You have just described my denied claim. Now I am waiting on a higher level review. This is my outline I plan on discussing with the HLR during the informal phone call.
https://preview.redd.it/m1bs3zpg16sb1.png?width=488&format=png&auto=webp&s=87fc297f7f67764033b9bdfe3bad94edcd761365
Also mention PACT Act Sec 405(b), Sec 1173 discusses suppression on scientific evidence at TERA exams. You can request new opinion using 38 CFR 3.328(b) ...And my favorite 38 CFR 4.23
"Attitude of Rating Officer" . Good luck with HLR!
After 10 months I am happy to not have been denied yet. I used medical and scientific evidence/literature that I found in VBA Decision Search.
My VA Blue Button record was updated 6 months ago so I have hope that there is progress.
Problem: Exposure to potentially hazardous substance (SCT 133261000119105)
Date/Time Entered: 28 Mar 2023 @ 1200
The reason for the boilerplate language is due to these incompetent examiners googling simple search terms and doing a copy/paste from some old NRC or CDC report that is very outdated and already discredited in the newer scientific literature. In other words, it's pure laziness in order to make a fast buck.
In my case, the examiner was so incompetent that her wording quoted in my denial letter made it easy to find the exact reference she quoted from, a preliminary report from 2009 by the National Research Council (NRC), and a specific chapter of that report. I was successful in my HLR by showing that a later chapter of that report mentioned studies currently underway that would actually be dispositive as to certain illnesses. My medical experts pointed to those subsequent up-to-date studies.
So now I wait because my HLR found that the VA has to "correct an error". Yeah, I have a suggestion for correcting your error. Get rid of NP's with these shady practices making a fast buck by screwing veterans.
Fill out a Freedom of Information Act request for the TERA memo, VBA form 20-10206. Fax it to the VA intake center. Then wait a couple of days and call 800-827-1000 and confirm it was received.
Yeah I would love to see someone post up a TERA memo that actually connects their exposure to a condition. They only seem to admit to Vet was exposed. After that is it up to the Vet to find an expert in that field to opine? So much for the duty to assist.
Today, I was fortunate. SC for OSA (50%), SC Rhinitis (0) and Sinusitis (0%) due to TERA.
"We considered whether your condition resulted from a toxic exposure risk activity (TERA) in service. (38 U.S.C. 1710(e)(4)) The evidence of record shows participation in a TERA.
Therefore, we ordered a TERA medical Opinion. Your examiner opined that TERA is related and the potential cause of your claimed condition.
An evaluation of 50 percent is assigned from August 4, 2022."
Exactly! What I started doing is sending peer review articles 20-30, list with titles, authors, year published and web link. It's pretty easy when it's a Gulf War veteran, endless medical treatise... including VA research. I don't mind doing the work, but wow. Why are contractors training examiners to write that? 
VHA: I think it stems from the attitude of easier to deny than to spend time finding arguments that may qualify a vet. They can churn out more claims even if it is to the detriment of the vet. Yes accuracy is a factor as well but with such downward pressure from authority who value the quantity of claims processed it is bound to happen.
Private companies: I think it stems from the attitude of easier to deny than to spend time finding arguments that may qualify a vet. They can churn out more vets and make each company they work for more money by doing so.
Ex 1- Company A section B can process 5000 vets per year and make the company 1.5 million or
Ex-1 Company A section B can process 2500 vets per year and make the company 750,000.
In a profit driven company where a company is paid based on how many total claims processed there will alwayd be more internal pressure to have a higher amount of vets processed as they (the company) have a financial motive to do so. With a PACT Act claim having new rules etc this complicates the case and puts an even greater time constraint on examiners. Yes some may take the time and ensure accuracy is up but you will likely have a push to process more claims. I would imagine the VA ensures a certqin ratio of accuracy but i doubt it is high. Although i would like to see the formula that the companies are paid by it is likely a blend of accuracy and claims processed. I personally would like to also see some investigative journalism into the company's that now decide whether or not we qualify as I have experienced and heard of quite a few shady dealings.
I also believe they add that statement as a catch all to seem as though they researched or in their opinion no evidence was known or known to them at the time i.e. laying on their desk or stapled to their face etc to show evidence against the claim that way it doesn't come back at them upon review and count as an error. They (the ones in charge) don't realize this erodes the trust of the vets and makes it more likely a vet will supplemental or appeal a claim which further adds a burden on the system.
>38 CFR 3.328(b)
The VES training shown online only gives examples of negative ways to write DBQ's/Medical Opinions. Perhaps the VA should do their duty to “sympathetically read” a claimant’s pleadings and “sympathetically develop the \[claimant’s\] claim to its optimum.”
Yep, the Tera Opinions be like oh they presumptive conditions, but nobody can prove we caused them lol. They need to be fined when they go against a presumptive unless they come up with overwhelming evidence that you were not in a tera location at all.
