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    • CUE? Not using SMR?
      Yes, if they notice the CUE they can adjust on their own.  I just had the EED adjusted on my initial claims for asthma and left ankle, the rater looked at my entire record while processing my unadjudicated claim for diabetes.  He immediately file a cue and adjusted the EED.  I didn't have to do anything for the EED/CUE. However, my ED was actually a CU they started them in 98 vs. 97.  
    • C&P Exam Results, WTH is going on, Please Help!!!
      Agree with killemall. You got this Navy04, we can't wait for you to come back here and say DONE!    
    • Code Sheet
      Thanks Asknod My problem is finding out the code for the disability.?? PTSD Code has it at 9411&9435 Code for Unspecific Depresssive Disorder VA Notes from  PCP  has PTSD  As : SCT47505003  My Sleep Apnea Notes has the code as SCT 73430006, Some of these I get confused with Insurance Codes  for Insurance Purposes. Jbasser & Jerrel Cook had a blog talk radio show on these rating codes Last year some times Maybe I'll recheck the Archives Shows. I tried to look up the code for OSA but never found it. just the SCT #73430006..?  And I have a Boo-Coo List of NSC disability's/contentions.  with the SCT# at the end of them
    • Auto Adaptive Reimbursement
      Update. My friend talked to the head of prosthetics in Tucson(kristine) and she informed him that the VA will not cover some items like power options,automatic transmissions and a few others.(I can't remember the list of things he told me).These were all covered by the VA previously.
    • NOD / DRO or TARP?
      All, Thank you for the response's. Due to me posting all of my documents intermittently, there seems to be some confusion with the timeline and issues. I will attempt to run thru this chronologically and repost all documents including my 2015 decision which I had not previously posted and answer all questions. March 2009- Filed original Claim for the following issues and received results October 2009 (see 2009 - Rating Sheet below) I do not have the entire decision packet: TBI - 10 % SC Residuals, gallbladder removal - 0% SC Back Condition - declined SC Psoriasis - declined SC PTSD - declined SC / Stressor conceded as combat action badge. October 2010 - Filed NOD / DRO for PTSD March - 2011 - Appeal decision received. I never stated that PTSD was due to MST. The paragraph on page 2 of 2011Appeal decision below is just the last part of 10 pages that I cut out covering rules and US code that they sent in the letter. The actual decision starts at the bottom of that page. Results: PTSD declined - I did not submit any new evidence. Diagnosed as "adjustment disorder with mixed anxiety and depressed mood". Blamed on me worrying about my husband returning to Iraq, even though he had just returned??? October 2014  - Initiated following claims: (I had transferred to the North Texas VA and had finally began receiving treatment after being fed up with OKC VA. I live in southern Oklahoma, so its a drive for me to go to either one) PTSD - Re-open Claim. TBI - Request for increase. May 2015 -  I reported for C&P exams at the Dallas VA clinic for PTSD and TBI. I'm not sure if this is relevant, but I received a call while my husband and I were driving there stating that the TBI examiner had to leave early and they would have to re-schedule that exam. I protested because it is a 3 hour drive. They called me back 10 minutes later stating that he would conduct the exam. He seemed pissed the whole time. His notes stated that No TBI residuals were present.  This is also the exam where the PTSD screener stated "However, it should be pointed out that most of the symptoms the veteran described during today's MH examination certainly those common to a PTSD diagnosis- she also described during her 7/8/09 Initial PTSD examination, in Oklahoma City, three years PRIOR to her son's illness."  ( see 2015 C&P exam notes below) June 2015 - Latest decision received. Results (see 2015 - decision part 1 &2 below): TBI - Decreased to 0% SC PTSD - 50% SC May 2016 - Wondering what my best next COA should be? Would like to get PTSD effective date back to 2009 and get TBI increased to at least percentage it was before. I have about 50 days to file my NOD. Q&A: Berta: What did the C & P doc diagnose you with? 2009 - TBI (SC) and adjustment disorder with mixed anxiety and depressed mood (not SC) 2015 - No TBI residuals and PTSD w/ major depressive disorder.   Berta: Have you googled the doctor who did the C & P? I do not know the Doctor's name from 2009. But I have found several articles referring to a Dr. Gail Poyner who was conducting PTSD exams at OKC VA at the time. She was fired from the VA in 2010 for applying test to Veterans to see if they were malingering or faking. Her research paper can be found here: http://link.springer.com/article/10.1007%2Fs12207-010-9076-x?LI=true I would like to have my C-File to see if she conducted the evaluation.   Gastone: What did you claim as the PTSD Stressors in your 09 app for PTSD? Combat Action Badge   Gastone: The 1st Denial, discussed "No Evidence of Personal Assault," MST? No MST ever claimed. The paragraph that covers PTSD due to MST was just the last paragraph of 10 pages of regulations that they sent with the decision. Actual decision starts at the bottom of that page.   Gastone: Did you know anything about the DRO Process Requirement, for the N & M Evidence? I did. My fault I didn't send any. I was fed up with OKC VA and assumed they would send me for a new C&P exam. Stupid on my part.   Gastone: Did you ever get a copy of your 09 PTSD C & P DBQ? No, I did not. Blue button records do not go back that far. I have requested a copy of my C-File. EBenefits states that I will get it between NOV 2017 and NOV 2018.   Gastone:  Do you currently have a VA MH Psychiatrist/Psychologist that treats you on a regular basis? I was being seen at Bohnam, TX VA. After they kept switching Dr's a few times, I now just get my meds re-filled thru my family physician. My husband is active duty, so we are on tri-care prime remote. I also qualify for VA choice, but have not used it.   Gastone: Have they given you an official PTSD DX? I have a PTSD diagnosis and receive 50% SC in 2015.   Berta: Did they have the incident reports? I faxed in two incident reports. They do not show on the evidence list, but stressor was conceded with CAB.   Flores97: Email congressman for C-File. Thank You for the advice. I emailed my congressman today and reiterated the time crunch I am under.     2011 - Appeal decision.pdf 2015 - C&P exam Notes.pdf 2015 - decision part 1.pdf 2015 - decision part 2.pdf 2009 - Rating Sheet.pdf
