War On Veteran's Health Care Blog: Corruption at Las Vegas VA Part 2: Criminal Enterprise or Team Health: Las Vegas VA, Medicare, Sunrise Hospital, UMC, UNLV Medical School The three specific elements (with exception) that define a crime which the prosecution must prove beyond a reasonable doubt in order to obtain a conviction: (1) that a crime has actually occurred (actus reus), (2) that the accused intended the crime to happen (mens rea) and (3) and concurrence of the two

January 14, 2020

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Dear Sir or Madam, Reviewer, Adjudicator, or Honorable Judge,

Thank you for reading my case.

I received many favorable Decisions: I was found Service Connected,

11/22/2019 Department of Veterans Affairs, Regional Office Director, Evidence Intake Center, P.O. Box 4444, Jackson, WI, 53547-4444 decision on Service Connection and Disabilities.

which I accept claim in-part, but not all parts, with many disabilities identified by the reviewer as diagnosed disabilities shown by Medical Evidence. The reviewer overlooked many others that appeared to be because of missing information from military medical records while decision made, misdiagnosed information in medical record, some very important decision was left out, like decision on neck spasms, head, cervical spine, decisions left out altogether, ie. head injury requiring stitching and other treatment, not even included in the review, and information that I had yet to file that I spoke with a Veteran Rehabilitation Representative Collins in August 2019 that I was filing January 1, 2020, mainly nexus information. I am allowed to request Supplemental further review, add additional information, and provide argument on the old information that I see not interpreted correctly by the Reviewer. My last day to file claim information is January 7, 2020 being I opened the claim January 10th, 2019, and 2-day Mail Service and January 22, 2020 60 days after initial determination.

That was my visit from 10/28/2018. From my visit to UMC, just 30 days, after what they did, my determination reads, #5, Service Connection for dermatitis (also claimed as cellulitis) is denied. I never claimed dermatitis skin problems was cellulitis, I had many dermatitis problems in the military and in my records, connecting the two, and the service records was not cellulitis. Of course they denied the foot because I did not see their Doctor when there was enough evidence in the military record, which they said was none, to Service Connection. It goes on.

Hacking my sites for Witness Intimidation.

A sticking point which I thought satisfied was showing "Good Cause" for missing appointments with VA/Q & C Doctor Examiners. I thought I had satisfied that burden but I have to submit additional Show of Good Cause for missing 3 appointments and declining scheduling for others from May 2019 - August 2019.

NRS 41A.015 “Professional negligence” defined. “Professional negligence” means the failure of a provider of health care, in rendering services, to use the reasonable care, skill or knowledge ordinarily used under similar circumstances by similarly trained and experienced providers of health care.

NRS 41A.017 “Provider of health care” defined. “Provider of health care” means a physician licensed pursuant to chapter 630 or 633 of NRS, physician assistant, dentist, licensed nurse, dispensing optician, optometrist, registered physical therapist, podiatric physician, licensed psychologist, chiropractor, doctor of Oriental medicine, medical laboratory director or technician, licensed dietitian or a licensed hospital, clinic, surgery center, physicians’ professional corporation or group practice that employs any such person and its employees.

In the case of the Indian Medical Association vs. V.P. Shanta and Ors., III (1995) CPJ 1 (SC), the Supreme Court finally decided on the issue of coverage of medical profession within the ambit of the Consumer Protection Act, 1986 so that all ambiguity on the subject was cleared. With this epoch making decision, doctors and hospitals became aware ... all patients are consumers even if treatment is given free of charge. (Maybe why VA/Insurers have unpaid or not paid bills).

NRS 42.001 Definitions; exceptions. As used in this chapter, unless the context otherwise requires and except as otherwise provided in subsection 5 of NRS 42.005:

1. “Conscious disregard” means the knowledge of the probable harmful consequences of a wrongful act and a willful and deliberate failure to act to avoid those consequences.

"The right to refuse treatment goes hand in hand with another patient right—the right to informed consent. You should only consent to medical treatment if you have sufficient information about your diagnosis and all treatment options available in terms you can understand. Before a physician can begin any course of treatment, the physician must make the patient aware of what he plans to do. For any course of treatment that is above routine medical procedures, the physician must disclose as much information as possible so you may make an informed decision about your care.

When a patient has been sufficiently informed about the treatment options offered by a physician, the patient has the right to accept or refuse treatment, which includes what a health care provider will and won't do.

It is unethical to physically force or coerce a patient into treatment against his will if he is of sound mind and is mentally capable of making an informed decision."

Retrieved from:

https://www.verywellhealth.com/do-patients-have-the-right-to-refuse-treatment-2614982

2. “Fraud” means an intentional misrepresentation, deception or concealment of a material fact known to the person with the intent to deprive another person of his or her rights or property or to otherwise injure another person.

3. “Malice, express or implied” means conduct which is intended to injure a person or despicable conduct which is engaged in with a conscious disregard of the rights or safety of others.

Good Cause; Attempted framing me: In December, 2019, I filed allegations of 24 Misdiagnosis VA, 27 Misdiagnosis UMC, 3 Misdiagnosis Sunrise Hospital. Many attempted at framings:

A couple days after I dropped off my form at the Las Vegas VA Jan. 08, 2020 and Wisconsin overnighted Jan. 09, 2020, I went online to update my medications. They have been set up for a couple years where I can order medications to be sent out a couple months ahead of time like Screen Shot 1. But, the fishy action came from someone at the IT department manipulating style sheets in Screen Shots 1 - 3. I updated medications on 1/10/2020 and nothing showed up as late being overdue to order. Then I went back to check everything a second time after submitting order, and the IT people had set up so after I ordered the style/sheets would reset to show many things ordered late, not the couple months ahead of time. So, of course, I have to resubmit the order, now late. But, it did not stop there with the IT VA department; internet people. I called in two medications because they showed non available. This in screen shot 2 where you see the empty box that I have never seen before in many years ordering using myhealthvet. Top Swab for folliculitis and Mupirocin for foot, Service Connected maybe, show empty boxes. The young lady that I talked to get on the CPRS communicating machine doctors, nurses, administrators and said the last medication were order by new doctor on bottle, and she said she was a pharmacist, but on the bottle from the new doctor on bottles, it states she is Primary Care Doctor. She say one of the medication, foot powders, was in someone else name and she would have to contact Doctor Garcia to order this one. I told her that Doctor Garcia is not my Doctor yet because I have never seen him. Well, she changed the foot powder medicine to Mupirocin for foot, Screen Shot 3, which I think I had ordered. But, it too has a blank so that any date, backdate, can be written to cause an adverse decision on my claim. They may put 12 months? No using medication for problems.

This continued misconduct by the VA IT people is a problem.

But, you say there is history of me not using medication or not as prescribed which has a lot to do with gastritis. There are 5 reasons my medications may have been off over the last twenty years. This is documented in my medical records, repeating these:

1. 06/10/2016 Greene, John 04:31 Diagnosed: dermatitis and cellulitis, Patient's questions have been answered satisfactorily. Patient verbalized understanding of our plan of care and is agreeable to it. No mental health changes, Coherent, cooperative, does not appear depressed, (doc 182.5)

12/21/2015 John R. Greene Peripheral Nerve Disease Hands and toes 12/21/2015 John R Greene suggested that I decrease metformin for few days to test if the problem(s) 12/21/2015 John R Greene ruled out stroke after different test, maybe pinched nerve from back

2. 10/19/2016 David L Shepard put in test I received result letter from Larry (nurse) negative for illicit drugs 10/19/2016 David L Shepard I had sent Doctor Shepard’s nurse a letter to decrease Tramadol to 3x to 2x 10/19/2016 David L Shepard His nurse, Larry Preston, responded p117 that I could take 3, 2, 1 or none it said as needed

10/19/2016 Shepard IMED on opioid, tramadol "may reduce a person’s pain enough for you to feel better to do more" 10/19/2016 David L Shepard I had sent Doctor Shepard's Nurse a letter to ask Doctor Shepard decrease Tramadol to 3x to 2x

10/19/2016 David L Shepard's Nurse responded in letter that I could take 3, 2, 1 or none it said as needed

3. At work, one of my Doctors wrote that I had to stop using most of my medicine because they, side effects, were affecting me adversely on the job.

4. My eye doctor in 2019 states that something in Aspirin was negatively affecting my eyesight. So, some medicines are good for one thing, but damaging to another.

5.Naproxin (allergy, stomach pain)

If you have gastritis caused by NSAIDs or other drugs, avoiding those drugs may be enough to relieve your symptoms.

https://www.healthline.com/health/gastritis#diagnosis

So with these five things, medicine may build up, where I order medicine later than what is stated as order date on eBenefits. But, what happen this week has happened before around my disabilities times, and I am sure they have happened with other Veterans as they are skilled at adversely manipulating fabricated false data against me, the Veteran (s).

Screen Shot 1

Additional Good Cause Added to claim:

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The regulations prohibiting Healthcare fraud are both specific and complex. This means that if you are charged with a Healthcare fraud violation, your conduct may be punishable under a number of different federal statutes.

I was always suspicious of being sent to UMC for a head injury, and switched to a workup for a heart attack which I told VA ER that I had no chest pain, and I told UMC, no chest pain, and that I had a Heart Attack, and I was not having a heart attack. My condition had already been diagnosed as Defecation syncope. Doctors from VA and UMC put into the medical records that I said that I was not having chest pain. The Readings did not show it to be a heart attack which would make it easy to prove that I did not have a heart attack in 2018, and the Doctor at UMC that was to do the workup seem anxious to test while saying she found nothing to test for. I thought it was a planned attempt to try to disprove my 2009 heart attack by reconstructing a fake heart attack that was not there. A nurse imported to the VA to try to make it legitimate mixing up a sentence to look like I said I had pain.

08/29/2018 Fares, Robert A M.D. Non-VA Care Hospital Note, UMC< NSTEMI, His EKG does show some ST elevation in V1 and V2. "The patient is also complaining of any chest pain"

Nyugen, Sun, and Nazia notes read I had chest pain furthering the fabricated false statement, misdiagnosis, that I had chest pain. In viewing the VA Decision, 11/22/2019, 30 days after Nyugen, Sun, and Nazia notes read I had chest pain furthering the fabricated false statement, misdiagnosis, that I had chest pain, another Doctor at UMC misdiagnosed that I had heart surgery in the past, when I have never had heart surgery. The incident showed up on the VA Decision, as #2 decision "Service connection for coronary artery disease (CAD) (also claimed as syncope, fainting spells) is denied. I did not put that sentence together on my application but it was something that the fabricated evidence prove that did happen. CAD and Syncope were claimed separately. My two syncope experiences did not come from heart attacks. This was put together by the Doctors at the VA and UMC to disprove CAD, when I never had a heart attack; staged to deny disability is my belief. I filed a misdiagnose by the Doctors on an Amendment to the Record in December. I did have elevated STs in 2018 and in the past, and since 2001 diagnosed with abnormal T-wave at the VA, and other different CAD problems, not specifically claimed as fainting spells by me. The Doctor proposed doing an additional electrocardiograph (ECG) which traces the negative or abnormal T-wave that I speculate with the rest of UMC misdiagnosis would have found no abnormal T-wave anymore, and the ST-Elevations explain away by testing, maybe. The main signs of a Stemi is Chest pain and sweatiness which I had neither. A couple Doctors diagnosed that my problem was Defecation syncope but I don't see that recorded in my records; those over my Doctor in ER that diagnosed Defecation syncope wanted to do the heart attack testing workup.

05/13/2013 Tsuda M.D. Abnormal ECG, Nonspecific T Wave abnormality, early repolarization, Sinus tachycardia, atrial rate 113 BPM, QT 326 MS, QTC 447 MS

08/29/2018 Supervisory Statement J Villaflor M.D. UMC Syncopal episode. He has a mild headache locally. He denies any chest pain or any other pain from the fall. He has no chest discomfort. He denies any vision change or speech change. Patient still maintains that he did not and currently does not have any chest discomfort. The VA Hospital obtained ECG number concern for possible STEMI. He reports that he never smoked. He has never used smokeless tobacco. He reports that he does not drink alcohol or use drugs. 08/29/2018 Roth, Taylor M.D. UMC University Medical Center, Syncope, Patient was unconscious for about 30 minutes. Cardiology team was present at bedside immediately who agreed that this did not have the appearance of acute ST elevation myocardial infarction.

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Submitted 12/26/2019 Request for Amendment to Medical Records UMC, ER 5 NORTH, Claim # 10, Allege/Legal Argument: Sharon Weiser (my case manager that was assigned to me), RN misdiagnosed "he refused to sign requested to s/w mgr. and requested a complaint form right now." "By yelling that at me" Weisner has this out of sequence, I requested a complaint form, she informed me UMC does not have "written with letterhead" complaint forms. So, I requested to speak with her supervisor. No one else places in my medical records except the person coordinating misconduct in my case. (And Denise Delgado from VA who talked to A Nyugen UMC in 2015 in VA notes, and that November 28 was written by Nazi Khan as my release, discharge, date, instead of November 22, 2019 my actual discharge date. I filed several complaints against Denise Delgado when she fabricated false statements, racial slurs, and misdiagnosis in my medical records January 2019 and she contact Doctor Asistores and my VA case manager, that worked similar to Weisner, over the past two years, I assume as case managers, they Coordinate corruption and misconduct between Doctors, Billing Offices, and Nurses.) 3 pages attached; pages 201 - 203. One week before my first appointment with Doctor Asistores, these communications took place, Virginia C Vega, Denise R. Delgado's Supervisor, signed 11/06/2017 receipt acknowledged by Lynda S Kruithoff, Doctor Asistores’s Administrative Nurse, on 11/10/2017; after Larry Cohen Authored a note on 11/06/2017 whom also wrote false statement in my medical records, whom was working with Virginia C Vega, Supervisor of the ER, doc 24. I think this is when I was switched from Doctor Shepard as Primary Care Provider to Doctor Asistores. Nurse Delgado angrily writes after calling me a few names: "THIS Nurse ATTEMPTED TO EDUCATE PT THAT "GETTING WET" DOES NOT MAKE A PERSON ILL." But, it can. She misdiagnosed my problems to cover up Sinusitis. A problem that I had in the military:

01/12/2019 Gordon, Jessica DO ER assessment 01/12, 2019 @ 02:10 bronchitis, sinusitis Low inspiratory volumes. Albuterol 90 mcg, 2000 oral inhl, 2 puffs every four hours as needed for breathing Pseudoephedrine Hcl 30 mg tab signs and symptoms of a person’s condition include trouble breathing, drainage from a person’s nose, pain and pressure in a person’s face, headache, ear pain, fever and weakness. Sinusitis comes more than likely from infected "deviated septum" that I have. Prohibited from driving or operating vehicle next 6 hours because of medication. Weight 293 pounds. A sinus infection happens when viruses, bacteria, or a fungus grow within the sinuses..."moist environment for an infection to grow. Physical Exam General Appearance, well developed, well nourished, in no acute distress (they see me simultaneous and two very different me, it would seem) The sclerae were anicteric and conjunctivae were pin and moist. Lungs revealed rhonchus breath sound. He admits to sinus pressure, sore throat, runny nose. Patient had improved on re-evaluation. (I was given a couple Tylenol and put on some sort of Sinus breathing machine for about twenty-minutes to half-hour and check for nasal pneumonia with soaves by the Nurse. I was given chest x-rays with by a portable machine by radiologist person.

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Allegation 8. Nurse James. The Agreement, the third was Doctor Asistores Nurse, first time seeing me, wrote in the medical records that I walked/ambulated with a cane (Document 97). She did not put anything in the place of Monofilament Exam, but she said she did a foot exam and did not (Document 96 11/17/2017). This done so Asistores could import statement from Doctor Shepard associating it with the foot. A year later, she was the same person that wrote the false statement, misdiagnosis, misdiagnosis, misdiagnosis, about the filament test being normal the same day Doctor Asistores asserted the second Service Connection: Yes. But, on 8/17/2018 when Asistores wrote Service Connection: NO, Nurse James told the truth in Document 98, Right Foot: Not Done, Left Foot: not done, because I took my shoes off for an examination this time and she did not do them because she would have to put "abnormal" in some form of speech. Then James wrote the false statement, misdiagnosis, misdiagnosis, misdiagnosis, about I had a normal foot filament test (Document 99, 100, 101, 102); when fifteen years of Doctors and Nurses had written the opposite, even one on the same day, a foot specialist Nurse wrote abnormal (Document 103, 104), and Resident Sheth wrote Abnormal (Document 105), (Document 107, 109, August 16, 2005 and 07/18/2014 same) and the MRI proves the same (Documents 108).

Use of the 10g monofilament in the screening of the diabetic foot · Sensory examination should be done in a relaxed setting. First apply the monofilament on the patient s inner wrist so the patient knows what to expect. · The patient must not be able to see if and where the examiner applies the monofilament. The five sites to be tested on both feet are the pulp of the 1st and 3rd toes, and MPJ s 1,3 and 5 (total 10 sites). (See figure). · Apply the monofilament perpendicular to the skin surface. · Apply sufficient force to cause the filament to bend or buckle for 1-1.5 seconds. · Apply the filament at the edge of and not on an ulcer, callus, scar or necrotic tissue. · Do not slide the filament across the skin or make repetitive contact at the test site. · Ask the patient to respond with a yes every time pressure is detected. · For the purposes of annual review: normal sensation = detecting eight or more monofilaments or abnormal sensation = detecting seven or fewer. NB any patient with a current or previous foot ulcer, or amputation of any part of a foot, is already high risk, irrespective of the presence or absence of neuropathy.

They try to narrow the "Diabetes Mellitus Without Complication" only to the foot; which the statement to be true would also include my full Diabetes Mellitus problems in my 25 year medical records in the military and Veterans Hospital; the foot is one primary Nexus to Service Connection injury and/or disease but I have many Complications from Diabetes Mellitus as some actual Complication of Diabetes (Mellitus) are listed on the American Diabetes Association Website, such as:

It appears after Social Security ruled still disabled in 2014, Doctor Shepard set off to change this by my next review, by fabricated false diagnoses, fabricating false evidence by using trickery. His nurse, like James, wrote normal, but like Doctor Shepard, his nurse did not go as far as to say I smoked totally, analogy to monofilament exam normal, but with an indirect implication with cover in this statement:

Right foot normal numbness and pain

Left foot normal numbness and pain

Doctor Shepard was the preparer, the trial run, but something happened and Asistores took over with more aggressive fabricated lies. The eye doctor under Doctor Shepard wrote the trial run in 2017, but had to write the exact same thing in Jan 2019, a second time, under Doctor Asistores because things were preplanned to fabricate false evidence to cause my claim, benefits, compensations to be denied.

08/29/2018 Fares, Robert A M.D. Non-VA Care Hospital Note, UMC< NSTEMI, His EKG does show some ST elevation in V1 and V2. "The patient is also complaining of any chest pain"

05/13/2013 Tsuda M.D. Abnormal ECG, Nonspecific T Wave abnormality, early repolarization, Sinus tachycardia, atrial rate 113 BPM, QT 326 MS, QTC 447 MS

10/28/2018 VA Medical Records, "ST-Elevation Myocardial Infarction (STEMI) is a very serious type of heart attack during which one of the heart's major arteries (one of the arteries that supplies oxygen and nutrient-rich blood to the heart muscle) is blocked. ST-segment elevation is an abnormality detected on the 12-lead ECG" I have this ST abnormality in other ECGs that were not heart attacks. Retrieved from: https://www.ecgmedicaltraining.com/what-is-a-stemi/

A silent heart attack is possible with no pain, but they were trying to add pain, not a silent heart-attack with no pain, when I told them there was no pain, as if I described to them a stemi that could possibly be detected as nonexistent by testing; an attempt to correlate a heart attack to the one in 2009 that was with severe pain for a long period of time after lifting boxes:

"You can have a heart attack and not even know it. ... They are described as "silent" because when they occur, their symptoms lack the intensity of a classic heart attack, such as extreme chest pain and pressure; stabbing pain in the arm, neck, or jaw; sudden shortness of breath; sweating, and dizziness." https://www.goredforwomen.org/en/about-heart-disease-in-women/facts/silent-heart-attack-symptoms-risks It is called a silent heart attack, or medically referred to as silent ischemia (lack of oxygen) to the heart muscle.

"One of the most significant findings of myocardial infarction is the presence of ST segment elevation. ... It is not possible to diagnose a non-ST segment elevation myocardial infarction by ECG alone. Patients are treated presumptively and diagnosis is made if the level of serum cardiac markers rise over several hours." https://www.webmd.com/heart-disease/guide/heart-disease-heart-attacks

"Blood tests can measure the amount of these proteins in the bloodstream. Higher than normal levels of these proteins suggest a heart attack. Commonly used blood tests include troponin tests, CK or CK–MB tests, and serum myoglobin tests. Blood tests often are repeated to check for changes over time." https://en.m.wikipedia.org/wiki/Myocardial_infarction_diagnosis

"Imaging tests such as stress radionuclide myocardial perfusion imaging or stress echocardiography can confirm a diagnosis when a person's history, physical exam, ECG and cardiac biomarkers suggest the likelihood of a problem."

"Blood may be drawn to measure levels of cardiac enzymes that indicate heart muscle damage. These enzymes are normally found inside the cells of your heart and are needed for their function. ... Detecting troponin in the blood may indicate a heart attack." https://www.webmd.com/heart-disease/guide/heart-disease-heart-attacks

2001 VA Medical Records, Abnormal T-wave, "The T wave is the most labile wave in the ECG. T wave changes including low-amplitude T waves and abnormally inverted T waves may be the result of many cardiac and non-cardiac conditions." Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5544149/

For around 10 years, I have been diagnosed with low lung volumes, diagnosed in many sections of my medical records. "Mixed lung disease most commonly occurs in people with chronic obstructive pulmonary disease (COPD), who also have congestive heart failure. ... Restrictive lung diseases cause a decreased lung capacity or volume, so a person's breathing rate often increases to meet their oxygen demands." "Types of diseases and conditions involved in extrinsic restrictive lung disease can include: obesity." "Most people with restrictive lung diseases have similar symptoms, including: shortness of breath, especially with exertion, chronic or a long-term cough, usually dry, but sometimes accompanied by white sputum or mucus, wheezing, fatigue or extreme exhaustion without a logical reason, and depression." Retrieved: https://www.medicalnewstoday.com/articles/318905.php#symptoms

I was consulted by a Doctor about increasing the iron in my blood and problems with choking from sleep apnea.

