Looking for advice, 3rd time filing

[bernie07]

So I am going down the path again and trying to educate myself a little better this time. There is a lot more information available today than ever before and finding this site has been a great help.

Little bit of history.

I got out in 2000 and filed a claim about 30 days before I got out. I received a letter that because I filed while I was still on Active Duty that my claim was not valid.

Fast forward to 2009. Filed another claim. Denied for my knees, surgery I had on my leg while in and my liver. I did not appeal, shame on me. My liver I thought would be slam dunk since it is heavily documented in my records but I guessed wrong. I had also sent in my civilian records. I used the DAV to help.

This time I hope I am armed with information a little better information.

Here are the steps I have taken.

I have a copy of my service medical records and had copies made before I got out. I have my entrance and exit medical exams.

Online account to eBenefits

Requested a copy of my C-File Oct 21 2016 and received a letter from the VA stating they had received it. The date to fulfill the request is two years but from what I have read it can be shorter. I spoke to my DAV rep and asked about the C-File but he said I didn't need it. I was a bit taken back based on what I have read here so I requested it on my own.

Scanned all my service and military medical records into my computer and renamed them by date and ailment.

I have spoken with my PCP about my back, knees and toes and she is willing to complete the DBQ forms.

 

My liver is of the utmost concern as I have NASH with stage 4 cirrhosis and all the accompanying serious ailments that go along with cirrhosis. I will need a transplant. They denied me for cirrhosis because I was not diagnosed with it in the military. They stated it shows elevated liver functions. The closest I have to a diagnosis in the military is the internal medicine doc stating most likely NASH. This hunt actually started when the military doc who prescribed my grespeg got spooked at my elevated LFT's and sent me to internal med. From research Grespeg should not be given if there is suspected liver issues. I was told to stop taking it. I was also referred to Wright Pat AFB to see an internal medicine doc there. He left before a biopsy could be performed and I had gotten out of the military.

Once I got out I continued to see doctors and have had several labs done, everyone pointed to NASH but never had a biopsy. I finally got a  good doc who did a biopsy in Jan 2006, impression is NASH evolving to cirrhosis and elevated LFT's. I gave all this information to the VA when I first submitted my claim and was still denied. I have found two appeals documents where veterans received compensation for NASH and liver disease, one due to medication and the other for NASH. www.va.gov_vetapp08_files4_0832813 and www.va.gov_vetapp14_Files4_1431676. I am not sure how to go about using these to assist me.

Just for my liver I see a hemotologist, liver transplant specialist and internal medicine doctor, costs are out the roof even with insurance. I still have to speak with the internal and liver docs about helping me with the VA. I spoke with my hemotologist and she offered to help but then when I was ready for her to help she changed her mind and made a comment about it being a scam. I was completely perplexed and a bit deflated leaving that day. I spoke with my PCP about her comments as she is the one who sent me to her and she thought that maybe she didnt understand what it was for. I'll discuss it with her again.

I guess where I need assistance is am I going down the right path this time. I was also a little confused between the DBQ forms and the Nexus if both are needed or just one.

Thank you for any advice.

Bernie

[Berta]

"I got out in 2000 and filed a claim about 30 days before I got out. I received a letter that because I filed while I was still on Active Duty that my claim was not valid."

Do you still have that letter?

"Fast forward to 2009. Filed another claim. Denied for my knees, surgery I had on my leg while in and my liver. I did not appeal, shame on me. My liver I thought would be slam dunk since it is heavily documented in my records but I guessed wrong. I had also sent in my civilian records. I used the DAV to help."

Can you scan and attach here ( cover C file # etc prior to scanning the decision as to their rationale for the denial on all issues? And a copy of the evidence list?

Here are the BVA cases you mentioned.

http://www.va.gov/vetapp08/Files4/0832813.txt

This was a Section 1151 claim for liver disease that the VA proposed to reduce.

“In a December 2004 rating decision, the RO proposed to sever

compensation for non-alcoholic fatty liver disease under

38 U.S.C.A. § 1151 on the basis of clear and unmistakable

error in the initial grant.  Specifically, the RO noted that

the October 2004 VA examiner opined that the veteran had

liver disease prior to VA's prescribing simvastatin.”

 

BVA thought differently based on the medical evidence:

 

“In summary, it is not shown that the grant of compensation

for non-alcoholic fatty liver disease under 38 U.S.C.A.

