Private DBQs and Refusing C and P exams

R

retsvin

PEB Forum Regular Member
Registered Member
I have a few questions regarding my VA claim process and would appreciate some clarity.

  1. Approval Based on Private DBQs:
    • If a veteran is unable to attend a VA exam or has a claim for an increase, and wants the claim to be rated based on the evidence from private DBQs, can the veteran's claim be approved?
  2. Living Abroad with Private DBQs:
    • Additionally, I live abroad and have provided a sufficient DBQ from a private doctor for the increase. Does the law still support the veteran in these actions?
  3. Conflicting Information:
    • I have read the CFR and VBA Manual, which support the veteran's use of private evidence in lieu of a C&P exam. However, I have also read conflicting reports from others on various forums.
  4. Current Status:
    • Exams have already been refused, and I am now awaiting the rating decision.
Given this situation:

  • What is the truth about the acceptance of private DBQs?
  • How can I ensure my claim is handled fairly?
 
Just from keeping an eye on Reddit from how these typically go (check r/VeteransBenefits for reference) the provider must fall in line with these criteria:


The strict enforcement of these guidelines wax and wane from my understanding. As of recent times it's been quite strict as the OIG is tired of claim sharks and DBQ "mills" pumping out favorable DBQs for large amounts of cash. A lot of fraud was going on so private DBQs are a lot harder to justify, though I would assume you have recourse if you are denied entirely. I would definitely call the VA via a regional office or the 1000 number and discuss what may happen from there.
 
Fully developed claims are based on DBQs from healthcare providers.
 
chaplaincharlie said:
Fully developed claims are based on DBQs from healthcare providers.
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I had a doctor who specializes in VA claims assist me. My primary care does not know how to fill out a DBQ and refused.

Can you assist With the other questions? Very much appreciated.
 
thanks4urhelp said:
Just from keeping an eye on Reddit from how these typically go (check r/VeteransBenefits for reference) the provider must fall in line with these criteria:


The strict enforcement of these guidelines wax and wane from my understanding. As of recent times it's been quite strict as the OIG is tired of claim sharks and DBQ "mills" pumping out favorable DBQs for large amounts of cash. A lot of fraud was going on so private DBQs are a lot harder to justify, though I would assume you have recourse if you are denied entirely. I would definitely call the VA via a regional office or the 1000 number and discuss what may happen from there.
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I find reddit to be inconsistent with information. VBA employees there have posted opposing opinions on the matter.
 
retsvin said:
I find reddit to be inconsistent with information. VBA employees there have posted opposing opinions on the matter.
Click to expand...
You're right, which is a decent snapshot as to how spun up the VBA can and can't be on the topic. That's why I forwarded that link with the info from the horse's mouth.

So long as your private provider meets the listed criteria you should have no issue. There's just infinitely more that can go wrong here than a VA appointed exam since it's all in the formatting and detailing. If this provider specializes in claims of this nature that can be a good thing, but I warn you of those mills that are being cracked down on.

Ultimately what's done is done, but you need to have a plan on addressing this should the VA deny you outright for refusing your exam/refusing given evidence.
 
thanks4urhelp said:
You're right, which is a decent snapshot as to how spun up the VBA can and can't be on the topic. That's why I forwarded that link with the info from the horse's mouth.

So long as your private provider meets the listed criteria you should have no issue. There's just infinitely more that can go wrong here than a VA appointed exam since it's all in the formatting and detailing. If this provider specializes in claims of this nature that can be a good thing, but I warn you of those mills that are being cracked down on.

Ultimately what's done is done, but you need to have a plan on addressing this should the VA deny you outright for refusing your exam/refusing given evidence.
Click to expand...

https://www.reddit.com/r/VeteransBenefits/comments/1dgy0qi/comment/l8tcwo5
View: https://www.reddit.com/r/VeteransBenefits/comments/1dgy0qi/comment/l8tcwo5/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button


This VBA employee says all private evidence that is filled out correctly must be used. Another chimes in, without a VBA flare stating the opposite. It's mentally exhausting. Is the law black and white or not?

What IS the truth?
Regardless, I will mentally prepare for a HLR as it seems VBA employees have the right to use their own judgment and personal bias instead of the law on claims.
 
retsvin said:
https://www.reddit.com/r/VeteransBenefits/comments/1dgy0qi/comment/l8tcwo5
View: https://www.reddit.com/r/VeteransBenefits/comments/1dgy0qi/comment/l8tcwo5/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button


This VBA employee says all private evidence that is filled out correctly must be used. Another chimes in, without a VBA flare stating the opposite. It's mentally exhausting. Is the law black and white or not?

