Posts Tagged ‘C-File’

A Winning Medical Report In A VA Appeal ~ What’s Needed

Written by Maurice Abarr on . Posted in Veterans Disability

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As a Veteran appealing an unfavorable disability claim decision from the VA, you have several impediments to overcome. After you have established that you have a CURRENT disability, you next have to prove that it is service-connected. In most instances, you are going to need medical evidence to accomplish this.

If you are using a private doctor (as I often recommend), the physician will need to write a report that the VA or the Veteran Law Judge at the Board of Veteran Appeals finds CREDIBLE. And, to be credible, the report must (at minimum) contain the following:

A statement that says that the doctor finds that it is “as likely as not” that the specific disability is service-connected. This “as likely as not” standard is your MINIMUM burden of proof in the claim. If your doctor says “more likely than not” or “reasonably, medically probable,” these are fine. Actually, they are stronger, though not absolutely required. Some doctors may prefer to say “at least as likely as not” (slightly stronger than the minimum threshold) which is also fine.

A statement that says the doctor has “reviewed your entire C-File.”

The report must contain the doctor’s explanation for the conclusions that have been reached in the report. In other words, the doctor must justify his/her opinions. This tells the VA the “how” and the “why” of the physician’s opinions in your case. If you also have Lay Witness or Buddy Statements which attest to a pattern of continuous symptoms since the time in service, these boost the doctor’s opinion that the condition is indeed service-connected.

The report must REBUT contrary opinions in the C-File. The doctor reporting on your behalf must review the C & P Exam reports and tell the VA and/or the Veteran Law Judge how and why they disagree with those opinions. Your doctor must show why his/her reasoning is better than that provided by the C & P examiners. Sometimes one medical opinion is deemed superior to another because of the expert’s superior qualifications, background, special training, or clinical experience. Other times, the C & P doctor may have made a diagnosis that is unsupported by the facts in your case or in currently-accepted medical literature.

The doctor’s CV (curriculum vitae/resume) should be attached to the report. Frequently, the C & P examiner will not attach his/her CV to the report disputing your condition as being a Service-Connected Current Disability. Or that, while it is service-connected, there is little or no measureable percentage of disability.

The Bottom Line: This is but one of the reasons why you need the guidance of an Accredited Attorney who specializes in Veterans Disability claim cases. There is much more to it. And, your case is. . .yours. It’s unique. My staff and I are at your disposal. Contact us for a free case evaluation.

Veterans Can Hire DVA-Certified Attorneys WITHOUT Upfront Money

Written by Maurice Abarr on . Posted in Veterans Disability

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A common fallacy Veterans have when contemplating acquiring an attorney to appeal a DVA decision is that there will be an upfront or “out of pocket” expense. Depending on the attorney, it’s possible for there to be NO such cost. Certain attorneys—including ourselves—are willing to work on a “contingency-fee basis.” This arrangement is similar to the way lawyers are paid in Workers’ Compensation and Personal Injury cases.

This means you must be awarded retroactive compensation benefits—AFTER the attorney is hired—BEFORE the attorney receives a fee. Conversely, if you receive no retroactive award of benefits, you owe the attorney nothing.

The changes in the law that Congress approved in 2007 provided, among other things, that:

  1. Attorneys who became certified with the DVA could appear at earlier stages of a Veteran’s appeal of a DVA decision.
  2. The VA would withhold as an attorney fee 20% of any retroactive benefits awarded after the Veteran hired an attorney who was authorized to appear before the Regional Office or Board of Veterans Appeals.

Of course, you are free to negotiate a different payment percentage. However, if you and your attorney agree on a percentage greater than 20%, your attorney is entitled to collect the fee from you at the time the retroactive benefits check is received. If the likely overall recovery is projected as modest, the attorney may request more than a 20% fee in order to justify the amount of time (and overhead expense) that will be incurred during the time the case is being worked on. The norm in such instances is one-third (33 1/3%) of the award.

This is a good arrangement for Veterans because you are not forced to dip into your own possibly limited funds in order to proceed with your appeal. The right attorney will share with you both the risks inherent in any litigation, as well as the benefits.

