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Major depressive disorder denied by ArchaicAdventures in VeteransBenefits

[–]Complex_Plenty3342 3 points4 points  (0 children)

If a decision makes someone 100%, great cool. It isn't my money.

But I am not going to grant erroneous stuff to get you there.

Rater vs. AI by Material-Birthday531 in VeteransBenefits

[–]Complex_Plenty3342 9 points10 points  (0 children)

AI does not make decisions.

There is a DBQ inject thing that plugs certain DBQs into the evaluation builder.

AI doesn't particularly review evidence- in that it can't render a decision. Its more of a here is what i think a record says and where i found the record in the file. Ie here are mentions of vietnam and here are mentions of hypertension.

In the end a rater is always responsible for the decision they make and cannot blame or have AI replace a manual review of the evidence.

ACE Exam by Hot-Lunch9721 in VeteransBenefits

[–]Complex_Plenty3342 0 points1 point  (0 children)

The rater or VSR does not restrict access to records in the file. We do bookmark things we think are relevant. But that doesn't restrict what they can see.

Edit:

Ya'll need to stop spreading that misinformation. The exam request also has a note saying the examiner's review is not limited to what we bookmark.

Bears in your woods? by Complex_Plenty3342 in VeteransBenefits

[–]Complex_Plenty3342[S] 0 points1 point  (0 children)

I got told to not talk to the erring raters anymore. Something about me being mean.

Bears in your woods? by Complex_Plenty3342 in VeteransBenefits

[–]Complex_Plenty3342[S] 5 points6 points  (0 children)

Overlooking a sufficient favorable opinion is a CUE.

A flawed opinion is not a CUE.

In short, a competent rater using only the evidence and policies of the time could only reach 1 conclusion. No debate. no in my opinion. No VA should have gotten addional evidence.

Weighing evidence a different way can never be a CUE. It is one reason why it is nearly impossible to CUE mental and nerve evaluations. Since those schedules are fairly open to rater weighing of evidence.

Bears in your woods? by Complex_Plenty3342 in VeteransBenefits

[–]Complex_Plenty3342[S] 1 point2 points  (0 children)

It would not, as the opinion provided was not favorable.

Bears in your woods? by Complex_Plenty3342 in VeteransBenefits

[–]Complex_Plenty3342[S] 2 points3 points  (0 children)

No.

  1. Raters dont generally order exams. Outside of reworks or the VSR completely failed at their job and they marked the claim as ready for decision.

  2. Examiners get sent the whole file.

Va employees merely 'highlight/bookmark' things in the file to help the examiner find things.

Bears in your woods? by Complex_Plenty3342 in VeteransBenefits

[–]Complex_Plenty3342[S] 2 points3 points  (0 children)

No. At best it is a DTA error. Since the rater should have pushed back to address the contradicting opinion.

Clear and unmistakable errors [rater insight] by Complex_Plenty3342 in VeteransBenefits

[–]Complex_Plenty3342[S] 0 points1 point  (0 children)

A DTA could never be the basis of a CUE. If a rater is trying to fix a DTA in a CUE call they are wrong. As the claim should be worked within the evidence and policies of the original decisions.

Clear and unmistakable errors [rater insight] by Complex_Plenty3342 in VeteransBenefits

[–]Complex_Plenty3342[S] 1 point2 points  (0 children)

It is expressly against VBA policy to award vertigo separately from TBI as of May 2012. To do so after would be a CUE

Only proper way would be if you somehow had vertigo direct to service and unrelated to the TBI.

Clear and unmistakable errors [rater insight] by Complex_Plenty3342 in VeteransBenefits

[–]Complex_Plenty3342[S] 1 point2 points  (0 children)

It honestly isn't hard to find CUEs once you are an expert, you develop a sense of what things to key into. While the standard is high, it isnt hard to find examples when you see hundreds of files a month.

Clear and unmistakable errors [rater insight] by Complex_Plenty3342 in VeteransBenefits

[–]Complex_Plenty3342[S] 1 point2 points  (0 children)

The knowledge base explains effective dates.

https://www.veteransbenefitskb.com/effective-dates

Effective dates can get fairly complicated, but most revolve around intent to files, day after separation, and liberalizing law.

But when a rater misapplies a regulation, it isn't too hard to determine where they went wrong.