§ 1151was clearly and unmistakably erroneous.  The burden of

proof required for severance is not met, and restoration of

compensation under for non-alcoholic fatty liver disease 38

U.S.C.A. § 1151 is warranted."

and

http://www.va.gov/vetapp14/Files4/1431676.txt

"At his August 2013 Board hearing, the Veteran testified that his liver disorder had its onset during his military service.  The Board observes that the Veteran's service treatment records reflect that the Veteran was diagnosed with fatty liver during his active military service.  In October 1999, the Veteran had elevated liver enzymes.  In January 2000, he was diagnosed with fatty liver.  In October 2007, the Veteran's liver had moderate fatty replacement.  Records dated in November 2007 reflect that the Veteran had a diagnosis of fatty liver.  He had "mildly elevated LFTs, fatty liver and normal serological [workup] most likely consistent with NASH."  July 2008 treatment notes show that the Veteran had a diagnosis of non-alcoholic fatty liver. “

 

ORDER

 

Service connection for a liver disorder is granted.”

BVA decisions cannot be used as evidence to support a claim unless they involve a legal situation.

However they hold a wealth of information that can help vets with similar claims.

1151 wont work for anything the Military does but does VA know of this?

"The closest I have to a diagnosis in the military is the internal medicine doc stating most likely NASH. This hunt actually started when the military doc who prescribed my grespeg got spooked at my elevated LFT's and sent me to internal med. From research Grespeg should not be given if there is suspected liver issues."

Did VA state they had obtained your SMRs when they denied in 2009? If so they probably never got them or if they did they probably never even read them. They also missed that inservice surgery which I assume could have involved your knees and/or back and that you still have residuals from....?

 

"I have spoken with my PCP about my back, knees and toes and she is willing to complete the DBQ forms."

Great.

I hope we are able to see the scanned 2009 decision....and a word of advice......

You are the best vet rep you will ever have...vet reps get paid whether they are good or bad....some don't have a clue on what they are doing.You might have a good one...but I dont know why your rep didnt want to see your  C  file because that older 2009 decision in it might be critical to what your next step will be with this claim....the decision will tell you exactly why they denied.....but they sure might have missed a lot in the SMRs. 

And if they did that is a CUE under 38 CFR 4.6.

 

 

 

Edited December 15, 2016 by Berta

[Buck52]

Ms Berta has great advise...listen to her!

Also if its not been mention here?

 Obviously Gather up all your military medical records while on A.D.

Any medical diagnose you been diagnosed with while in the military by Military Dr's  or Private Drs & Specialist.

This is what you need & most important to help substantiate  all your claims  while on A.D.

The CLAIM letter you had 30 days while still on A.D. is Irrelevant to the VA...VA deals with after your A.D. service  or prior military service...although your treated for medical problems while on A.D.  This is the vital information you need for evidence when filing a claim.

After you ETS from the military...then the next day or the next day or years later qualified you for Intial VA Claims  due to the fact  your medical condition was established while on A.D.

[bernie07]

Here are both of my denial letters and thank you for the advice. The one from 2002 was when I filed right as I was getting out in 2000. I remember doing this while out processing during my physical. For about a year they kept sending me a letter saying they were working on my claim. They asked me for more medical documentation but they had my SMR at the VA in Louisville, KY so I was perplexed at what else they needed. When I requested my SMR from St Louis thinking something was wrong they couldnt find them. When I filed at the VA in Waco TX they were able to find them.

 

Feb 1 2002

 

We received an application for compensation benefits from you on October 20, 2000. We sent you a

letter on April 11, 2001, requesting medical evidence to support your claim. As of this date, we have

not heard from you.

After reviewing your claim, we discovered that you were not discharged from the service until

November 6, 2000. Therefore, you were not eligible for veterans' benefits at the time of your filling.

If you wish to continue your claim, you may do so by responding on the enclosed VA Form 21-4138;

Statement in Support of Claim, within one year from the date of this letter. Your response must be

received before February 1, 2003, if you wish to be considered on your original application date.

We have stopped processing your claim until we hear from you.

 

 

 

 

We made a decision on your claim for service connected compensation received on

March 3, 2009.

This letter tells you what we decided. It includes a copy of our rating decision that gives the

evidence used and reasons for our decision. We have also included information about what to do

if you disagree with our decision, and who to contact if you have questions or need assistance.

What We Decided

We determined the following conditions were not related to your military service, so service connection could not be granted:

 

Medical Description

Left knee condition

Right knee condition

Left leg injury, surgery compartment release

Left torn hamstring

Right torn hamstring

Cirrhosis, liver disease

 

We have enclosed a copy of your Rating Decision for your review. It provides a detailed

explanation of our decision, the evidence considered, and the reasons for our decision. Your Rating Decision and this letter constitute our decision based on your claim received on March 3, 2009. It represents all claims we understood to be specifically made, implied, or inferred in that claim.

