# VAC Doctor does not agree with my Doctors



## rand_d (2 Mar 2013)

In 2010, I had a form of Brain Surgery to release cranial fluid pressure on my brain. Since then, I have various symptoms that started after the surgery, and I am being medically released because of them. SISIP has deemed that I will be on LTD until I am 65, and due to my mental state, I will be unable to do any Vocational Rehab. I just received my decision letter from VAC, and according to their Medical Adviser, my surgery had nothing to do with my disability. In their explanation, the adviser seemed to only use only the medical records that supported her diagnosis, but seemed to gloss over the records that supports my claim. Does this happen often?


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## Fishbone Jones (2 Mar 2013)

It happens all the time. You've just started down a long, administratively burdensome but well travelled road. Get to your nearest Legion and engage the VAC Service Officer.


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## maniac (2 Mar 2013)

yup, recceguy that's good advise.


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## rand_d (2 Mar 2013)

I was told that I would get a lawyer to fight the decision, is this good enough, or should I go to the legion? Recceguy, how long are we talking here?


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## George Wallace (2 Mar 2013)

rand_d said:
			
		

> I was told that I would get a lawyer to fight the decision, is this good enough, or should I go to the legion? Recceguy, how long are we talking here?



Try the Legion.  Lawyers cost money.


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## rand_d (2 Mar 2013)

Thanks George Wallace, I didnt think of that.


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## Occam (2 Mar 2013)

George Wallace said:
			
		

> Try the Legion.  Lawyers cost money.



If he was told he would get a lawyer, then it's a pretty safe bet that they're talking about a BPA lawyer - which I would take any day over a Legion Service Officer.

rand_d, has BPA (Bureau of Pensions Advocates) been in touch with you?


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## Fishbone Jones (2 Mar 2013)

rand_d said:
			
		

> I was told that I would get a lawyer to fight the decision, is this good enough, or should I go to the legion? Recceguy, how long are we talking here?



That lawyer you were promised works, and is paid for, by Veteran's Affairs.

It kinda like being charged for a crime by the Crown Attorney and then asking him for advice on how to beat the charge. You figure out if that's good enough for you. 

You can, literally, be fighting this for years. Especially, if they decide after the first couple of appeals, to dig in their heels.


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## Occam (2 Mar 2013)

recceguy said:
			
		

> That lawyer you were promised works, and is paid for, by Veteran's Affairs.
> 
> It kinda like being charged for a crime by the Crown Attorney and then asking him for advice on how to beat the charge. You figure out if that's good enough for you.
> 
> You can, literally, be fighting this for years. Especially, if they decide after the first couple of appeals, to dig in their heels.



That's an awfully cynical view of BPA lawyers.  It's their job to represent you to the best of their abilities.  I don't know if Legion Service Officers have access to VAC's computer network, and to decisions databases or whatever other legal resources they have, but I can tell you that BPA lawyers do.  

My personal experience with Legion Service Officers (at least at the branch level) can only be described as craptacular.  

However, BPA lawyers have, over the last 6 years, successfully increased my disability pension from 5% to 15% through the Departmental Review processes and one VRAB review hearing.  Whenever VAC threw up a roadblock or botched paperwork, BPA did as advertised and tried to find ways around it.  I have nothing but good things to say about them.


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## the 48th regulator (2 Mar 2013)

rand_d said:
			
		

> In 2010, I had a form of Brain Surgery to release cranial fluid pressure on my brain. Since then, I have various symptoms that started after the surgery, and I am being medically released because of them. SISIP has deemed that I will be on LTD until I am 65, and due to my mental state, I will be unable to do any Vocational Rehab. I just received my decision letter from VAC, and according to their Medical Adviser, my surgery had nothing to do with my disability. In their explanation, the adviser seemed to only use only the medical records that supported her diagnosis, but seemed to gloss over the records that supports my claim. Does this happen often?



Was the original injury caused by Service.  If not, are you saying that your Doctor's are accusing the Surgeon, who operated on you, and was contracted by the CF caused further injury, and now you suffer these symptoms?

