I feel like the Oak Ridge Boyz are gonna start playing any moment
How does one get denied service connection but at the same time it says that there was an qualifying event, injury or disease during service and says you have been diagnosed with a disability during favorable findings? Thoughts
There are a billion scenarios coming out of this
They like to do that.
I have migraines 5 to 8 times a month and im on medication to help prevent tge medication but the medication i take morning and evening i do not think they do anything for me and ive been telling them ive had the same amount of migraines since i was active duty in 2008. Im only rated at 30% now but im not going to challenge anything right now until the va drops me from 100% p&t
In other words, that 38 CFR, read up and study. Take your notes with you into the C&P, and read off the symptoms exactly the way they are listed in the schedule of ratings. Too easy
I recently received a decision letter with two denials and four deferring claims. My question is based on the information you just provided. If the computer makes the initial decision based on the 38 CFR, then how does the claim end up deferred? Did the rater make that decision based on the computer input?
My VSOs say you don't need a personal statement, I asked them twice
You don’t and for some claims we recommend them 9/10 and for other claims we don’t recommend them.
Dude, I got the same advice and got a 0% back on the primary condition with CLEAR evidence that comports with the diagnostic code. Hopefully it will be rectified now that I've filed a supplemental with clearer evidence and a personal statement that ties every threshold in the diagnostic code to my provided evidence.
What I'll say about the VSO is I likely wouldn't have done it without him getting me started and I'm thankful for that. Aside from that, I think doing my homework, collecting evidence myself and laying it out in a clear and concise manner will, hopefully, get me at the appropriate rating.
When it comes to service connection for migraines be sure to use the word "prostrating".
Nononono no x10,000 read the M21-1 as for the use of prostrating.
@@VeteransDaily I stated prostrating and they gave me 30%
Environment, War, Leads 2 Issues Plain and Simple.....🪖🇺🇲🪖🦀🏊♀️🌊💯👀💯🏊♀️🌊🦀🪖🇺🇲🪖
Do DBQ results carry same weight as provided private nedical records? Doctors dont always record everything that is shared, but CP examiner may be able to..
If you are filing a claim for disability/ compensation does the VA verify your income/ job or do they only verify your income/ job if you’re filing for TDIU?
Short answer, yes.
Does anyone know if community care doctors that are paid by VA (example psychiatrist) can refuse to fill out a DBQ for you, claiming their company won’t allow for it?
When the VSR keeps sending you to a Yale doctor for every C&P you need to see the the red flag something is wrong in your claim.
Does this system also apply to presumptive conditions under the Pact Act?
Question for anyone that may know.. I’ve been given an unbelievable amount of ibuprofen 800mg, which I take 2 at a time twice a day.. can that lead to gerd? Because I’ve gotten that heartburn really bad which I never had before. Can I get this service connected because of taking the ibuprofen for years???
It can but you’ll need a rock star C&P exam.
@@VeteransDaily how about getting my doc to say that it’s because of the ibuprofen is why I’m having serious heartburn along with this god awful pain in my sternum and that regurgitation?
gawwd i don't even want to take a peek at the workload of all the PACT act stuff
Job security for sure!
What is the number of the cfr and other regulation that I need
38 CFR and M21-1 are the foundation policies that guide VBA decision making on Veteran claims.
At the Board level, it gets a bit more complicated. If that’s you, you might want to consider an Accredited Attorney.
Wish I seen this before my 3 C&P exams.
I did not bring a prepared note sheet with me. I thought that would be more natural.
I always forgot to give them an important piece of information. Then you kick yourself afterwards.
Why would the VA cancell my MH C&P with a FDC
If I applied under mental health condition A, denied and reapplied under B condition that doctors treated me under and ultimately given C rating but B backpay date. Is it worth fighting for 2 yrs on A since it was all within a year to keep fighting mental health?
By the way this put me to 100 so only fighting effective date if i do and whats best way to do it or leave it alone?