 

Represented by:

DISABLED AMERICAN VETERANS

Rating Decision

August 17, 2009

INTRODUCTION

The records reflect that you are a veteran of the Gulf War Era. You served in the Army

from April 4, 1995 to November 6, 2000. You filed an original disability claim that was

received on March 3, 2009. Based on a review of the evidence listed below, we have

made the following decisions on your claim.

DECISION

1 . Service connection for cirrhosis, liver disease is denied.

2 . Service connection for left leg injury, surgery compartment release is denied.

3 . Service connection for right torn hamstring is denied.

4 . Service connection for left torn hamstring is denied.

5 . Service connection for right knee condition is denied.

6 . Service connection for left knee condition is denied.

EVIDENCE

• Service treatment records to include treatment from Wright Patterson Medical Center

from December 1, 1994 to June 26, 2000.

• DAV memorandum and VA Form 21-526 Application for Compensation and

Pension, received March 3, 2009.

n Copies of service treatment records received March 3, 2009.

• Veterans Claims Assistance Act (VCAA) letter dated April 2, 2009.

n Supplemental letter dated June 11, 2009.

n Supplemental letter dated July 9, 2009.

• Treatment records from St Thomas Hospital from January 4, 2007 to August 24,

2008.

 

REASONS FOR DECISION

1. Service connection for cirrhosis, liver disease.

Service connection may granted for a disease which began during active military service

or active duty for training or for any injury incurred during active military service, active

duty for training or inactive duty for training. Additionally service connection may be

granted for specific diseases or conditions which are, by law, presumed to have been

incurred during service if manifested to a compensable degree within a specified period

of time, generally, one year. Service connection may also be granted for conditions

which existed prior to service if the condition is shown to have been aggravated beyond

normal progression by service.

Service treatment records are negative for treatment or a diagnosis of cirrhosis of the

liver. The service treatment records show treatment for elevated liver function test and

elevated liver enzymes. The service treatment records do not give a diagnosis of

cirrhosis of the liver in service. Treatment records from the St. Thomas Hospital only

show a mild diffuse fatty liver infiltration with focal sparing in the posterior gallbladder

fossa. The evidence of record does not show that the claimed cirrhosis, liver disease is

related to your military service. Service connection for cirrhosis, liver disease is denied

since this condition neither occurred in nor was caused by service, the evidence of record does not show that the claimed cirrhosis, liver disease was diagnosed to a compensable degree within one year after separation from service, and the evidence of record does not show that the claimed cirrhosis, liver disease has been clinically diagnosed.

 

2. Service connection for left leg injury, surgery compartment release.

Service connection may granted for a disease which began during active military service

or active duty for training or for any injury incurred during active military service, active

duty for training or inactive duty for training. Additionally service connection may be

granted for specific diseases or conditions which are, by law, presumed to have been

incurred during service if manifested to a compensable degree within a specified period

of time, generally, one year. Service connection may also be granted for conditions

which existed prior to service if the condition is shown to have been aggravated beyond

normal progression by service.

Service treatment records show that you underwent a left leg compartment release

surgery in September 1996. The service treatment record do not show any residuals or

complications from the left leg surgery. Treatment records from St. Thomas Hospital do

not reference any clinical findings regarding a left leg injury, surgery compartment

release. A disability which began in service or was caused by some event in service must

be considered "chronic" before service connection can be granted. Although there is a

record of treatment in service for left leg injury, surgery compartment release, no

permanent residual or chronic disability subject to service connection is shown by the

service medical records or demonstrated by evidence following service. The evidence of

record does not show clinical finding of a current left leg injury, surgery compartment

release, therefore service connection for left leg injury, surgery compartment release is

denied.

 

3. Service connection for right torn hamstring.

Service connection may granted for a disease which began during active military service

or active duty for training or for any injury incurred during active military service, active

duty for training or inactive duty for training. Additionally service connection may be

granted for specific diseases or conditions which are, by law, presumed to have been

incurred during service if manifested to a compensable degree within a specified period

of time, generally, one year. Service connection may also be granted for conditions

which existed prior to service if the condition is shown to have been aggravated beyond

normal progression by service.

Service treatment records are negative for treatment or a diagnosis of right torn hamstring

in service. Treatment records from St. Thomas Hospital do not show any treatment of a

right, torn hamstring. The evidence of record does not show that the claimed right torn

hamstring is related to your military service. Service connection for right torn hamstring

is denied since this condition neither occurred in nor was caused by service and the

evidence of record does not show that that claimed right tom hamstring has been

clinically diagnosed.

