oldtimer92

@broncovet, thanks for your advice. I want to apologize for this long post but I wanted to give you dome history. think I could do this on my own but it seems as though every time I think I have the i’s dotted and t’s crossed then the VA sucker punches me with something else. I filed for and increase of migraines in 2015 due to fact that I developed a facial tic during and after attacks. The VA referred me to. Botox doctor to treat both conditions. My claim for facial tics was denied, so I was advice to claim the diagnosed condition secondary to migraines. And that is where this journey began. I had an intent to file done every year since the initial claim was denied in 2015 until I opted into RAMP at that point I was told I didn’t need to do one because the claim was being reviewed. That was in 2018. When the claim appeared in ramp, it again read as service connected condition and I kept telling the va that it for secondary condition and not direct service connected. During this time the VA sent me to c&p exam that was suppose to be for both conditions but the examiner was only sent DBQ for increase and not second condition. But the examiner did make remarks regarding the second condition based on my history and current condition. When decision letter came they stated the examiner did not find a connection for the secondary condition. I knew this to be false because she said that it was 50 % or greater that is was from sc condition. I went to examiner and she wrote a statement to clarify this and I sent it with the supplemental claim. So I’m thinking how can you deny something that you did not ask for an opinion for? So once the supplemental was was submitted the secondary condition’s medical terminology had been changed to another condition. I was sent to another c&p exam for that condition and the examiner said that the confirm was correct. My V and VII facial nerves were damaged and she agreed at 50 or greater as well. She also stated this would affected the sc connected migraines. She also made remarks that my right side of the face was showing symptoms as well. So when I finally see the claim was closed. First thing I see is the condition rated is not the same condition that I was sent to exam for, they have made up names that are not even listed in CFR as conditions, but as symptoms. Second thing is they rated it at the lowest percentage, when CFR clearly states those symptoms should be rated higher. Third thing I see is the also rated the right side with 0 percent with the same medical terminology that I have been using since 2015. And they did that based on remarks from examiner but did not rate the condition from the other exam based on the remarks of the examiner. i think I can explain all of this in a higher level review but think an attorney would be an option after that. Again I apologize for the long post and I hope it makes sense

Can someone riddle me this please? So how does the va get away with changing the condition that you have been trying to claim for four years and they have denied before (facial nerve disorder that secondary to migraines) give you a low ball rating on the left side affected area but not the nerve that caused it. They sent me to c&p exam for facial nerve disorder. Examiner stated 50 % or greater secondary to migraines. They made up conditions like unequal smile, unequal eyebrow raise, left side droop to face. I could only find these when looking up the nerve itself and not these as conditions. Then they rate the right side with the same condition that you have been putting on my claim and denied for in the past at 0 service connected. Changed effective date to late c&p exam in 2019 because that’s when the affected areas where listed on exam.

Thanks everyone . I was wondering the same thing in regards to her writing the statement but she volunteered to do it so I’m assuming she isn’t afraid of any backlash from VA. I do know one thing she really wanted to address was the fact that they denied the secondary claim based on the exam findings and the secondary condition was not listed anywhere to be evaluated by her. But she did address it due to our conversation and put on the medical opinion that the secondary condition was at least as likely as not (50% or greater probability) due to or the result of the service connected condition and they still denied the secondary condition. Diagnosis, connection and favorable findings. So I don’t know what really happened here.

First let me apologze for this long post. I had a NOD that was submitted in 2016, I opted into RAMP in 2018. I had a c&p done in my hometown by an outsource company called LHI. Exam was very detailed and i think that was due to the fact the examiner was prior military and she suffered the same conditions i filed on my claim. i thought the exam was for both claims because we discussed both conditions. I was requesting an increase for migraines and the other was for a secondary condition from the botox injections given for the migraines. i thought it went ver well, the examiner asked me to keep in touch and let her know how everything came out. I was estatic because I felt like I was finally getting heard. Fast forward, I get my decision and both claims are denied. The letter listed all evidence reviewed, all favorable evidence with diagnosis for each condition. The denial letter said the increase was denied because examiner only stated one episode per month and the secondary was denied because examiner did not find a connection to migraines. I was baffled and lost. But I also know how exams can go great and denials come later, so my next step was to get VSO to file an appeal. Fast forward again, Im in out at the grocery store one day and the examiner seen me and walked up to asked how things were going. I wanted to say a few choice words, but I politely told her the claims were denied and the letter stated due to VA exam findings. She told me that she remembered me and my claims because she had the same conditions. She said that was not what she put on the forms and she receiving nothing in regards to the secondary condition. She said she received a questionnaire to evaluate the migraines and a medical opinion for the migraines only. She told me to request a copy of the exam and to come see her once I received it. When I got the copy, i took them to her and she read them and wrote a statement on my behalf concening both conditions. I also had VSO to help me with my statement to include with her statement. I was told by an ex-claims rater that this may not be considered new evidence. So my question: will this be considered new evidence under the supplemental lane? Or should I have done an appeal?