How To Proceed

If you would like a free consultation with our office, please contact Maria at Extension 5 and she will get you started in our intake process. We usually need the entire C File (claim file) from the VA before we can commit on a case. Our intake process begins with some questionnaires which we will need completed. We will also send you a FOIA (Freedom of Information Act) Letter for you to review, sign, and send by Certified Mail/Return Receipt Requested to your Regional VA Office.

We at the Law Offices of Maurice L. Abarr are authorized and uniquely qualified to address your Veterans Disability issues. We look forward to serving you.

Establishing Service Connection

Written by Maurice Abarr on . Posted in Veterans Disability

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For the VA to approve your claim, they’re looking for these three things:

  1. Evidence of a current disability.
  2. Evidence of something that happened in-service.
  3. Evidence connecting the first two.

Simply put, the VA needs to know that you’re currently disabled and that the something that happened while you were a service member is connected to your current disability. Here’s an example:

You have trouble getting around because your knee hurts; that’s the current disability. When you were in the service, you hurt your knee during training and you went on Sick Call to get it treated. There will be a record of treatment that should now be a part of your C-File. This is the in-service incident. The next part is up to a doctor to provide evidence that the past injury is, at least in part, causing your current disability.

A key point to remember is that it’s not enough to have a bad knee. Nor is it enough to have had an injury during your time in the service. The medical evidence connecting the two is crucial.

Of course, if your disability claim was initially rejected by the VA, it may not have been such an obvious case. In other words, in the eyes of whoever reviewed your application, one of the necessary elements was lacking. When you file your Notice of Disagreement (NOD), the VA is required to respond with a Statement of the Case (SOC). The SOC should outline the reasons that the VA came to the decision that they did–referring to specific claims and the evidence that they evaluated to reach their conclusions. So, that means it should be a guide to which of the three elements of service connection needs to bolstered in your appeal.

This highlights why it’s so important to have your Claim File (C-File): It contains the evidence that the VA used to evaluate your claim. Having the C-File allows for verification that records of in-service injuries are actually there. Or, that medical reports regarding your current disability are being included. Or, that a current medical opinion is actually connecting the two.

Consequently, it’s advisable to seek qualified legal help. It’s easy to believe that your situation is as obvious as the example above. After all, you lived it and you’re still living it. But, a trained and experienced professional can look at what you’re telling the VA, find the parts that need to be shored up, and put you on the path for a favorable ruling.

The best way to approach your appeal will depend upon the “what’s” in the VA’s SOC. For example, if there’s not enough evidence of an in-service injury, you may need to get “buddy letters” from your fellow service members to confirm what you experienced. Sometimes you may need a private doctor to perform a medical examination and write a report to provide evidence of service connection. Such a report will frequently contradict the findings from the Compensation & Pension Exam, done by a doctor that the VA themselves selected.

We at The Law Offices of Maurice L. Abarr are familiar with appealing VA Disability claims and can guide you to the specific elements you need to prove Service Connection. Contact us for a free consultation.

SOC, Form 9, & You

Written by Maurice Abarr on . Posted in Veterans Disability

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So you’ve filed your Notice of Disagreement (NOD). The VA must respond with a “Statement of the Case” (SOC). The SOC is designed to explain all reasons that the VA reached their decision. It should refer to your specific claims, the evidence that they used to evaluate your claims, and the laws and regulations they applied to reach their conclusions.

Depending upon your particular claim, an SOC can get long and complicated. It may comprise many pages of arcane language regarding the laws, regulations, and rules that the VA Regional Office used as the basis for their decision. It’s important to know and understand everything that’s in there, however. Did the VA miss an important piece of evidence in your C-File? Did they rely on an outdated rule?

Once you have the SOC, it is your responsibility to respond with VA Form 9, “Appeal to Board of Veterans Appeals,” or as it’s more commonly called Form 9. This may be the most important form that gets filed in your appeal and you may hear it referred to as the “Substantive Appeal.” That’s because this is where you specify all of the reasons you believe the VA got it wrong.

On the Form 9, you’ll need to state each decision with which you disagree–and state every reason for your disagreement. The idea is to include everything that you want the VA to consider. This might include new evidence that should have been in your C-File but turned out to be missing. And, since the goal is to make it as easy as possible for the VA to say, “Yes,” to your appeal, it’s also a good idea to include what you think is the right decision.