What IS the truth?
Regardless, I will mentally prepare for a HLR as it seems VBA employees have the right to use their own judgment and personal bias instead of the law on claims.
Click to expand...
My understanding is this: so long as the private DBQ is correctly filled out, you will be fine. As I said before the OIG is cracking down heavily on private practices for their typically extremely favorable DBQ services, which has made private practice subject to extreme scrutiny. Little details that are commonly mistaken on VA contractor DBQs being missed on private DBQs would likely cause a denial. This is probably so common VBA employees just wholly recommend against the practice, but VBA employees aren't expected to be professionals on the matter and simply having the VBA flair does not mean you have ultimate authority.

It is a possible avenue, just a lot more likely to go down in flames from small mistakes, bias, etc.

If you scroll for longer you'll find the commentary of an associated attorney:


He posts useful commentary and case specific notices in that thread.
 
thanks4urhelp said:
My understanding is this: so long as the private DBQ is correctly filled out, you will be fine. As I said before the OIG is cracking down heavily on private practices for their typically extremely favorable DBQ services, which has made private practice subject to extreme scrutiny. Little details that are commonly mistaken on VA contractor DBQs being missed on private DBQs would likely cause a denial. This is probably so common VBA employees just wholly recommend against the practice, but VBA employees aren't expected to be professionals on the matter and simply having the VBA flair does not mean you have ultimate authority.

It is a possible avenue, just a lot more likely to go down in flames from small mistakes, bias, etc.

If you scroll for longer you'll find the commentary of an associated attorney:


He posts useful commentary and case specific notices in that thread.
Click to expand...
I appreciate your input on this topic and hope you have an amazing day.
 
thanks4urhelp said:
My understanding is this: so long as the private DBQ is correctly filled out, you will be fine. As I said before the OIG is cracking down heavily on private practices for their typically extremely favorable DBQ services, which has made private practice subject to extreme scrutiny. Little details that are commonly mistaken on VA contractor DBQs being missed on private DBQs would likely cause a denial. This is probably so common VBA employees just wholly recommend against the practice, but VBA employees aren't expected to be professionals on the matter and simply having the VBA flair does not mean you have ultimate authority.

It is a possible avenue, just a lot more likely to go down in flames from small mistakes, bias, etc.

If you scroll for longer you'll find the commentary of an associated attorney:


He posts useful commentary and case specific notices in that thread.
Click to expand...

I want to clarify that missing an exam for a new disability claim is a very bad idea. However, I've noticed that for increases in existing conditions, especially static and long-established ones, private evidence seems to face less scrutiny. In my situation, does this mean that static conditions with private medical evidence are generally reviewed with less scrutiny compared to new claims? I would never miss an exam for a new claim.

I just want them to use the evidence for my claim.
 
retsvin said:
I do want to clarify, I believe missing an exam for NEW claim is probably a very bad idea. I seldom see cases for increases. So I wonder if static, long-existing conditions with private evidence are less scrutinized?
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I would imagine the same criteria are taken into account. Only difference is a static condition would have established service connection already. You must know you have subjected yourself to reexamination for filing for an increase, correct?
 
thanks4urhelp said:
I would imagine the same criteria are taken into account. Only difference is a static condition would have established service connection already. You must know you have subjected yourself to reexamination for filing for an increase, correct?
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The conditions I applied for increase are static and 12 years service connected. They must find overwhelming evidence to reduce me, such as my life-time condition magically healing. Not worried. Also the main reason I don't want some back-room c and p examiner evaluating me and my benefits.
 
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I suggest you call and ask why the DBQs were refused. It might be the specific doctor you used is the issue.
 
chaplaincharlie said:
I suggest you call and ask why the DBQs were refused. It might be the specific doctor you used is the issue.
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Thanks for your reply sir. I called when exams were initially scheduled and they had no reasoning. Also scheduled exams out side of the country despite my statement explaining where I live. So I'm under the impression it was automated and my documents were ignored.
 
My experience, way back in 2016 was that my private doctor Psychiatrist who had treated me for a year filled out a DBQ that aligned with a 70% rating, and the VA psych that only met with me one time only for 20 minute psych CP exam filled out the same DBQ at a 50% rating… and so what I learned was that if this is the case, then the VA must consider the non-VA doctors DBQ and give it more weight… because that doctor has been treating you for a longer period time, vs the snapshot of what the VA psych doctor who has only ever looked at your records and spent only 20 minutes with you.

This was stated in policy years ago… that more weight would be given to the doctor who is currently treating the patient… not sure how current that policy is today…

It worked for me, I was bumped from 50% mental health to 70% based solely on my private practice psych doctor DBQ…
 
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We accept private DBQs as long as they are appropriate for whatever condition you are claiming. Like hearing get an audiologist. I am a rater.
 
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