These are the things VAC is looking at.  Just because you become ill, does not mean that you are entitled to VAC coverage.  Can you please give us more information.

dileas

tess


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## Fishbone Jones (2 Mar 2013)

Occam said:
			
		

> That's an awfully cynical view of BPA lawyers.  It's their job to represent you to the best of their abilities.  I don't know if Legion Service Officers have access to VAC's computer network, and to decisions databases or whatever other legal resources they have, but I can tell you that BPA lawyers do.
> 
> My personal experience with Legion Service Officers (at least at the branch level) can only be described as craptacular.
> 
> However, BPA lawyers have, over the last 6 years, successfully increased my disability pension from 5% to 15% through the Departmental Review processes and one VRAB review hearing.  Whenever VAC threw up a roadblock or botched paperwork, BPA did as advertised and tried to find ways around it.  I have nothing but good things to say about them.



I've had the same experience with VAC lawyers as you've had with the Legion.

You know nothing of my cases. I'm entitled to be cynical.

The OP asked for advice. He's entitled to hear it, warts and all. 

Now he has more than just your option and can decide for himself.


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## blackberet17 (3 Mar 2013)

From the VAC guy:

Legion Service Officers can represent you. However, they are not necessarily the best people to do so.

They can be like the blind date. Nice personality, but do you really want to take her home, let alone home to mom?

LSOs don't have the experience with the disability application process. Far too many a time I have seen LSOs lead people down the wrong path. It wasn't intentional, it was simply good intentions backed by little to no experience.

Yes, Bureau of Pensions Advocates are laywers paid by VAC. However, they ARE lawyers. There is a fair amount of legislation and procedural wrangling involved in the process. They also have far more experience with the process, more often than not (we hope) can quickly and easily determine what is missing from your claim and help you figure out how to get it, and, as someone else pointed out, have access to our internal database, which can be a useful tool.

BPA lawyers can also turn out to be the blind date you don't want to take home. But at least mom might like her.


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## maniac (3 Mar 2013)

You should be advised that the RCL Service Officer are co-representing you with the BPA.  The are acting as one and the Service Officer does hold the BPA Office's feet to the fire.


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## rand_d (3 Mar 2013)

My condition is not military related, but any doctor I talk to says it was aggravated by the military. I was misdiagnosed in 1991, and I had been asking for a MRI since 1995 to clarify my condition. I finally got one in 2008 which proved that I did not have what was diagnosed in 1991, and it took until 2010 to finally come up with the proper diagnosis. My symptoms got so bad that surgery was required, the surgery was considered risky, but I decided to go for it anyways. The surgery cleared up my symptoms of severe vertigo, constant migraines, and co-ordination symptoms. But since the surgery, I have become severely narcoleptic to the point that my drivers license was taken away within 8 months of the surgery.  I also cannot tolerate any cold temperatures, I get severe headaches and severe tinnitus under any temp below 10C. I have problems concentrating on mental tasks, and most physical tasks cause headaches and vertigo symptoms.  All of these symptoms that appeared after the surgery, I did not have before the surgery. Even with all the new symptoms, I am in better shape than before. On my last MRI of my head stated that my brain seemed to sag lower than normal, and my specialist seems to think this is the cause of my symptoms. I have not been contacted by anyone, since I just got word of the decision Friday.

Thanks for all the comments.

p.s.  Just typing this has given me a headache.


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## the 48th regulator (3 Mar 2013)

rand_d said:
			
		

