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.”

Experience with the RAMP Program

Host: “Getting back to this RAMP thing, Dr. Bash, have you had very much good experience with it or much dealings with it?”

Dr. Bash: “Well, like I said, the only thing I’ve seen so far is I just see them start to talk about relevant evidence. They used to talk about new material evidence, but now I see a couple of decisions where they’re talking about relevant evidence. So they’re starting to get it ramped up. A couple of the decisions came out, and they’re going to be in the RAMP format because RAMP has certain rules where they have to list the laws that apply and the positive evidence. In a couple of decisions I saw, it said ‘positive evidence: none.’ They said there wasn’t any new relevant evidence, they got rid of the new evidence, and they said there was no positive evidence. So the decisions are going to be very cut and dry, I think. When I send my stuff in, I’m going to document if this is positive supportive evidence or relevant new evidence so that they have to address it.”

Host: “I did read something else, Dr. Bash, about them coming up with a deal on foster care for veterans. Have you heard of that?”

Dr. Bash: “No, no, tell me what you know.”

Host: “Where a family can take a veteran in, just like they would a foster child, only it would be a foster veteran. I was reading an article on that, and they started it up toward Springfield. They had a VA center there that started it, and they were taking in homeless veterans or veterans who didn’t have anyone to care for them and were elderly. They started a foster care program in Mount Vernon, Missouri.”

Dr. Bash: “So veterans can use their benefits for the family. Does the family get any benefits from it, or do they just provide for the veteran?”

Host: “I don’t know yet. I just ran into this the other day and was reading about it. For some veterans, it may turn out to be a good thing. We’ll have to learn more about it, but it’s something new that they’re working with.”

Dr. Bash: “Over the years, we’ve kind of had that informal setup where veterans help each other, like your radio show and stuff I do. We all try to help each other. This is more of a housing thing, with room, board, and help to keep their meds straight and all that. It’s not for every veteran, of course, but for someone by themselves in their upper age who just needs help, it could be very beneficial and keep them off the street.”

Host: “Yeah, you don’t want to see veterans out on the street. It could be a win-win for some veterans. It wouldn’t work for me. I’ve got enough kids and grandkids; they better take care of me. Hope I ain’t too sick to whoop them.”

Concerns with RAMP

Host: “Anyway, that is something new I ran into, and I wondered if you’d heard about the program.”

Dr. Bash: “Nope, I hadn’t come across it. I’ll have to check it out further.”

Host: “But this RAMP, like I say, it’s going to take some doing to get it proved up to me. I got a bad feeling about it. Maybe that’s just me.”

Dr. Bash: “They got that higher level review thing too. If you go down that pathway, you don’t get to put new evidence in. I don’t know why a higher level review would necessarily be any better than the first review if there’s nothing new to look at. If it’s a DRO (Decision Review Officer) where they do a de novo review of the whole case, I had an interesting case. People talk about CUEs (Clear and Unmistakable Errors), but I had a case with a guy who had a CUE. They wrote it up for his bowel condition; they didn’t find he had a bleeding bowel, and they didn’t work him up. He had polyps, but they treated the polyps, so he got a 0% for the polyps. But in the process of the CUE, the DRO looked up his record and found he had flat feet (planter fasciitis) and ended up with a 50% rating for his feet. It was the second CUE off the first one. Those DROs have a lot of time to look at those records. I think in a higher level review, it’s just going to be a cursory review again, not an in-depth analysis. It might not result in a much different outcome.”

Host: “Well, go in for one thing and get rated for another. That’s good. That turned out good for him.”

Challenges in the Review Process

Dr. Bash: “Yes, there’s also some psychology going on. If it’s in the same station, you know, if Smith is reviewing Jones’s work and they live in the same building and have worked together for 20 years, it’s hard for them to be totally objective. They might just go along with the other guy. It’s going to be hard to have a really good objective higher level review, but we’ll see.”

Host: “The problem I’ve seen is they look at the last Raider’s decision and go from it. They don’t give their own opinion; they just go from the last Raider’s opinion, and that goes nowhere. I had a case today just like that. A guy had peripheral neuropathy, and he also had spinal cord disease with leg neuropathy and radiculopathy. The first Raider, 10 years ago, looked at the record and saw that the guy was claiming peripheral neuropathy. The Raider looked at the record and said, ‘Oh, he has spinal cord disease; that’s not peripheral neuropathy; that’s a different type of neuropathy.’ So he said the record doesn’t have the diagnosis and denied it. He never looked at the rest of the record to see the peripheral neuropathy was already diagnosed five years before. Then the second Raider came along and did the same thing. The third guy had three denials the same way. It’s probably going to be a CUE case because they obviously didn’t read the record and see that he had peripheral neuropathy along with spinal cord disease. Two processes, not one disease.”

Dr. Bash: “That’s what we’re running into. One of the major problems with the claims process is the first Raider, then the second, and then the third. They all read the same thing and write nearly the same report. They change a word or two, but it’s the same finding. They don’t want to do their job, just copy what the last one did. The system has generated a quagmire on its own, by design. They’re lazy and don’t want to read the report and give a factual finding or opinion, and that’s hurt a lot of veterans.”

Host: “Social Security kind of goes into the same thing. They shifted to analysis, trying to look for more objective things, and are using nurse practitioners and PAs. Just the fact that they use those types of trained people makes the analysis more shallow. They don’t have the same knowledge base and don’t understand the interconnections of everything.”