"The most common cause of anemia is low iron levels in the blood – iron-deficiency anemia. Without iron, your red blood cells may become low in a protein called hemoglobin, which carries oxygen from the lungs to the rest of the body. You essentially begin to suffocate from within." Retrieved: www.everydayhealth.com › anemia › anemia-basics

I have been diagnosed with several Irregular heart conditions since 2001, not tied to syncope and syncope not tied to heart conditions, but stress, standing for long periods of time, and dehydration in 2018 and the one in 2019, "Defecation syncope: The temporary loss of consciousness (syncope) upon defecating (having a bowel movement). Syncope is the temporary loss of consciousness or, in plain English, fainting. The situations that trigger this reaction are diverse and include having blood drawn, straining while urinating (micturition syncope) or defecating, coughing or swallowing. The reaction also can be due to the emotional stress of fear or pain. Under these conditions, people often become pale and feel nauseated, sweaty, and weak just before they lose consciousness. Situational syncope is caused by a reflex of the involuntary nervous system called the vasovagal reaction. The vasovagal reaction leads the heart to slow down (bradycardia) and, at the same time, it leads the nerves to the blood vessels in the legs to permit those vessels to dilate (widen). The result is that the heart puts out less blood, the blood pressure drops, and what blood is circulating tends to go into the legs rather than to the head. The brain is then deprived of oxygen, and the fainting episode occurs." Retrieved from: https://www.medicinenet.com/script/main/art.asp?articlekey=9312 The vasovagal reaction is also called a vasovagal attack. And situational syncope is also called vasovagal syncope

Common causes of syncope include:

Low blood pressure or dilated blood vessels.

Irregular heartbeat.

Abrupt changes in posture, such as standing up too quickly, which can cause blood to pool in the feet or legs.

Standing for long periods of time.

Extreme pain.

Extreme stress.

Dehydration.

Retrieved from: https://www.healthline.com/health/syncopal-episode#causes

4. “Oppression” means despicable conduct that subjects a person to cruel and unjust hardship with conscious disregard of the rights of the person.

(Added to NRS by 1995, 2668)

12/12/2019

Emergency Department, Medical Clinic Visit, Medical Facility or Institution Records Department, Organization, Agency, Chief/HIMS

Letter of Disagreement, Amendment, and Additional Evidence for Allegations

To whom it may concern,

This Statement, Background and history, and Evidence for Health Information Management Request for Amendment of Protected Health Information (PHI) / Amendment Request for Records / Request for Amendment of Health Information is submitted for those purposes from a Medical Facility, Institution, or Organization.

I request that all Request be administratively deleted from the record if applicable and replaced with the correction. If an amendment is made, instead of a permanent deletion from medical record if applicable, which leaves the permanent scar in the record, which I believe was the intent, I request this total document serve as my Letter of Disagreement with such actions, and that this Letter of Disagreement included in any future releases of documents requested.

Please notify and share the following Letter of Disagreement and amendment, or the permanent administrative deletion from medical record if applicable, agencies, doctors, health care providers, and insurance companies, organizations that have relied on this information to review medical records, make decisions, or make diagnosis about this ongoing pattern of misconduct:

Fee Basis, VA Administration, RM 1H 110, 6900 N. Pecos Road, North Las Vegas, NV, 89086 {Note*****I talked to Mike, only person in Fee Basis, so he says, 12/10/2019 he has received and scanned in the following bills UMC, 32,264 Sunrise 7053.00 Radiology Spec 32.00 250.00 Desert Radiology 549.00 Tim has not received any ER Doctors Bill from UMC nor Sunrise Hospital, and not the May 28-29 $20,000 bill Tim has paid $0} {Medicare Part A has on file receiving Radiology Spec 32.00 250.00 twice and no other bills on file submitted Medicare had Paid $0 Mike has no record of receiving my two certified letters with 19 claims scanned into fee basis files under my name. Mike and representatives at Medicare said I cannot submit or bring in medical bills, they can only come from the medical vendor}

VA Southern Nevada Health Care Systems, Records Department, 6900 North Road, North Las Vegas, Nevada, 89068

Privacy Act Department, Department of Veterans Affairs, Claims Intake Center, PO Box 4444, Janesville, WI 53547-4444

Nordian Healthcare Solutions, LLC, Medicare Claims office, Policy #9UW9NK6MX54, PO Box 6776, Fargo ND 58108-6776

Doctor Larson, Ortro, Podiatry, and Foot, VA Southern Nevada Health Care Systems, 6900 N. Pecos Road, North Las Vegas, NV, 89086

Doctor Lal, PAV Clinic, VA Southern Nevada Health Care Systems, 6900 N. Pecos Road, North Las Vegas, NV, 89086

Doctor Asistores, VA Southern Nevada Health Care Systems, 6900 N. Pecos Road, North Las Vegas, NV, 89086

Private Medical Retrieval Center, PO Box 8890, Virginia Beach, VA 23450

Nevada State Board of Medical Examiners, 6900 Gateway Drive, Reno NV 89521

Social Security Administration, Central Processing Center, 1500 Woodlawn Dr. Baltimore, Maryland 21241

Social Security Administration, Southern Processing Center, 1200 Reverend Abraham Woods Jr. Boulevard, Birmingham, Alabama 35285

Nevada State Board of Nursing, 5011 Meadowood Mallway #300, Reno NV 89502

Department of Veterans Affairs, VA Records Management Center, 4300 GoodFellow Blvd. Bldg. 104, St Louis, MO 63100

Board of Veterans Appeals, PO Box 27063, Washington D.C. 20038

This complaint does not include the medical documents listed throughout this document, that are not included as a best copy in this document writing; but they are available on CD-ROM or at Request of the Institution. If requested, I will provide one paper Copy that can be copied for each claim by institution and submit one copy as new evidence if an appeal is necessary. Please, make the writing to the above address within 10 days of this document.

For me the litmus test to allege that a mistake is intentional with intent to cause an adverse effect on my disability reviews is, can the mistake be linked to adversely affecting a disability law? A typo, or repeat word, or a voice reader mistake does not meet the litmus test in my opinion.

Some of these are my Beliefs, Writings at Issue, Issue Stated, Legal Argument, Supporting Documents, Block quotes, Writings, Best Copy; Any errors, misstatements, typos, omissions are without malicious intent and I will correct if contacted; if I agree they are mistakes. Rod Jackson.

I have requested the following Medical Bills Paid in full within 30 days by VA or Medicare Shared Portion. I request even though bills purged in my name, I request VA or Medicare pay full claim with their normal adjustment. If Sunrise won't accept billing, I request a check made out to me for the amount and I will deliver that amount to Sunrise or subsidiary company for ER doctors or Radiology readers, as not to affect my Credit Score or Continued Health Care Emergency Services at these Medical Institutions, if necessary. Appeal dates for Sunrise billing incorrectly to Medicare B, November 3, 2019 and November 7, 2019 (Document 306). I was told by Medicare that I did not have anything to appeal, all claims were filed against Part B which I do not have.:

• Claim 1 $33.24 PlusStar Collections, 6345 South Pecos Road, Suite 212, Las Vegas, NV 89120. Plus4 $33.24 Document: 79, 81, 82

• Claim 2 Payment Desert Radiology $153.00 Document 77, 78, 80 Desert Radiology, PO Box 3057, Indianapolist, IN 46206-3057 Desert Radiology Solutions, PO Box 952591, Saint Louis, MO, 63195-2591

• Claim 3 $32.00 2/16/2019 Beaty, Radiologist Specialist, LTD, PO Box 50709, Henderson NV, 89016-0709

• Claim 4 $30 X-ray 03/28/2019, Outpatient Stay $32 X-ray 2/16/1019 Document 37C, 37D, 56, 57, 37E, 37F, 74, 75, 76 Desrt Radiologist Specialist, LTD, PO Box 50709, Henderson NV, 89016-0709

• Claim 5 Payment Inpatient Stay $250 MRI Outpatient Stay Owen, Radiologist Specialist, LTD, PO Box 50709, Henderson NV, 89016-0709

• Claim 6 Payment Claim March 28, 2019 Outpatient Stay $7, 053.00 Documents: 37, 37B, 53, 54, 55, 56, 57, 58

Sunrise Hospital Billing Departments, 3186, Maryland Parkway, Las Vegas, NV 89109. Sunrise Hospital PO Box 403399, Atlanta Ga, 30384. Sunrise Hospital Nashville. Sunrise Hospital, Po Box 740766, Cincinnati OH 45274 (Document 1) same city as Fremont Emergency Services AKA TeamHealth.com, PO Box 638972, Cincinnati OH 45263 (Documents 25, 22) All 4 of my stays 2000 I visited Fremont Medical Centers 24 Hour Emergency Services on Fremont Street, maybe connected, 2013, 2/16/2019 and 3/28/2019 ended up with billing company with Doctors under Fremont Emergency Services as my occupation is listed Disabled by Sunrise administrators and the medical records not properly sent with billing, except Doctor for inpatient stay is part of TeamHealth but billed by TeamHealth, and not Fremont Emergency Services and the bill was not sent to Atlanta Office but to me and automatic purged from Nashville office.

• Claim 7 Payment Inpatient Stay $105, 988.00 Sunrise Hospital 2013, May 12 - May 21 Documents: 19, 20, 42, 46, 47, 48, 49, 50, 51, 64, 65, 69, 269 Prior Billed to Medicare, then to VA. Sunrise Hospital Fax 2013 Surgery Medical Records "Attn: VA Medical Records for Rodney Jackson" to VA Medical Records Dept. 6900 N. Pecos Rd. N. Las Vegas, NV 89086 9/3/2013 (Document 305).

• Claim 8 Payment $20, 492.00 Inpatient Stay at Sunrise Hospital, Cincinnati 3/28/2019 - 3/29/2019 Documents: 40, 41, 56, 57, 58, 59, 60, 61, 64, 65, 67, 70, 71, 72, 73

• Claim 9 Payment Outpatient Stay $3, 899.00 2/16/2019 Sunrise Emergency Room, Cincinnati, OH, Outpatient Visit, Documents: , 11, 12, 13, 14, 15, 16, 36, 65, 66, 68, 69 Denied by Las Vegas, Fee Basis, 6900 North Pecos Road, North Las Vegas, NV 89068

• Claim 10 Payment Outpatient Stay $927 and Outpatient Stay $44, ER Medical Doctor Tang. Documents: 22, Outpatient, TeamHealth, Fremont Emergency Services, PO Box 638972, Cincinnati, OH 45263

• Claim 11 Payment Outpatient Stay $1428.00 and Outpatient Stay $46 ER Doctor Walker. Documents: 18, 22, Outpatient TeamHealth, Fremont Emergency Services, PO Box 638972, Cincinnati, OH 45263

• Claim 12 Payment Arrastia MD $564.00 3/29/2019 and $564.00 3/28/2019 Documents: 44, 45 {Extremity Injury} Inpatient Stay TeamHealth, Nevada Acute Medical, PO Box 639229, Cincinnati, OH 45263

• Claim 13 Payment Arrastia MD $298.00 3/29/2019 and $564.00 3/28/2019 Documents: 44, 45 {Extremity Injury} Inpatient Stay TeamHealth, Nevada Acute Medical, PO Box 639229, Cincinnati, OH 45263

• Claim 14 $428.00 Sunrise Hospital, Bill after Adjustment

• Claim 15 $34.13 Wong, Desert Radiology, PO Box 3057, Indianapolis, IN 46206-3057 Desert Radiology Solutions, PO Box 952591, Saint Louis, MO, 63195-2591

• Claim 16, $132.07 Hubert, Desert Radiology, PO Box 3057, Indianapolis, IN 46206-3057 Desert Radiology Solutions, PO Box 952591, Saint Louis, MO, 63195-2591

• Claim 17 $546.09 10/20/2019 - 10/22/2019 Pulner, Desert Radiology, PO Box 3057, Indianapolis, IN 46206-3057 Desert Radiology Solutions, PO Box 952591, Saint Louis, MO, 63195-2591

• Claim 18 Payment ER Doctor Bill, EMP of Clark UMC, PO Box 18925 Belfast ME, 04915 $1700

• Claim 19 Payment $32,119.71 10/20/2019 thru 10/22/2019 University Medical Center ER, UNLV, School of Medicine, Internal, 1800 W Charleston BLVD, Las Vegas, NV 89102-2329

•

Priya Sundaram, Do, Radiologist X-ray Reader March 1, 2019 at VA. No soft tissue injury. (Document 34, 35, 37), in my opinion, is inconsistent with findings by Sunrise Hospital Radiologist Readers and Pictures of Foot before and after the reading by Sundaram. It is my belief that the last X-ray at the VA ER, the person that read it, tried to disprove a lot of soft tissue problems that I currently had, when MRIs generally read soft tissue problems, and X-rays do not give good readings on soft tissue which his reading went in great detail, maybe fudged though omission of fact about x-rays and readings, saying no soft tissue injury. A true statement can be a lie with the omission of facts. I took pictures of my feet problems.

3-28-2019 MRI Sunrise Hospital 3186 S. Maryland PKWY, Las Vegas NV, 89109 Focal swelling and wound involving the distal second toe. Chronic bone erosion with bone loss in the distal phalanx of the second toe. No acute erosion or bone marrow edema to indicate acute osteomyelitis. Diffuse cellulitis with soft tissue edema in both forefoot and hind foot. Diffuse muscular atrophy with fatty replacement characteristic of chronic neuropathy. Chronic degenerative changes in the great toe.

Forefoot findings: There is a chronic appearing soft tissue wound in the distal tip of the second toe with adjacent soft tissue edema and hyper enhancement. Chronic degenerative changes in the interphalangeal and metatarsophalangeal joints of the great toe.

Hind foot findings: There is diffuse subcutaneous soft tissue edema in the hind foot. There is plantar fasciitis with thickening of the central cord of the plantar fascia and mild adjacent hyper intense edema. There is muscular atrophy with fatty infiltration.

2-16-2019 X-ray Sunrise Hospital 3186 S. Maryland PKWY, Las Vegas NV, 89109 chronic erosion of the second right toe distal phalanx with pencil tip appearance and bony sclerosis. Chronic osteomyelitis and healed osteomyelitis are considered. Moderate to severe degenerative changes of the great toe IP joint. Subacute to chronic ununited intra-articular fracture at the medial base of the right great toe proximal phalanx, best demonstrated on the AP view. Mild degenerative changes of the first MTP joint. Mild to moderate productive changes at the midfoot and hind foot. Regional soft tissue swelling, greatest about the second toe.

3-28-2019 X-ray MRI Sunrise Hospital 3186 S. Maryland PKWY, Las Vegas NV, 89109 Comparison 2-16-2019 X-ray No visible acute abnormality. No change from prior exam [X-ray is the same as prior exam]. Impression: Diffuse decreased joint space at the interphangeal joint first digit. History: male right foot pain and swelling.

Allegation 1. Doctor Asistores used the word Service Connection Documents 90 (November 17, 2017 "THIS IS A SERVICE CONNECTED VISIT: YES" [tooth dental and foot diabetes ) 93, 94, 95 (August 17, 2018 "THIS IS A SERVICE CONNECTED VISIT: no" after several complaints I wrote and requested a change of Doctor) 91, 92 ( November 16, 2018 "THIS IS A SERVICE CONNECTED VISIT: YES" foot diabetes visit and she found out she would continue to be my Doctor), 96, 97, 98, 99, 143) in my medical records as a secret code directing other Doctors and Nurses to enter false statement, misdiagnosis, misdiagnosis adverse to disability law, as many did. Doctor Toung was the first to do this in 2014, a couple months after that statement maybe from the ER/or a specialty visit, Doctor Sarazan was appointed my Primary Care Doctor where false adverse statements to Disability Service Connection became a constant put in my records when many Doctors and Nurses read this code. From Newspaper reports, Doctor Sarazan has a history of overseeing misconduct at Las Vegas VA. Doctor Asistores asserted this code again in 2017 for a Social Security Review, stopped it, with a "no" Service Connection for my visit August 17, 2018, correcting adverse statements, but with another derogatory statement, where the lie about the conversation with me smoking was removed; that lie made by Doctor Asistores to off-set my Service Connected dental injury specific and smoking also adverse to several other diseases I have, CAD, Diabetes Mellitus, etc., also at appointment November 17, 2017 she imported a false statement, misdiagnosis, misdiagnosis, "Diabetes with no Complications." (151, 152, 153, 154, 155, 156, 157, 158, 159) Asistores and Doctor Olcott, foot specialist, imported this into 2017 records, during the beginning of a November 2017 Social Security Review (Documents 91, 92, 93, 94, 95, 96, 97, 98, 99, 143). After I filed this 51 page complaint on ebenefits.va.gov to VA Central Processing for Claims, Wisconsin, Doctor Asistores starting signing es/ as receiving documents from other Nurses and Doctors in June, 2019 catching up those not signed by anyone in nearly two months. The statement was from 2015 Shepard’s misdiagnosis of my foot injury and disease in the foot "Diabetes Mellitus without Complications." Then Asistores reasserted the quote for a foot injury November 17, 2017 and the statement Service Connected, and then the statement again Service Connected, after stating I was not Service Connected on August 16, 2018, on November 16, 2018 where three groups of Doctors and Nurses followed her orders proceeding thru 2019. Supporting Documentary Evidence for this claim and additional allegations can be found on annotated Pages: 6, 16, 181, 182, 183 While awaiting C & P exams March - June, Doctor Asistores signature did not show up on any, or very few signed notes as if she was not my Primary Care Doctor, 3/29/2019 ER Note from rewriting medication for Sunrise Hospital thru April 26, 2019 Nurses Visit was not signed by Doctor Asistores until 06/08/2019, 6/11/2019, respectively (Documents 201, 210). Along the same time I filed complaint of not seeing any C & P doctors for the Dental or Foot for good cause, and a complaint about Doctor Garcia and his Nurse acting under false pretense as my Primary Care Doctor and Nurse, but I would see the given list if they would approve them. (Document: 193 April 25, 2019 Doctor Garcia's Nurse Triage, vs. Documents 202, 203, 204, 205, 206, 207, 208, 209, 210 April 25, 2019 VA ER Nurse, Documents: 194, 195, 196, 197, 198, 199, 200). The C & P doctors were never approved that I requested to see, Doctor Asistores and the network that she assembled was not a specialist in those fields. It was all about stopping the foot and the dental Service Connection.

Document 524 Doctor Asistores, my first appointment writes she and I had this conversation that I, a life time non-smoker has been smoking for two weeks, two weeks is since the last time noted in my medical records that I never smoked:

Colorectal cancer screen.

Tobacco use Screening: (*************NOTE: I AM A LIFETIME NONSMOKER).

“Patient had tobacco use screening at this encounter and within the past 12 months, patient states "I am a current tobacco user." The patient was counseled on risks of tobacco use and benefits of discontinuing. Advised to stop using tobacco products. Offered and discussed mediation options available. Offered tobacco cessation classes, to assist the patient in quitting. Patient was given brief counseling to; 1. Set a quit date within 2 weeks. 2. Get support from family, friends, and co-workers. 3. Review past quit attempts - what helped, what lead to relapse. 4. Anticipate challenges to quitting, particularly in the first two weeks. 5. Identify reasons and benefits of quitting. Level of understanding: Fair” When forced to change, she follows up this statement with another statement on me smoking with a racial-gay slur calling me her. She seemed angry at having to retract all of that.

• Allegation 2. VA Doctor Lal signed Doctor Khaldly's false and misdiagnosed medical notes from my visit, January 29, 2019 (98, 99, 100, 101, 102, 103) when Medical Evidence Testing (Documents 123, 124, 113, 118, 119, 120, 121, 122) and other Doctors' Diagnosis and other Nurses Diagnosis showed significant difference (Documents 125, 109, 110, 111, 112, 114, 115, 116, 117, 126, 127, 128, 137) and digital picture evidence of foot 2/16/2019 - 3/28/2019 annotated (Documents 129, 132, 131, 132, 133, 134, 135, 136, 140, 141). showed different On December 16, 2018 with my first visit to her, Lal's Nurse measured the foot ankle right as same as left, when clearly other Doctors and Nurse were recording swelling in the right foot larger than the left. On my first visit, Doctor Lal failed to order at minimum an X-ray for my chronic foot infection for osteomyelitis, cellulitis, bone fractures, and other past diagnosis, which later X-rays and MRI showed conditions of healed osteomyelitis, cellulitis, and other soft tissue injury and diseases (138, 139) to be treated as emergency. Such action at the VA, non-actions, and failure to diagnose, caused under diagnosis of the foot by Doctor Lal (105), Doctor Khaldy (98, 99, 100, 101, 102, 103), and VA Nurses () affecting billing and additional treatment of the foot at the VA. This caused an Emergency to seek help from Sunrise Hospital as it was closest Hospital of Treatment at onset of pain. Supporting Documentary Evidence for this claim and additional allegations can be found on annotated Pages: Documents 7, 101, 102, 103, 171, 181, 182, 183 Supporting Medical Documents Annotated and Circled, mostly, 211 - 240

• 3/02/2017 Social Security BPQY Stating that my Social Security Review would start around 10/17, November 2017 (Document 303).

• 4/05/2019 contact from Department of Veterans Affairs stating they were working on my Service Connected Claim (304). Request for Documents: (243, 244, 245, 246, 247)

• Complaints filed with Medical Board of Nevada (Document 241) Medical Documents on Outlook (258)

• VA Director and Supervisors Complaint Page 1 of 64, Page 1 (Document 260)

• Complaints filed with US Senators of Nevada (Document 242)

• PDF Medical Documents Available on ebenefits.va.gov Sunrise, VA, Health South, Industrial Medical Group, Clinica de Medica, Military, MOTH AFB, Nellis ER, Virginia VA, and additional medical Websites and personal medical writings (Documents 248 and 249)

• Fremont and Fremont Billing, Work comp, similar to Sunrise/Insurer Corruption 2000 and Sunrise/VA Corruption 2019 (Documents 261, 262, 263, 264, 265, 266, 267, 268, 269 and 274 - 282).

