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.

Discussion with Gail

Gail’s our person who does a lot of the lay letter work, you know, and Fer has that law he tells us about. It’s not really necessarily continuity of care; it’s more about continuity of symptoms. The law says that, so the continuous symptoms are where the lay letter comes in a lot. So, like in Matt’s case, Matt, you could say that you didn’t have many visits, you know, continuity of care, but you had a lot of symptoms over the years. And so, when we write a letter for you, we might have already done it, you know, we’d highlight that. We’d highlight the laws that say that it’s about the continuous symptoms, not so much about the continuity of care. The VA likes to ignore that, but that’s the kind of stuff that goes to higher-level review. You say we have continuous symptoms, this is the lay letter that goes with it, this is the law that they’re supposed to apply, and then higher-level review is supposed to say that’s right and make the raters go after it.

Symptoms vs. Care

It’s all a little bit crazy because when I’ve had three surgical consultations with a neurosurgeon at Bethesda, and when I mentioned to them—I didn’t realize that most of the neurological stuff had been deferred, had been tied to my appeal—but I said I didn’t get a percentage for my spinal cord injury, I got 30% for asthma and 10% for tinnitus. He said that’s perplexing. I said that’s bizarre. He said, you know, you’re right. He looked at me and said you’re 100% right. If you could walk into a room with the raters and they could just take a look at me, it would make it so much easier.

The Examination Process

When you go, you think it’s overt enough that when you go to have, like the first physician assistant examiner, get it, I could have spent an hour, I could have spent two hours there. Although, interestingly enough, she said it was service-connected, she just didn’t know how to diagnose it or explain it. There are three basic tests, I think I’m correct when I say this. You can correct me if I’m wrong, Dr. Bash, but Babinski, Hoffman, and clonus. Actually, somebody at the VA, a physician assistant at the VA, had me negative on all three. My second visit with Dr. Shai at Bethesda, this is before I met Dr. Bash, I said to him, am I missing something? I said I’ve always been off the charts on all three, and I even demonstrated with my left wrist. I have sustained clonus when they push your hand back, and it just shakes. He said I’ve never seen anybody do that themselves before. He glanced at the screen and said yeah, she’s over three.

Specialized Care

That’s actually the physician assistant who specializes in neurological cases at a medical center. Unless you’re dealing with a neurologist, a neurosurgeon, a neuroradiologist, and you have a spinal cord injury, you’re climbing a steep hill because chances are they’re just not going to get it, even if they’re very attentive. VA has done this with TBI; they mandated that the testing people have to be neurosurgeons, neurologists, psychiatrists, and rehab medicine for that very reason. They probably should do the same kind of rule for spinal cords because there’s a lot of aspects that are complicated, and the average person in the clinic can’t deal with it. That’s the problem you’re running into, Matt.

Nexus Proof

Host: “Matt, were you able to prove your Nexus, that you were injured in service and that it’s actually service-related?”

Matt: “Yes. The reason that complicates my case a little bit is that I was in the hospital for three months. My Battalion Commander came to visit me at Bethesda three weeks after I got hurt. Five of my buddies from the Marine Corps came up when I was still in the ICU the first week, and they brought my paddle, which is what you get when you get out. Nobody thought I was ever coming back, including me. I was in three different hospitals, in the hospital for three months, then I went home for a month, and then I went back to Camp Lejeune to kind of see everybody and check out. They had done nothing with my discharge; the S1 shop didn’t know what to do with me, so they said I had to stick around until they got it finished. I stuck around for five months, and they didn’t do anything. I finally had to go to the Battalion Commander, Lieutenant Colonel Smith, who had visited me in the hospital. He understood and sent me home in two days. After I filed the claim, I was about a year into it when the line of duty determination popped up.”

Missing Records

Dr. Bash and I have spoken a lot about this. They spent five months trying to get my records, and there’s apparently no record of an investigation related to the car accident or anything. That’s why it took me so long to file to some degree; things were getting worse. I remember when I was in college a couple of years after I got hurt, a good friend’s brother, a naval medical officer, always said he didn’t understand why I wasn’t getting anything. It just played out that way when I left the Marine Corps.

Medical Discharge

Host: “Did they give you a medical discharge?”

Matt: “They did, but it didn’t follow the normal path. By the time I requested mass with the battalion commander and he sent me home within two days, I started school five days later in January 1985. The notice to member of recommended findings was February 27. I have no recollection of going back to Camp Lejeune to sign that, and there’s no other authorizing signature on it. It was never completed.”

Procedural Complications

Dr. Bash is right; it was never completed. Mr. Creger says it wasn’t completed, so your line of duty is probably right. When I explained it to Jim Fishell, he seemed to think there was probably no formal determination. Another strange aspect is that should be a threshold question. Why go through all the CMP exams for a year and a half if the line of duty status is in question? VA doesn’t tell you anything. They came up with new information about the line of duty but didn’t tell me what it was. They’ve been trying to get my records for five months. I requested the predetermination hearing two months ago, so they’re also not very anxious to speak with me. It’s kind of a repeat of what happened 35 years ago, where you’re waiting for somebody to do something, and you’re at their mercy.

Need for Proper Documentation

Host: “It seems like you need to get your paperwork straightened out in proper order before anything much will happen. Bill Creger is good at getting that squared away. If they didn’t do the proper procedure in discharging you, it seems like the VA is going to have to buckle down and do the right thing by you.”

Matt: “I hope so. The most important thing is the request for the predetermination hearing. According to my contact at the VA, that’s a statutory requirement. If they make a decision without that, presumably, I have some recourse. Having the Nexus opinion is similar. If they have a Nexus opinion from someone with 30 years of experience in the neurological field and they line it up against a CMP exam from a nurse practitioner, then you have recourse. The more you can influence them upfront, the better. If the decision doesn’t come out as you want, at least you have an obvious recourse. I’m just waiting on the next step, the predetermination hearing. I wouldn’t be surprised if they make a decision without that because something about my claim seems to spook them.”

Dr. Bash: “Your case is unusual, 35 years with a spinal cord not being rated. The VA is worried about some kind of a clear error on their side that might allow you to open the case up all the way back and have a huge retroactive award. That’s part of what’s probably scaring them.”

Host: “Have you got an up-to-date claim file from the VA?”

Matt: “I do on the medical side. I was just going through it today. I have everything on the medical side, but I really don’t have anything on the administrative side except for the notice of member of recommended findings and the board decision, neither with an authorizing signature.”

Lack of Records

Nobody from the VA or VSO knew what to do with that. That’s why I’ve had a lot of discussions with Mr. Creger about that. The most important part is the predetermination hearing. There’s a whole set of specific appeals Mr. Creger explained, but right now, I’m just waiting on the next step. I wouldn’t be surprised if they make a decision without the hearing because something about my claim spooks them.

Conclusion

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