Dr. Bash: How are you and Bill doing today?

Guest: I’m doing good. Bill just called in and wanted to know what the link was. I sent the link for the radio, so he’ll be here in a second. Am I in?

Dr. Bash: There you go, Bill. Yep, Bill’s in.

Bill: Hey, all right. I made it.

Dr. Bash: Just about. Did you tell them about my new YouTube video? You can YouTube Craig Bash, and it’s got a little six-minute video on veteran stuff. It has a bunch of contact information at the end. That’s the newest and brightest.

Decision Ready Claim

Dr. Bash: Bill and I had a couple of cases recently that we thought we might talk about. I think that Pastor wanted to talk about the meals ready to eat, the RAMP case we talked about last week a little bit.

Bill: Sure, I’m up for whatever we need.

Dr. Bash: What was that called last week? You described something you used for years. It was called a RAMP case or something ready to read?

Bill: Oh, a Decision Ready Claim, yeah. The process is that before the case goes to the rating board for a decision, the development team, the pre-decision team, assembles all the relevant necessary evidence and makes sure that the case is “ready for a decision.” Then they transfer it to the rating team for a decision.

Dr. Bash: So, it’s kind of like baseball. You get it ready for the batter to hit it, right? The pitcher puts it in the box, and the pre-decision team gets it all set up. Is there a certain pathway for that, Bill? Do you have to apply for something special, or do you send it in with all the details?

Bill: That’s just a general process described in the manual. Your offices are generally divided into three parts: a pre-decision team that assembles evidence, a rating team that makes the decisions, and a post team (post-decision) that implements the decision and makes the payments. Each section has its own responsibilities in that regard.

Dr. Bash: So, when you put it in, you said, “This is a RAMP case,” and kind of told the pre-decision team that they could move it forward fast? Something like that?

Bill: Yes, well, in recent history, VA has now created a standard called the Decision Ready Claim. You must use a representative for that to help you prepare your case. If you have assembled and presented VA with all the evidence they need to make the decision, they attempt to try to have that decision done within 30 days. In fact, in recent history, VA actually did that for me.

Dr. Bash: That’s good. Look at all the time you can save. And Bill, if they do happen to deny you, you still have the right of appeal, right?

Bill: Absolutely. That didn’t change.

Disability Questionnaires

Guest: What about a C&P exam?

Bill: VA has published these disability questionnaires, DBQs. These can be completed by a physician of your choice, and you can submit them with the claim.

Guest: Now, what happens if you’re with an outside doctor and they want to write an opinion on there? There’s no location for that on the regular DBQs.

Bill: That’s correct. They would just attach the opinion on the physician’s letterhead, sign it, and that’s good evidence. It’s important for the opinion to offer the reasoning. It’s understandable if a doctor says, “In my opinion, this gentleman’s ankle condition today is related to the ankle sprain he had in the military 50 years ago.” But why? How do you know that? What evidence are you relying on to support that conclusion? If the explanation is reasonable, I have every reason to expect the claim would be granted.

Dr. Bash: When we do ours now, I’ll write my Nexus letter about the topic and try to link it so it’s consistent with the lay letter, which should be consistent with the medical record, and the medical record should be consistent with the testing. In a perfect world, everything aligns.

Bill: Yes, in a perfect world. But we live in a messy world, and sometimes there are clues. Military records might not contain a precise diagnosis or symptom. Military members often endure pain and symptoms without reporting them—that’s part of the culture. However, a veteran’s statement that they experienced symptoms is evidence if it’s a sworn statement and must be considered.

Real-World Example

Dr. Bash: Can you use that concrete example of a case we had recently about night vision goggles?

Bill: Certainly. Take the case of a pilot training other pilots to use night vision goggles. These helmets and goggles exert forces on the neck as the helicopter maneuvers or the pilot looks in different directions. You take a person who made no complaint while in service about a neck problem and now years after service has a very advanced degenerative state of the cervical spine. The question is, is that natural aging or did it result from trauma like the forces of these night vision goggles? Even though the veteran didn’t report it on active duty, his statement that he experienced those symptoms in service while flying is evidence and counts. A doctor can look at what the veteran tells them and compare that with their medical knowledge to say, “This is what I would expect if it was a result of trauma. I wouldn’t expect it to be this bad if it were just aging at this veteran’s age.” That would be a plausible basis for granting the claim.

Dr. Bash: Many times when I do these cases, the VA offers a C&P exam, and their go-to phrase is, “This is the aging process.” So, you need another doctor’s opinion to counterbalance that and see if the lay letters corroborate the chronic process.

Bill: That’s right.

Guest: How many pilots using night vision goggles are going to start complaining about their neck hurting? They’d be afraid they’d be pulled off duty.

Dr. Bash: Yes, they’d lose their flight play. That’s exactly right. My dad was a World War II fighter pilot, and he used to say that doctors are only troublemakers. It’s a long-standing process to stay away from physicians.

Guest: Your dad was an Army Air Corps pilot?

Dr. Bash: Yes, sir. Brown shoes. Even back in the day, doctors were trouble.

Occupational Hazards

Dr. Bash: I’ve seen other pilots besides those using night vision goggles, like fighter pilots, who have helmets and experience high G-forces. I’ve seen some of the worst spines in my entire career from fighter pilots. Multiple discs, necks are a mess—it’s a real deal.

Guest: Think of those Navy pilots hitting that carrier deck.

Dr. Bash: Yes, they get neck and back injuries. I’ve seen pilots with retinal tears, hemorrhoids, rectal prolapse, neck disease, shoulder disease, and back disease from G-forces. It’s incredible.

Guest: Imagine flying a $500 million fighter jet, and the only thing keeping you on the carrier when you land is a $250 tail hook. You have to admire those guys.

Dr. Bash: In the radiology field, we have a lot of radiologists and heart cath doctors developing back problems from wearing lead aprons all the time.

Guest: Yes, those lead aprons are heavy.

Dr. Bash: Yes, there are occupational hazards everywhere. Radiologists often die from radiation-induced cancers, cataracts, and skin cancer. The first radiologist, Dr. Rankin, lost his fingers from osteonecrosis due to x-rays.

Importance of Medical Evidence

Bill: We were discussing the importance of medical evidence when establishing entitlement to compensation. Raiders are well-versed that they are not supposed to use their own opinions on medical questions; they are to rely on expert medical witnesses, such as VA examiners or private physicians.

Dr. Bash: Yes, that’s right. The effort to streamline claims puts the onus on the patients. I’m only one doctor with a specific skill set, so I can’t opine on every condition. We might need sub-specialty exams to support my opinions. In the past, my opinions would force the VA to get their own exams, but now this new rule means we need to develop cases more thoroughly upfront.

Bill: That’s right. The VA manual now says the responsibility for submitting evidence rests with the claimant. If the veteran fails to provide evidence establishing the baseline and the degree of aggravation, the claim should be denied.

Guest: So, the veteran has to go to an independent doctor like Dr. Bash and can’t rely on a nurse practitioner?

Dr. Bash: Yes, it’s crucial to have detailed, consistent medical evidence. We need to ensure that everything aligns and is presented upfront to avoid denials.