> My condition is not military related, but any doctor I talk to says it was aggravated by the military. I was misdiagnosed in 1991, and I had been asking for a MRI since 1995 to clarify my condition. I finally got one in 2008 which proved that I did not have what was diagnosed in 1991, and it took until 2010 to finally come up with the proper diagnosis. My symptoms got so bad that surgery was required, the surgery was considered risky, but I decided to go for it anyways. The surgery cleared up my symptoms of severe vertigo, constant migraines, and co-ordination symptoms. But since the surgery, I have become severely narcoleptic to the point that my drivers license was taken away within 8 months of the surgery.  I also cannot tolerate any cold temperatures, I get severe headaches and severe tinnitus under any temp below 10C. I have problems concentrating on mental tasks, and most physical tasks cause headaches and vertigo symptoms.  All of these symptoms that appeared after the surgery, I did not have before the surgery. Even with all the new symptoms, I am in better shape than before. On my last MRI of my head stated that my brain seemed to sag lower than normal, and my specialist seems to think this is the cause of my symptoms. I have not been contacted by anyone, since I just got word of the decision Friday.
> 
> Thanks for all the comments.
> 
> p.s.  Just typing this has given me a headache.




Now, I am going to play Devil's advocate here, as these are the questions they will ask you in the appeal.   



			
				rand_d said:
			
		

> My condition is not military related, but any doctor I talk to says it was aggravated by the military. I was misdiagnosed in 1991, and I had been asking for a MRI since 1995 to clarify my condition. I finally got one in 2008 which proved that I did not have what was diagnosed in 1991,



_How many times from 1991-95 did you request for an MRI?  Are these requests documented, and are they on your medical file?  If so, what was the reason given to you for a delay in receiving an MRI?  Who misdiagnosed you, a CF medical officer, or a Doctor contracted out by DND/CF?_

You see where the crux of it all is?  VAC wants you to provide evidence that the Government is onerous in aggravating your injury/illness.  If not, sorry mate, but I agree with them.

You do not have a service related injury, and unless you put in an aggressive effort to have this cared for, and the CF put road blocks in your way, which you can prove you do not have a case you will win.  That is my opinion, based on many years fighting the system to prove my Service related injuries deserved to be dealt with by VAC.

If you have the evidence, start getting it all together.

dileas

tess


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## blackberet17 (4 Mar 2013)

Demonstrating the CF aggravated a condition is not very easy.

It's also not very easy to prove medical mismanagement, which is what 48th's questions are getting to...

Rand, if you want to chat more specifics, feel free to pm me, I may be able to provide some direction. Your case sounds complex, and I can't look into your VAC file without getting myself in trouble  Do you know what your DO is? I know a number of the BPA lawyers, I may be able to recommend one over another depending on your VAC DO...


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## rand_d (4 Mar 2013)

Yes, my case is quite complicated. I had asked multiple times for an MRI, but was told that my original diagnosis was accurate. My diagnosis was done over the phone and by snail mail, I did not even see the specialist who came up with the diagnosis.  I had issues with pain medications that I told the surgeon that I had severe reactions to, but was given them anyways (Oxycontin) that aggravated my condition. I could go on, but you get the idea. Blackberet17,  my application was for medical mismanagement, but the reply I got back was " The department does not officially investigate the medical care provided by the CF".

Blackberet17 , as for my VAC DO, I have no idea. I will pm you.


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## FJAG (4 Mar 2013)

blackberet17 said:
			
		

> Demonstrating the CF aggravated a condition is not very easy.
> 
> It's also not very easy to prove medical mismanagement, which is what 48th's questions are getting to...
> 
> Rand, if you want to chat more specifics, feel free to pm me, I may be able to provide some direction. Your case sounds complex, and I can't look into your VAC file without getting myself in trouble  Do you know what your DO is? I know a number of the BPA lawyers, I may be able to recommend one over another depending on your VAC DO...



I'll echo this post. In my private law practice I was frequently contacted by members and former members with VAC issues and I always referred them to the BPA for two key reasons. 1) These types of issues are very specialized and the BPA has the expertise to handle these claims and 2) Legal representation on these types of claims can be very time consuming and therefore be very expensive if a private lawyer is involved on a paid basis.

Regretfully my contact in Charlettetown is no longer with the BPA and therefore I can't assist you with any referral but from the sounds of it blackberet17 may be in a position where he can make a recommendation. 

Don't delay. In my experience no claim gets better with time and there may be some time limits that you need to deal with.