• Allegation 3. Doctor James T. Walker Sunrise Hospital wrote false statement, misdiagnosis, misdiagnosis, misdiagnosis, in medical record adverse to billing and future release of proper medical records and proper diagnosis stating the admittance for the wrong limb (Document 108), left instead of right during outpatient admittance or certified the false diagnosis by signing the document as true. (98, 99, 100, 101, 102, 103). I believe his actions, it seems he was the author, of signature for the author, were malicious with intentions since the medical bill from the visit was billed to me and not billed to any insurance company properly, then sent straight to Sunrise collections and disposed of; write off, without any collection attempts from third parties I had listed phone numbers. Supporting Documentary Evidence for this claim and additional allegations can be found on annotated Pages: Documents 7, 101, 102, 103, 18, 21, 22, 172, 181, 182, 183 Supporting Medical Documents Annotated and Circled, mostly, 211 - 240

• Allegation 4. VA Doctor Khaldy wrote "0" pain when there was pain, she ordered leg stockings extremely small, which was in question by another nurse, attempting to reduce the actual girth measurements of swelling causing injury to my foot, 4 inches in diameter (Document 170), and she wrote my leg and foot measurements opposite to what limb they were measured for to go into the medical record. She corrupted the medical records (98, 99, 100, 101, 102, 103, 104, and 171). I allege she did these things with malicious intent to cause harm, as secondly she failed to change the leg misdiagnosis when alerted in Progress Notes by a Nurse named Wendy, and a message that I left requesting her to, and two other Doctors followed her failure to properly diagnose at Sunrise Hospital writing the same false information in my medical records where neither bill from the two visits were properly billed and/nor with proper medical records attached because of these two Doctors writing false diagnosis and symptoms for injury or disease which is another sign of malicious intent by these four Doctors. Supporting Documentary Evidence for this claim and additional allegations can be found on annotated Pages: Documents 7, 101, 102, 103, 172 in my medical history infection generally meant some pain, 181, 182, 183 Supporting Medical Documents Annotated and Circled, mostly, 211 - 240

• Allegation 5. Doctor Tang Sunrise Hospital misdiagnosed my foot similarly to Doctor Khaldy wrote "0" pain (Document 106) when there was pain (98, 99, 100, 101, 102, 103), and medical literature (Document 114, 115, 116, 117, 118, 119, 120, 121, 122) state there is pain associated with the kind of injuries or disease that I had at that time, and a Nurse recorded pain 7 swelling (Document 109, 110, 111), another noted I walked in and left with crutch, and a next similar visit on March 28, 2019 a Nurse noted pain 6, extremity injury priority 3 (Document 112, 122) and an X-ray noted similar to X-ray February 16, 2019 of regional soft tissue swelling and severe degenerative change to the great toe IP joint, degenerative changes in the mid and hind foot (Document 113), same pain same injury (Document 161, 162, 163, 164, 165, 166, 167, 168, 169) and prior similar infections and swellings records similar pain as Doctor Tang wrote prescriptions for infection and the VA ER Emergency Dept. Advanced Provider specialist filled the prescriptions (Document 142) as emergency visit, and Doctor Tang wrote no pitting (Document 107) in the foot when pitting had started in the right foot and the right leg before and after the visit on 2/16/2019, and apparently his actions caused the bill for that visit not to be paid by fee basis, 6900 North Pecos Road, Las Vegas, Nevada 89098 when they used their nurses and his misdiagnosed instead of Sunrise Hospital Nurses as good cause not to pay the bill from 2/16/2019. Supporting Documentary Evidence for this claim and additional allegations can be found on annotated Pages: Documents 7, 101, 102, 103, 22, 107, in my medical history infection generally meant some pain, 171, 173, 174, 175, 176, 177, 178, 179, 180, 181 August 16, 2018, Asistores wrote "foot risk score level 3, high Risk" (Document 182) the same as the Nurse on 2/16/2019, Asistores approved the visit on 2/16/2019 (Document 16), then Fee Basis denied payment as non-emergent according to Jack. Examples of Non Emergent Outpatient: 270, 271. Supporting Medical Documents Annotated and Circled, mostly, 211 - 240 Even though the X-ray showed past chronic osteomyelitis and present pre-osteomyelitis symptoms that he gave me anti-biotics to treat and they stopped the drainage, but not the cellulitis, Tang writes "no pain." The admission paper noted Doctor Asistores as my Doctor and I had not told anyone who my Doctor was at the VA. VA Medical Documents noted Doctor Asistores and her Nurse were in contact while I was under Doctor Michael Tang. It was for a planned reason which I had already considered when I read his strange input. I said, I bet his and his transcribers false statement, misdiagnosis, misdiagnosis were to deny payment. In the end, it was just that.

These are the ER Doctors, Tang and Walker. In 2013 (Billing Documents 29 and 30) the billing printout states that the Hospital Reports were never sent which cause the account to go to collection, then I was contacted by collection, ant the VA eventually paid it. When I was in the ER 2/16/2019 and the lady confirmed my billing address to be my PO Box on 2/28/2019-3/29/2019, and when I went to the ER Billing this week they have my updated address as PO Box, but nowhere else in the system but a different address. When the overall address changes at Sunrise it changes sending bills out to ER Doctors. I updated my information at UMC took all of twenty minutes through the whole system.

Team Health (702) 224 - 2555 2/28/2019-3/29/2019 702-304-2144 ER (Documents 21 and 22).

Fremont Emergency Services (702) 823-4255 Collection 800-984-1115 Recovery Group, 2

• Allegation 6. Sunrise Hospital Billing Departments, 3186, Maryland Parkway, Las Vegas, NV 89109. Sunrise Hospital PO Box 403399, Atlanta Ga, 30384. Sunrise Hospital Nashville. Sunrise Hospital, Po Box 740766, Cincinnati OH 45274 (Document 1) same city as Fremont Emergency Services AKA TeamHealth.com, PO Box 638972, Cincinnati OH 45263 (Documents 25, 22) All 4 of my stays 2000 I visited Fremont Medical Centers 24 Hour Emergency Services on Fremont Street, maybe connected, 2013, 2/16/2019 and 3/28/2019 ended up with billing company with Doctors under Fremont Emergency Services as my occupation is listed Disabled by Sunrise administrators and the medical records not properly sent with billing, except Doctor for inpatient stay is part of TeamHealth but billed by TeamHealth, and not Fremont Emergency Services and the bill was not sent to Atlanta Office but to me and automatic purged from Nashville office. Supporting Documentary Evidence for this claim and additional allegations can be found on annotated Pages: 11, 14, 15, 17, 20, 23, 24, 25,

My 2000 work comp case and billing department corruption when I tried to prosecute my employer White Cap at the Industrial Insurance Agency (Document 300).

2001, I thought my employer had fired me for the second time over the 1 year past out of work (Document 301, 302) when I filed for Unemployment benefits and was denied saying that I was still employed by White Cap on a leave of absence.

• Allegation 7. Even though not much evidence, I do make Doctor Cohen part of this complaint; not enough evidence of Malpractice acts or evidence of actions done to adversely affect my claim, maybe. He was Supervisor during X-rays but did not actually read the X-rays that I believe written summiting soft tissue injury to my right foot, when there was, to adversely affect rating, disability, or review of foot injury. He omitted evidence to make a statement that could adversely affect my claim about my Doctor’s prescription that I reduced when I had pain thought from the medications. Supporting Documentary Evidence for this claim and additional allegations can be found on annotated Pages: medical notes from my visit, January 29, 2019 (98, 99, 100, 101, 102, 103) when Medical Evidence Testing (Documents 123, 124, 113, 118, 119, 120, 121, 122) and other Doctors' Diagnosis and other Nurses Diagnosis showed significant difference (Documents 125, 109, 110, 111, 112, 114, 115, 116, 117, 126, 127, 128, 137) and digital picture evidence of foot 2/16/2019 - 3/28/2019 annotated (Documents 129, 132, 131, 132, 133, 134, 135, 136, 140, 141). Supporting Medical Documents Annotated and Circled, mostly, 211 - 240

• Allegation 8. Sunrise Hospital Billing Department Assistant Director Sunrise Hospital Jamie Brower-Hoffman was intentionally deceptive in billing and not billing my medical visits correctly to the insurers. The last time I saw her, she acting under false pretense updating my address, and never updated the 2/16/2019 and 3/28-March 29, 2019 billing account information nor my current address, that would automatically update subsidiary billers for Doctors and Radiology readers, but she handed me a document from 2013 updated by a Nurse two days prior in the Children's admissions office. The two Doctors, Tang and Walker, use a deceptive company called Fremont Billing that is a similar 2000 name of a Medical Center that I visited in 2000, that worked with work comp medical and insurers in Work Comp. Today the similar named company uses deceptive trade business tactics in not billing the proper insurer, hiding its phone number and address for locating Doctor Tang and Doctor Walker (Document 21, 22). They seem to do things intentionally incorrectly in an attempt to run out the clock of filing proper claims which I believe their goal was, and is, to stick the insured person with the bill instead of the proper insurer paying the bill. They were on the name of the Doctor from the 2013 Billing (document 19, 8) also $105, 988 seemed to be showing unpaid until purged, written off, this August by billing in Nashville Office. In Document Supporting Documentary Evidence for this claim and additional allegations can be found on annotated Pages: 12, 13, 17, 18, 27, 28, 29, 30, 31

• Allegation 9. Las Vegas Southern Nevada Veteran Health Care System Fee Basis 1H110. I never received denial letters from Las Vegas Fee Basis, only confirmations from billers that the VA denied payment. So, there has been intentional misconduct to stop me from appealing any decisions by not sending me denial letters. Employee named Jack and the VA Nurses made a false diagnosis at the VA that decided at 6900 North Pecos Road, North Las Vegas, Nevada 89086 that 2/16/2019 visit to Sunrise Hospital was not an emergency. This was an Emergency visit with evidence that prior similar visits were emergency visits, evidence that similar Nurses and Doctors were acting in a malpractice manner of misdiagnosing my injury and disease during, before, and after this decision at Fee Basis. Example of non-emergency past outpatient visits are given, much lower than a similar X-ray in the past lead to additional treatment of 6 weeks of zosyn and other medications to heal, similar X-rays in the past that lead to additional testing, that found osteomyelitis in the toe, and similar X-rays that have led to MRIs that found serious emergent conditions to the foot that lead to an impatient stay of more than a day under zosyn at Sunrise Hospital; and an additional X-ray on March 28, 2019 that states that March 28, 2019 X-ray is about the same condition as February 16, 2019 X-ray, which an MRI would have shown emergency conditions, as I visited VA ER March 1 which showed emergent condition of Cellulitis in toe; MRI (Document 9)showed infection in large part of foot which was an emergency, but misdiagnosed and a false diagnosis given by Doctor Tang which had to have caused the same from Nurses at Fee Basis. Supporting Documentary Evidence for this claim and additional allegations can be found on annotated Pages: 16, 36, 26, 27,

Past like-kind payments by fee-basis, seems to be retaliatory for filing corruption complaints involving Doctors and Nurses at Las Vegas VA, so I should have expectation as a Veteran that Fee Basis will pay the same bills as in the past: Documents: 32, 33, 34, 35, 31, 83, 84, 85, 86, 87,

Like-kind past emergency visits that did not medicate, anti-biotics, my osteomyelitis symptoms of drainage, swelling and pulse which cuts off the oxygen to the bone, pain before bone infection occurred, and too conservative care did not treat early warning symptoms in time to stop bone infections and further treatment: Documents:

Past Medical Records Testimony from Doctors and Nurses supporting the X-ray results 2/16/2019 and MRI and X-Ray 3/28/2019, injuries and diseases diagnosed, in the past have been emergency care needed at the like-kind VA ER, so I should have expectation as a Veteran that VA Fee Basis should pay the same bills as emergent; a preponderance of Medical Evidence supports this, with my Primary Care Team and Doctors in written documents state for me to report to the nearest Emergency Room. Sunrise was the nearest. Documents:

All these representatives of the VA said I should report to the Emergency Room if symptoms worsen or did not stabilize, which I did under direction of the agents of the VA, so the VA should take responsibility to pay bills, even if there is corrupt practices going on in the proper billing of my claims, and for that reason alone should without hesitance pay all claims. Veterans cannot get healthy under such circumstances which causes conditions actually, maybe to worsen, awaiting proper treatment and payment of such treatment: 144, 145, 146, 147, 148, 149, ). As of September 1, 2019 it was evident that Fee Basis and Sunrise Billing had not billed properly, medical records, and evidence for the VA to pay Claim from 2/16/2019 (Document 158) letter from Sunrise Nashville office.

Examples of Non Emergent Outpatient: 270, 271

Misconception from New Doctors and Nurses that I have seen short-term of what "breaking in a new shoe" means when I say it and what does it have to do with foot ulcers. My long term Doctors understand somewhat, but they have a lot of patients and probably I know more than they remember each time that I visit. I can only wear a new shoe or old regular shoe about three days straight before signs of blistering and ulcers show up. Darco I can wear much longer when some but few may show up in a six month period. Whether it is a new Doctor that orders me a new shoe to wear, that fits properly, or it is an old shoe already broken in that fits properly, the over-rotation of the feet causes ulcers; noted more when the back heal of the Darco shoe that has worn down. After the ulcer, moisture accumulates under and around the feet and toe areas while blisters expand and pulse, liquid, and blood are pushed out of the feet and toes with pressure of normal walking in the shoe. Infections add to swelling and expanded swelling of the foot and ankle. I have collapsed arches which adds to the pain and the formation of ulcers. The Darco relieves many of the problems but ulcers still may form because of Diabetes Mellitus complications. Darco allows air so the moisture is less. Darco helps with the over rotation of the foot, by the show rotating on a pivotal arch itself. Darco does not allow any touching of the top toes to the surface of a show. Darco allows adjustments straps when my feet do swell from edema and infection to be adjusted to reduce pain and friction of the shoe rubbing the foot tightly. The shoe has support pads that can be cut out to relieve pressure points, as I was taught, of observed how this was done, and do it myself, from visits to Excellent of Prosthetics on Shadow Lane through the VA. In addition to this prosthetic, I use a crutch to relieve pressure off the foot when they do get ulcers even with the Darco shoe at times, because of the thinning of the skin tissue from edema, cellulitis and Diabetes Mellitus as I was explained this by Vascular Surgeon Johnson on my Visit in 2019, stated, "worse right than left" (Document 183). Doctor Johnson said my sugar was too high to do non-life/death situation surgeries, heart attack or past Stomach Surgeries that I have had, at the time of the visit 2019. Supporting Documents: 114, 115, 116, 117, 118, 119, 120, 121, 122, 125, 126, 127, 128, (Document 163, "Diabetic male with chronic right foot pain. Patient notes about 6 - 7 years {2015}, that he had sustained a traumatic right foot fracture. The patient has been wearing Darco Wound Care Shoes/size 15. Ordered a right foot X-ray.), 166, 167, (Document 168, 169, BLE +3 edema to both (RLE is pitting) 11/16/2018. Edema causes thinning of the skin. VA Medical Document 175 "what causes osteomyelitis?" Medical VA Document 180 "symptoms of cellulitis?" VA Medical Document 181, Pressure on foot, weight 301 lbs. Mar 29, 2019, Document 220 My 10 year foot Doctor, 04/30/2014 Assessment Infected ulcer hallux, probable underlying osteo. Non-insulin dependent diabetes with peripheral neuropathy. Plan: Mupirocin topically, MRI, Darco offloading with crutches. Document 221, Doctor Lal's Nurse, Left calf 18.5 inches Right calf 19 inches. Document 222, Khaldy Plan: "treatment is medically necessary to decrease pain" signed by Khaldy, Doctor of Physical Therapy and signed by Pratibha Lal, certified wound specialist physician. But, the Khaldy agreement wrote and signed, and Lal signed "0" pain before any physical therapy treatment which is the Asistores Service Connected agreement to prove no pain, no injury, no stasis dermatitis, no soft tissue injury, no disease, no level 3, no Diabetes Mellitus complications, which would all mean some pain or failure to diagnose symptoms and zero pain "0". Document 280, Glucose 503, ER VA Virginia 1998. Document 272 11/10/2015 Release from Surgery, Patient's Goal: I just want crutches because I feel steadier and safer with them." The nurse had brought me a cane to walk with. I walked out with two crutches, and I declined the cane.

Similar, like kind, visit to Las Vegas VA ER treated as emergency to Sunrise Visits 2013, 2/16/2019, March 28 and 29, 2019: (Documents: Discharge Summaries from Las Vegas VA ER: 186, 187, 188, 189, 190, 191 Summary from MOTH, Nellis AFB ER: Document 192).

Nurse Williams. My Primary Care New Doctor's Nurse who saw me in triage made similar false statement, misdiagnosis, misdiagnosis as the Fee Basis nurses made, when she prescribe X-rays and then said she never saw my foot and leg and that I kept them covered in bandages when I showed her; the same Nurse at last check never scanned in MRI, X-rays from Sunrise, nor Nurses notes from Sunrise that I gave her; and the same Nurse said I needed no emergent follow-up, as she said without looking at my foot and leg and failed to diagnose, when two Nurses at the Las Vegas ER gave different testimony the next day in their Progress notes. Cellulitis can spread throughout the body: (Document: 193 April 25, 2019 Doctor Garcia's Nurse Triage, vs. Documents 202, 203, 204, 205, 206, 207, 208, 209, 210 April 25, 2019 VA ER Nurse, Documents: 194, 195, 196, 197, 198, 199, 200). Supporting Medical Documents Annotated and Circled, mostly, 211 - 240

Documents 279 - 299 are VA Medical Doctors, Administrators, UNLV, admissions assessment at ER VA Las Vegas, medical appointments that all have my address correct over the dates and years prior that could contact me successfully and updated my information successfully when Sunrise Hospital would not update successfully over their entire system through the course of 2-16-2019 through August 2019 after repeated attempts by me'; and maybe not today, but on a need to correct to send a letter basis.

Overview of Case 5 Documents are in Case 5 Folder

Overview of Case 5. This case was about hidden agreements, that are readable if you understand the code they are using, in the medical records as Doctors took part in fabricating false statement, misdiagnosis, misdiagnosis to adversely affect my disability ratings, compensation, present Service Connected Review, and maybe future reviews if their false fabricated evidence is allowed to stand in my medical records.

The date was 2/16/2019 and I had an emergency visit to Sunrise Hospital with a foot infection that was in somewhat severe pain, swelling, and bleeding at the toe where I have chronic osteomyelitis and cellulitis. According to the billing statement the Emergency Visit was approved (Document 16) by the VA and they had contact Doctor Asistores (Document 16) according to the billing statement. Everything went normal until I got my medical records printout and I noticed Doctor Tang had made false statement, misdiagnosis, misdiagnosis about pain, swelling, and pitting which there was all of, but he pretty much described it as none of. The nurse put pain level 7 and swelling. Others recording I entered with a right crutch to relieve pressure off the swollen foot and I left with the swollen foot; still in pain, but I already had pain medicine so I did not request any. But, Doctor Tang prescribed anti-infection medication to help stopped the bleeding and treat the infected toe and foot. I thought his writings may have something to do with billing later and it did. 0 pain was written so the Fee Basis Nurses could write the appointment was not an emergency even though the Sunrise Hospital Nurses and the X-ray images say it was. A common practice of Sunrise Hospital according to records is to send Doctor Progress Notes without nurses notes and X-rays are neither required, which is more than likely what happened in this case. But, as I looked at the records and the billings months later, it was something better planned out than just incident. This had to do with Doctor Khaldy and Doctor Lal from the VA and Doctor Walker and Doctor Tang from Sunrise Hospital. This outpatient bill was then billed to Medicare Part B which nowhere on the admittance say I have Part B, Outpatient. I was told by Jack in February that VA would cover an outpatient visit.

On January 28, 2019 there was an agreement made between Doctor Khaldy and Doctor Lal, which Lal was already doing when she did not order an X-ray for my foot infection from my visit to her December 2018. That agreement was to find nothing wrong with the foot and if so fabricate false evidence to offset the condition, injury of the foot. On that day, Khaldy wrote "0" pain in the foot and she did measurements on the foot and leg, distorting the measurements by measuring the girth while I was wearing compression wraps issued by Lal giving a false reading of the true swelling of the leg and foot; but furtherer her acts into malicious by switching the measurements around so the left leg read larger than the left leg. Another Nurse noted this in her notes, but Khaldy would not correct the measurements to read right. I left a message on the issue. She sent me out a letter avoiding the issue to say that I did not have a phone so she could not contact me; but she never willfully changed those girths to correct them in the medical records which suggest they were intentional. Doctor Lal signed this document Khaldy wrote as being medically correct; a second signature to corruption into my medical records. Just like Doctor Gruel in 2014 wrote Service Connection, which a couple months later gave me Doctor Sarazan and his group of Doctors, and 2017 Asistores's Service Connection gave me her first group of Doctors and Nurses, and then August 17, 2018 Asistores wrote not Service Connected, and then November 17, 2918 she wrote Service Connected again giving me three different set of Doctors attacking me. Khaldy was the second group of that, forming her own group, when on March 1, 2019 I requested Doctor Asistores have no further contact with my Doctors corrupting my medical records. Khaldy Agreement (Documents 7, 101, 102, 103). Sunrise Hospital Tang followed her "0" pain in the foot and Doctor Walker followed her switching the foot/leg injury around, so the left leg show injury and not the right foot/leg which the medical records supported. The malicious part came when their actions to corrupt the medical records also was followed by attempts to destroy the billing for those injuries and x-rays so maybe they could not be requested in the future by Social Security, VA, or other medical facilities. They destroyed the evidence; exculpatory evidence.

. Looking at the other five cases, Service Connection Veterans, at least in my case, are targeted for being service connected by Doctors and Nurses, like they targeted the Work Comp Case with Nurse Judy Rodriguez and the later Social Security Disability case with Doctor C. Degracious, these are intentional acts to corrupt a veterans medical record which could lead to false diagnosis or misdiagnosis in future medical incidents, and have, on record. Social Security Disability, the VA is as well in corrupting the medical record against the Veteran to attempt to cause them adverse Social Security Disability Reviews as Doctor Melody C. Degracious again did when she said a fork lift fell on my head, instead of the actually fact that I fell 10' from a fork lift. Latter, Nurse James, Nurse Guoin, Nurse Alejandro Delgado, Nurse Delgado, and Nurse Williams all took same roles in corrupting my medical records with adverse actions, fabricated evidence such as a cane and scooter, and fabricated testimony like Nurse Alegandro stating in the prosthetic records that I had a bad address, when there with multiply letters mailed to me before and at the same time he said in prosthetic records to the other Doctors, Administrators, Nurses my address was bad. He had communicated to Doctor Olcott about shoes she put on order, that also put multiple false statement, misdiagnosis, misdiagnosis in my medical records on two occasions, and those were 2014 and 2017 disability reviews for Social Security. I do not recall seeing Doctor Olcott any other time in my 19 years at Las Vegas VA, but just to write false statement, misdiagnosis, misdiagnosis in my medical records during two disability reviews instead of my normal foot doctor. She was number two in rank in the office and went overboard as stated in the medical notes to overbook if necessary to schedule me to see her, when my 10 year Doctor walked in during the appointment, so she could have booked the visit to him. So, the Nurses were acting under the guidance of Doctors to destroy and corrupt my medical records for an adverse disability reviews, denied compensation, denied necessary treatment and testing, low rating on injury, and/or denial of bill pay. The VA nurses decided 2/16/2019 visit was not an emergency. The Sunrise Hospital Nurses thought it was an emergency.

This was all confusing at first as I was given so much wrong information. / But, with enough information, I think I got this now close. Sunrise Hospital has a couple billing departments. The Billing Department in Atlanta seems to be the first contact billing department. Sunrise in Nashville Tennessee seems to work as a collection agency, which purges or collects outstanding bills.