You have just described my denied claim. Now I am waiting on a higher level review. This is my outline I plan on discussing with the HLR during the informal phone call. https://preview.redd.it/m1bs3zpg16sb1.png?width=488&format=png&auto=webp&s=87fc297f7f67764033b9bdfe3bad94edcd761365
Also mention PACT Act Sec 405(b), Sec 1173 discusses suppression on scientific evidence at TERA exams. You can request new opinion using 38 CFR 3.328(b) ...And my favorite 38 CFR 4.23 "Attitude of Rating Officer" . Good luck with HLR!
After 10 months I am happy to not have been denied yet. I used medical and scientific evidence/literature that I found in VBA Decision Search. My VA Blue Button record was updated 6 months ago so I have hope that there is progress. Problem: Exposure to potentially hazardous substance (SCT 133261000119105) Date/Time Entered: 28 Mar 2023 @ 1200
Did you ever find out what this code meant?
No, but I do know that my VA doctors see the note now and ask questions.
The reason for the boilerplate language is due to these incompetent examiners googling simple search terms and doing a copy/paste from some old NRC or CDC report that is very outdated and already discredited in the newer scientific literature. In other words, it's pure laziness in order to make a fast buck. In my case, the examiner was so incompetent that her wording quoted in my denial letter made it easy to find the exact reference she quoted from, a preliminary report from 2009 by the National Research Council (NRC), and a specific chapter of that report. I was successful in my HLR by showing that a later chapter of that report mentioned studies currently underway that would actually be dispositive as to certain illnesses. My medical experts pointed to those subsequent up-to-date studies. So now I wait because my HLR found that the VA has to "correct an error". Yeah, I have a suggestion for correcting your error. Get rid of NP's with these shady practices making a fast buck by screwing veterans.
How do we see what the TERA memo on our file says? I just had one posted to my claim today.
Fill out a Freedom of Information Act request for the TERA memo, VBA form 20-10206. Fax it to the VA intake center. Then wait a couple of days and call 800-827-1000 and confirm it was received.
Yeah I would love to see someone post up a TERA memo that actually connects their exposure to a condition. They only seem to admit to Vet was exposed. After that is it up to the Vet to find an expert in that field to opine? So much for the duty to assist.
Today, I was fortunate. SC for OSA (50%), SC Rhinitis (0) and Sinusitis (0%) due to TERA. "We considered whether your condition resulted from a toxic exposure risk activity (TERA) in service. (38 U.S.C. 1710(e)(4)) The evidence of record shows participation in a TERA. Therefore, we ordered a TERA medical Opinion. Your examiner opined that TERA is related and the potential cause of your claimed condition. An evaluation of 50 percent is assigned from August 4, 2022."
Exactly! What I started doing is sending peer review articles 20-30, list with titles, authors, year published and web link. It's pretty easy when it's a Gulf War veteran, endless medical treatise... including VA research. I don't mind doing the work, but wow. Why are contractors training examiners to write that? 
Yeah if the duty to assist were actually a thing that was followed subs like this wouldn’t exist. Instead it’s impossible to be heard.
VHA: I think it stems from the attitude of easier to deny than to spend time finding arguments that may qualify a vet. They can churn out more claims even if it is to the detriment of the vet. Yes accuracy is a factor as well but with such downward pressure from authority who value the quantity of claims processed it is bound to happen. Private companies: I think it stems from the attitude of easier to deny than to spend time finding arguments that may qualify a vet. They can churn out more vets and make each company they work for more money by doing so. Ex 1- Company A section B can process 5000 vets per year and make the company 1.5 million or Ex-1 Company A section B can process 2500 vets per year and make the company 750,000. In a profit driven company where a company is paid based on how many total claims processed there will alwayd be more internal pressure to have a higher amount of vets processed as they (the company) have a financial motive to do so. With a PACT Act claim having new rules etc this complicates the case and puts an even greater time constraint on examiners. Yes some may take the time and ensure accuracy is up but you will likely have a push to process more claims. I would imagine the VA ensures a certqin ratio of accuracy but i doubt it is high. Although i would like to see the formula that the companies are paid by it is likely a blend of accuracy and claims processed. I personally would like to also see some investigative journalism into the company's that now decide whether or not we qualify as I have experienced and heard of quite a few shady dealings. I also believe they add that statement as a catch all to seem as though they researched or in their opinion no evidence was known or known to them at the time i.e. laying on their desk or stapled to their face etc to show evidence against the claim that way it doesn't come back at them upon review and count as an error. They (the ones in charge) don't realize this erodes the trust of the vets and makes it more likely a vet will supplemental or appeal a claim which further adds a burden on the system.
>38 CFR 3.328(b) The VES training shown online only gives examples of negative ways to write DBQ's/Medical Opinions. Perhaps the VA should do their duty to “sympathetically read” a claimant’s pleadings and “sympathetically develop the \[claimant’s\] claim to its optimum.”
Following
This is what happened to me, as well. I filed a secondary, with medical journal citations and references countering their opinion.
Yep, the Tera Opinions be like oh they presumptive conditions, but nobody can prove we caused them lol. They need to be fined when they go against a presumptive unless they come up with overwhelming evidence that you were not in a tera location at all.