    • Full Knee Replacement
      I just came back from the Ortho doctor in town he said I need a full knee replacement for my service connected injury after looking at past 11 years of x-rays from the VA and what he just took today. The Marine Corps. somehow don't keep x-rays after a certain period of time. The VA says they will not do one until I'm 60 years old, all they wanted to do was give me injections for the pain. What I have now is a Torn ACL and I'm running bone on bone, and my knee cap is just about gone so here is the question. I already receive 20% for my left knee, due to the past 3 surgery's. So after having the knee replacement what will I be looking at? for an increase? Does the VA have to pay for this since I live 178 miles from the Nearest VA hospital? because they are still telling me if you were injured on active duty you must go to the VA hospital even through the VA says They will not do a knee replacement until I'm 60? I already talked to two Veterans in town at the Vet center and they had the same problem but they paid for it out of their own pocket for the surgery then filed for an increase award. So far they are still waiting for the VA to answer them back. any ideals on the best route to take? I hate to get this done out in a local hospital then fine out the VA will not pay and give me an increase for the full knee replacement. Thank for any information on this subject.
    • CUE? Not using SMR?
      I'm trying to piece together every decision and the docs from the c-file. I cannot for the life of me find the evidence listed as "treatment records from VAMC dated Sept 2003 and received 10-23-03.  Are they required to have the actual document/documents in the c-file as evidence? Also, there certainly were more progress notes about the foot conditions outside of Sept 2003. Would they have been required to get all records on condition from the VAMC?     Thanks as usual!
    • Code Sheet
      A filing for a disease secondary to an existing one is not an increase. Each disease that evolvves as a secondary is a stand alone claim. If you win, the rating diagnostic code will be an amalgam of the primary rating such as DC 7354 for hepatitis C and the second disease such as Porphyria cutanea tarda. The rating sheet would read 7354-7815. I have two like that. the other one is 7354-7700 ( 60% anemia -old 1994 DC 7700). I appealed for 100% for it based on the similarity to 4.115a (dialysis) because there was no 100% rating for porphyria phlebotomies-just 40% under DC 7704. It's called rating by analogy when there is no specific code for a disease/injury. Look at 38 CFRs 4.20 and 4.27   § 4.20 Analogous ratings. When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin § 4.27 The diagnostic code numbers appearing opposite the listed ratable disabilities are arbitrary numbers for the purpose of showing the basis of the evaluation assigned and for statistical analysis in the Department of Veterans Affairs, and as will be observed, extend from 5000 to a possible 9999. Great care will be exercised in the selection of the applicable code number and in its citation on the rating sheet. No other numbers than these listed or hereafter furnished are to be employed for rating purposes, with an exception as described in this section, as to unlisted conditions. When an unlisted disease, injury, or residual condition is encountered, requiring rating by analogy, the diagnostic code number will be “built-up” as follows: The first 2 digits will be selected from that part of the schedule most closely identifying the part, or system, of the body involved; the last 2 digits will be “99” for all unlisted conditions. This procedure will facilitate a close check of new and unlisted conditions, rated by analogy. In the selection of code numbers, injuries will generally be represented by the number assigned to the residual condition on the basis of which the rating is determined. With diseases, preference is to be given to the number assigned to the disease itself; if the rating is determined on the basis of residual conditions, the number appropriate to the residual condition will be added, preceded by a hyphen. Thus, rheumatoid (atrophic) arthritis rated as ankylosis of the lumbar spine should be coded “5002-5240.” In this way, the exact source of each rating can be easily identified. In the citation of disabilities on rating sheets, the diagnostic terminology will be that of the medical examiner, with no attempt to translate the terms into schedule nomenclature. Residuals of diseases or therapeutic procedures will not be cited without reference to the basic disease.
    • CUE? Not using SMR?
      He had 3 0% disabilities that were combined to make the 10%. I guess that ended when he was awarded 30% PTSD IN 2003. 
    • Auto Adaptive Reimbursement
      He deals with a rep in Tucson but I think that falls under Phoenix.It was the Tucson rep that told him that they stopped doing it.I found the link you posted before I asked the question on here.I just wanted to make sure it was still an active program.I will pass this on to him.Thanks.