 

4. Service connection for left torn hamstring.

Service connection may granted for a disease which began during active military service or active duty for training or for any injury incurred during active military service, active duty for training or inactive duty for training. Additionally service connection may be granted for specific diseases or conditions which are, by law, presumed to have been incurred during service if manifested to a compensable degree within a specified period of time, generally, one year. Service connection may also be granted for conditions which existed prior to service if the condition is shown to have been aggravated beyond normal progression by service. Service treatment records show treatment for a pulled left hamstring on January 12, 1998 and June 9, 2000. Treatment records from St. Thomas Hospital do not show any treatment for a left torn hamstring. A disability which began in service or was caused by some event in service must be considered "chronic" before service connection can be granted. Although there is a record of treatment in service for a pulled left hamstring, no permanent residual or chronic disability subject to service connection is shown by the

service medical records or demonstrated by evidence following service. The evidence of

record does not show a current diagnosis of a left torn hamstring, therefore service

connection for left torn hamstring is denied.

 

5. Service connection for right knee condition.

Service connection may granted for a disease which began during active military service

or active duty for training or for any injury incurred during active military service, active

duty for training or inactive duty for training. Additionally service connection may be

granted for specific diseases or conditions which are, by law, presumed to have been

incurred during service if manifested to a compensable degree within a specified period

of time, generally, one year. Service connection may also be granted for conditions

which existed prior to service if the condition is shown to have been aggravated beyond

normal progression by service.

Service treatment records are negative for treatment or a diagnosis of right knee condition in service. Treatment records from St. Thomas Hospital do not show any treatment for a right knee condition. The evidence of record does not show that the claimed right knee condition is related to your military service. Service connection for right knee condition is denied since this condition neither occurred in nor was caused by service and the evidence of record does not that the claimed right knee condition has been clinically diagnosed.

 

6. Service connection for left knee condition.

Service connection may granted for a disease which began during active military service or active duty for training or for any injury incurred during active military service, active duty for training or inactive duty for training. Additionally service connection may be granted for specific diseases or conditions which are, by law, presumed to have been incurred during service if manifested to a compensable degree within a specified period of time, generally, one year. Service connection may also be granted for conditions which existed prior to service if the condition is shown to have been aggravated beyond normal progression by service.

 

Service treatment records show a one time treatment for a left knee strain on September 14, 1999. Treatment records from the St. Thomas Hospital do not show any treatment for a left knee condition. A disability which began in service or was caused by some event in service must be considered "chronic" before service connection can be granted. Although there is a record of treatment in service for left, knee condition, no permanent residual or chronic disability subject to service connection is shown by the service medical records or demonstrated by evidence following service. The evidence of record does not show a current diagnosis of a left knee condition, therefore service connection for left, knee condition is denied.

REFERENCES:

Title 38 of the Code of Federal Regulations, Pensions, Bonuses and Veteran& Relief

contains the regulations of the Department of Veterans Affairs which govern entitlement

to all veteran benefits. For additional information regarding applicable laws and

regulations, please consult your local library, or visit us at our web site, www.va.gov.

[Berta]

The rating decision is dated 2009.

Did you appeal it?

If not you will need new and material evidence to re-open it.

Elevated liver enzymes do not always indicate liver problems or cirrhosis. That can happen with medication.

And it can be a transitory situation with no liver damage.

I think you will need a strong IMO from the doctor who treats you for cirrhosis,who might be able to provide a nexus to the SMR entries (as there might be more in addition to the enzyme values)with a full medical rationale, that these were inservice manifestations ,that have led to the full blown cirrhosis.

You stated: "The closest I have to a diagnosis in the military is the internal medicine doc stating most likely NASH. This hunt actually started when the military doc who prescribed my grespeg got spooked at my elevated LFT's and sent me to internal med. From research Grespeg should not be given if there is suspected liver issues."

That is something the IMO doctor should consider. He/she will need copies of your SMRs and all private medical records.

Others will opine on the additional denied conditions.

They will all need new and material evidence in order to be re-opened.

 

[paulcolrain]

bernie07

i agree with Berta 100% . i went down a similar road and beat myself up with time. i could see all the records that where in my favor but i didnt have an IMO... i ended up paying for one and got the Dr. name from this site. Once i got the IMO back everything started Rolling better for me... 

[Buck52]

bernie07

Call around and ask of the Dr will give you his professional medical opinion..and have him to use  in his impression that he has examined you and reviewed your medical records pertinent to your claim and it is in his opinion it is most likely as not  the current diseases/Injury you suffer with currently is most likely aggerveate or Related to your service connected disability.

Call around and find  you a veteran friendly Specialist Dr  in the field of medicine that you need.

 don't be shy to ask   you will be supprised at the young Dr's willing to help.