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. So thank you for listening, and here we go.

Court Precedents and Case Examples

Some of the court precedents that must be applied, and that’s why I was able to grant more. I might give you a brief example. A case came to my desk where a veteran claiming diabetes had been denied for 10 years because his individual service records did not reflect that he was stationed in Vietnam. We couldn’t look through his service records and say, “Okay, here we see you were stationed in Vietnam,” but his claim was that he landed at Da Nang, Vietnam, and transferred to a shuttle plane and flew out to a carrier, the USS Coral Sea, at Yankee Station, which is off the coast of Da Nang. The veteran’s statement is a sworn statement and provides evidence that he set foot in Vietnam.

Lay Evidence and Its Acceptance

Lay evidence, according to the manual, is to be accepted unless there’s evidence to the contrary. If a veteran says he set foot in Vietnam, our job is to compare what he told us with the circumstance, place, and type of service, and decide whether that’s consistent or not with his experience. I granted it and was questioned about that. They asked, “Why did you grant this?” I replied, “Why shouldn’t I?” They said, “The service records don’t show that he set foot in Vietnam.” I responded, “Well, what do you know? He was in California on day one, and days later, he’s on the deck of an aircraft carrier at Yankee Station off the coast of Vietnam. How did he get there?” They didn’t know.

Consistency with Historical Context

You should know if you’re going to do this work how people got to an aircraft carrier at Yankee Station. The routine was you would land at Da Nang, which serviced Yankee Station, and they routinely had shuttle aircraft and boats going back and forth between Da Nang and Yankee Station, transferring mail, personnel, and replenishing supplies. His statement is consistent with history, and there’s nothing else in the record that shows it didn’t happen. So he got his check. There were times when I was questioned, but I was never found rewarded for denying claims. I never saw that happen to anybody. There were rewards for deciding a lot of claims, so how fast an individual works might affect their opportunity for a bonus.

Forensic Analysis and Medical Reasoning

The forensic analysis you did reminds me of how we do things with the brain with multiple sclerosis. We had patients who lost their hearing or had changes in their vision. We would check the MRI scan, and it would show a lesion in the place that caused the loss of vision or hearing. The same kind of reasoning applies in these cases.

The Importance of Detailed Medical Opinions

What I found distressing many times was getting medical opinions from physician assistants who would just say “no” and point to some literature. The literature would say the most frequent cause of condition A is, for example, age. That doesn’t tell me how you determined whether this individual case is part of the minority affected versus the majority suffering from an age-related condition. The medical opinion has to explain why this patient’s experience is not in the minority. The court’s jurisprudence has made that clear.

Consistency in Medical Evidence

If the opinion says 70% of these conditions are age-related, the court found that you need to explain whether the patient is in the 70% or the 30%. The rationale for the opinion and the reasons offered are the most important aspects. It’s the same logic you used with the veteran who claimed he set foot in Vietnam. That’s the way the history went, and it’s the same kind of logic for medical pathways or neurological pathways.

The Case of Hearing Variability

I recall a case about hearing where we overturned an opinion of a department head of a college of neurology. He suggested that the individual’s problems with sinusitis and respiratory infection were affecting his hearing, explaining why his hearing was different at different times in service records. What I pointed out was that if you have an infection, hearing loss is going to be flat across the board because all frequencies are affected. In this case, the veteran’s hearing was not flat but variable at various times, and the periods of hearing problems were not coincident with the periods of infection. The Board of Veterans Appeals agreed with us.

Recent Reduction Case Example

We recently had a reduction case where the VA looked at treatment records to conclude that a brain tumor was in remission. When you reviewed the imaging, it clearly demonstrated that it was not in remission but quiescent, not active. The veteran faced a reduction from 100% to 0%, which was wrong. The proposal to reduce was incorrect. Once you took a look at the records and saw the facts medically, we brought that to the attention of the VA, and they promptly reversed their position.

Conclusion

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