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nanaeris

Va Doctor Did Not Have Service Medical Records

6 posts in this topic

I am in the process of going through the Appears process for an increase for bilateral knee disability. I think some of you will remember when I asked about a CUE claim about 6 month ago. I have been going through my C-File for evidence. I was discharged in November 1974. I filed a claim in 1975. I am looking at the VA C&P exam results for Osgood Schlatters Disease. The Rating Decision stated the Evidence of Record is insufficient to substantiate the clain aggravation of veteran's pre-service knee condition and the Veterans was hopitalized for myocarditis subsequent to to service. In 1999 when I reopen the case. The VA wrote me and ask me if I had a copy of my Service Medical Records because they would have to send and request them from the Air Force. I am getting the impression from this that the 1976 decision was made without my service record. I am considering filing a CUE claim based on the fact that all the evidence was not before the Rating specialist. I was granted service connection in 2001 after a long and hard fight. Also when the VA denied me for Myocarditis they fell to realize that the claim was filed within the presumptive period. My understanding is this condition is considered to be one of the presumptive condition and the VA failed to recognized this. Although I was considered to be one of the lucky ones be cause I did not have any permanment damage to my heart i was still disabled for about 3 months. Although the VA still denied my claim in 1999 I won the case on appeal. At the time I did not know about asking for an eariler effective date. My question is should I asked the V A to CUE themselves and with this kind of clear evidence, do you think the VA will still try to drag this out because it is very clear they did not have my service medical records and made a decision without this knowledge. Any advice with be greatly appreciated. I don't think I will be able to CUE this claim until I get through the current appeal concerning my knee disability. This involve where the VA had rated my knee disability un range of motion using limitation of flexion but my last C& P exam the doctor stated my range of motion under limitation of extension is limited to 20 degrees which would give me 30%. I did not think this would be such a problem if the doctor stated this in his C&P exam report. Any insight on the range of motion limitation which change for flexion to extension. I can't see the problem and the VA will not give me a clear and percise answer. this has been going on over 3 years. When I responded to the SSOC, I pointed out to the VA what the chart they had on the SSOC stated and that if another DC in this case 5261 would give me a higher rating the VA should revied the rating and what the GC stated about rating knee disabilities. I know this is the wrong forum for the last part of this topic but I have learned so much and how much research is required is to get the VA to get it right from this web site and froums. Thank again everybody for all the help. Since I join this form my percentage has went from 40% to 60%.

nanaeris

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nan,

I think you would be going about it the wrong way in filing a CUE claim for your EED.