Update: Went in for 2nd mental health exam. I was thinking it was another one for the claim for anxiety or a followup on the noncombat ptsd. I get there and she tells me it is for a new claim for depression. So now, I am totally lost because again my claims were for 2 other conditions. Now my question is, did VA change the condition and requested a medical opinion and will they automatically deny the other claim and I have to reapply for the new claim that I went for?? by the way, the mental health doctor did service connect me for Major recurring depression with anxious distress due to traumatic event that occurred in service. Now just waiting to see what VA can come up with now!!!

Some exams are just for the fun of it for VA. I am getting sooooooooooooooooooooo frustrated right now I can just scream!!!!!!!!!!!!!!!!!!!!!!!!! Put in claim for anxiety and another claim for Ptsd (didnt know they rated under one) ONLY after speaking with VA psychologist the first time. He eventually recommended me to speak with VA Psychiatrist for medicines to help me. Now i am seeing both of them I personally sent in my medical records with dates and hospital stay of stressor/ Buddy statements, etc. Went for exam with contractor. Spent 2 hours with him, he stated that he couldnt decide if I suffered from Ptsd with anxiety disorder and depression or more anxiety and depression. As I looked back at my sessions, I have been diagnosed with as Generalized Anxiety Disorder and Adjustment DO with depression from psychologist, but never PTSD. From VA Psychiatrist it states Insomnia, other trauma related anxiety, mood disorder, panic disorder, but AGAIN, never has written ptsd. First time ptsd was said to me was during the c&p exam by the VA contractor BUT, I am assuming the doc for the Ptsd wasnt clear enough in his wording because after all these months claim went back to gather evidence for a medical opinion and/or 2nd ptsd exam. I had requested my C-file and C/P notes in February, I am told they are behind and it could be 3-6 months before I get them. What on God's green earth could possibly be the hold up now?

Thanks Buck52 and Berta, I have copies of my medical and the event, with dates are in there along with some of the info. But my reports does not got into detail regarding the things that occurred while I was in ICU, like the hemorraging, blood transfusions, etc at the hospital. I did send in a Buddy statement from my roommate that was there with me thru the whole thing.

UPDATE: This is what the status of my claim changed to as of this morning. I submitted SMR, lay statements and VA clinic medical records, also had a C&P exam thru QTC for anixety and PTSD. Now they are wanting this, what gives? Are they trying to help me or give more reason to deny claim. We need specific details of the stressful incident(s) in service that resulted in post traumatic stress disorder (PTSD). It is important that you read the following information and respond to our request within 30 days from the date of this letter. If you do not respond, VA may deny your claim. * Complete and return the enclosed questionnaire. If you are not able to provide the exact date of the incident, please indicate the location and approximate time (a 2-month specific date range) of the stressful event(s) in question. * Provide reports of private physicians, if any, who have treated you for this condition since discharge. The reports should include clinical findings and diagnosis. * If you have been treated for this condition at a VA medical facility, furnish the date(s) and place(s). We will obtain the report(s).

Ok, in Nov '16, I sent in a letter requesting a reconsideration with new material and evidence on a decision that was denied in Dec '15. I sent this information to the Intake Center, well Dec 23, I finally just sent information again on ebenefits so I would not lose my 1 year date, but on Ebennie, I also included new claims that I was told I needed to submit. I completed the NOD form and included it with documents for the claims I disagreed. At the beginning of March claimed moved to prep for decision, then 2 weeks later it was sent back to review of evidence, the next day it moved back to review of evidence. They hadn't rated any of the claims, but they sent me a letter stating they needed a NOD form from me, but I had already sent one. So now I am waiting in Gathering of evidence. So any ideas as to why they requested that form again?

So what is going on for the claim to get stuck in prep for decision if no other documents are needed?

My claim status went to prep for decision on 3/3 but estimated date changed from April to May. I was confused on this too because no more documents needed. So why move the date further out? Thanks

I went online and googled the VA ROI form and faxed it to the intake center. It will give you the fax number to send it to. Hope this helps.

Gastone, No sir, I had a QTC exam with Psychiatrist for my claims. I have been seeing VA Psychologist for last 8 months, he has referred me to VA Psychiatrist for mental health counseling and medication regulation. Never done PTSD screenings. During the evaluations with the QTC Psychiatrist and the VA Psychiatrist, both made the statement that I have PTSD symptoms but dont fit all the criteria to be diagnosed with it totally. QTC doctor stated he couldnt make a opinion if I was suffering more from PTSD or depression.

ok, so I went to 1st mental health appointment with psychiatrist yesterday. He also said symptoms of PTSD but not full criteria. Don;t see his notes on HealthVet yet. He also wants to study mt sleep habits and feel like I may have sleep disorder. Gave me sleep diary to do for 2 weeks. Will decide on my next visit in a month if I need to do sleep study. I sent in ROI for QTC exams, I was told it could take up to 30 days to get them and claim maybe already decided by the time I get them.