The 2/16/2019 bill was as the bill says sent out to me on 2/20/2019. It appears after the x-ray showed soft tissue damage which contradicts what VA x-ray showed no soft tissue damage, the bill and medical records were never going to be paid by the VA. So, after they sent my bill to the wrong address, then they contacted VA when I talked to Sharon at a later date. When they received the fax by Sharon, VA denied the visit as non-emergency according to Jack.

The 2/28/2019 outpatient bill was sent to Atlanta where normal billing procedures take place, but they billed Medicare B instead of billing VA for an outpatient billing. While, UMC radiology, and an old Sunrise Hospital 2013 Doctor Billing billed the VA and were paid; radiology billed Medicare part B which nowhere says I have that instead of the VA, and the Doctor Billing say they did not have any billing information for an insurer; but Sunrise has Medicare Part A on the patient billing information statement for 2/28/2019 and the VA Fee Basis and Medicare A for 2/16/2019 outpatient visit. The inpatient visit March 28, 2019 through time March 29, 2018 which is billed by the Doctor A as a two day stay after more than an half hour over the twenty-four hour period which it was. This billing went straight to straight to Nashville and was written off in my name; not billed to any insurer. It had the MRI and the second X-ray saying not much change from the 2/16/2019 x-ray showing soft tissue injury but catching the X-ray from VA, similar to that one in 2017, saying no soft tissue injury when there was clearly soft-tissue injury before and after that x-ray which means, could mean, X-rays at the VA are being under read failing to correctly diagnose severity of injury of me. So the effort came about to destroy the billing and to destroy the medical documents: The Agreement. After, Director of Billing gave me a lot of information from Nashville, Nashville sent me a letter that the $20,000 inpatient stay had been paid. But, the assistant director notes showed it billed to Medicare Part B, which they know I do not have, but Part A which I surely have and just got the new card, they did not bill for the impatient stay. It was accepted more than likely and they take a couple months to decide acceptance or denial, so it will be denied of course. They are stalling for time to run out the clock on submitting bills properly.

So this was a second agreement. But, there is a third agreement involved. This is with Fremont Billing (Documents 7, 8, 262, 263, 264, 265, 88, 89, and 90). In 2000, Fremont was a work comp billing company actually located on Fremont Street as I still have the business card when the insurance Company RSYCO ran the scam then of not paying bills and billing to wrong insurers. Today Doctor Tang and Doctor Walker are represented by Fremont Billing (Document 21, 22, 23, 24, 25, 88, 89, 90, 260, 261, 262, 263, 264, 265, 266, 267, 268) which seem to tweak their name a little and moved to Cincinnati Ohio which was where Sunrise billed me from on 2/20/2019 a few days after my visit.

Assistant Director of Patient Billing Customer Service when she began to lie and make changes in the system that the other people said they had no excess to do. I called Sunrise Billing Office in Atlanta, Pricing Hotline, 1-800-307-7595 Atlanta Patient Account Services, 5707 Peachtree Parkway NW Norcross, Georgia 30092. I found their office to be corrupt. First they took all my new information, address, phone, and insurer, VA as primary and said they would bill the VA Las Vegas Fee Basis. I called back and the information had been changed on one account and not on the other 3 bills. The lady said the notes had not billed VA Fee Basis. But, she said she would do so. I call back to make sure my information was updated on the accounts. The lady would not give me my new address. I had to tell her and I could hear her typing it in but she told me it was already correct and the VA had been billed.

Radiologist Specialist, Henderson NV I talked to Joapel in Billing and he told me that he changed my address and would bill the unpaid bill from 2/16 and 3/28 and 3/29 to the VA, and email me the bill shortly. I called back and talked to a young lady because he never emailed me the bill, and she read the notes on my account and my address was changed back to the old one and no one was billed. So, she said she would email me the bills that I received shortly. She said she would bill VA.

I spoke to Desert Radiology and I had six bills. 5 had been paid. One had been put on my credit report, the first time I noticed it was June 2019. I talked to the lady in billing and the collection company. They were both helpful. I requested she rebill the bill around August 7, 2019. I think she said she resubmitted it and the VA, Las Vegas Fee Basis, denied it saying they could not confirm that I was in their system. They did not know me. I asked her how they knew me on the other five years. She said she had two numbers for my identity, one was my social security that paid the other five bills and this odd number on this one account. I agreed, they gave me copies of the bill, that I would submit the bill myself.

Assistant Director of Patient Billing Customer Service was good with the computer and the second time I talked to her she was on a laptop in children admissions front counter supervisor the attendant on another computer. All of the other person each expressed they had limited abilities to access information of mine on Sunrise Hospital Computers; even in the ER this information is denied.

Around August 7^th, I started investigating medical payment information after noting a bill placed on my credit repot in June, 2019. Billing Customer Service Represented 1 at Sunrise Billing was the first person that I was directed to. I asked her, if I could speak to Sharon about the faxed bills and medical records to the VA. She told me that her office was closed and that she was no longer there. I requested that she give me a printout of my bills to see what was paid. She could only pull up the 2013 bill and the March 28 and 29^th bill. I asked her about the other bills. She said nothing else was available that she could pull up. One bill, stomach surgery, said that I had a balance of $105.988.00 with no payments, no adjustments, and no reference to it being purged. (Billing Document 20). The other bill was or the March 28 and 29 payment, $20,492.00, with no payments and $20,492.00 adjustment showing no insurer payment adjustments. (Billing Documents 2 and 3) Assistant Director of Patient Billing Customer Service first comment on the bill was that it looked like it had been written off. So in my opinion, any future care would be denied at Sunrise by billing because I had one bill outstanding with zero payments for 6 years and another showing no insurer that had been written off. Bad credit in my book. Kind of like what was put on my credit report that I noticed in June, from PlusFour, all these were contract partners with the VA.

Billing Customer Service Represented 1, whom did not have the answers to the questions that I needed to know, but she did direct me to someone who may have had he answers, Assistant Director of Patient Billing Customer Service. Assistant Director of Patient Billing Customer Service first impression was to approach me as I was not very educated, but after talking for a while, she said she would have an auditor look at my case, which was on a Friday, and the auditor had not contacted me by mid-day Monday. It was merely chance that Assistant Director of Patient Billing Customer Service saw each other Monday as I used the bathroom by the admissions office and she recognized me and spoke on the issue as I did not recognize her. She was down dressed from Friday. I asked her to give me a printout Friday of my bills payed. She did. None were billed to any insurer. And they all had under $1000 dollar amounts billed to me. But, I got home and noticed she did not give me a paid bill on the $105.988.00. I requested that bill. She went into a backroom and came out showing the bill with $0 balance saying that it appeared that someone had written it off. I thought and then I came back and told her that the bill showed I owed $105.988.00 last week when Billing Customer Service Representative 1l gave me a printout. She said she did not know about that. I told her that I had a printout. She told me that she sent the March 28 and 29 payment to fee basis. By chance, as I just left the Hospital grounds, I was able to call Fee Basis and get through. I talk to a person named Jack that I knew from before handing bills to. He said the 2/16/2019 bill was faxed over and denied because VA nurse said the bill was not an emergency. That meant the Sunrise Nurses report that said it was emergency was not sent and what I had said about Doctor Michael Tang and a transcriber put that the foot had no pain and had no swelling was done for a purpose, even though the X-ray showed past chronic osteomyelitis, and pre-osteomyelitis symptoms that I was given antibiotics to treat; the nurse noted swelling and pain level at 7, and all the other nurses over the last couple months noted cellulitis and edema in the foot and swell, Doctor Tang at his final notes put no pain and no swelling. I walked in on a crutch with the foot leaking blood and osteomyelitis drainage. The admission paper noted Doctor Asistores as my Doctor (Michael Collins packet of Documents number 10) and I had not told anyone who my Doctor was at the VA. VA Medical Documents noted Doctor Asistores and her Nurse were in contact while I was under Doctor Michael Tang. It was for a planned reason which I had already considered when I read his strange input. I said, I bet his and his transcribers false statement, misdiagnosis, misdiagnosis were to deny payment. In the end, it was just that.

By now, I figured out that Assistant Director of Patient Billing Customer Service, Nashville, and Atlanta Offices had access to the backend at letting people see what and when. I returned the day after I left the voice mail to Assistant Director of Patient Billing Customer Service. I was late and the office had closed and directed me to the Children admissions office. I requested the attendant give me a printout of a document that I had that showed my personal information and insurer. Someone had blocked access to all my payments except the $105.988.00 assumingly the same unpaid bill. The attendant updated all the information fine, (Document 27): Patient Information address, next of kin, person to notify, guarantor, patient employer, occurrence codes, Insurance Information Primary VA21, Secondary Insurer, Physician Information, and Documentation. But, Children admissions office could not access any other in/out patient admissions records. This one six years old, still up as none paid, but the one partially paid or written off not available to update and bill the proper insurers. Instead, billing me writing it all off as bad credit. The HCS code on the page is not Sunrise Hospital, HCS 7943 and HCS: 0081 where the two other bills have the right Sunrise HCS Codes 9999 and HCS 9715. (Document 17, 18, 19, 27, 28, 29).

So, the next day, I decided to go to records and get the printout of the in/out patient admissions records and saw that there was coordination to stick me with the bill after the 2/16/2019. Patient Information is mostly incorrect: address, next o kin, person to notify, guarantor, patient employer, occurrence codes, Insurance Information Primary VA21 was not there, Secondary Insurer that only covers inpatient visits was put as my primary, Then Sunrise billed them for only an outpatient visit, reducing the bill and not sending notes of the inpatient stay in ICU nor MRI; making $13,000 worth of treatment just disappear as a write-off or for that matter, maybe the entire $20,000 written off by Nashville. But, then billing $7000 dollars, or $20,000 of that write-off as only an outpatient stay to the insurer that only pays inpatient stays, Medicare Part B. They never billed the VA any part of the bill nor does the Insurer, Medicare A, that pay inpatient stays. I have a Doctor’s appointment November 2, 2019 and I am still receiving medication; so I am a patient and should be covered as a Veteran. Fee Basis has not said I was not covered. This is someone doing someone a favor, maybe insurance billing fraud, at a high level under Assistant Director of Patient Billing Customer Service Assistant. Later, that day, I visited the ER at Sunrise and spoke with the same young lady that I saw before that checks insurance. She no longer had he VA as an Insurer, and I asked her to update what she had. She tried and said only the people with backend access could change insurers. That would be Assistant Director of Patient Billing Customer Service.

On 8/22/2019, I received a bill from Sunrise, Nashville, TN office that March 28 and 29 payment had a $0.00 balance. Yes, I knew that Billing Customer Service Representative 1, Billing Customer Service, showed me that it had been written off in my name. But, I think this is insurance fraud maybe by someone not billing my insurers proper and sticking my credit with the bill; which may show up a couple years later on my credit report (Billing document page 41).

I decided to stop by Billing Customer Service at Sunrise on Friday, one last time, before sending Mr. Collins a Response to see what had changed since the voice mail left with the Assistant Director of Customer Service.

I went into the office and she, Assistant Director of Customer Service, was walking through about at the same time and said she had some more information for me. She said she only had this position for about three weeks moving from Florida which explains some of the things she was unfamiliar with and had no prior involvement in what some individuals in charge before her arrival were already doing. But, they seemed to have her certain protocol dealing with my account consistent with the motive listed below about the network of individual’s associated or contracted out with the VA. She showed me a worksheet that she had been investigating my account, or had someone else relaying her answers to her (Billing Document #42, #45, #46). She showed me another printout that said she had been working with the VA since 8/19/2019 on the account from 2/16/2019 and 03/28/2019 (Billing Document 45). 3/28/2019 had been reduced more than the previous printout on the same bill to $578.57. But from what she said, she was not billing the whole bill, but two bills similar to what they were billing me.

The 5/28/2019 and 05/28/2019 bill still had a zero balance. The Inpatient bill, ICU and MRI, just disappears (Billing Document 46) and the outpatient bill still only exist billed to the VA ((Billing Document 45). There was no attempt to rebill any part (Billing Document 45 and 46) to my insurer that covers inpatient stays. She said Sunrise does not consider my impatient stay, impatient stay. But, they do not bill it as an outpatient visit either. It has that MRI and ICU stay which proves severity of injury. She also states that the $105, 988 from 2013 was billed the same to my second insurer as an outpatient stay. I stayed in their for about 12 days and thought at the beginning that I was going to die with this stomach surgery things were so bad. I will resend the VA, and request that they pay this bill so it will not affect my credit. They can't have their nurses say this was not an emergency. The printout have Nashville West as the biller; probably, the same people who sent me the paid bill with a $0 Balance from Nashville for now. But, I was told the 2013 bill was paid to have it show up six years later with no write downs and no payoffs as still owed on the Sunrise Computer Screen (Billing Document #20).

I noticed it said on Document 42 that, "No bill has been sent to you." Well, I did get that paid bill on August 22, 2019 who had my right address. I requested she update my information on this account on the computer. She acted reluctant by first saying she could not pull it and she did not have access. She requested me give her the information and she would have someone do it. I said I would come back next week to see the person that was out, one person was out today, and she asked me to wait a minute. She left and came back and was able to pull up the account. The address and insurers information had not been updated that I gave to the lady in children admissions office. Assistant Director of Customer Service said that the information updated across all systems after 24 hours. I told her that a person in the Atlanta billing told me that each account had to be individually changed manually. I handed her the sheet (Collins Document 8) that I had updated for the account to put in all correct information. I asked her why the HCS number was different on this one bill. She said the HCS depends on the hospital that I attended. I told her that I only been to this one Hospital for these three bills. Then she said the HCS depends on the section, like radiology, ER, ICU that I was in. But, she did change it to what the other two had. Assistant Director of Customer Service, was hesitant to change the VA as my Primary Insurance, stating that she had to get approval that they were my insurer. I told her I had a Doctor appointment November and receiving meds so they were. She said a few other reasons why not to put them on the 3/28/2019 and 3/29/2019 account. I pointed out Document 42 that she said that she had billed them 08/19/2019 and working with them, so they would have to be my insurer. She them put them as the primary insurer and gave me a printout (Billing Document). After I left, while putting this information in the computer. Assistant Director of Customer Service had given me a copy of the 2013 visit updated as 03/28/2019 and 03/29/2019 update. She pulled a switch a-rooo. I probable want go see her again over this issue. The Document (Collins Document number 17) is dated today 08/21/2019 at 1023 AM. I guess in law, I would say now I know what her intent has been.

Assistant Director of Customer Service (Billing Document #42)

I went into the Hospital on a Sunday afternoon. I received the treatment and testing for what I went in for, pain in the bone, from the lower right extremity swollen right leg into the right knee. The same problem that started about six months ago when I went to the Triage Nurses at the Southwest Clinic and Nurse Williams ordered an X-ray on both VA Hospital April 26, 2019 as the pain had now worsen where I had to walk off and on with a crutch for the last week to relieve weight and pressure from the leg. The cellulitis redness had come back but differently on the side of the right leg, not so much the shocks going through my leg and smoothness, the outer parts of the patch of cellulitis had risen and became more rough and puffy in skin texture. The Doctors ordered an X-ray of leg bone lower extremity, and an ultrasound of the leg to rule out blood clot causing the swelling. I requested an MRI to rule out bone infection. The Doctor explained that there could be a couple hundred bone infection or infections around the bone causing pain. I had been admitted as an Inpatient for the most part. I was given two doses of medicine, after leaving the ICU, 12 AM and 6 AM, by the nurses.

I was awoke when the nurse started the new medication going in the vein at 6 AM. I went back to sleep and woke up in an hour or so and saw that the medication had been disconnected with the bottom of the bag with much medication left. I now had a new nurse and brought it to her attention and she hooked the medication back up to my arm IV and let it finish. Later, I put it together, and more than likely Doctor Khan had ordered it stopped because it was treating my leg. Doctor Khan, a case worker assigned named Sharon had been in contact with the VA and had set up a scheme for billing purposes not to charge Medicare and make the Visit a Service Connected foot evaluation, instead of leg. Sharon talked to me about Medicare did not cover foot wound and cellulitis, and I told her I was not there for my foot, as I wrote on the paper, I was there for bone pain in the leg bone, possible bone infection around or inside the marrow, up to the knee. All previous testing had centered on this over my stay so far. So Doctor Khan, Sharon, and the VA set out to change the diagnosis visit to a foot visit. Sharon brought in the sheet below stating the treatment would be observatory with testing for the foot. I again told her that I was not here for the foot. Then two nurses came in and tried to X-ray the foot with a bedside X-ray and I declined. On the billing side Sharon had a Medicare lady come in and tried to get me to sign papers that I understood treatment, but I had not taken MRI leg, so I refused to sign them until the next day after the leg MRI. Sharon brought me the papers and she said I did not have to sign them which I did not, and after the X-ray attempt, another lady came in and said she called the VA and they were not covering it; outpatient stay which the Medicare lady said I was inpatient, until Sharon brought her documents to switch it over for the MRI to be outpatient for the foot when it was inpatient for the leg, which was covered by Medicare as inpatient. Later, they had an older gentlemen, Doctor, attempt to treat the foot again by bringing me shoes, which I tried before and considered them a cheap version of Darco Shoe which fell apart when insert sections removed, and became to flimsy to support my weight in about two weeks. I returned them to the Prosthetics place that I had got them from. So, I turned down any services from this Doctor because I knew I was not there to treat my feet; and they had no reason to observe my feet without treating my feet which they could have call a wound care person as the right foot bleed all over the end of the bed while I was sleep and one of the Resident Doctor noticed the foot redness underneath. I had no feeling and did not notice it. The skin came off the foot and the Nurse treated the foot with scissors, medication and wrapped it. Both of my nurses wrapped my feet when Doctor Khan saw problems with the feet but never wanted treatment, wound care. The MRI is for emergencies only and was for the leg and knee which were my initial inpatient stay, but Doctor Khan working with Sharon, the others, and VA did not want an MRI for my bone pain problems. So, Doctor Khan ordered my MRI for my foot and lower leg, instead of leg and knee where the severe pain had been increasing for six months. I showed the MRI person my MRI of my foot from Sunrise just months ago for six thousand dollars and requested he change the order because I had to pay for some of this and was not willing to pay for an MRI having just taken one of the foot. So, he shifted to where I identified the pain had been over the last six months and he had to do two shots because my leg was so long to the knee. But, from the MRI, he got the correct part of the knee as it identified the problem. It also look at the marrow for an bone infection that could have been around or in the bone, out of the two hundred I guess mentioned. \

He explained that with contrast put in a person’s body highlights infection if there was one. But, I did not have the feeling of warmth in my blood stream as when I took the MRI at Sunrise. I asked him why. He explained that he did not use the full recommended contrast, which was 30 units for me, and he only used 15. The medication had actually taken much of the swollenness out of my leg and reduced the bone pain in the leg, but not so much in the knee as the MRI show; and maybe the MRI leg showed, but it did not use full contrast, so some infection may have been there but not highlighted. But, the severe pain in the leg did not exist as much after three bags of anti-biotics.

But, still the top part of the ankle was mentioned in the report to maybe still try to connect the MRI to being a foot MRI which it was really not, but maybe grasped the bottom leg where the ankle attached.

They wanted to disprove the foot injury; why there was no wound care person called in three days. But, Khan could not comment as she was a part of my last visit there when they pulled something suspicious about I had a heart attack, when I had a head injury. It was rigged to mimic my heart attack of 2009 so Khan could do the work to disprove by ordering test that I did not need; at least not for the head injury that they again switched for a Service Connected issue CAD. The heart attack I had in Virginia came while lifting boxes with a lot of pain for hours. The one they staged, I had no pain, but a Doctor wrote a suspicious sentence that could seem I had pain to get me in the door; then another Doctor at UMC wrote a suspicious misdiagnosis that I had heart surgery in the past to qualify Khan to do certain test that I probable showed no signs of needing.

I had two roommates. On my third day, the second was moved out while I was sleep. I was awoken by this large black gentlemen screaming of a tooth ache talking about the nurses lied to him. He pulled my curtain back so he could watch me differently from my other two, which we kept the dividing curtain closed. He then ate a full breakfast and talked on the phone for an hour or so, which did not seem to be the symptoms of three severe teeth that swollen so large that he was going to need surgery to extract them. He was not on any anti-biotics to reduce the swelling. He tried to have a couple conversation with me before I left about 2 hours into his stay. Other than the foot, the tooth, was the second major Service Connection they, the VA wanted to disprove.

When Khan came in the second day, she dismissed my leg pain as neuropathy. The third day, she switched all doctors on the team from my last two days, and switched my Nurse, whom I saw, when I requested AMA forms, leaving without doctors permission forms, "Against Medical Advice." After this new roommate, service connection, and the attempt they tried to turn my visit into a foot visit on the second day, and the three billing people deception actions time with each other to not bill Medicare, and not bill the VA, as the balance of the bill was made out for a couple hundred dollars which I presumed they billed me.

Research Articles on issue:

Under the Veterans Claims Assistance Act (VCAA), when VA receives a complete or substantially complete application for benefits, it must notify the claimant of the information and evidence not of record that is necessary to substantiate the claim, including apprising him of the information and evidence VA will obtain versus the information and evidence he is expected to provide. 38 C.F.R. § 3.159 (2015). Retrieved from: https://www.va.gov/vetapp07/files1/0700871.txt

The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107 (West 2014); 38 C.F.R. Retrieved from: https://www.va.gov/vetapp15/Files4/1529414.txt

The Board notes that under Johnson v. McDonald, 762 F.3d 1362 (Fed. Cir. 2014), a Veteran may be awarded an extra scheduler rating based upon the combined effect of multiple conditions in an exceptional circumstance where the evaluation of the individual conditions fails to capture all the service-connected disabilities experienced. Retrieved from: https://casetext.com/case/johnson-v-mcdonald-3

See 38 C.F.R. § 19.9 (2015). VA has a duty to make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate the claims for the benefits sought, unless no reasonable possibility exists that such assistance would aid in substantiating the claims. 38 U.S.C.A. § 5103A (a) (West 2014); 38 C.F.R. § 3.159(c), (d) (2015). Retrieved from: /WST.aspx

My last X-ray at the VA, the person that read it, tried to disprove a lot of soft tissue problems that I currently had, when MRIs generally read soft tissue problems, and X-rays do not give good readings on soft tissue which his reading went in great detail, maybe fudged though omission of fact about x-rays and readings, saying no soft tissue injury. A true statement can be a lie with the omission of facts. I took pictures of my feet problems. On the same visit, it took several hours, I nodded off, the blood work Nurse came in, I gave her my arm, closed my eyes back, and when she finished and had left, I looked on the table and a vial of my blood still lay there. I thought that strange. I nodded back off, and woke up when a Doctor told me I had Cellulitis in my toe and the blood vial was gone. There was a lot lies, fabricated false statement, misdiagnosis, misdiagnosis, planted fabricated false evidence, in my medical records. I always wondered about that missing blood vial; or at least the blood vial the Nurse missed. If Jesus rose from the dead with his foot problems; then I would be okay too. Try walking in my shoes. The MRI and my 15 years of radiology, X-rays and MRIs and Doctor Diagnosis say something much different; more consistent with my feet injuries in the military. His X-ray much like the filament test was to prove the lie "Diabetes Mellitus with No Complications."