Dr. Bash: “Right, they’re not educated on what to look for in reading these progress reports, medical reports, and such from doctors and hospitals. Usually, the data is all there; they’re just not paying attention to it or don’t understand what they’re reading.”

RAMP Strategy

Host: “I’m hoping the RAMP program will work, but right now, I don’t have too much faith in what I’ve seen so far.”

Dr. Bash: “So like I said, my strategy is to try to get as much medical testing data as I can up front when we first get the claim in. The second thing is to try and get relevant testing and more relevant evidence along the way.”

Host: “That’s the only option I see you have, Dr. Bash. Get it all in up front that you possibly can. Usually, there’s other things lurking in the background, but if you can get the ball going, someone will pay attention to it. It’s got to be there in the beginning. If they don’t look at it on the first claim and they deny it, you reapply for another claim with new information. Maybe if RAMP is really fast, they bring them in, deny them quickly, and the patient reapplies with a new claim and new evidence. Maybe that’s the way to do it, although it’s cumbersome. You lose retroactive pay, but you might get the rating right.”

Dr. Bash: “You’re right, they do lose retroactive. But if you get a speedy reply, it wouldn’t mean that much. If it goes on for years, that’s a big deal. It can turn into quite a sum, and it seems like the longer the claim runs, the harder it is to get a satisfactory result. That’s just the way the system works. They’ll play with it for a while, maybe get it squared away, but last I heard, they already had quite a backlog on the RAMP. I don’t know how they’re going to keep up with that.”

Host: “I believe that.”

CUE and Speedy Decisions

Dr. Bash: “You see these short decisions now. Creager and I were talking about this today. They list the evidence, like Dr. Bash’s DBQ and letter, but they won’t ever describe it, talk about it, or expand on it in the decision. That’s another fertile place for CUE because if there are things in my letters or the medical record that they don’t look at and don’t describe, that are positive and could change the outcome, then that’s a CUE because they never really considered it. In the speed they’re trying to do these cases now, there are going to be a lot of places where they just blow by it. They list a bunch of medical evidence and blow by it with boilerplate, making lots of mistakes.”

Host: “I’m afraid that’s what it’s going to boil down to, a lot of mistakes. If the RAMP program sends out all these decisions that are error-filled, there might be a huge increase in CUE cases, and then the VA will have to pay those cases anyway. Maybe that’s how patients can get a correct result out of the whole thing.”

Dr. Bash: “Let’s hope there’s some sort of recourse. It sounds like they’re already doing their thing. If there’s no evidence, they only have one option, which is to deny. So the veteran has to file it. I don’t know if it goes back to the regular claims process or what it does, but sooner or later, I’m surprised they haven’t eliminated the claims process after you switch over to RAMP.”

Host: “I think you’re stuck with either filing a new claim with new evidence or going to the BVA, which could take a long time.”

Dr. Bash: “That’s going to eat up everyone’s retroactive pay. The VA still comes out on top, whether intentional or not.”

Host: “It might get hard to get lawyers to help you because if they eliminate all the retroactive pay through this process, there isn’t much incentive for lawyers to help. Veterans might have a harder time getting legal help.”

Dr. Bash: “That’s another good point. I don’t know what it’s going to take to make this thing work. The VA tried to get me to go to RAMP. They sent me paperwork on it. I spoke to the VA today, and they wanted me to switch over to RAMP. I said no. My claim has been in the system so long, and switching to RAMP means if you guys haven’t done it now, you won’t get it done in a RAMP period of time. They’re really pushing it. I get three letters.”

Host: “Yes, they are pushing it.”

Dr. Bash: “I told them no. I’ve read through the paperwork, and I didn’t like what I read. I’m going to leave my claim in the process it’s in and expect them to do their job properly. I don’t like RAMP. Some people may be okay with it, but for me, it wasn’t. I’ll have to fight it out to the end, but they’re pushing RAMP really hard.”

Contact Information and Closing

Host: “Well, Dr. Bash, we’re about out of time here. Do you want to give us your contact information?”

Dr. Bash: “Oh yeah, the best way to get me is to Google Dr. Craig Bash. You can find all my websites and videos. My main website is www.veteransmedadvisor.com. My scheduler is Skip, and his number is 925-381-7561. I talk to Skip two or three times a day. Call Skip up and tell him you want to talk to Dr. Bash, and he’ll set you up at a time when I’m not typing or studying stuff, usually the same day or next day. So 925-381-7561. Skip’s in California; you can text him or call him, and he’ll hook you up with me.”

Host: “Good, and Bill, when is he coming back?”

Dr. Bash: “Bill’s going to come back in a month or so. He’s got a couple of good CUE cases we can talk about in great detail with the VA regulations and the manual.”

Host: “He’s sharp as a tack. He knows those VA laws inside and out. He used to work at the local office, the BVA, the PVA at the appeals level, and did a lot of work at the court. He’s been at the VA central office for decades, so he’s got lots of experience.”

Dr. Bash: “Yes, he does, and that shows. We’re certainly glad to get him on, and you give us a lot of good information here, Dr. Bash. We appreciate it. We want these veterans to know everything they possibly can and let them know they’re not alone. There are people trying to give them the best information we can get our hands on, and we’ll put it out there.”

Host: “We’ll just keep on keeping on. Happy Valentine’s Day, everybody. See you later.”

Dr. Bash: “Same to you. Thanks for coming on.”

Host: “We appreciate it. You have any questions at the end, anything you want to add?”

Guest: “No, you hit the topics pretty good. I just sit back and soak in all the information. If I have any questions, I’ll contact Dr. Bash.”

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