If you have SMR's / STR's that were not of record in the original decision, that

are strong enough to have gotten an issue granted SC, then I would file a 21-4138

and refer to 38 CFR 3.156 © and request the EED due to these records.

CUE is a much harder ladder to try and climb.

JMHO,

Hope this helps a vet.

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Actually, if your claim(s) were static, (no change etc.) --- After a number of years, the VA may return your service records to the custodians. (Usually at the ST Louis Mo center) I was able to sort of trace mine from an original VA medical records request, then back to the repository for several decades, then to the VARO that is handling my current claims. It's really difficult to prove that the VA did or did not look at the appropriate records in making a decision. Often, a statement of case (SOC) is a cut and paste document, with language so general that it's actually almost useless to a veteran. I always felt that the repository should send the VA a "certified copy" rather than the original document. Fairly recently, the service record custodians were complaining that the VA was returning incomplete service records to them.

I am in the process of going through the Appears process for an increase for bilateral knee disability. I think some of you will remember when I asked about a CUE claim about 6 month ago. I have been going through my C-File for evidence. I was discharged in November 1974. I filed a claim in 1975. I am looking at the VA C&P exam results for Osgood Schlatters Disease. The Rating Decision stated the Evidence of Record is insufficient to substantiate the clain aggravation of veteran's pre-service knee condition and the Veterans was hopitalized for myocarditis subsequent to to service. In 1999 when I reopen the case. The VA wrote me and ask me if I had a copy of my Service Medical Records because they would have to send and request them from the Air Force. I am getting the impression from this that the 1976 decision was made without my service record. I am considering filing a CUE claim based on the fact that all the evidence was not before the Rating specialist. I was granted service connection in 2001 after a long and hard fight. Also when the VA denied me for Myocarditis they fell to realize that the claim was filed within the presumptive period. My understanding is this condition is considered to be one of the presumptive condition and the VA failed to recognized this. Although I was considered to be one of the lucky ones be cause I did not have any permanment damage to my heart i was still disabled for about 3 months. Although the VA still denied my claim in 1999 I won the case on appeal. At the time I did not know about asking for an eariler effective date. My question is should I asked the V A to CUE themselves and with this kind of clear evidence, do you think the VA will still try to drag this out because it is very clear they did not have my service medical records and made a decision without this knowledge. Any advice with be greatly appreciated. I don't think I will be able to CUE this claim until I get through the current appeal concerning my knee disability. This involve where the VA had rated my knee disability un range of motion using limitation of flexion but my last C& P exam the doctor stated my range of motion under limitation of extension is limited to 20 degrees which would give me 30%. I did not think this would be such a problem if the doctor stated this in his C&P exam report. Any insight on the range of motion limitation which change for flexion to extension. I can't see the problem and the VA will not give me a clear and percise answer. this has been going on over 3 years. When I responded to the SSOC, I pointed out to the VA what the chart they had on the SSOC stated and that if another DC in this case 5261 would give me a higher rating the VA should revied the rating and what the GC stated about rating knee disabilities. I know this is the wrong forum for the last part of this topic but I have learned so much and how much research is required is to get the VA to get it right from this web site and froums. Thank again everybody for all the help. Since I join this form my percentage has went from 40% to 60%.

