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Old 5 September 2019, 18:31
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Thumbs up Accuracy of Claims Decisions Involving Conditions of the Spine

Received this up date today, I think it will help a lot of individuals who like to jump out of thing that fly also other Veterans

Accuracy of Claims Decisions Involving Conditions of the Spine
09/04/2019 08:00 PM EDT

Spinal conditions account for two of VAs top 10 service-connected disabilities, totaling some 1.5 million cases as of September 30, 2018. The VA Office of Inspector General (OIG) conducted this review after determining disability claims related to conditions of the spine have a higher risk of processing errors, which can result in veterans not receiving the proper benefits. The OIG estimated the Veterans Benefits Administration (VBA) incorrectly processed more than half of the 62,500 claims decided in the first six months of 2018, accounting for at least $5.9 million in either over- or underpayments. Processing errors included improper evaluations, missed secondary conditions, and evaluations based on inadequate exams. The OIG found these incorrectly decided claims resulted from VBAs inadequate process for ensuring accurate and complete evaluation. VBAs primary means of evaluating disability contains minimal guidance and a procedure manual is too subjective in key areas, which can lead to an inconsistent evaluation for related conditions stemming from the primary disability. During the review, VBA acknowledged issues the OIG identified were problematic and that it has taken steps to update some of its tools and guidance. VBA has also initiated mandatory training to help employees who approve and review claims better understand medical opinions. The OIG recommended the undersecretary for benefits instruct VBA to update its disability rating process to establish objective criteria for spine-related conditions and improve VBAs internal controls to help ensure the accuracy and consistency of claims decisions for conditions of the spine.

http://links.govdelivery.com/track?t...letins/25d4b74
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Old 6 September 2019, 23:40
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It has always been this way. You get different opinions from different doctors and then physical therapist usually don't agree with the doctors. After I busted up my spine I would lose us of my right arm for up to about two weeks at the time. My right hand would have no feeling or would feel like it was asleep. Air Force said 20 percent and the VA said 10. I ended going up to the VA in Birmingham and a Sports Medicine doctor ask me what was going on and the he told me some of my symptoms and said he knew exactly what it was and told me which vertebra were jacked. I would go see him every couple of months and he help but did not completely fix it. It got worse over the years and have learned how to deal with it. His theory was if he fixed that what other problems was it going to cause because of the multiple spots. After a lot of paperwork and a couple C&Ps my rating was raised.
An Army guy that had basically the same symptoms was given 40 or 50 percent from the Army and 50 from the VA.
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Old 10 September 2019, 08:21
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It’s also a small part due to Vet’s not speaking up on what exactly is hurting. This could be in part due to feeling good that day and denying any problems or not understanding the question or the pain they feel and how it relates to their back. Be honest, think of your worst day(not your best day) and if you don’t understand the question ask for the examiner to elaborate.

FYI, this is also seen with tinnitus. Vet claims tinnitus on the 526, has a MOS that was moderate to high probability of hazardous noise exposure and goes to the exam and denies tinnitus because he does not not have it that day.
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Old 10 September 2019, 10:31
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Gray Rhyno Gray Rhyno is offline
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Quote:
Originally Posted by 10thvet View Post
Its also a small part due to Vets not speaking up on what exactly is hurting.
I think part of it to stems from our original days in basic training where we learn either directly or through observation that only weakasses go to sick call. Follow that with decades of sucking it up medically, taking Motrin, and pushing through the pain have taught many of us to ignore those little aches and pains that, thirty years later, are serious joint issues.
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Old 10 September 2019, 11:49
bullet65 bullet65 is offline
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when going to a C&P exam think about what you are going to say. I work with the public in customer service so when someone ask me "how are you today". My programed answer is good and you. Do not lie to them but remember every word you say will be notated. I learned this after I read the notes on my 1st exam. second thing I did on my follow up is to stop taking any prescribed or over the counter pain meds 5 days before I went. this way you can tell them how it hurts.
have a written note of how this affects your job as it will be asked.my last observation on this is everyone is affected by pain differently. what might be a 5 to veterans might be a 9 to every one else. We are taught to overcome.
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Old 10 September 2019, 13:14
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wildman43 wildman43 is offline
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Quote:
Originally Posted by bullet65 View Post
when going to a C&P exam think about what you are going to say. I work with the public in customer service so when someone ask me "how are you today". My programed answer is good and you. Do not lie to them but remember every word you say will be notated. I learned this after I read the notes on my 1st exam. second thing I did on my follow up is to stop taking any prescribed or over the counter pain meds 5 days before I went. this way you can tell them how it hurts.
have a written note of how this affects your job as it will be asked.my last observation on this is everyone is affected by pain differently. what might be a 5 to veterans might be a 9 to every one else. We are taught to overcome.
What get me is they will ask what is your pain level today/right now. That what I was asked yesterday when I had an appointment. Yes in my crazy remarks I stated what part of my body do you mean.
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Old 10 September 2019, 20:18
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Quote:
Originally Posted by Gray Rhyno View Post
I think part of it to stems from our original days in basic training where we learn either directly or through observation that only weakasses go to sick call. Follow that with decades of sucking it up medically, taking Motrin, and pushing through the pain have taught many of us to ignore those little aches and pains that, thirty years later, are serious joint issues.
That is where I am now. Still fighting after 14 years
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