Introduction

We’re here today to try and inform as many veterans as we can. We’re here with Dr. Bash. Welcome, Radio Land, TV Land, and YouTube viewers and listeners. This is Dr. Craig Bash. I’ve been doing Veterans Medical Opinions for 30 years, and I have dozens and dozens of these radio shows, which we’re going to publish on this YouTube channel, numbered one to whatever. So thank you for listening, and here we go.

Case Analysis and Package Building

That’s quite a trick that gets us into how we do our work, right? How we try and do our case analysis. One way to do that is through the package we build. Some people are just doing one-and-done projects, so they do one DBQ and one Nexus and call it a day. But if you do a holistic whole-body analysis, a lot of these different codes will cross and interact, and you get a more comprehensive look at it. So we do a DBQ for all the different organ systems, then we do a Nexus for all the systems, and we do the lay letters. The lay letters give you another look at what you’re talking about there, right Bill?

Bill: Yes, yes. It’s so important. A lot of people were taught to follow the documentation rather than follow the evidence. The law and the regulations are clear. The VA must consider all the medical and all the lay evidence when making a decision. It’s not limited to what’s documented.

Herbicide Exposures and Evidence

One of the things we could relate this back to is herbicide exposures. I was assigned for a while to handle the M21-1MR cases at the office, and people were bringing cases to me saying, “Well, you know he said he went ashore, but it’s not documented.” Let me see what he said. If you have enough experience and knowledge of the circumstances, place, and type of service, you can make a pretty fair guess without speculating. It’s about determining if it’s more or less likely. You can understand the circumstances that person experienced at that time and make a judgment about whether it sounds reasonable.

For example, the Army cook who said he flew food up to Khe Sanh and was shot down there, having to stay during the Battle of Khe Sanh. I can just look at his DD214 and see that he arrived in Vietnam the year after the Army returned Khe Sanh back to the enemy. But then you have the opposite circumstance where someone says he was sent aboard the aircraft carrier at Yankee Station, and his plane landed at Da Nang, where he transferred to a hop and flew out to the carrier, so he set foot in Vietnam.

Handling Lay Evidence

When it gets to the Raider, the Raider does not have any evidence of radiculopathy that may be separately compensable. They have to make these decisions quickly and may not get credit if they defer it, so they might accept a less than fully complete exam to avoid developing for the radiculopathies. This is why our approach, which evaluates all the complications of the primary condition, helps the process go smoother and quicker.

Orthopedic Disabilities Evaluation

Let me discuss evaluating orthopedic disabilities as an example. The court has been asked to review BVA decisions about evaluating joints like knees and elbows many times. They’ve come out with decisions saying VA must consider all factors such as pain, endurance, speed of motion, and incoordination. The DBQ prompts the examiner to answer whether there is additional loss during a flare-up or on use. Most of the time, the examiner cannot observe a flare-up, so they don’t provide an answer.

As a Raider, I can’t fill in the blank. If an examiner says it’s going to be worse but doesn’t specify how much worse, I have to look through the record to find examinations that show more limitation. If one of those examiners notes a flare-up, I use that higher limitation for the evaluation.

Importance of Specific Documentation

I often write out in the DBQ boxes specific information about flare-ups and other symptoms to ensure the Raider has a clear picture of the veteran’s condition. This specificity helps when they have to make a decision based on the available evidence.

Upcoming Changes and Blue Water Veterans

There are thousands of claims that will need to be redone based on HR299. The new law presumes exposure if you were within 12 miles of shore, eliminating previous debates about specific bays. This will require a lot of re-adjudication of cases, especially those involving diabetes.

Consistency and Probative Weight

We want the lay letter to be consistent with the DBQ, the Nexus letter, and the testing. Consistency is a factor when evaluating claims. If a veteran states they are very disabled but the treatment records show otherwise, it creates an inconsistency. We must assess objectively instead of subjectively, looking at the general record to make a fair evaluation.

Conclusion

Thank you all for listening. That ends this show. Now I’m going to zoom off.