Skin Complications
Eye Complications
Neuropathy, Foot Complications
Heart Disease, MI Complications
High Blood Pressure, Hypertension Complications
Mental Health Complications
Kidney Conditions Complications
Gastro Complications

For me the litmus test to allege that a mistake is intentional with intent to cause an adverse effect on my disability reviews is, can the mistake be linked to adversely affecting a disability law? A typo, or repeat word, or a voice reader mistake does not meet the litmus test in my opinion.

“This technology is important because MRI scans illustrate more clearly than ever before, the difference between healthy and diseased tissue, and can provide important information about the brain, spine, joints and internal organs. It can lead to early detection and treatment of disease and has no known side effects.”

Thus, "Diabetes Mellitus with No Complications" could have been a voice error reader that meant to say with Complications; he did write that Alibi at the end of a visit, but Doctor Asistores importing the statement into my first appointment was no typo, repeat word, nor voice reader mistake, it was intentional with malicious intent to cause an adverse effect; when fruition.

Examples of Medical Malpractice according to the Board of ABPLA, Attorneys:

"Medical malpractice can take many forms. Here are some examples of medical negligence that might lead to a lawsuit:

• Failure to diagnose or misdiagnosis

• Misreading or ignoring laboratory results

• Unnecessary surgery

• Surgical errors or wrong site surgery

• Improper medication or dosage

• Poor follow-up or aftercare

• Premature discharge

Retrieved from: https://www.abpla.org/what-is-malpractice

"Fraud definition, deceit, trickery, sharp practice, or breach of confidence, perpetrated for profit or to gain some unfair or dishonest advantage" https://www.dictionary.com/browse/fraud

"When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant." 38 U.S.C.A. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Retrieved from: https://www.law.cornell.edu/uscode/text/38/5107

Slack, Donovan. “'I Knew Something Was Not Right': Mass Cancellations of Diagnostic Test Orders at VA Hospitals Draw Scrutiny.” USA Today, Gannett Satellite Information Network, 1 Oct. 2018, www.usatoday.com/story/news/politics/2018/10/01/VA-hospitals-cancellations-diagnostic-exam-orders-draw-scrutiny/1424298002/

“Cancellations of more than 250,000 radiology orders at VA hospitals across the country since 2016 have raised questions about whether…Those hospitals are in Tampa and Bay Pines, Florida; Salisbury, North Carolina; Cleveland; Dallas; Denver; Las Vegas; and Los Angeles.” “Employees estimated they canceled thousands of radiology orders without checking first with doctors or patients, according to depositions in a discrimination lawsuit brought by four ultrasound technicians.

And https://caselaw.findlaw.com/us-federal-circuit/1016628.html

"With chronic diseases shown as such in service, or within the presumptive period after service, so as to permit a finding of service connection, subsequent manifestation of the same chronic disease at any later date, however remote, are service connected unless clearly attributable to intercurrent causes." 38 C.F.R. § 3.303(b)

Daily Kos asked who killed Stanley. Would the above be enough duress to drive a man with PTSD over the edge; suicide or suicide by cop. “Who Killed Stanley Gibson? The Military? The VA? The Las Vegas Police?” Daily Kos, www.dailykos.com/story/2011/12/23/1048214/-Who-Killed-Stanley-Gibson-The-military-The-VA-The-Las-Vegas-police

Westervelt, Eric. “For VA Whistleblowers, A Culture Of Fear And Retaliation.” NPR, NPR, 21 June 2018,

Retrieved from: https://www.va.gov/vetapp16/Files5/1637892.txt

And https://caselaw.findlaw.com/us-federal-circuit/1016628.html

Retrieved from: https://www.va.gov/vetapp16/Files5/1637892.txt

• In 2019, Writing “0” (doc 178) when there is clinical evidence that support an injury should be painful. In 2018, the courts ruled that pain was a disability. So, many will write zero problems or a zero in pain spots for everything that they never ask you about because you may disclose that there is a problem. In 2019, you may look at your records, my records, on my swollen, bleeding, osteomyelitis (doc 210, 209), cellulites (doc 214.5, 212, 213, 214, 182.5), edema (182, 182.5) (foot injury for wearing a shoe, one of the prosthetic shoes since 2013 (doc 189) they recommended, twice, that would work, I told them that it would not, and find that long after you have left the ER or Doctors office because they did not give you pain medicine, you have a person’s own pain medicine from another Doctor or over-the-counter, which people are trying not to give now to Veterans, maybe because of this court ruling, they write, ‘this injury has no pain.’ The Darco Special Prosthetic shoe is the only shoe that has worked for my feet consistently for the last six years because of the arch and pressure points relief, as an open toe sandal, in its design, I told two new Doctors and a couple new Nurses at the VA this. But the Sunrise Doctor does not write it by himself, because you told him there was pain, the other nurse wrote pain at 7 (doc 2011) and looked at the foot saying how nasty of a wound it was, and he has another nurse transcriber (178) write for him “0” pain, because there is “0” medicine prescription written, to have a second witness, a second verifier “0” pain, and of course the Nurse never saw the foot, and add own “0” pain medicine, zero swelling, so might a disability reviewer see it, there is a second verifier against the Nurse that wrote “7” and this has corrupted the record. In 2019, they corrupt the record from a person’s past diagnosis dealing with degenerative diseases, chronic diseases, pain (doc 207, 208), and need for medication by falsely writing in an instance, a twenty-five year old problem riddled with degenerative disease, as now, a normal foot and “0” pain to attempt to cut the pain medication (doc 207 208) and allow disability not to rate the “injury” anymore. Medical Malpractice is my opinion. I listened to the person investigating these false statement, misdiagnosis, misdiagnosis at Las Vegas VA on the phone, flick through about a dozen new claims by Veterans, before telling me, my claim was in another pile, an old pile, these were the new, that she sent out an email and a letter to Nurse, but “Nurse never responded” that said, I rode a scooter into her office, but could walk well, and deceptively made to changes but not to say that I did not ride a scooter into her office, manipulating adverse Social Security and Disability Law. I never ridden a scooter. I never walked with a cane into a Doctors nor Nurses office. The network firewall the incidents so they stay in the medical record. Someone went to a lot of plans to put them in the records. Veteran denied because his records are made inconsistent by the very people he trusts within; so, the Veteran turns and leave stressed and depressed, maybe suicide.

• With the utmost respect, I think there is a network of people in Las Vegas VA, maybe a person’s organization running a con-job on some, maybe many, Veterans on Disability, Applying for You may say a Veteran may lose his benefits if he complains? Well, if Veterans do not complain, they will lose them eventually anyway. Each year this network grows waiting for their next chance to coerce you out of a person’s deserved and earned benefits at the next review, 3 – 5 -7 years or so. They get better using more tactics each time; better now, after this, covering their paper trail. Many have different reasons to participate. How Institutional Discrimination works? A large portion of the overlapping population must dislike a smaller group of people in the area. It will take all parties to find a solution to this. A diagram on page 12.

• Whistleblowers and complaint filers are targeted by the network. If you were not disabled, they would not have to coerce the medical records.

6 Key issues at your C and P exam

Posted on July 2, 2012 by joeaveragevet

1. Remember the 5 P’s, they will serve you well. Proper Preparation Prevents Poor Performance. Also remember this: “If caught in a lie, you will be denied”. Don’t take a chance on getting caught, but instead be on the lookout for when the VA lies to you, like Mr. Cushman, where the VA tried to alter the Veterans records in order to deny him.

2. Know what you are going to say when the C and P exam doc says, “How are you?” While many of us automatically respond, “fine”, to this question, you may have to do lots of backpedaling if you do this. If you were thrown in jail last week for domestic violence due to PROBLEM, then don’t tell him you are “fine” today. You are not in the military any more, and your C and P exam is not the time to “suck it up” and pretend everything is ok. To reiterate, do not lie or exaggerate as that will bite you later. Instead, simply tell your doc about your worst day, as opposed to the day you felt fine.

It isn’t the examiners fault if you failed to tell him about your “incidents” and instead told him you were “fine”. He reports to the VA there is nothing wrong with you and you get denied.

4. Bring your medical records with you. Offer them to the examiner. An incomplete or inaccurate exam is a time burner.

5. Remember what the examiner stated and write it down if necessary. Review your C and P exam at your earliest convenience, and compare it to what he said, noting any discrepancies.

Catherine Trombley August 6, 2012 at 2:00 pm

Hi SSgt.
Sometimes we have to ask the C&P examiner for clarification even though the opinion is clearly stated. An opinion has to include a statement say the doc reviewed the record, and a rationale. If the C&P opinion differs from other opinions, the doc has to state why. Without a rationale, or statement of review, the opinion will not hold up. This is a legal requirement and is meant to give you the most informed opinion possible.

12/28/2000 Neurologist did EMG study: findings Abnormal nerve conduction study at the left ulnar sensory response, which shows the decreased amplitude and slow conduction velocity. Conclusion: Abnormal nerve conduction study showing electrophysiological evidence of left ulnar nerve injury. (Billing Document 65). Health South Records for the initial two weeks of physical therapy, March 21, 2000 (Documents 90 - 93). Doctor Trouach s/p fall - 10 ft. C-spine spondylitis’s (X-rays), left elbow soft tissue, trauma w/nerve (Billing Document 94). Sunrise Hospital 07/07/2000 X-rays and Diagnosis: Neck Pain and Herniated Disk (Billing Document 95 and 96, 98 and 99). Sunrise Hospital 7/11/2001. Elbow Pain. Acute exacerbation of Chronic Left Elbow Pain (Billing Document 97). C-4 Pallet broke in half and I fell about 10' landing on back and striking elbow, filled out on March 14, 2000 (Billing Document 106). First Notice System 4/4/2000. (Billing Document 107). First Report injury Supplement 4/10/2000 (Billing Document 108). Witness to fall, Jay First Notice System (Billing Document 109). Department of Business and Industry Division of Industrial Relations, Claim Registration/Index of Claims System, submitted 7/13/2000 (Billing Document 110).

C-3 Employer have me sign as employer and then sends the document to their old insurer.

This invalidated the claim. The insurer name was spelled CAN, instead of its actual name CNA. The claim number went from 81141390 (Billing Document 69) to 81143901 (Billing Document 71) when a correct claim was issued by the insurer on November 2, 2000; injured left elbow contusion and Cervical Spine from a ten-foot fall with cuts on back and left elbow 03/13/2000. There was a document that Electro diagnostic was requested by Industrial medical Group and a consult to Othro Dr. Vahey, fine doctors that I am sure, was requested by them but never approved by the insurer, RSKCo; while the insurer provided a document that they had approved the Doctors but could not contact me and I was a no show on 5/1/2000 per IMG. I had contacted IMG and they said the insurer would not approve the Doctors consult as of 5/1/2000 and they said they would contact the insurer again, and document from IMG shows they contacted the Insurer, RYSKo on 5/5/2000 (Billing Document 66) for approval and they did not approve the appointments then either; but scheduled me to see a Doctor Mashood/Mashhood about 3 or 4 weeks later (Billing Document 66).

YEARLY PERFORMANC IN THE AIR FORCE

Document 506 I created an entrance sheet for UMC with my information Copied and the reason for my admission. It included my VA card, Medicare Cards (2) new number and old number, social security number, Driver License, Social Security Card and my UNLV ID. I included the reason that i wanted to admit myself. It read, "I would like to be admitted inpatient or outpatient for blood work & MRI R Leg/Knee for bone infection ongoing for 6 months, gotten worse this weekend, with edema swelling, venous staceous changes and maybe cellulitis patch of infection differently. I would like to get treatment and "I think" bone infection possible. My pain level ranges from 6 to 7 but, I have been taking Naproxen, 'gabapentin, and Ibuprofens over the counter. A nurse from Sunrise said I may have a bone infection, with the infection coming to the surface. But, I was admitted R. Foot, not right leg problem.

Document 507 Patient Refusal of medical Care B. (Circled) i am unsatisfied with medical care and my case worker Sharon was deceptive about billing. I have refused prescription of 5 days Augmentin as being adequate treatment for my leg. Augmentin is a penicillin used for foot and skin treatment. RAJ

"Augmentin is used to treat many different infections caused by bacteria, such as sinusitis, pneumonia, ear infections, bronchitis, urinary tract infections, and infections of the skin." "Augmentin contains a combination of amoxicillin and clavulanate potassium. Amoxicillin is an antibiotic belonging to a group of drugs called penicillin. Amoxicillin fights bacteria in the body." https://www.drugs.com/augmentin.html

Document 510, 511 Sharon, case manager, billing and medical, was assigned to me by Monday morning, my second day stay, October 21, 2019. I saw how the corruption worked first hand as if I was in their office. She entered the room, told me that Medicare did not cover foot and cellulitis treatment, and I told her that I was not admitted for foot and cellulitis treatment, but a bone infection and pain from the top of the ankle pass the kneecap. I asked her to put what she was saying in writing and let me talk to supervisor. She then sent in the Medicare woman to get me sign a paper that she had answered all my questions, Document 508, 509. I refused to sign that until after my MRI and my discharge expected date tomorrow. But, i asked her was this stay inpatient, and she said yes. The MRI was scheduled at 5 PM. Then Sharon brought in Document 510, 511,"Cellulitis & wound observation are considered outpatient service per Medicare guidelines." You're a hospital outpatient receiving observation services. You are not an impatient because "your Doctor orders observation and outpatient testing." I told her again, I am not there for foot treatment nor cellulitis treatments, as everything you look at from testing to other Doctors conversation that I was there for and i refused to sign the document affirming such. She had already prearranged for a Billing person that had already talked to VA that this was now an impatient stay, that VA may cover, and the lady said the VA said they were not going to cover the outpatient stay because it was not service connected. I told her I did not wish to discuss billing today, that I would do it on my discharge date. As i said, evidence in the medical record did not support that I was there for foot treatment, and no wound care person was sent to visit me in three days. Doctor Khan tried to turn the hospital visit into a foot visit, because she was the Doctor that talked to Doctor Asistores in 2018, when I walked out because of what i thought was a scheme that dealt with disability by the two. This one seemed the same that she was trying to change this to what the VA wanted adverse information on, a foot appointment, but just observation, and no treatment as would be considered emergent care. But, nothing in the medical record showed this a foot appointment by Monday morning. Sharon set the stage where there needed to be evidence in the record of the foot and without an x-ray or MRI foot, Doctor Khan could not testify in any fashion to disability of the condition of the foot. So, a foot x-ray was scheduled, that I declined, an orthopedic prosthetic for foot was brought down, which I declined, the most absurd, because Khan did not want me to get a leg MRI and wanted to push to release me before the leg MRI because she said MRIs were for emergency only, someone turned the Leg/Knee MRI to a foot/lower leg MRI excluding the knee which i was using a crutch to relieve pressure off because of pain, and I persuaded the giver to change it to Leg/Knee MRI; for the purpose of my visit. Document 512 was what I scribbled on the back of one of the sheets of questions and answers that I was getting.

Document 513 Anne-Michelle, Ferko was the Director of Cases that Sharon had sent in. She brought a Records Release form, I told her that I would sign tomorrow, because I was unsure about getting the MRI. She brought another lady, an older black lady whom may have been the intern Director, that told me the MRI was at 5 PM. Doctor Khan came in after they left and said that she had not heard anything about the MRI being scheduled. I told her it was at 5 PM. The MRI was changed inconsistent with all my previous testing to include the foot; and the person doing the MRI used 50% half the strength for my weight to use. He previously said contrast makes infection light up like a candle; so half the contrast may not detect infection as well in soft tissue, bone, or bone marrow.

Document 514, 515, 516, 517, 518 I took medical records that were relevant to my condition to show doctors, they included Sunrise Hospital foot MRI, Sunrise Hospital 2/16/2019 and 3/28/2019 X-ray foot, VA ultrasound, 'reflux is noted on the right at the level of the proximal and mid-calf, and on the left at the proximal and mid-thigh as well as the mid and distal calf." UMC ultrasound person said that they did not do this test as part of ultrasound testing; so they would never probable discover this problem. Venous stasis changes in BLE, Leg edema, Sunrise Hospital note from 3/28/2019, Peripheral Edema swelling Note From VA 4/26/2019.

Document 520 3/29/2019 x-ray of right lower leg, Enthesopytes at the level of the patellar tendon and quadriceps tendon insertion.

"Causes of enthesopathy include: Overuse, particularly from repetitive movements, such as running or playing tennis. The most noticeable symptom of enthesopathy is pain in the area around a joint when you use that joint. You may also notice that the area of the tendon that attaches to the bones is tender to the touch." https://www.healthline.com/health/enthesopathy Enthesitis that is caused by an inflammatory disease can be persistent but often resolves in response to treating the underlying disease.

Tendons are the tissues that attach your muscles to your bones. Ligaments are what attach your bones to one another. The place where a tendon or ligament meets your bone is called an entheses. Your doctor might use the plural, entheses. Enthesopathy is an umbrella term for conditions that affect these connection points. Enthesitis is when they get inflamed and become painful because of injury, overuse, or disease. https://www.webmd.com/arthritis/psoriatic-arthritis/enthesitis-enthesopathy#1

My concern was a disease was infecting my bone causing pain at the bone. The admitting Doctor said, while laughing, there could be some two hundred, maybe, infections that could effect the bone.

Document 521 x/ray Right Knee There is spurring at the tibia spines mild spurring along the medial aspect of the knee joint. There is mild narrowing of the medial compartment. Minimal spurring noted at the patellofemoral joint Mild Osteoarthritis.

Patellofemoral arthritis affects the underside of the patella (kneecap) and the channel-like groove in the femur (thighbone) that the patella rests in. It causes pain in the front of your knee and can make it difficult to kneel, squat, and climb and descend stairs. https://orthoinfo.aaos.org/en/diseases--conditions/patellofemoral-arthritis/ When joint space narrowing occurs, the cartilage no longer keeps the bones a normal distance apart. This can be painful as the bones rub or put too much pressure on each other. Joint space narrowing can also be a result of conditions such as osteoarthritis (OA) or rheumatoid arthritis (RA).

Document 522 Department of the Air Force "Discharge from the Hospital against Medical Advice, AMA”.... Heart attack or death... standard warning. I had a preplan function to do before they wanted me to prepare for stomach surgery. The last time i stayed for 10 days. I had not prepared personal items for a long stay. I returned later that day.

Document 523 Patient Returned from AMA, as promised. ER physician. 10/28/2015 He will be transferred as we do not have any beds and do not have ERCP capabilities. Patient was refused by Nellis because they are also out of beds. I discussed the case with UMC and he was accepted by...

Colorectal cancer screen.

Tobacco use Screening: (*************NOTE: I AM A LIFETIME NONSMOKER).

Active Outpatient Mediation

1) Accu-Chek Aviva plus (Glucose)

Document 525 - 532 Pictures of foot soft tissue wounds

Document 533 UMC prints out AMA complaint on file

Document 534 Admitting Dollar

Document 535 ultrasound Cathode Duplex

CBC with auto differential (abnormal) WBC 8.4

Document 536 Doctor Cancels all plans for cardiac UMC 8/29/2019 on arrival. I was and had not been in pain and I told them that I did not think I was having or had a heart-attack.

Document 537 ECG Severity Abnormal ECG 08/31/2019 UMC

Document 538 2252 08/29/2018 Discontinued all medication

Document 539 CT Head without contrast Martinez, "CT Head with Contrast" canceled, again "contrast" may have definite problem with brain more if there was a problem other than the soft tissue swelling that was noted.

Document 540 Doctor Misdiagnoses Surgery 2018 "Cardiac Surgery" Doctor Roth Initiate Inpatient Observation 08/29/2018 2215

Document 541 Peripheral IV Patient Transferred to OTF

Document 542 Chief Complaint syncope. He presented initially to the VA hospital complaining only of head pain. 12 lead EKG abnormal.

Document 543, 544, 545, 546, 547, 548 Sunrise Hospital Wound Assessment report Photographic Wound Document Hospital admit Length cm 1.5, Width cm 1.6, and Depth cm 0.2. Open approach debridement.

Document 549 UMC CAT SCAN 3 Mild bilateral maxillary sinus disease. Sinusitis.

Document 550 Mean Glucose calculated 286 Glycohemoglobin 11.2 10/20/2019

Document 551 - 555 Lab Orders

Document 556 Glucose finger test 206 10/20/2019

Document 557 White Blood Cell 6.50 10/21/2019

Document 558 Glucose 275 10/21/2019 0130

Document 559, 560 GFR calculation requires an accurate age and gender of the patient. For African Americans multiply value by 1.21

Document 561 Glucose finger stick 249 10/21/2019 1248 Glucose finger stick 230 10/21/2018 0720

Document 562 Glucose Finger stick 249 10/21/2019 1604

Document 563 Glucose finger stick 260 10/21/2019 2041

Document 564, 565 Blood results WBC 7.40

Document 566 Glucose Finger Stick 164 (Nurse got to this value by given me a long term insulin and maybe increasing the other insulin. I complained to her that my insulin had been high since i had been there eating light meals). 10/22/2019 0737

Document 567 Radiology X-ray right tibia and fibula Soft tissue edema noted. Plantar calcaneal spur. UMC x-ray did not show as much as VA x-ray was showed the underlying problem with my leg. 10/20/2019

Document 568 Ultrasound Bilateral lower Extremity Venous Duplex impression: No DVT NOTED. They did not to the VA ultrasound, 'reflux is noted on the right at the level of the proximal and mid-calf, and on the left at the proximal and mid-thigh as well as the mid and distal calf." UMC ultrasound person said that they did not do this test as part of ultrasound testing; so they would never probable discover this problem.

Document 569, 570 CAD W/PRIOR MI (2010) had previous episode of chest pain for which he was transferred from VA to UMC, however left AMA before having any workup. Patient today has no chest pain or palpitations. Editor: Christopher Nguyen DO internal medicine. Attending provider: Nazia Khan, MD (I, nor any Doctor, said I had chest pain on that previous visit.) I did not see Resident Doctor Nguyen, UNLV School of Medicine, on my last day. Chief Complaint Leg Swelling c/o R leg cellulitis; h/o osteoarthritis on 05/19

Document 571 Neck: no neck pain or stiffness (I have chronic neck pain and on medication, misdiagnosis by Nguyen. Has new rash of right lower extremity.