nanaeris

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This was my orginal and first claim when the doctor made the decision and did not refer to my Service Medical Records. I thought after the first decision was denied the information would have been added to my C-file. The doctor and the Rating specialist did not refer to any thing in my Service Medical records. The doctor stated he did not have enough information to determine if my supposely pre-existing osgood schlatters disease was aggravated or not by military service. As for the heart condition, the only thing the doctor stated was he could not determine if I had permernat damage from rheumatic fever. In other words it was possible but he could'nt tell. I thought after the inital determination the information was part of the C-file. On this matter of the supposely Osgood-schallter disease the doctor stated this was unusual for a individual of my age to have osgood-schllatter disease because I was 24 years old. This is another matter I would to know about. I went into the Air Force when I was 20 years old my induction Physical did not indicate I had any thing wrong with my knees. I had other problems with my knees such as patella tendonistis, chondromalacia from injuries during some type of training and playing basketball. I had been in the military 2 1/2 years before the doctors told me I had this condition and I had it before I entered the military. The only thing I told the doctors when they asked me whether I had any knee injuries before I entered the service and I stated I injuried my knee while playing basketball when I was in the 11th grade. How they got osgood schlatters disease from this I don't know. Although I had seen orthropedics doctors for my other injuries and had x-rays they didn't state I had this condition. It was 2 1/2 years latter that the doctor at the Air Force clinic in Okinawa told me I had this condition. When I went to March AFB for an evaluation by another Orhopedic doctor he stated I had chondromalacia and patella tendonistis. The two MEB stated the condition was permanment aggaratavate by military service and after a hospital stay was able to return to duty and to wait for orders. Then they call me back to the hospital and told me I would have to finish my tour in Okinawa. The treating orthropedic doctor stated I was able to return to work without any limitations. I was then sent back to the barracks to wait for orders. After about 2 weeks I was called back to the hospital and told I would have to wait for a PEB. The PEB disagreed with the two MED and stated I had this condition and it wasn't aggravated by military service. I was told about five years ago the reason this happened the military was downsizing after Vietnam and the just found a way to get you out of the way with out paying you disability retirement because they had rated my knee disability at 20% and didn't rate my hearing loss although it appeared on my profile as a 2 which mean they knew about it and they didn't rate the heart murmur discovered while I was stationed in Okinawa because if they had rated either one at 10% combined with the 20% for knee disability they would have had to give you disability retirement. So what they did is stiffed you. If all this is true is there any thing I can do about it or is it two late and I just have to keep fighting with the VA? It is very easy to prove that I didn't have Osgood-schlatters disease before I entered the military and hearing loss and heart murmur is part of the record.

Thank you again,

nanaeris

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If the VA made a legal error in any past denied claim you have had, then you could file a CUE claim on it.

The error however must have manifestly altered the outcome-

meaning their error cost yo compensation.

There is considerable info here on CUE claims and many BVA decision posted that show how they can succeed and why many fail.

It has to be a legal error in a final decision that involves the regulations at time of the alleged CUE.

This was my orginal and first claim when the doctor made the decision and did not refer to my Service Medical Records."

Were they missing? If so the recent post here in Claims Research regarding Evidence (from Allan) might help you.

Or search hadit for "newly discovered Service Records" as this might be better approach then CUE claim.

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Sec. 3.156 New and material evidence. (a) General. A claimant may reopen a finally adjudicated claim by submitting new and material evidence. New evidence means existing evidence not previously submitted to agency decisionmakers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. (b) Pending claim. New and material evidence received prior to the expiration of the appeal period, or prior to the appellate decision if a timely appeal has been filed (including evidence received prior to an appellate decision and referred to the agency of original jurisdiction by the Board of Veterans Appeals without consideration in that decision in accordance with the provisions of Sec. 20.1304(b)(1) of this chapter), will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period. © Service department records.(1) Notwithstanding any other section in this part, at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim, notwithstanding paragraph (a) of this section. Such records include, but are not limited to: (i) Service records that are related to a claimed in-service event, injury, or disease, regardless of whether such records mention the veteran by name, as long as the other requirements of paragraph © of this section are met; (ii) Additional service records forwarded by the Department of Defense or the service department to VA any time after VA's original request for service records; and (iii) Declassified records that could not have been obtained because the records were classified when VA decided the claim. (2) Paragraph ©(1) of this section does not apply to records that VA could not have obtained when it decided the claim because the records did not exist when VA decided the claim, or because the claimant failed to provide sufficient information for VA to identify and obtain the records from the respective service department, the Joint Services Records Research Center, or from any other official source. (3) An award made based all or in part on the records identified by paragraph ©(1) of this section is effective on the date entitlement arose or the date VA received the previously decided claim, whichever is later, or such other date as may be authorized by the provisions of this part applicable to the previously decided claim. (4) A retroactive evaluation of disability resulting from disease or injury subsequently service connected on the basis of the new evidence from the service department must be supported adequately by medical evidence. Where such records clearly support the assignment of a specific rating over a part or the entire period of time involved, a retroactive evaluation will be assigned accordingly, except as it may be affected by the filing date of the original claim.

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