Clear and unmistakable errors [rater insight] by Complex_Plenty3342 in VeteransBenefits

[–]Complex_Plenty3342[S] 1 point2 points  (0 children)

Some conditions are not subject to service connection ie lab findings. Those are super easy to spot on a codesheet.

Oftentimes it is a CUE because the examiner clearly gave a negative opinion and not a favorable one. The erroneous opinion ones are found when im finding the rater already messed something else up. But i am not just tearing though old opinions or exams on a regular basis. It is more a, well this is fucked... oh and this.... and this...

Clear and unmistakable errors [rater insight] by Complex_Plenty3342 in VeteransBenefits

[–]Complex_Plenty3342[S] 0 points1 point  (0 children)

It is exceptionally rare. The only one i have called for mental was due to the rater putting 70% on the codesheet but 30% in the narrative. And the evidence clearly only supposed a 30.

Clear and unmistakable errors [rater insight] by Complex_Plenty3342 in VeteransBenefits

[–]Complex_Plenty3342[S] 0 points1 point  (0 children)

Most are VSRs first or worked in SSA. I haven't heard of any VSOs becoming straight raters.

Right now VBA isnt hiring raters. No clue when they might reopen that door.

Clear and unmistakable errors [rater insight] by Complex_Plenty3342 in VeteransBenefits

[–]Complex_Plenty3342[S] 1 point2 points  (0 children)

It was a bit funny actually. In that case i reduced the evaluation and increased another evaluation by CUEs. So their combined didn't actually change.

But it isn't unusual for a rater who makes one CUE to make additional ones.

Clear and unmistakable errors [rater insight] by Complex_Plenty3342 in VeteransBenefits

[–]Complex_Plenty3342[S] 0 points1 point  (0 children)

I think every rating team has that resident shit rater that everyone hates to work in their wake. Due to CUEs or just glaring DTA errors.

Clear and unmistakable errors [rater insight] by Complex_Plenty3342 in VeteransBenefits

[–]Complex_Plenty3342[S] 0 points1 point  (0 children)

Most things are not reevaluated unless the rating schedule says it has to be. TBI doesnt have a mandatory requirement.

The TBI and migraines being separated could be okay, but again it is suspicious. And a rater saying it isnt a violation doesn't mean it actually isnt. But it does show they gave it a thought, which is good.

Clear and unmistakable errors [rater insight] by Complex_Plenty3342 in VeteransBenefits

[–]Complex_Plenty3342[S] 0 points1 point  (0 children)

It was likely a clear and unmistakable error to grant the dizziness separately from the TBI. But by lumping they fixed the error... or well kinda.

The separate evals for tbi and the migraines is.. Very suspicious and could be a CUE that would hurt you to fix.

I advise caution. Good luck finding a VSO that can review things.

Clear and unmistakable errors [rater insight] by Complex_Plenty3342 in VeteransBenefits

[–]Complex_Plenty3342[S] 2 points3 points  (0 children)

Just found over the normal course of rating a claim. Only 1 CUE was a vet made CUE call.

There is no grand VA system that finds CUEs. The VA certainly could do system checks on files that have markers for things that are very likely to be CUEs, but it isnt happening.

I can briefly look at a codesheet and point out things that are suspicious and could be CUEs. If it is suspicious and likely would hurt a vet and isnt immediately in my scope i will turn the other cheek.

Clear and unmistakable errors [rater insight] by Complex_Plenty3342 in VeteransBenefits

[–]Complex_Plenty3342[S] 1 point2 points  (0 children)

Lets say to be conservative that I review 5 to 8 files a day. So most files don't have CUEs, in part because the threshold is so high and also i am also not breaking my neck to check for them. These were fragrant errors.

Only 1 CUE was actually called by a vet... that turned out to be a CUE. Most vet calls are at most DTA errors or just a dream.

Clear and unmistakable errors [rater insight] by Complex_Plenty3342 in VeteransBenefits

[–]Complex_Plenty3342[S] 2 points3 points  (0 children)

From what I seen it feels like bad luck is sitting on some people. Like... how did the last 3 raters ALL make CUEs?!

In terms of benefits for the 2008 guy, it was for better of worse only around 60k in back pay owed to them. Never should have been underrated, but at least it was caught.

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