Document 572 Lab Average last seven days WBC 7.23

Document 573 Misdiagnosis by Christopher Nguyen, same protocol as Doctor Watson, and bill not paid 10/21/2019 signed CN1, CN2, CN3 H P Admission notes: "male with a past history of type 2 diabetes mellitus complicated with R foot osteomyelitis x/p antibiotics coverage and recent hospitalization in 03/2019 at Sunrise Hospital, who present to UMC on 10/20/2019 with worsening L foot rash and pain. (They in the network mess up the admissions so the /admissions/discharge summary are errored which insurers/VA require to look at before considering paying bill and must be corrected, corrections at Sunrise Hospital can take from 60 to 90 day which mean the bill denied may past the 90 day denial period. Imagine a Doctor taking care of your health already has ill will to cause you harm before they know you and you know them).

Document 574 "Chest Pain" misdiagnosis, so I have to ask Denise Delgado with the racial slurs and misdiagnosing at VA Hospital ER was in contact with Kara Nguyen at UMC over the last 4 years and is the two Nguyen related and maybe Delgado know and contact both. This was a set up? Another Frame? 10/28 Kara Nguyen is the date, 10/28 that Doctor Khan put instead of the day I discharged on 10/22. doc 151, VA Triage/Time Jan 10, 2019@07:19 signed 01/10/2019 07:19 Lidia Free doc 153, Denise R. Delgado communicates with Lynda S Kruithoff, Doctor Asistores Administration Nurse Signed 01/12/2019 02:14 Denise R. Delgado /es/ Signed 01/12/2019 07:21, as night shift ends Jan 12, 2019 Letter from Dr. Asistores, a person’s IBUPROFEN 600 MG was not reordered due to a person’s history of heart disease., doc 138. But Asistores list Spine injury, ddd-c1, c3, c5, c7 as one of my major problems, she cuts pain medication because of possible heart effects from the medicine but says in the syncope’s incident that there are no significant changes in my EKG, heart, from past, 2009 heart attack till present. My prescription for IBUPROFEN was not scheduled to run out until 2020. 08/17/2018 Asistores list Hypertension as one of my major problems, she is the center of what is happening caused unreasonable excess stress, doc 134. She lists me as non-smoker in current problems, active problems which is inconsistent with any problems in the list, nonsmoking is positive effect on life and the other problems have negative effects on life; and with her other two adverse comments on smoking sends a signal that addictive smoking is maybe in fact a problem, doc 120. Nurse Delgado angrily writes after calling me a few names: "THIS Nurse ATTEMPTED TO EDUCATE PT THAT "GETTING WET" DOES NOT MAKE A PERSON ILL." (doc 18)

01/12/2019 DO ER assessment 01/12,2019 @ 02:10 bronchitis, sinusitis Low inspiratory volumes. Albuterol 90 mcg, 2000 oral inhl, 2 puffs every four hours as needed for breathing Pseudoephedrine Hcl 30 mg tab signs and symptoms of a person’s condition include trouble breathing, drainage from a person’s nose, pain and pressure in a person’s face, headache, ear pain, fever and weakness. Sinusitis comes more than likely from infected "deviated septum" that I have. Prohibited from driving or operating vehicle next 6 hours because of medication. Weight 293 pounds. A sinus infection happens when viruses, bacteria, or a fungus grow within the sinuses..."moist environment for an infection to grow. Physical Exam General Appearance, well developed, well nourished, in no acute distress (they see me simultaneous and two very different me, it would seem) The sclerae were anicteric and conjunctivae were pin and moist. Lungs revealed rhonchus breath sound. He admits to sinus pressure, sore throat, runny nose. Patient had improved on re-evaluation. (I was given a couple Tylenol and put on some sort of Sinus breathing machine for about twenty-minutes to half-hour and check for nasal pneumonia with soaves by the Nurse. I was given chest x-rays with by a portable machine by radiologist person.

Document 575 Susan Yiquan Sun (Resident), MD Right lower extremity rash, suspicion for non-purulent cellulitis diabetes mellitus, uncontrolled and complicated by peripheral neuropathy 10/22/2019 this is what Doctor Khan diagnosed on 10/21/2019 and I told her that there was more problems than leg neuropathy. I have not had leg neuropath in the last 10 years or so, since foot neuropathy. The onset of the pain I had was not Neuropathy solely. I demanded an MRI. She said they were for emergency only. Bone pain was an emergency. Patient not seen by me on day of d/c - left AMA. Nazi Khan did not see me on the final day to write false discharge so she messes up the Discharge summary by writing twice: Attestation signed by Nazi Khan, M. D. at 10/28/2019 1:14 pm as cosigner when Sun, MD (Resident) write, and right beside her the correct date 10/22/2019 10:15 when I left AMA. Nazia Khan extends the time past 11 AM when she is setting right beside Sun, when I left. After, showing Khan the AMA, the Nurse refused to give me a copy and hid the document deep in a pile of papers, only to give me a copy at the direction of the Head Nurse when I complain to the Doctor team that she was with. They change the form over a year, before there was a yellow duplicate copy so the patient has to get a copy; now, it is only a one-sided white piece of paper. Khan sent Sun in to tell me about release, it would be determined neuropathy, cellulitis, and i would not be allowed to see MRI nor X-rays before released with 5 days anti-biotics. I AMA as improper diagnosis and treatment for my leg and knee pain. The Doctor said I was there on a crutch to relieve pain off the knee, I left with the same crutch. To, help out Asistores, VA problems.

576 - 577 additional evidence

Document 578 MSK pain to palpation of R distal leg where mild erythema and rash is present, otherwise no other gross deformities of upper and lower extremities.

Document 579 patient seen by myself and ER Resident under my supervision. I did examine the patient and directed the emergency department care. Patient complains of increasing right lower leg redness and pain. The patient does have a history of previous osteomyelitis and recurrent cellulitis. .. Right lower extremity is slightly more swollen than the left with 3+ edema is of somewhat warm to the touch over the anterior lower leg. Likely consistent with mild cellulitis. Patient had a negative ultrasound for DVT as well. No signs of sepsis. Patient started on IV antibiotics and will be admitted overnight for... Agree with resident evaluation and management. Doctor, DO

Document 615 UMC MRI Impression read by Desert Radiology, Polner MD:

This MRI describes also what is going on in my ankles and my left knee. I thought it was affecting my elbow joints but I don't see that in my reading; this may be something else.

1. Osteomyelitis not identified.

2. Diffuse subcutaneous edema consistent with cellulitis.

3. Degenerative changes in the medial distal femur with cortical erosions, subchondral cystic change and ill-defined marrow edematous change consistent with stress reaction or posttraumatic change. Joint effusion and Bakers cyst. Mild inflammatory change of the knee UM

History: Leg Infection Comparison to: Tibia x-ray of 10/20/2019

Technique: multiplanar pre postcontrast

MR imaging of the right tibia. Multihance, 15mL (30 ml is recommended for my body weight via technician). Performed 10/21/2019 1928 / 7:28 PM

Ordering Provider: Christopher Viet Nguyen, DO 10/21/2019

Other Findings: moderate diffuse subcutaneous edema without abscess formation.

There is a large joint effusion and there is a small Baker's cyst.

Smooth thin synovial enhancement noted in the knee.

Fluid distends the tendon sheath of the flexor hallux longus at the ankle.

Small cortical erosion in the inferior aspect of the medial femoral condyle with moderate ill-defined edematous change in the adjacent bone marrow.

There are degenerative signal intensity changes in the medial meniscus.

Ill-defined marrow edematous

"Bone marrow edema is a term used to describe the build-up of fluid (edema) in the bone marrow. ... Bone marrow edema is a condition that can be identified on an ultrasound or magnetic resonance imaging (MRI) scan and is often associated with osteoarthritis, a fracture, or joint. Edematous, Avascular necrosis is the death of bone tissue due to lack of blood supply. If the bone undergoes avascular necrosis, the resulting damage might be irreversible. The healing time of a bone bruise depends on its severity. Bone bruises can heal in as little as 3 weeks or take as long as 2 years to fully repair." "Bone marrow edema most commonly occurs in the hips, knees and ankles. In this case, bone marrow edema of the knee is a main cause of localized knee and joint pain, and is only diagnosable via a Magnetic Resonance Imagining test (MRI). It is usually caused by the following scenarios: ... Avascular necrosis, or “bone death”." https://www.g2orthopedics.com/bone-marrow-edema-in-the-knee/

Current treatment of bone marrow edema does not cure the condition, but only helps in alleviating the associated symptoms. In more serious cases, surgery may be required. A common procedure for bone marrow lesions or edemas is core decompression. https://www.precisionorthosports.com/bone-marrow-edema.html

"Knee effusion occurs when excess synovial fluid accumulates in or around the knee joint. It has many common causes, including arthritis, injury to the ligaments or meniscus, or fluid collecting in the bursa, a condition known as prepatellar bursitis. NSAIDs may also be used to treat swollen joints from an injury. Along with NSAIDs, applications of moist heat or ice can help ease swollen joints and pain. Steroid medications taken orally for a short period of time may be effective in reducing painful, swollen joints https://www.webmd.com/arthritis/swollen-joints-joint-effusion Gout. Gouty arthritis usually strikes suddenly, with severe joint pain, swelling, warmth, and redness, often in the big toe (about 50% of cases). Gout causes a painful, swollen joint that's so severe that the weight of bed sheets can cause distress. It usually involves one joint when it strikes, but occasionally gout can affect more than one joint."

"A Baker's cyst is a fluid-filled cyst that causes a bulge and a feeling of tightness behind your knee. The pain can get worse when you fully flex or extend your knee or when you're active. ... Both conditions can cause your knee to produce too much fluid, which can lead to a Baker's cyst." https://www.mayoclinic.org/diseases-conditions/bakers-cyst/symptoms-causes/syc-20369950

Treatment https://www.mayoclinic.org/diseases-conditions/bakers-cyst/diagnosis-treatment/drc-20369955

"Sometimes a Baker's cyst (may mimic blood clot, aneurysm or tumor) will disappear on its own. However, if the cyst is large and causes pain, your doctor may recommend the following treatments:

Medication. Your doctor may inject a corticosteroid medication, such as cortisone, into your knee to reduce inflammation. This may relieve pain, but it doesn't always prevent recurrence of the cyst.

Fluid drainage. Your doctor may drain the fluid from the knee joint using a needle. This is called needle aspiration and is often performed under ultrasound guidance.

Physical therapy. Icing, a compression wrap and crutches may help reduce pain and swelling. Gentle range-of-motion and strengthening exercises for the muscles around your knee"

"Surrounding muscles, tendons and ligaments support the joint allowing it to move smoothly and without pain. Rheumatoid arthritis causes the normally thin synovium to become inflamed and thickened, leading to an accumulation of synovial fluid and causing pain and swelling. “Treatment for synovitis usually consists of rest and anti-inflammatory medications. Medications may include oral drugs known as DMARDs (disease-modifying antirheumatic drugs) and, in some cases, steroid injections." https://www.hss.edu/condition-list_synovitis.asp

"BACKGROUND: Tenosynovitis of the flexor hallucis longus (FHL) tendon is a condition typically found in ballet dancers and sometimes in soccer players and is related to chronic overuse. A traumatic cause for this situation, such as an ankle sprain, is considered rare." https://www.ncbi.nlm.nih.gov/m/pubmed/23199862/

"Venous stasis is probably the most common cause of diffuse cortical thickening in the tibia. The pathogenesis is uncertain; it may be due to tissue hypoxia, venous hypertension, or other local environmental change that ultimately leads to periosteal stimulation (diffuse, often asymmetric cortical thickening results)" https://pubs.rsna.org/doi/full/10.1148/rg.231015088

Failure to Diagnose, Failure to properly treat, by Doctor Khan, Doctor Nguyen, DO (Resident under Khan 10/20/2019 and 10/21/2019) and Doctor Sun (Resident under Doctor Khan 10/22/2019). These Doctors are consistent with VA Doctors and Sunrise Hospital Doctors, when the evidence MRIs, X-Rays, Pictures, Test and Labs, Patient, Medicine all say pay, they misdiagnosis, fail to diagnose, and/or right false statement, misdiagnosis, misdiagnosis, muscleskeleton "no pain" inconsistent with the evidence.

Document 578 - 586 additional medical evidence

Document 587 Back: has chronic back pain, but no acute midline back or CVA tenderness, as of interview his pain is a 6 or 7/10 then misdiagnosis "no muscle aches" Neck: "no neck pain or stiffness" 10/20/2019

Documents 588 - 590 additional medial evidence

Document 591 10/21/2019 8:32 AM Doctor Khan dismissed my knee and leg problem as peripheral neuropathy. We disagreed. She saw no reason for MRI. I told her of the bone pain and severe pain in my knee and the danger of leaving it uncheck by an MRI. I did have bone marrow infection. She more than likely pulled the plug on my IV treatment that reduced the swelling in my leg and was working reducing the pain; and wrote this misdiagnosis of my problems: "i personally examined the patient and evaluated the patient's medical history, physical examination, laboratory results/studies, EKG/telemetry, OLD RECORDS and assessment and i discussed the findings and formulated the care plan documented with the resident physician. Pt. seems to be stable with not much evidence of an acute infection at this time - will benefit from good and consistent outpatient f/u. needs better BS control. Can consider sending him home later today with outpatient f/u. khan, Nazi S. MD

592 - 599 additional medical evidence.

Document 600, 605 Misdiagnosis "ambulates with cane to reduce weight bearing on R Knee" Occupation: Self employed

Document 601: US Venous Duplex leg bilateral soft tissue edema is noted.

Document 602 Misdiagnosis: "had previous episode of chest pain" for which he was transferred from VA to UMC, however left AMA before having any workup." (NO chest pains).

Document 603 Provider Nazia Khan, MD Admission date/time 10/20/2019 3:11 PM

Document 604 Misdiagnosis Neck: No neck pain or stiffness The Doctors writing implies he read the documents previously mentioned that i left a copy with the Doctors made by the nurse.

Document 605 large singular lesion across R distal medial tibia

Document 606 Medication list

Document 607 Misdiagnosis "worsening L foot rash and pain"

Document 608 Misdiagnosis "Cardiac Surgery"

Document 609 Blood Pressure 152/77 White Blood Cell 8.40 8/29/2018

Document 610 Mild bilateral maxillary sinus disease

Document 611 CAT Scan Syncope, and Scalp hematoma

Misstatement Needs correction can cause false diagnosis of pain, "The patient is also complaining of any chest pain." Christian j Villaflor, MD

Document 612 Attestation: Please not this report has been produced using speech recognition and may contain errors related to that system, including errors seen in grammar, punctuation and spelling, as well as words and phrases that may be inappropriate. If there are any questions or concerns, please feel free to contact the physician for clarification. (I did not see much of this from Sunrise and UMC, unless Doctor Khan's five or so words in discharge that she could not seem to be able to get right. What I see is my litmus test:

Document 613 Smoking Status: Never Smoker Smokeless tobacco never used

Document 614 Misdiagnosis "cardiac surgery" (I never had cardiac surgery) "ambulates with cane"

Document 615 MRI UMC

Document 616 MRI TIBIA FIBULA RIGHT W WO CONTRAST Nguuyen, DO 10/21/2019 6:30 PM

Document 617 Admission to the Hospital

Document 618 Racial Slur used by Doctor Asistores, and I think n she was forced to admit that I was a non-smoker, was calling me a "she' as a homosexual man. Misdiagnosis; 'This is similar to prior cellulitis of the lower extremity for which "she" was treated and released from Sunrise Hospital March of 2019. Misdiagnosis: "Reports subjective fever" (I do not remember saying I had a fever, I have fevers with Sinusitis, not normally foot, leg, and knee pain). ED, Document 619 - 616 I can't make out who wrote statement. Author: Nicholas Schulack, DO (Resident)? Cosigner: Jefferson D Bracey, DO

Document 619 Chief Complaint Leg Smelling, leg swelling and pain, leg swelling worsened. ER Adult ED Provider, Ed attending physician,

Document 620 Medication List

Document 621 HIV Antigen Value nonreactive Ref Range Nonreactive. Misdiagnosis "Musculoskeletal: there is full range of motion of all extremities. There is no joint pain or joint swelling erythema. There is no muscle pain or tenderness or swelling." (They set the MRI up to read the foot and lower extremity leg, and not the knee. They saw the Knee X-ray from the VA, and mention I was on a crutch.) The patch of Cellulitis patch approximately the 20 x 8.5 centimeters. The MRI room was backed up and they could not get me in until after PM.

Document 622 Hemoglobin 13.1 10/20/2019

Document 623 X-ray Tibia Ribula RLE edema, cellulitis, soft tissue edema is noted.

Document 624 On several hospital visits Doctors have noted tachycardia, but not this visit as said (achycardia refers to a high resting heart rate. In general, a resting adult heart beats between 60 and 100 times per minute. When an individual has tachycardia, the upper or lower chambers of the heart beat significantly faster.) Achycardia refers to a high resting heart rate. In general, a resting adult heart beats between 60 and 100 times per minute. When an individual has tachycardia, the upper or lower chambers of the heart beat significantly faster.

Document 625 Patient will require admission to internal medicine service for further evaluation management of their disease process. Case was discussed with resident, DR. of the admitting service, including any possible incidental findings. Admitting service kindly accepted the patient. Patient condition at admission was stable: cellulitis of right lower extremity.

Document 626, 627 Labs 2018

Document 628 Venous Duplex Exam

Document 629 Labs

Document 630 Family history Noncontributory

Document 631 Misdiagnosis Cardiac Surgery

Documents 632 - 700 Additional medical documents, request, and evidence. 10/2 0/2019 1433 or 2:33 PM 10/20/2019 1949 / 7:49 PM Diagnosis #1 add Cellulitis of right lower extremity (primary) Schulack, DO

Additional Medical Evidence

In my case, they did, and continue to do, cause, induce, incite, fabricate, cook up, frame, concoct, makeup, whatever it takes, to have an adverse effect on disability, rating, compensation, law or review; omit material evidence, hide exculpatory evidence, fabricate false documents and evidence, and then plant or exclude the evidence in my medical records. Prove "Diabetes Mellitus Without Complications" through manipulating the evidence to stop the fulfillment of compensation and or rating of injury or disease, Diabetes with complications. A Practical Guide to Appellate Advocacy, Third Edition, , Wolters Kluwer Law & Business, 2010 wrote in part P. 221 - 222 "If the law is with you, argue the law; if the facts are with you, argue the facts; [if the medical documentary evidence is with you, argue the medical record, 5000+ documents argued]; if neither [none of these] is with you, call the other guy names." The Agreement has been indefinite in nature; one building on the others past acts, like that one in the past leaves behind a corrupted part of the medical record from an active supporting role to a supporting passive role in the record.

It is my belief, Doctors, and Nurses attempt to stop compensation and rating for military injury and disease through fraud. In my opinion, the military foot injury and disease showed symptoms of Diabetes, injury, disease, in the military medical records, while in the Military, creating a Nexus to Medical connected to today's condition of a foot injury, disease, Diabetes. The Diabetes, injury, disease, Nexus is in the foot, so the secondary complication of Diabetes, injury, disease, and the Diabetes, injury, disease, Secondary's Complications may be Nexus to the foot injury and foot disease from the military. They attempted, attempting, to do the same with other Service Connected Injuries, illness, and diseases, which such acts are contrary to U.S.C.A. AND C.F.R. Codes and Regulations on Issues.

Regardless if no propensity evidence, Federal Rules of Evidence, 404 of prior acts from other cases, and even if excellent character claimed from some of these Doctors and Nurses, I believe the admissible evidence shows motive, opportunity, preparation, intent, plan, knowledge, identity, absence of mistake, lack of accident, and a final fruition of such acts. (P. 157, Fisher).

P. 313, Evidence, Third Edition, George Fisher wrote, "evidence tending to show a witness's bias, prejudice, or motive to lie is so significant that it is not considered a mere collateral matter but is deemed exculpatory evidence that may be established my extrinsic proof as well as by impeachment through cross-examination."

"Fraud definition, deceit, trickery, sharp practice, or breach of confidence, perpetrated for profit or to gain some unfair or dishonest advantage" https://www.dictionary.com/browse/fraud

Complaints emailed to Nevada Senators Cortez and Rosen; and Governor Office Susolak (Document 8).

Complaints against the following Doctors, Administrators, and/or Nurse with Document dates of specific incidents:

Doctor Melody C. Degracious date April 17, 2008 Medical Document Number 2 in this Overview writing, Nurse Judy Rodriguez date July 11, 2001 Document Number 1 in this Overview writing, wrote one statement each adverse to work comp and Social Security Disability Review, respectively. I think intentionally to disconnect records from work accident, with intention to cause harm by writing this misdiagnosed of the medical records from accident to deny any compensation, awards, reviews, or state ratings that were available to support injured workers. Much like Service Connection code-word used to attempt the same against this Veteran, discriminatory against the disable, and maybe against many others that have already died unjustly denied their benefits. Their medical treatment benefited me, but they were malicious in writing fabricated false statement, misdiagnosis, misdiagnosis to attempt to stop equal access to benefits under the Nevada/Federal Work Comp Program, Federal Disability Social Security Program, and/or the State/Federal Veterans Service Connection Program...

Doctor Tri M. Thoung wrote Service Connection in my medical records which appeared to be the first time by a Doctor which set off 5 years of Doctors and Nurses corrupting my medical records starting in 2014. Doctor Thoung coded-word, Service Connection, created a move to make Doctor Sarazan my primary care Doctor, 2014, as Doctor Asistores used twice once for a Social Security Review, 2017 conspired with three others, and another which lead into a Service Connection Review which many were willing to participate in the corrupt practice of maliciously corrupting a Veterans medical record, unless mine was one isolated case of discrimination which evidence proves discrimination may have been the case, but they are to skilled at doing it to be isolated. This complaint not filed against Doctor Kaiser. He was helpful during the incident. Case to connects false fabricated evidence from 2014 to past Social Security Case of fabricating false evidence about a "forklift fell on my head" that shows how these fabricated false statement, misdiagnosis, misdiagnosis are intentionally written with malicious intent separate the Veterans Medical Records from his/her work related injury or Service Connection disabilities. "Forklift fell on my head" is not the same injury as "10' fall from a forklift" but the medical records and conditions may have come from the later, but not considered connected to the fabricated false evidence a "forklift fell on my head" in legal matter; that could clog or bog down a case just over that issue. Saying there are two different injuries validates that the injury did not come from as "10' fall from a forklift" which could be service connected but came from a different injury "Forklift fell on my head" that may not be Service Connected. This is what fabricated false evidence does that the Doctors and Nurses with such a great number, are intentionally putting in the record discriminating against me, a Service Connected Veteran; as the evidence supports.