BPA lawyers are something like "legal aid" lawyers: qualified members of the bar but paid by the government to represent individuals who have an issue with a government agency. They are bound by solicitor / client confidentiality and are there to represent your interests. I would not hesitate to use their service but do remember that every individual is different and some might be better than others. If you have a choice of which one you can go to and you can get a positive recommendation, go with it and let him or her help you evaluate your case.

Best of luck.


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## blackberet17 (5 Mar 2013)

I did a quick search of the VRAB Web site for some of the medical mismanagement cases we may have posted for reading.

Here's one, to give you an idea of some of the difficulties inherent with med mis claims:

http://www.vrab-tacra.gc.ca/Decisions/Leading-sub-MedicalMismanagement-eng.cfm

I've only worked on two, maybe three max, in over five years, where medical mismanagement was claimed. The burden of proof is quite high...


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## rand_d (8 Mar 2013)

I got contacted by BPA yesterday, and I was surprised at the tone. The lady was pessimistic, and kept saying that  it was hard to prove medical mismanagement. We got talking, and she was surprised to learn that I am being medically released on the same issues that the VA decision dismissed.  I also told her that SISIP reviewed my case and that I would be on LTD until I am 65. She seemed more optimistic then, and suggested that I get my neurologist to write a letter supporting my claim. A lawyer will contact me next week, so hopefully she will think that I have a case.


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## blackberet17 (8 Mar 2013)

As much as possible, ensure your neurologist provides a thorough review of your medical history in his/her report.

If he/she can provide copies of any studies (ie from medical journals), plus any test results, that would help.

The neurologist needs to be very clear about his medical opinion, that your medical condition is either related to your service - somehow - and/or the medical treatment or lack thereof provided by CF medical personnel caused or aggravated your medical condition.

It's clear the neurologist is not a lawyer - but the medical opinion they can provide, as to: timeliness of diagnosis, causes of wrongful diagnosis, inappropriateness of medical care provided, courses of treatment, etc.; all would be helpful in determining medical mismanagement.

From our Adjudicative Guidelines:

10.4 Disability resulting from medical treatment 
•For a claim of “medical mismanagement” to be made, there must be some evidence that the medical treatment provided to the Applicant was unorthodox, or not in accordance with accepted standards of medical care for medical professionals treating this condition at that time. For example, in one of the Board’s Leading and Persuasive Decisions, it states there was no evidence that the medical treatment provided to the Applicant by the medical professionals at the Veterans Hospital in 1962 was negligent, or fell below the acceptable standard of care, and that this negligence caused the Applicant to contract Hepatitis C. The Board denied pension entitlement. 

(See also Gannon v. Canada (Attorney General) 2006 FC 600 at par. 19)
Edit: to include link to above Federal Court case: http://decisions.fct-cf.gc.ca/en/2006/2006fc600/2006fc600.html


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## rand_d (15 Mar 2013)

Update.

BPA is sending a letter to specify what my Neurologist needs to confirm on my medical condition. Since he works with the neurosurgeon who did my surgery, I will try to get his input also.

BPA did make a comment that confuses me. According to the medical files available to them, I do not have a medical issue that they consider a disability. This is opposite to my actual situation, since I am being medically released from the military due to these issues, I have not worked a full day since 2010, have not worked at all since Aug 2012, am on LTD with SISIP until I turn 65, and I will be on VAC's  Rehabilitation Program when I release. I am beginning to suspect that they are cherry picking my medical records to support their decision. This is really getting confusing. :facepalm:


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## Fishbone Jones (15 Mar 2013)

rand_d said:
			
		

> This is really getting confusing. :facepalm:



Now your getting the hang of it. There's tons more where that came from.


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## blackberet17 (18 Mar 2013)

recceguy said:
			
		

> Now your getting the hang of it. There's tons more where that came from.



What he said 

This is actually not a surprise, and it's not necessarily a question of cherry picking.

Is there a diagnosis of a specific medical condition, is probably what BPA meant. If it's something vague (let's say "back pain", then it's difficult to say you have a medical condition. We all have back pain. But if you say you have osteoarthritis lumbar spine, with a medical diagnosis provided by an orthopaedic surgeon or confirmed on x-ray, then there's a disability for pension/award purposes.

