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.

Host Introduction

Host: “Now, here’s your host, Jald Cooks.”

Jald Cooks: “Yes, welcome, ladies and gentlemen, on this 24th day of October, 2019. We are here with Dr. Bash, and he’s going to have a guest on. We’re going to be discussing back injuries, spinal cord injuries, and what have you, among other things. So be sure to take notes and remember we keep these broadcasts in archives all the time, so it’s well worth going back and reviewing if you need to. Dr. Bash, how are you doing tonight?”

Introduction of Guest

Dr. Bash: “I’m doing good, doing good, and I’m glad that our friend Matt Hay is here with us tonight. You know, Matt and I went to West Roxbury in Boston VA hospital for a few months about 35 years ago, and we never even knew of each other because he left a few weeks before I got there. But we had the same doctor and the same staff, and all of a sudden, he resurfaced now with a spine injury which hasn’t been rated or assigned any kind of a code for 35 years. So Matt is now into the new system, the new appeal system since February. Matt, you want to tell them a little bit about yourself and maybe a little about what happened with the claim?”

Matt’s Experience

Matt Hay: “Well, I guess I kind of stumbled along until I ran into here. When I first thought about my claim, I was really just trying to get my medical records from the VA Medical Center. The volunteer out there actually wound up filing a claim, but it was a claim you could have fit on a postcard. It just said ‘spinal cord contusion, neurological impairment.’ So of course, it was denied almost immediately.”

Dr. Bash: “How long was that denial? How many sentences was it?”

Matt Hay: “Not very long. It just said, you know, you only had one visit. But at that point, I really wasn’t intending to file a claim. But it kind of points out when I get to the next step when I went to the VA, everybody gave me the name of somebody. I talked over to the VA, he was very helpful, but he filed the notice of disagreement. So really the first claim that I filed was already an appeal, which was going to slow everything down. That was in May 2018, then I filed the appeal in July 2018, and then I filed the notice of disagreement in July 2018.”

Filing a Claim

“In November, I went up to the VFW, and again, I was really just trying to get my medical records. It was the end of November, and I spoke to somebody there. Like two days later, they turned out a really detailed supplemental claim. The notice of disagreement just kind of said ‘neck injury, shoulder, hand, left leg, left foot’ because all my neurological damage, as Dr. Bash knows, is almost all on my left side, which is unusual. People are used to seeing somebody that’s injured from the neck down or from the waist down. With me, it’s on my left side, which is unusual. Even healthcare practitioners and some physicians have a hard time wrapping their heads around that.”

Supplemental Claim

“But then the supplemental claim was filed at the end of November, and that moved a lot faster than the appeal. The first decision letter came out on July 1st, and a lot of the neurological injuries were deferred pending the line of duty determination. The way I describe it to people is like going from kindergarten to graduate school. When I went to the VA and filed a detailed claim, I thought I was in pretty good shape. But when I stumbled into the VFW, and they went through my medical record and my in-service records because I was hospitalized for three months, it was a much more formidable claim. The problem is, they are very helpful people, good people, hardworking, but they’re not physicians.”

Involving Dr. Bash

“I was in a conversation with somebody, and they mentioned Dr. Bash. When I found out he had a neurological background and expertise, I didn’t know how considerable it was at the time, but I thought he would understand me immediately. So I reached out to Dr. Bash and included an impression of an MRI that I had. He got back to me within an hour, and we spoke the next day, which was a Saturday. I think the first question he asked me was, ‘What hospital were you in?’ I said, ‘I was in Roxbury.’ He said, ‘Roxbury? I was in Roxbury!’ He asked, ‘When were you there?’ I said, ‘Back in 1984.’ He said, ‘1984? Excellent! I was there.’ And the next question was, ‘Who was your doctor?’ It was the same neurosurgeon, Dr. Sarati.”

Filing a Nexus Opinion

“In February, we were able to get together in D.C. while Dr. Bash was here, and we filed the Nexus opinion. Once you see the Nexus opinion, you realize how deficient the other claims were. The Nexus opinion had a physical exam, medical records, and in-service records. It’s a tiered approach: physical disabilities, the regulations that underpin them, and the case law underneath that. That’s why I refer to it as graduate school. It’s much harder for the VA to deny and much easier for them to understand what they’re looking at.”

CMP Exams

“The supplemental claim was filed under orthopedics, and I saw another physician. I had another CMP exam last summer, and the physician assistant was outstanding. She had studied my medical record, was familiar with my claim, and before I even sat down, she said, ‘Your claims are a bit uneven.’ One was filed correctly as neurologic, and one was filed incorrectly as orthopedic. She did a thorough exam. When I read the decision letter in September, there were 14 or 16 orthopedic denials that shouldn’t have been there. I had never broken a bone. Somehow, the exam she performed didn’t get conveyed.”

Working with Dr. Bash

“Right now, I’m trying to get that CMP exam into my file. Until I get it, I can’t have Dr. Bash add a letter because everything has been attached to my appeal. Dr. Bash, what are your thoughts?”

Dr. Bash: “I agree, Matt. Patients need to understand that the new system is moving quickly. They might make decisions in a month on a supplemental claim, which might only be one sentence when we submit 100 pages. But the idea is to keep adding data and building the case. With Matt, we have the first letter, and now we’re thinking about the second letter. It’s important to get the CMP exam data so we can challenge anything that needs to be challenged. It takes a team of people. The system is pretty complicated.”

Host’s Experience

Host: “Dr. Bash, I ran into the same thing with my CMP examination. The examiner looked at things in my favor, but when he submitted the report back to the regional office, they tried to get him to alter it.”

Dr. Bash: “I see that a lot. The doctors write stuff, but then the rating team behind them tries to influence it. If the patient says they have foot pain and it’s not in the report, they need to make sure it gets added. If the exam report is wrong initially, it’s hard to change six months or a year down the road.”

Host: “At least my CMP examiner stuck to his guns, but I can see how easy it is to manipulate an examination. Matt, what do you think?”

Matt Hay: “My spinal injury happened back in 1983, and I faced similar issues. It took me 14 years to get my claim approved. The first time you do anything, you don’t know what you’re doing. Working with Dr. Bash and Bill Creager would have helped immensely.”

Conclusion

Dr. Bash: “That initial information is important. Even for me, it took seven years to get my case through the system. Patients often minimize their problems because they get used to dealing with them.”

Matt Hay: “One thing I’d note about the supplemental claim is that there were things on there I never would have thought to include, like asthma and tinnitus. They were approved even though they seemed secondary to my main issues. Talking to more people helps, and getting your records and exams is crucial.”

Dr. Bash: “Absolutely. Getting that data and involving the right experts is key. It’s a complex system, but with the right team, you can navigate it. Thank you all for listening. That ends this show. Now I’m going to zoom off.”