Doctor Asistores used the word Service Connection Documents 90 (November 17, 2017 "THIS IS A SERVICE CONNECTED VISIT: YES" [tooth dental and foot diabetes ) 93, 94, 95 (August 17, 2018 "THIS IS A SERVICE CONNECTED VISIT: no" after several complaints I wrote and requested a change of Doctor) 91, 92 ( November 16, 2018 "THIS IS A SERVICE CONNECTED VISIT: YES" foot diabetes visit and she found out she would continue to be my Doctor), 96, 97, 98, 99, 143) in my medical records as a secret code directing other Doctors and Nurses to enter false statement, misdiagnosis, misdiagnosis adverse to disability law, as many did. Doctor Toung was the first to do this in 2014, a couple months after that statement maybe from the ER/or a specialty visit, Doctor Sarazan was appointed my Primary Care Doctor where false adverse statements to Disability Service Connection became a constant put in my records when many Doctors and Nurses read this code. From Newspaper reports, Doctor Sarazan has a history of overseeing misconduct at Las Vegas VA. Doctor Asistores asserted this code again in 2017 for a Social Security Review, stopped it, with a "no" Service Connection for my visit August 17, 2018, correcting adverse statements, but with another derogatory statement, where the lie about the conversation with me smoking was removed; that lie made by Doctor Asistores to off-set my Service Connected dental injury specific and smoking also adverse to several other diseases I have, CAD, Diabetes Mellitus, etc., also at appointment November 17, 2017 she imported a false statement, misdiagnosis, misdiagnosis, "Diabetes with no Complications." (151, 152, 153, 154, 155, 156, 157, 158, 159) Asistores and Doctor Olcott, foot specialist, imported this into 2017 records, during the beginning of a November 2017 Social Security Review (Documents 91, 92, 93, 94, 95, 96, 97, 98, 99, 143). After I filed this 51-page complaint on ebenefits.va.gov to VA Central Processing for Claims, Wisconsin, and Doctor Asistores starting signing es/ as receiving documents from other Nurses and Doctors in June, 2019 catching up those not signed by anyone in nearly two months. The statement was from 2015 Shepard’s misdiagnosed of my foot injury and disease in the foot "Diabetes Mellitus without Complications." Then Asistores reasserted the quote for a foot injury November 17, 2017 and the statement Service Connected, and then the statement again Service Connected, after stating I was not Service Connected on August 16, 2018, on November 16, 2018 where three groups of Doctors and Nurses followed her orders proceeding thru 2019. Supporting Documentary Evidence for this claim and additional allegations can be found on annotated Pages: 6, 16, 181, 182, 183 While awaiting C & P exams March - June, Doctor Asistores signature did not show up on any, or very few signed notes as if she was not my Primary Care Doctor, 3/29/2019 ER Note from rewriting medication for Sunrise Hospital thru April 26, 2019 Nurses Visit was not signed by Doctor Asistores until 06/08/2019, 6/11/2019, respectively (Documents 201, 210). Along the same time, I filed complaint of not seeing any C & P doctors for the Dental or Foot for good cause, and a complaint about Doctor Garcia and his Nurse acting under false pretense as my Primary Care Doctor and Nurse, but I would see the given list if they would approve them. (Document: 193 April 25, 2019 Doctor Garcia's Nurse Triage, vs. Documents 202, 203, 204, 205, 206, 207, 208, 209, 210 April 25, 2019 VA ER Nurse, Documents: 194, 195, 196, 197, 198, 199, 200). The C & P doctors were never approved that I requested to see, Doctor Asistores and the network that she assembled was not a specialist in those fields. It was all about stopping the foot and the dental Service Connection. Air Force Medical Records pages 125 - 158).

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Allegation 1. Doctor Okechukwa Time of Incidents: November 6, 2017 - December 13, 2018 Progress Note signed by Doctor Okechukwa for or in place of Doctor Asistores. Doctor Okechukwa (Primary Care Supervisor) at Northeast Clinic and Hospital New Primary Care Clinic when there was a shift of Veterans from Northeast Clinic. After I filed this 12-page complaint (Documents 67 - 79) under Sarazan and Sheth, I was assigned Doctor Shepard on a follow up visit replacing Doctor Kaiser who approved the statement to be scanned into the medical records.

Allegation 2. Doctor Shephard. I believe Doctor Shephard , "Diabetes Mellitus Without Complications" (Document 22, 25C, 25D, 50, 51, 52, 57, 58, 59, 159, 160) put in my records on 12/08/2015 was no accident, even though he wrote an alibi on 10/24/2016 about voice recognition equipment he used (Document 14). Olcott and Asistores imported the quote into my first visit in November 2017 and I believe that may have been my first visit with Doctor Shephard. They were to continue the protocol that started under Doctor Sarazan in 2014. After I filed a complaint about the false statement, misdiagnosis, misdiagnosis being put in my medical records and they were allowed to be scanned into my medical records. My Doctor then, and Sarazan's Mily Sheth Resident were replaced with Doctor Shephard. He said he was taking over Sarazan duties with interns and at the time, I did not know that meant with the entering of statements adverse to disability law, many false, many misdiagnosed made by Doctors and Nurses. Nurse Delgado and Doctor Tran followed the protocol of corrupting Service Connected medical records during the time Shepard as Primary Care Doctor, still acting under Doctor Sarazan as he was still in Administration till the time I was moved under Sarazan, Okechukwa, and Asistores as she followed the same protocol, but became more aggressive. Doctor Shepard disable with the false statement, misdiagnosis, misdiagnosis, misdiagnosis, about me smoking, not saying I smoked, but making the statement similar to Doctor Asistores, and Shepard said I had not smoked for the last twelve months. 1 Doctors, 1 Resident, and a Nurse during my Primary Care under Doctor Shepard, and Doctor Shepard, followed Protocol set by Sarazan, Thoung's Service Connection: Yes, statement in 2014:

Allegation 3. Nurse Alejandro Delgado consulting with Olcott 11/13/2017 - 12/12/2017 (Document 110) communicating with Olcott in the notes wrote "Veteran has a bad address" when I received all this mail from the VA Before and After at the same address, and these people communicated with me fine without a phone on file, he states to adversely affect the medical records: Documents: 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124).

Allegation 4. Resident Mehendran Jayaraz went further than Doctor Shepard on the same protocol of, if treating a disabling disease, then put an adverse statement to not connect it to the Service with an alternative legal medical statement. Here, Jayaraz offset the possibility of Cancer by stating that I quit smoke. I am a none smoker, life-time as it states in my twenty-five year medical records, VA and Military.

Allegation 5. Doctor Tran, Oncology is part of and discussed in Case 4. Doctor Tran followed the same protocol of adverse false statement, misdiagnosis, misdiagnosis to disability law under Doctor Asistores writing the identical same phrase. As if, I would repeat the same phrase in two different years about not caring about my long term vision with all my visits to doctors.

Allegation 6. Doctor Cohen. The Agreement, in 2017, The Doctor in the ER made a false statement, misdiagnosis, misdiagnosis, misdiagnosis, "negative intensifier" by leaving out that I told him that I reduced my medication because of stomach pain; a lie through omission of a material fact (Document 40). It is in medical records where a Doctor and Nurse said I should do so in the future when such problems occur. The Doctor in the ER is the same Doctor that oversaw the X-ray in 2019 that I believed was fudged by omission of a material fact of what X-rays can successfully read. Doctor Cohen contacts the Ortho Doctor Olcott (Document 86) that wrote the false statement, misdiagnosis, misdiagnosis, misdiagnosis, in my medical records "negative intensifier" in 2014 and falsely states, "has been treating it with local wound care and has had several courses of antibiotics" (Document 90); the only time in life seeing her was then, and then she writes another for my second time seeing her in 2017 (Document 88). Another Doctor with opposite opinion of Cohen (Document 41). Mandy Olcott communicates with Doctor Asistores November 2017 via medical records (Document 87) start of Social Security Review.

Allegation 7. Doctor Olcott. The Agreement, the Doctor in Ortho is second in charge over my ten year foot Doctor; but she does not schedule an appointment with him, he was there and even seemed concerned and walked into the appointment to check on me, because he will not write a false statement, misdiagnosis, misdiagnosis, misdiagnosis, in my records, he never has for 10 years, not even up to 2019, like the nurse, she indirectly states how "uneducated that I am" by stating I said I attended some medical school class that I have never heard of, but it sounded like an erroneous college medical class when my major was business and law and it was a medical school college class. So, the second time only seeing her she fulfills my medical records again with false statement, misdiagnosis, misdiagnosis about I do not know how to take care of trimming my toenails; again, insinuating that I am "uneducated" with a "negative Intensifier" when other Doctors have said that I am especially skillful in such; her lie was easily disprove; as I did in complaints by testimony from other Doctors already in the records. But, it shows her malicious intent to corrupt the medical records as many are skilled at since this has been going on for over a decade. The Doctor also imported as Asistores did; the "Diabetes Mellitus without Complications" statement as her intent. Only two entries in my medical records and they both have false statement, misdiagnosis, misdiagnosis in them; 100% malicious. Air Force Medical Records pages 125 - 158).

Then there was the fabricated false statement, misdiagnosis, misdiagnosis, misdiagnosis, evidence about me saying I was ripping out my toenail (Document 93) that had not been there for over a year (Cohen Statement Document 94) (Document 95) and I have been well trained how to remove a toenail. Doctor Olcott also wrote that I said I had no foot ulcers when the referral to her I was going to the ER seeking treatment about my foot ulcers. I had no open ulcers with fluid oozing out.

05/22/2015 George B Kaiser M.D. Patient reported removing his nail with a pair of scissors, toe swollen

06/02/2015 Miley Sheth / Keiser M.D. Swelling right 2cd toe, ingrown nail removing 5 years w/scissors

11/15/2018 Olcott and Asistores in a prosthetic request wrote or signed off they had full knowledge the imported statement from Shephard was false, but this document does not get sent to Reviews, wrote, "Type 2 Diabetes Mellitus with Diabetic Neuropathy Unspecified (ICD-10-CM E11.40

How to find Fraud in Medical Records from Doctors and Nurses Putting False statement, misdiagnosis, misdiagnosis/lies to adversely affect ratings, compensation, or disability? Audit by searching the words "He" or "She" then or with advanced search "said" because this is how they have perfected this at the Las Vegas VA over the last two decades: "The Basic Formula, it is only three parts, two that stay the same, with the middle part changing. The "he" or "she" is used to relieve the Doctor or Nurse from stating the lie themselves; when you find first and third part together, you simply ask the Veteran about the lie:

First Part Second Part Third Part (The Malicious Intent)

He *Said, " "The Lie" The lie must have an adverse effect on disability, rating, compensation, law or review.
She *Said, " "The Lie" The lie must have an adverse effect on disability, rating, compensation, law, or review.
*Of course you would have to substitute "said" with derivative words* like: stated, expressed, told, reported, affirmed, mentioned, replied, asked, listened, hid, spoke, verbalized, denied, mention, ask, deny, listen, hide, say, state, speak, verbalize, reply, etc.

It appears after Social Security ruled still disabled in 2014, Doctor Shepard set off to change this by my next review, by fabricated false diagnoses, fabricating false evidence by using trickery. His nurse like James wrote normal, but like Doctor Shepard, he did not go as far as to say I smoked totally, but with an indirect implication with cover in this statement:

But, this note allowed Doctor Shepard to write:

Acting with Malicious Intent. Outrageous, one Doctor wrote in 2015 "Diabetes Mellitus with No Complications" in my medical records which is almost an "oxymoron." Only one complication, of many, that is a pun, a filament test taken by many nurses and maybe a few Doctors for foot Neuropathy for about 15 years is a complication of Diabetes that has been abnormal when always taken, 10 years before this Doctor wrote this. I had not looked at my medical records in a couple of years, did not catch before this Doctor is now long gone. But, Asistores sees it, imports it into her first Patients Notes with the false claim of smoking. But, the filament test still existed for all these years that debunks this statement by the long gone Doctor and Doctor Asistores. So, they have to get rid of the filament test IN 2018. One of Asistores's Nurses does. She does not take the filament test in the three times I saw her, but wrote the test away in the last visit, by saying in 2018, she took the test and the foot is normal; meaning no more Neuropathy "Complication of Diabetes Mellitus" that is a degenerative disease and gets worse instead of better. Her malicious intent was for her to close her notes as finished with the appointment and then open them back up with an addendum, only for the purpose of writing a lie that she took the test. The first appointment, she said she did foot exam, but I did not take off my shoes, and she put nothing for filament test; second appointment, she acknowledges that she did not do the filament test and placed no results; so she knew there was a test. But, because it is a subjective opinion, they felt it okay to write it away. The only problem, a short time later, a foot Nurse actually took the filament test, it involves a pricking device, and wrote it was as before, abnormal just after Doctor Asistores's Nurse tried to write, "Diabetes Mellitus without Complications" which was always a lie in my records. An MRI taken several months later showed signs in the reading, as read, feet peripheral neuropathy history, as well, which another Doctor and his Nurse have refused to scan the MRI, X-rays from another emergency room into the VA records system; after his Nurse said she was having them scanned in April 2019. Again, "No Diabetes Mellitus with Complications" lie ongoing; just hide the evidence; hiding the exculpatory evidence. Why would your Doctor at a normal place not want anyone to see the most recent X-Ray and MRI> Then, on a regional level, the only C & P exams they are willing to schedule me for, the only two, are the "smoking" Dental and the "Diabetes with no Complication" foot; as Asistores still shows as my Doctor as they tell me no, you have a new Doctor at a new facility. If I recall correctly, the only Doctor to ever put I was "Service Connected" in my medical records in 2017 was Asistores on this first visit, but it was not to assist me, in my opinion, it was a message to the other Doctors and Nurses, maybe in the network, on what to do, and not to further question, who saw the false statement, misdiagnosis, misdiagnosis. That prompted me filing for "Service Connected" in 2019 to get to the bottom or top of this misconduct at the VA, which my military medical records are full of Service Connections injuries and diseases. I explain later how I think Doctor Asistores and the other Doctors got the information about my military injuries or diseases way before I had any idea of what was going on; to start writing the false/lies in medical records of course. The ER Doctor determine in 2019 that my symptoms were Sinusitis, and the ER Nurse tried to disprove Sinusitis and inferred how uneducated I was; very nasty words used in my medical records when she was wrong; it was in my Service Records. The Nurse contacted Doctor Asistores or her Nurse the same day. She was one of the four, with Gouin, in a row corrupting my medical records. So, I canceled or re-dated the rest of my appointments from a few of the good Doctors and Nurse that I visited in the past that had not written any false statement, misdiagnosis, misdiagnosis in my records; yet. I finally canceled them so they would not have too. This was coming from and covered from high above.

11/16/2018 Bannick-Mohrland, SU M.D. Duration of diabetes: 20 years, tingling and pain in feet, currently being treated for foot infection of the right foot and sores on both feet. Cause: wearing a new pair of shoes order put in by Dr. Olcott which was entered a year ago and he developed blisters because they were to narrow. States he had a test at UMC several months ago that showed his circulation in his lower extremities was good. Focus exam: bandages, gait and balance using crutches; right foot sensory exam using monofilament: absent; unable to palpate due to edema; right foot skin exam color: erythema Turgor: 3+ edema; same signs documented for left foot. The patient meets criteria for diabetic footwear. Prosthetics order entered for the following diabetic footwear item: Diabetic socks (6 pair). He was added to PAVE MDs schedule for today.

6/25/2006 Henrich, Rosemary C-FNP Monofilament Sensory Exam: Monofilament exam - right foot. Abnormal only dorsal surface sensation. Monofilament exam - left foot. Abnormal loss of sensation in some plantar surface areas. Will stress staying away from meds metabolized in liver. Visual foot inspection: Findings: Skin intact but has darkened brawny areas both feet. Patient was advised to do daily foot checks, and advised that loss of sensation leads to callouses, skin breakdown, ulcers, and then possible infections. Hepatomegaly - liver extends mildly below RSB. Pedal Pulse. Dorsalis Pedis - bilateral completed. Weak but palpable. The use of non/restrictive socks.

04/15/2014 Hutton, Steven Podiatry mild edema of the right ankle, circular ulceration on the plantar distal tip of the digit measuring 12 x 9 mm. central sinus probing 6 mm in depth; however, no bone is palpated. Left foot shows mild pinch callus beneath the 1st metatarsal head with no open ulceration. X-ray show an os trigonum with calcaneal spurs both posteriorly and inferiorly. Underlying osteomyelitis. A1C 7.6 random blood sugar 150.

06/14/2013 Hutton, Steven M.D. Treatment has consisted of switching to an open sandal and application of mupirocin ointment to the ulcer sites daily. He is currently a student at UNLV. He is a non-smoker. The left foot shows a small residual site of ulceration beneath the 1st metatarsal head which is dry and nearly closed with epithelium. This area measures 2 mm x 2 mm. Neurological exam: Semmes - Weinstein filament testing is scored as 0/5 bilaterally. Dermatologic exam: right hallux shows a shallow, circular ulceration at the distal tip. This measures 7 mm x 5 mm in greatest dimension with no depth. Neuropathic ulcerations, right hallux and left foot.

11/16/2018 Lal, Pratibha B PAVE VA, Foot Exam: Hypertrophic Nails, open ulcer over the right toenail with the would measuring 0.8 x 1.5 cm pink and granular, right first metatarsal head ulcer 1.1 x 0.7 cm pink and superficial, left medial foot ulcer 1.5 cm x 1.5 cm, Monofilament diminished bilaterally, vascular clinic hand held Doppler confirmed gilateral DP and PT (PAVE is Prevention of Amputation in Patients Everywhere Program) Monofilament diminished bilaterally.

Allegation 9. Doctor Asistores. The Agreement, then, that leads to the fourth initial person in the original conspiracy in 2017; Asistores wrote false statement, misdiagnosis, misdiagnosis with the plot of proving through fabricating and planting false evidence about "Diabetes Mellitus without Complications" in my medical records that I told her I started smoking and importing the same document as Conspirator 2 into my appointment that stated, "Diabetes Mellitus Without Complications." Doctor Asistores used the word Service Connection Documents 9, 17 (November 17, 2017 "THIS IS A SERVICE CONNECTED VISIT: YES" [tooth dental and foot diabetes ) Document 10, 11 (August 17, 2018 "THIS IS A SERVICE CONNECTED VISIT: no" after several complaints I wrote and requested a change of Doctor) Document 12 ( November 16, 2018 "THIS IS A SERVICE CONNECTED VISIT: YES" foot diabetes (23 8/17/2018) visit and she found out she would continue to be my Doctor). This put back in my medical records as a secret code directing other Doctors and Nurses to enter false statement, misdiagnosis, misdiagnosis adverse to disability law, to stop compensation, rating, billing, and Service Connection, as many did. My second request for a new Doctor was March 1, 2019 (Document 13). Medication other Doctors would provide for foot infection, Asistores would not look at the foot/leg to prescribe a simple topical anti-biotic on 1/17/2019 (Document 18). This long conversation she made up we had about smoking; when I have, lifetime, never smoked (Document 19, 20, 21). Social Security Review November 2017 - September 18, 2018 (Document 24) "will not review case. 8/16/2018 medical records from Social Security Review returned (Document 24B, 25B) "8. We are unable to process information without a claim number." The Las Vegas VA Records sent medical records with no Full Social Security number. All Documents for review must have a full claim number, Social Security, to be processed. I know this. They know this. Wilkes-Barre Direct Operations Center (Document 25). 8/17/2018, After the Social Security Review was over and the medical records returned without being reviewed, Asistores retracted her fabricated false information adverse to disability law, Service Connection about smoking (Document 23). These acts go to malicious intent. I have no trace of opiates in my system 11/06/2017 because I take so little dosage of Tramadol. Under Asistores someone at Social Security Review seemed to be cooperating with the network as was the start of my Service Connected Review, Department of Veteran Affairs, Wisconsin Intake Center when they sent me several corrupted smudged out release of information forms (Document 26). My first Service Connected exams, Dental (Document 27, 30) and foot (31, 32) matched what Asistores was trying to disprove, so other Departments at the Intake Center was cooperating with Asistores Network. Work Disability Certifications (Document 28A, 28B, 29, 49, 50, 51, 52). I was under Asistores, when she worked with Sunrise Hospital to deny my 2/16/2019 billing payment as non-emergent (Document 33). Under Doctor Asistores, UMC Ultrasound found nothing because they failed to order a critical test, but VA Ultrasound found problems when under another Doctor ordered the right test (Document 42, 48A, 79, 80). Military Dental Records Service Connection (81, 82, 83, 84). 2015 Dental Records (Document 85). Air Force Medical Records pages 125 - 158).

See 38 C.F.R. § 19.9 (2015). VA has a duty to make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate the claims for the benefits sought, unless no reasonable possibility exists that such assistance would aid in substantiating the claims. 38 U.S.C.A. § 5103A(a) (West 2014); 38 C.F.R. § 3.159(c), (d) (2015). Retrieved from: /WST.aspx

Allegation 10. Priya Sundaram, Do, Radiologist X-ray Reader March 1, 2019 at VA. No soft tissue injury. (Document 34, 35, 37), in my opinion, is inconsistent with findings by Sunrise Hospital Radiologist Readers and Pictures of Foot (53, 53A, 53B, 53C, 53D, 53E, 53F, 53G, 53H, 53I, 53J) on Soft Tissue abnormalities of the right foot or toes (Documents on Abnormalities 36, 38, 39, 43, 44, 45, 46, 47, 48A, 60A, 60B, 61, 62, 63, 64, 65, 66, 67) before and after the reading by Sundaram. It is my belief that the last X-ray at the VA, the person that read it, tried to disprove a lot of soft tissue problems that I currently had, when MRIs generally read soft tissue problems, and X-rays do not give good readings on soft tissue which his reading went in great detail, maybe fudged though omission of fact about x-rays and readings, saying no soft tissue injury. A true statement can be a lie with the omission of facts. I took pictures of my feet problems.

Hind foot findings: There is diffuse subcutaneous soft tissue edema in the hindfoot. There is plantar fasciitis with thickening of the central cord of the plantar fascia and mild adjacent hyperintense edema. There is muscular atrophy with fatty infiltration.

2-16-2019 X-ray Sunrise Hospital 3186 S. Maryland PKWY, Las Vegas NV, 89109 chronic erosion of the second right toe distal phalanx with pencil tip appearance and bony sclerosis. Chronic osteomyelitis and healed osteomyelitis are considered. Moderate to severe degenerative changes of the great toe IP joint. Subacute to chronic ununited intra-articular fracture at the medial base of the right great toe proximal phalanx, best demonstrated on the AP view. Mild degenerative changes of the first MTP joint. Mild to moderate productive changes at the midfoot and hindfoot. Regional soft tissue swelling, greatest about the second toe.