Welcome to the red tape... :


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## rand_d (20 Mar 2013)

Thanks for your input Blackberet17, but that's what is puzzling me about this whole situation.

I do have a specific diagnosis that was confirmed by a MRI. I had a case of a severe reaction to meds that aggravated my  condition that I had to be hospitalized for, and due to this I required surgery. As a result of my surgery, I had a piece of my skull removed, so that my brain is only covered by the brain dura and my skin. Since then I am so cold intolerant that I cannot go into Walmart during the summer due to the air conditioning, unless I wear a Toque. I also have narcolepsy, sleep apnea and other issues.

The reason I think that BPA and VAC may be cherry picking my records is that I saw a neurologist about my problem, and he dismissed it and told me to take Advil. When I went to the MIR, they said that since I was already on non-steroidal anti-inflammatory drugs, I could not take Advil. A month later, I saw my neurosurgeon, and was fast tracked for surgery in 6 weeks (normal waiting time, 12-18 months). My letter from VAC seemed to dismiss  my neurosurgeon's diagnosis, but referred to the neurologist's diagnosis at least 3 times. It was from the neurologist's diagnosis that VAC said that I do not have any symptoms from my diagnosis or my surgery.  My question is why would I have needed the surgery? My neurosurgeon is an Associate Professor at a major university in Ontario, so it is not like he doesn't know his stuff.


Sorry, but I had to vent. Thanks for all your input.  :bowing:   I will post an update after I get the letter from BPA.


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## Danjanou (20 Mar 2013)

maniac said:
			
		

> You should be advised that the RCL Service Officer are co-representing you with the BPA.  The are acting as one and the Service Officer does hold the BPA Office's feet to the fire.



Good advice. Nowhere does it say you can only have on or the other. Be a greedy bugger and have both. Best case scenario you end up with a both switched on BPA Lawyer and RCL VSO who work well together.  Worst case the exact opposite, a pair of mouth breathing numpties who hate each other.  Odds are though it will be somewhere in the middle and one will keep the other focussed.

I've met some really switched on, knowledgeable and dedicated RCL VSO's Tess probably knows one I'm thinking of. On the other hand I've met more than a few I wouldn't trust taking out my green bin once a week without them upgefucking that.  As for BPA, no real exposure yet, however I have never regretted turning down a chance to go to law school years ago , I do have some standards.  8)


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## dapaterson (20 Mar 2013)

Danjanou said:
			
		

> I do have some standards.  8)



...which you'll overlook for a pair of cohibas and a 40 of Cuban rum...


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## Danjanou (20 Mar 2013)

dapaterson said:
			
		

> ...which you'll overlook for a pair of cohibas and a 40 of Cuban rum...



I brought back 2 boxes (25 each) Cohiba Esplendido's and 3 Bottles of 7 year Habana Club last month, so I'm walking the high road for a while longer.  ;D


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## dapaterson (20 Mar 2013)

Danjanou said:
			
		

> I brought back 2 boxes (25 each) Cohiba Esplendido's and 3 Bottles of 7 year Habana Club last month, so I'm walking the high road for a while longer.  ;D



Well, 2 Cohibas per weekend means you'll run out in September.  And if you had any friends, they'd go even faster.


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## Danjanou (20 Mar 2013)

dapaterson said:
			
		

> Well, 2 Cohibas per weekend means you'll run out in September.  And if you had any friends, they'd go even faster.



I have friends and I share with them, draw your own conclusions.  8) Besides that was just part of the hall from *this* trip. I actually had to buy another humidor down there. Between the three of them I have a noce stockpile.


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## GAP (20 Mar 2013)

Danjanou said:
			
		

> I have friends and I share with them, draw your own conclusions.  8) Besides that was just part of the hall from *this* trip. I actually had to buy another humidor down there. Between the three of them I have a noce stockpile.



Now all you need is an eager intern......