Another important consideration is that while you had one year to file your NOD, you have only 60 days to file your Form 9. Just like the NOD, if you don’t meet the deadline, your appeal is pretty much over.

Once you’ve completed your Form 9, you’ll send it to the VA office that denied your initial claim. As with all paperwork sent to the VA, you should (a) save a copy for yourself and (b) send it to the VA in a way that provides proof of delivery.

Once the VA has your Form 9, a number of different things can happen. If you’re very lucky, the decision might get changed right there. But it’s just as likely that your appeal will continue. If you submitted something new for the VA to consider, you’ll receive a “Supplemental Statement of the Case” (SSOC)–to which you would respond with another Form 9. And, of course, all the same rules and deadlines would apply to the new submission.

Filling out an effective Form 9 can be tricky. Overlooking something at this stage can derail your appeal. Considering all the technicalities involved in this, if you haven’t contacted and retained qualified legal assistance now may be a very good time to consider it. We at The Law Offices of Maurice L. Abarr are at your disposal. Contact us for a free consultation.

The Veterans Administration C-File & You

Written by Maurice Abarr on . Posted in Veterans Disability

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The C-File (short for Claim File) is all of the evidence that the VA uses to make its decision on how your claim will be rated. So if you disagree with the VA’s determination and file an appeal, you will need to request a copy of your C-File. You should do this as soon as you’ve received your initial determination. Since the VA has made its decision based on what’s in there, it’s a good idea for you to have it and see the exact basis for that decision.

There’s no set structure to a C-File but there are certain things that should be there. These include:

  1. All of the correspondence between you and the VA regarding your claim.
  2. Your DD-214 form.
  3. Your military and VA medical records.
  4. Any private medical records you submitted.
  5. Your entrance and separation exams.
  6. Any Compensation & Pension (C&P) exams performed on you.
  7. The VA’s ratings decision and statements of the case.

As the C-File is the basis for the VA’s decision making process, this is your opportunity to make sure everything you want them to know about your claim is in there. It’s possible that a particular piece of evidence that supports your position slipped by your VA case reviewer. It’s even possible that such a piece of evidence is actually missing from your C-File. Consequently, reviewing your own C-File enables you to assess whether it was a simple oversight, a missing or misfiled piece of evidence, or whether additional evidence is needed.

You have a few options on how to get a copy of your C-File. The simple answer is, “Ask for it,” and the best way to ask for it is with what’s called a Freedom of Information Act (FOIA) request There’s no specific form for a FOIA request but you need to do it in writing and you must sign your letter of request. A FOIA request must reasonably identify what you’re seeking–in this case, all documents contained in any VA claims folder for you that exist in both physical and virtual/digital form. You should put your VA claim number near the top of the letter so the VA can identify which C-File is being requested. You should specify that you want hard copy of everything. Finally, you need to include your contact information, including your phone number.

The FOIA request needs to be sent to the Veterans Benefits Administration Regional Office FOIA/Privacy Act Officer. When sending something to the VA, it’s always a good idea to: (a) keep a copy for yourself; (b) send it in a way that provides proof of delivery (e.g., certified mail with return receipt requested).

If you’re considering getting representation (whether with an attorney or through a veterans service organization), we strongly recommend that you provide your C-File directly to your representative. While it may be tempting to go through it and start rearranging things, an experienced representative will know how to correctly manage this. Considering the wide range of documentation that should be in your C-File, it can get quite large and complicated. Since the goal is now to make it easier for the VA to approve your appeal, it’s critical to find the right pieces of paper among those reams to help your appeal move forward. A qualified Veterans’ Benefits attorney can help with that.

So, take responsibility for your record keeping. Maintain a copy of your C-File. Remember, your C-File is the very core of your VA claim and appeal.

We recognize that this process can become a bit overwhelming for some. Whether you’re trying to figure out exactly how to get your C-File or what to do with it once you’ve gotten it–or if you need to find the piece of evidence to help the VA approve your appeal–we at The Law Offices of Maurice L. Abarr are ready to provide you with the help you need. Contact us for a free consultation.

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