It is my belief that the last X-ray at the VA, the person that read it, tried to disprove a lot of soft tissue problems that I currently had, when MRIs generally read soft tissue problems, and X-rays do not give good readings on soft tissue which his reading went in great detail, maybe fudged though omission of fact about x-rays and readings, saying no soft tissue injury. A true statement can be a lie with the omission of facts. I took pictures of my feet problems. On the same visit, it took several hours, I nodded off, the blood work Nurse came in, I gave her my arm, closed my eyes back, and when she finished and had left, I looked on the table and a vial of my blood still lay there. I thought that strange. I nodded back off, and woke up when a Doctor told me I had Cellulitis in my toe and the blood vial was gone. There was a lot lies, fabricated false statement, misdiagnosis, misdiagnosis, planted fabricated false evidence, in my medical records. I always wondered about that missing blood vial; or at least the blood vial the Nurse missed. If Jesus rose from the dead with his foot problems; then I would be okay too. Try walking in my shoes. The MRI and my 15 years of radiology, X-rays and MRIs and Doctor Diagnosis say something much different; more consistent with my feet injuries in the military. His X-ray much like the filament test was to prove the lie "Diabetes Mellitus with No Complications."

They tried to narrow the "Diabetes Mellitus Without Complication" only to the foot; which the statement to be true would also include my full Diabetes Mellitus problems in my 25 year medical records in the military and Veterans Hospital; the foot is one primary Nexus to Service Connection injury and/or disease but I have many Complications from Diabetes Mellitus as some actual Complication of Diabetes (Mellitus) are listed on the American Diabetes Association Website, such as:

In 2019, the four initial people in the conspiracy work had evolved to lie about "Diabetes Mellitus without Complications." March 2019, I requested a new Doctor and I wrote on the request document; that the Doctor Asistores is connecting many people to corruption; she stopped signing documents sent her by Nurses mainly in the medical records; the paper trail she was leaving in the medical records, she was not taking part in any more; that is, from the medical records.

In 2014, Myron Lathan was the director of the VA Records Department. I was told at the northeast Clinic, that Doctor Sarazan was over interns, and Miley Sheth was one of his interns, was assigned to be my doctor with Doctor Kaiser, head doctor for the primary care wing, over-seeing and cosigning, signing off, her work. I think Doctor Okechukwu was also assigned to that clinic. The clinic was changing to serve mostly homeless but still a primary care unit, but many of the patients were moving to the VA Hospital new primary care unit to free up room for homeless and CBOC at that facility. Doctor Sheppard was assigned to me after my surgery for observation, as he was moving to the VA Hospital new primary care. From my understanding he said he was teaching interns now. 07/05/2018, I talked to the staff at VA Hospital new primary care and this is how they explained it: Doctor Okechukwu is now head doctor for the primary care wing at VA Hospital, Doctor Sarazan is more of an administrator who fills in if needed over Doctor Okechukwu or when emergencies come up.

My Belief of The Motive in My Case
It is my belief, Doctors, and Nurses attempt to stop compensation and rating for military injury and disease through fraud. In my opinion, the military foot injury and disease showed symptoms of Diabetes, injury, disease, in the military medical records, while in the Military, creating a Nexus to Medical connected to today's condition of a foot injury, disease, Diabetes. The Diabetes, injury, disease, Nexus is in the foot, so the secondary complication of Diabetes, injury, disease, and the Diabetes, injury, disease, Secondary's Complications may be Nexus to the foot injury and foot disease from the military. They attempted, attempting, to do the same with other Service Connected Injuries, illness, and diseases, which such acts are contrary to U.S.C.A. AND C.F.R. Codes and Regulations on Issues.

Today, almost twenty years later, when "insufficient evidence" started a cover-up, one nurse working under Doctor Asistores wrote in my medical records, that I walked/ambulated with a cane which I have not in Twenty-five years at any Veteran's Hospital or facility walked with a cane and a Nurse, while I am under Doctor Asistores, Nurse Goiun wrote I rode/ambulated a scooter to her appointment, which I have never ridden a motorized scooter, anywhere; all-in-all, in a legal evidence matter, this is an attempt to frame me for disability fraud to cover-up Doctor and Nurse illegal activity calling it typos which I think is medical malpractice. If I was not disabled for twenty years, limited to certain work, not substantial or sustainable, they would not have to write lies in my medical records and maybe many other veterans records; 500,000 claims denied, if like mine, have a lot to do with Doctors under the watch of Congress writing away Veterans benefits with false statement, misdiagnosis, misdiagnosis adverse to benefits. The Records Department was deceptive in not addressing the Scooter as was Goiun in a request to remove it. It was never removed from the records nor 'the scooter lie" addressed, only the ambulating which after doing research are two totally different issues. The more complaints you file, the more you see. At one point in 2019, like four in a row, every Doctor or Nurse began to distort the record, one wrote the wrong limb was swollen, an eye doctor didn't tell me about far vision problems and said I did not care about far vision problems, left instead of right, it does not matter. Now, what if a surgeon cut off the wrong limb because of writing the wrong limb. What if I have an accident because of the Eye Doctors misconduct? I think she said that I was "happy" with the problem. But, this was under Doctor Asistores and past Primary Care Doctors that were involved in this medical malpractice act of trying to stop Veteran, I say multiple, Veterans long before they filed for any benefits by corrupting the medical records in advance; as if they should have a stake in doing so? Higher Salaries? Maybe bonuses? Maybe if they are in the network, a guarantee not to be fired and a pension awaits? They protect their benefits, but the Veteran is not worthy of such protections, not even under the law? They voted VA as the 6th best place in the Country to work; but they built a Veteran's library at the New VA, computers, copiers, medical books to read about your illness, and then banned Veterans who were using it; from using it. It was for the Nurses only. Now. They love their jobs and the New VA facility. It was built for them? But, it allows you to understand the demeanor, disability discrimination, harassment, coercion, and other malicious misconduct, of some employees at the Las Vegas VA against a Veteran (s). I can offer these employee's conduct as evidence demonstrating some of the other Doctors and Nurses included in this writing intent when writing false statement, misdiagnosis, misdiagnosis in my medical records amongst many wrongful things. In my opinion, the false statement, misdiagnosis, misdiagnosis and actions by these individuals should be excluded evidence in any form they appear in decisions making on compensation, rating, disability review, medical diagnosis, or any court decision regarding such, because they are meant to, and may, cause prejudice and misdiagnosis; with very little probative value or relevance in making such important decision in medicine; no weight should be given to such malicious intent of these statement put in my medical records.

Regardless if no propensity evidence, Federal Rules of Evidence, 404 of prior acts from other cases, and even if excellent character claimed from some of these Doctors and Nurses, I believe the admissible evidence shows motive, opportunity, preparation, intent, plan, knowledge, identity, absence of mistake, lack of accident, and a final fruition of such acts. (P. 157, Fisher).

P. 313, Evidence, Third Edition, George Fisher wrote, "evidence tending to show a witness's bias, prejudice, or motive to lie is so significant that it is not considered a mere collateral matter but is deemed exculpatory evidence that may be established my extrinsic proof as well as by impeachment through cross-examination."

"Fraud definition, deceit, trickery, sharp practice, or breach of confidence, perpetrated for profit or to gain some unfair or dishonest advantage" https://www.dictionary.com/browse/fraud

In the note below, Sheryll Paige-Williams is Doctor Garcia’s Nurse and at the appointment she was acting like his Nurse. But, in this note that Doctor Garcia signs because she is his Nurse she writes, “Veteran advised to contact their primary care team” as she is not my team. She never mention the 43 documents. She said I would meet with Doctor Garcia before I showed her the documents on my ankle. I took the bandages off the right foot to make sure she saw the condition of my leg and foot. She left the room saying the computer did not work right and came back with a different story that I would not meet with the Doctor. In my opinion, he did not want the evidence, blocked the evidence, like Monday’s fax service blocked by Central Processing Office, busy, and ebenefits.va.gov blocked by someone. I reported to the emergency room on April 26, 2019. My condition was rated as a level three and needed further treatment with maybe Zosyn.

. Priya Sundaram, Do, Radiologist X-ray Reader March 1, 2019 at VA. No soft tissue injury. (Document 34, 35, 37), in my opinion, is inconsistent with findings by Sunrise Hospital Radiologist Readers and Pictures of Foot before and after the reading by Sundaram. It is my belief that the last X-ray at the VA, the person that read it, tried to disprove a lot of soft tissue problems that I currently had, when MRIs generally read soft tissue problems, and X-rays do not give good readings on soft tissue which his reading went in great detail, maybe fudged though omission of fact about x-rays and readings, saying no soft tissue injury. A true statement can be a lie with the omission of facts. I took pictures of my feet problems.

3-28-2019 MRI Sunrise Hospital 3186 S. Maryland PKWY, Las Vegas NV, 89109 Focal swelling and wound involving the distal second toe. Chronic bone erosion with bone loss in the distal phalanx of the second toe. No acute erosion or bone marrow edema to indicate acute osteomyelitis. Diffuse cellulitis with soft tissue edema in both forefoot and hindfoot. Diffuse muscular atrophy with fatty replacement characteristic of chronic neuropathy. Chronic degenerative changes in the great toe.

Hindfoot findings: There is diffuse subcutaneous soft tissue edema in the hindfoot. There is plantar fasciitis with thickening of the central cord of the plantar fascia and mild adjacent hyperintense edema. There is muscular atrophy with fatty infiltration.

2-16-2019 X-ray Sunrise Hospital 3186 S. Maryland PKWY, Las Vegas NV, 89109 chronic erosion of the second right toe distal phalanx with pencil tip appearance and bony sclerosis. Chronic osteomyelitis and healed osteomyelitis are considered . Moderate to severe degenerative changes of the great toe IP joint. Subacute to chronic ununited intra-articular fracture at the medial base of the right great toe proximal phalanx, best demonstrated on the AP view. Mild degenerative changes of the first MTP joint. Mild to moderate productive changes at the midfoot and hindfoot. Regional soft tissue swelling, greatest about the second toe.

Additional Evidence

Block Quote Retrieved from: https://www.nbcnews.com/news/veterans/court-rules-va-must-pay-veterans-emergency-room-care-decision-n1052131

"Sept. 10, 2019, 4:00 PM PDT by Courtney Kube, Mosheh Gains and Adiel Kaplan

WASHINGTON — The Department of Veterans Affairs must reimburse veterans for emergency medical care at non-VA facilities, a federal appeals court ruled Monday — a decision that could be worth billions of dollars to veterans.

The U.S. Court of Appeals for Veterans Claims said the VA has been wrongfully denying reimbursement to veterans who sought emergency medical care at non-VA facilities, and struck down an internal VA regulation that blocked those payments.

"All of this is unacceptable," said the ruling, which ordered the VA secretary to "readjudicate these reimbursement claims."

Plaintiffs' lawyers say that based on past estimates by the VA, the department is now on the hook for between $1.8 billion and $6.5 billion in reimbursements to hundreds of thousands of veterans who have filed or will file claims between 2016 and 2025.

Aug. 16, 201900:27 Former Coast Guardsman Amanda Wolfe, one of the plaintiffs in the case, told NBC News on Tuesday, "I’m just overjoyed. I think it means change, it means that veterans don’t have to be afraid of receiving care, emergency care. They can have that sense of security that sense of peace knowing they are covered if they have emergency care." “I served side by side with some of these veterans who were impacted and to think that this is going to make a difference for them is what is most important to me." In 2015, the court struck down a previous version of the internal VA regulation that refused any coverage for an emergency claim when another form of insurance covered even a small part of the bill. The court said the regulation violated a 2010 federal law. Hard-won victory In September 2016, Wolfe went to the emergency room because her appendix was about to burst. After a speedy recovery, she figured she was all set — she had two kinds of insurance, a private plan she paid for and her Veterans Affairs benefits.

The VA's Office of Inspector General released a report in August confirming Walz's suspicions, finding the VA had improperly processed 31 percent of claims filed by veterans for non-VA emergency services and the amount of incorrect claims denied April 1 through Sept. 30, 2017 -- estimated at $53.3 million -- represented "potential undue financial risk" for roughly 17,400 veterans. The August report found that in just one recent six-month period, the VA left roughly 17,400 veterans to pay out-of-pocket for $53 million in emergency medical treatment the government should have covered.

What is causing these cost against me and other Veterans, and maybe Disabled Americans? Your underlying causes not correct? Medicare for all, but the Insurer and Doctor just won't bill Medicare, through writing misdiagnosis for patient and billing wrong insurers as in my case and many others to run the clock out on filing a timely claim!

1) Block quote retrieved from: https://www.rollcall.com/news/congress/chairmen-announce-tentative-deal-ban-surprise-medical-bills

"Behind the scenes, lobbyists for doctors, hospitals, air ambulances, insurers and large employer groups have been making the rounds on Capitol Hill. The bonanza for lobbyists and media consultants demonstrates the deep pockets of the health care industry, and the intense interest it takes in even relatively small policy changes.

Reported, TeamHealth said in a letter to several senators that it now rarely sends surprise bills, but it did use the threat of out-of-network billing to negotiate higher prices from insurance companies.

The deal struck by the two committees — the House Energy and Commerce Committee and the Senate Committee on Health, Education, Labor and Pensions.

Up to one in five emergency room visits may result in a surprise bill, but research suggests that the problem is concentrated in a small number of hospitals that contract with physicians who fail to mirror their insurance arrangements. Envision and TeamHealth, the principal companies behind the advertising blitz, have employed out-of-network billing as a broad business practice, a study by Yale professors suggests. As Axios has reported, TeamHealth said in a letter to several senators that it now rarely sends surprise bills, but it did use the threat of out-of-network billing to negotiate higher prices from insurance companies.

Surprise bills can run into the thousands of dollars, representing shocks to patients who expect their care to be covered. The issue has emerged as a major consumer concern, popping up in public polling as a top health care worry and a priority for government action.

Passage of the bill is still not guaranteed, but the bipartisan agreement substantially increases the likelihood that the legislation will move this year, most likely as part of a large government funding package expected to pass before a Dec. 20 deadline. The Congressional Budget Office has said that the approach in the deal will save the government money, making it a helpful piece to help offset other priorities.

The deal struck by the two committees shares key features with a bill the Energy and Commerce Committee passed this summer. Doctors who provide care that is out-of-network for a patient’s insurance will automatically be paid the median price of in-network doctors in the area. For certain large claims, doctors will be allowed to appeal to an outside arbitrator for reconsideration. A similar process would also apply to hospitals that treat patients in medical emergencies, and to air ambulances (the helicopters and planes that transport patients from remote areas to major hospitals). Private equity is also highly invested in the air ambulance industry."

2) Block Quote Retrieve from: http://www.softpanorama.org/Skeptics/Health/Medical_industrial_complex/medical_bill_maze.shtml

Standard practice for insurers is to negotiate with providers to pay merely a fraction of the cost. In the case of inpatient hospital bills, for example, a NerdWallet study found Medicare negotiates, on average, a 73% discount. {The VA does similar, so Teamhealth is the mechanism used to make Veterans and maybe some disabled on Social Security Medicare pay the bills instead of accepting the discount. The Doctors receive the money are represented by Teamhealth incentivizing the Doctors into misconduct to assist the insurer, VA and Teamhealth, as two examples.)

3) Block Quote Retrieve from: https://www.axios.com/teamhealth-sent-thousands-of-surprise-medical-bills-in-2017-cb405e14-7ef5-4a0b-98b5-fff37334093f.html Caitlin Owens Dec 5, 2019

"Physician staffing firm TeamHealth sent thousands of surprise medical bills to patients in 2017, a strategy used to obtain higher payment rates from insurers, according to a letter from the company sent to a group of senators in March, which was obtained by Axios.

Why it matters: These bills can be unaffordable for the small portion of TeamHealth's patients who receive them, and the subsequently high in-network rates raise premiums for everyone.

In the same letter, Murphy said TeamHealth provides emergency care to 16 million patients a year, and 26% of its patients have commercial insurance.

It collects significantly less from Medicaid beneficiaries and uninsured patients, which collectively make up about half of its patient volume.

Yes, but: TeamHealth says it no longer practices balance billing.

"TeamHealth has a longstanding policy against balance billing... To the extent balance billing occurs from a TeamHealth facility, it is rare and unintended," Blackstone's Wayne Berman, head of global government affairs, wrote in a letter to the Energy and Commerce Committee in October.

Blackstone acquired TeamHealth in 2017."

4) https://www.vox.com/2019/5/9/18551274/trump-surprise-medical-bills-congress There are at least three ways Congress could outlaw surprise bills... (But, does this article really know what is going on with Doctors, Insurers behind closed doors with patient billing?)

How large is the incentive for Doctors to participate in this scheme? Those that participate misdiagnose to disqualify patient from receiving payments from medicare and VA; as well as service connection ratings.

Block quotes, graphs, screen shots, and information retrieved from https://www.va.gov/oig/pubs/VAOIG-18-00469-150.pdf

Prior to 2019, VA paid some of my bills under the Mill Bill. I still qualify for those payments.

(In 2019 No bills have been paid by VA, one denied that i will appeal and 2013 - 2019 no bills properly billed to Medicare; so no bills have been paid by Medicare.)

Block Quote: https://www.tampa.va.gov/patients/emergency-care.asp

“Emergency Care in Non-VA Facilities

If you are having a medical emergency, you should immediately seek care at the nearest medical facility. Please go to https://www.va.gov/COMMUNITYCARE/programs/veterans/emergency_care.asp for more information on procedures and notification requirements.

In 2001, the U.S. Congress provided VA with authorization (called the Mill Bill) to pay for emergency care in non-VA facilities for veterans enrolled in the VA health care system. The benefit will pay for emergency care rendered for non-service-connected conditions for enrolled veterans who have no other source of payment for the care. However, VA will only pay to the point of medical stability. There are very strict guidelines concerning these types of claims. Veterans and their non-VA providers should be aware that these claims must be filed with the VA within 90 days from the last day of the emergent care.

How do I qualify?

This benefit is a safety net for enrolled veterans who have no other means of paying a private facility emergency bill. If another health insurance provider pays all or part of a bill, VA cannot provide any reimbursement. Veterans who retired from the U.S. military are covered by TRICARE/CHAMPUS insurance and cannot file a Mill Bill claim. To qualify, you must meet all of these criteria:

You were provided care in a hospital emergency department or similar facility providing emergency care.

You are enrolled in the VA Health Care System.

You have been provided care by a VA health care provider within the last 24 months (excludes C & P, Agent Orange, Ionized Radiation and Persian Gulf exams).

You are financially liable to the provider of the emergency treatment for that treatment.

You have no other form of health care insurance.

You do not have coverage under Medicare, Medicaid, or a state program.

You do not have coverage under any other VA programs.

You have no other contractual or legal recourse against a third party (such as a Workman’s Comp Claim or a Motor Vehicle Accident) that will pay all or part of the bill.

Department of Veterans Affairs or other federal facilities were not feasibly available at time of the emergency.

The care must have been rendered in a medical emergency of such nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health.

Should I cancel my current insurance to meet these requirements?

VA encourages you to keep all current health insurance coverage. If you cancel your current insurance, your spouse may not retain health insurance coverage and spouses of veterans generally do not qualify for VA health care. Cancellation of current insurance coverage could result in you being disqualified for reinstatement based upon any pre-existing illnesses. If you are covered by Medicare Part B and you cancel it, it cannot be reinstated until January of the next year. If you are covered by a program or plan that would pay for the emergency care received, you would not qualify for this benefit.

What is the timeline to file?

Veterans have a responsibility to ensure that the VA is notified immediately upon any hospital admission. The Community Care Customer Service can be reached at 813-903-4275. Claims must be filed with the nearest VA Medical facility to where the services were rendered within 90 days of the discharge date of medical service; otherwise, the claim will be denied because it was not filed in a timely manner.

What type of emergency services will VA cover?

VA will reimburse health care providers for all medical services necessary to stabilize your condition up to the point you can be transferred to an approved VA health care facility or other federal facility.

What about pharmacy items?

The VA’s authority for reimbursement of pharmacy items to veterans from non-VA providers follows a strict set of guidelines. The veteran must be actively enrolled in a Fee Basis Program; the pharmacy item must be considered as urgent or emergent by the initiating physician; the pharmacy item cannot be reimbursed past a 10 day supply; and the prescription and receipts must be turned in to the Fee Basis Unit. The reimbursement is based upon the U.S. Government’s Red Book cost and no taxes can be reimbursed. For answers to questions, call 813-903-4275, option 1.

Do I need to get approval before going to the emergency room?

No. If you are an eligible veteran, and a VA facility is not feasibly available when you believe your health or life is in immediate danger, report directly to the closest emergency room. If hospitalization is required, you, your representative or the treating facility should contact the nearest VA within 24 hours to arrange a transfer to VA care. Alternatively, the James A. Haley Veterans' Haley Hospital Community Care Customer Service can be contacted at 813-903-4375, option 2.

How long will I stay in the private hospital?

If you are hospitalized, and the VA is notified, the VA will be in regular contact with your physician at the private hospital. As soon as your condition stabilizes, the VA will assist the private facility with arrangements to transport you to a VA, or VA-designated facility.

What if I do not wish to leave the private facility?

VA will pay for your emergency care services only until your condition is stabilized. If you stay beyond that point, you will assume full responsibility for the payment of costs associated with treatment.

Will I have to pay for my ambulance bill to the non-VA facility?

If the VA accepts responsibility for the emergency room visit and/or admission, the ambulance will be paid from the scene of the incident to the first non-VA facility providing necessary care.

Will I have to pay for an ambulance from the non-VA facility to a VA facility?

Yes. The VA is only authorized to pay for an ambulance to go from the scene of the incident to the first non-VA facility providing necessary care. Ambulance bills are considered unauthorized claims, and must be submitted to the VA in a timely manner.

What if the private hospital bills me for services?

If you are billed for emergency care services, contact the James A. Haley Veterans’ Hospital Customer Care Service at 813-903-4275, option 1, and a representative will assist you in resolving the issue. Under the law, payment from the VA is considered as “payment in full” for the dates authorized.

What documents are required by VA to process claims for emergency care in non-VA facilities?

The following page contains a list of documents necessary for the VA to process claims for emergency care in non-VA facilities. Remember, there is a 90-day deadline to file a Mill Bill Claim once you have been discharged from the Emergency Room/Hospital. Please submit all of the documents as a packet to the James A. Haley Veterans’ Hospital Fee Basis Office. The mailing address is: James A. Haley Veterans’ Hospital, Attention Fee Basis, 13000 Bruce B. Downs Blvd, Tampa, FL 33612.

What documents to I need to provide to VA to pay for my emergency care in a non-VA facility?

Here is a checklist of all the documents you will need to provide to the VA in order for your claim to be processed: Check List (PDF)”