Can I copy the symptoms from the CFR 38 or a DBQ into a personal statement? Would this be a red flag to a rater or should you use language that's similar?
I thought the same thing, the exact symptom wording is exactly what they want to see. So absolutely have your doctor put those exact words down. Got me 30% IBS because those are my exact symptoms.
@@T-SimHi! Did you get your IBS claim as a Gulf War presumptive? Direct? Or as a secondary to something else you are connected? Thanks!
@@cidcampeador7922 GW Presumptive , I’m a Desert Storm and Iraq war veteran.
@@cidcampeador7922 I did GW and Toxic exposure exams at VA (environmental) and the C&P examiner noted that.
If AI looks good the person doing the claim agree they should send it. But very bad for a veteran that has a full disability that the AI didn't see. BUT a disagreement claim after they rate. SHOULD go to the front of the line via first date submitted!!!!!!
Where can I find the schedule of ratings ??
Google “(your condition) 38 CFR eCFR”
Example:
Mental health 38 CFR eCFR
I have a completed FMLA form from my primary VA doctor for migraines 3x a month is that medical evidence
That is current medical evidence. Still need the in-service event.
@@VeteransDaily it’s secondary to my tinnitus
None of this matters without a nexus/event in service with records/evidence to prove it.
Gotta have the Big 3, absolutely. We preach the big 3 consistently.
A nexus can be achieved through a health provider’s opinion
Could you please make one of theses about Flat Feet
Well its not a secret anymore
It's no secret the exact same secret u are saying is on the narrative when u get the rating on how to get to the next higher rating. The recommendations are more like groupings if u have this many check marks then u fall under this percentage, to get this higher percent u need this. The VA tells u how to get to the next higher rating every single time
The ‘secret’ is referring to the software used for decisions when granting the % fed from the DBQ.
What's no secret is that you paid little to no attention to English composition when you were in school.
If any of this information different for someone Medboarding?
Your name is Jason? I had no idea😅😅😅
It could be very telling if the Vet comes across scripted.
Agreed. Which is another reason the evidence should support the testimony.
Even if you get evidence theyd look at you like you are stupid.
Not quite….
21-year vet here; what...!
Are VA raters Veterans?
Good question ?
Not all, there are some veterans but they do not have to be veterans.
There are veterans, I was an VSR, Air Force Vet and we are not private contractors, we are Federal GS employees@@citylimitpowersportsllc5872
Honestly, you do not want veterans to be raters. Other vets are some of the biggest gatekeepers when it comes to the claims of other vets.
Personal biases come into play and you really want unbiased people applying the regulations fairly.
For example, you have a rater who did 10 years in the infantry with several combat deployments working now as a rater. This particular vet is at 70%. That veteran rater will not rate anybody over 70% because that veteran rater personally feels he should be at 100%. That rater will definitely downplay any claims from an air force vet who spent 4 years at a comfy duty assignment and destroyed their knee at a command picnic volleyball game. Even though the regulations would say they deserve 100%.
@@kevinhendrix8786That is a very good point. I have seen this first hand with friends of mine who have already gone through the process.
My decision says “Service connection for allergic rhinitis (claimed as sinusitis) is granted with an evaluation of 10 percent .”
I thought the two were separate.
What is suggested to move forward to ensure I am rated for both conditions in this case?
Are you diagnosed with both? And they are.
Top sheet pencil whip negative opinion another denial all denials all day. Remember approval takes multiple employees meaning someone else will challenge ur approval so just lie n deny. Sop
That beard gives me anxiety.
Word play is very important
VA knows Veterans are Sick, How About Veterans start throwing People thru Windows 2 Get Help.....🦁🪖🦁🇺🇲🦀🌊🏊♀️💯🏊♀️🌊🦀🇺🇲🦁🪖🦁
Are these VRs ,Former Military Personnel.....🪖🇺🇲🪖👀🦀🌊🏊♀️🌊🦀👀🪖🇺🇲🪖