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## Danjanou (20 Mar 2013)

GAP said:
			
		

> Now all you need is an eager intern......



Please what a waste of a good cigar....and intern. 8)



And another thread spirals off on a tangent. Then again we are talking about VAC and the RCL here.......


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## rand_d (25 Mar 2013)

I got my letter from BPA, and there are some unusual errors  and omissions in the medical opinion.  The omission is that I had a severe bout of gastroenteritis, but omitted  that it was a severe reaction to Oxycontin. It was on my med files that I had a previous reaction to Oxycontin, but that is not mentioned, and other omissions like that. The big stuff is they seemed to get my doctors all mixed up. My neurosurgeon is now my sleep specialist and my normal doctor is now my neurosurgeon, and the doctor who did my sleep study is not mentioned at all, and their diagnosis seem to contradict what I have been told. The medical opinion stops in Apr 2012, so the letter states that narcolepsy has not been diagnosed, but my new sleep study doctor has diagnosed me with narcolepsy and sleep apnea in Sept 2012. All the medical info stops at Apr 2012, when I applied to VAC. Is all this normal? I could see the medical info from after my application being missed, but mixing up my doctors like this? Sooooo Confused??



> Danjanou
> 
> Good advice. Nowhere does it say you can only have on or the other. Be a greedy bugger and have both. Best case scenario you end up with a both switched on BPA Lawyer and RCL VSO who work well together.  Worst case the exact opposite, a pair of mouth breathing numpties who hate each other.  Odds are though it will be somewhere in the middle and one will keep the other focussed.



I may just do that!!


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## blackberet17 (25 Mar 2013)

What kind of letter? This is the side of the table I'm not overly familiar with.

My  :2c: :

Write everything down, as clearly as you can. Basically, create a chronology of all events, from the date of injury to the most recent consult with a physician/specialist/pharmacist. Add any points you deem relevant, such as for example when the reaction occurred to Oxy.

BPA could possibly be working only from the information they already have on file for you, what is already contained in your Head Office or Regional file, hence the Apr 12 endline. All of that documentation comes from all the reports they've received and from your service and service medical docs.

Don't hesitate to pm me with questions too. I'm in Gagetown as of next week until August, but will do my best to keep up to date here.


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## rand_d (25 Mar 2013)

blackberet17

The letter is from the Pension Medical Advisory to my specialist, that includes a copy of the Medical opinion from VAC that was used in denying my claim. It is in this medical opinion that all the errors are, and I just noticed that the medical advisor's signature and date is unsigned, so I have no idea who did the Medical opinion.  :facepalm:


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## Danjanou (25 Mar 2013)

rand_d said:
			
		

> I may just do that!!



let me know via PM if you run into any issues with the RCL on this.


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## blackberet17 (25 Mar 2013)

rand_d said:
			
		

> The letter is from the Pension Medical Advisory to my specialist, that includes a copy of the Medical opinion from VAC that was used in denying my claim. It is in this medical opinion that all the errors are, and I just noticed that the medical advisor's signature and date is unsigned, so I have no idea who did the Medical opinion.  :facepalm:



Is the Pension Medical Advisory asking specific questions from your specialist? BPA does this when requesting medical opinions from specialists, just wondering if it's similar.
It sounds as though they are forwarding the VAC Med opinion to your specialist, to see what his/her opinion is. Not uncommon, VAC doesn't have doctors covering all the specialties.
So the errors are in the VAC medical opinion? Oye vey :facepalm:


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## rand_d (25 Mar 2013)

blackberet17 said:
			
		

> Is the Pension Medical Advisory asking specific questions from your specialist? BPA does this when requesting medical opinions from specialists, just wondering if it's similar.
> It sounds as though they are forwarding the VAC Med opinion to your specialist, to see what his/her opinion is. Not uncommon, VAC doesn't have doctors covering all the specialties.
> So the errors are in the VAC medical opinion? Oye vey :facepalm:



That is exactly what the letter is, a letter to my specialist. OYE VEY  :facepalm: INDEED!


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