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Denial Letters
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47 topics in this forum
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I submitted an increase for OSA (2nd to PTSD) and SMC-R1 (AA) (currently at Housebound, SMC - S) in the early month of 2024. Just a few days ago my wife gave me a yellow envelope with the Rating Decision Letters for the aforementioned increase claims. The verdict appeared as: OSA (2nd to PTSD) granted 60%. - approved. (All reelevate medical documentation was reviewed and noted under the "Evidence" paragraph. But, SMC (R1) Aid & Attendance increase was Denied! (reason(s) why it appears intentional denial explained below) After meticulous review of this Rating Letter, I came across some areas of clear disregard of Private Treatments …
Last reply by broncovet, -
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- 2 followers
- 18 replies
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I just received a denial for my claim for GERD secondary to Obstructive Sleep Apnea. I cannot seem to find a way to scan it or attach to this post. It appears that the VA considered it a stand alone claim, and only did a records review and a DBQ filled out by the PA that did the records review. I sent in a Nexus Letter and DBQ that I had done with VBE and it's not listed as evidence considered. I don't even think they got the records from my Primary Care Physician to look at. What should my next move be?
Last reply by Rattler, -
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- 1 follower
- 5 replies
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Greetings, Hadit family As I’m currently waiting at the BVA for my appeals, I was reading over one of my denials. The VA put down something I was never appealing, which was IU effective date. I never was challenging that, I was challenging my rating effective date, that made me IU. I was determined to be IU from my PTSD alone, so I was challenging my effective date on my PTSD and not IU. It’s like they changed the narrative on this appeal which fits their story for a denial. They’re correct in the denial of the IU effective date because of my rating for PTSD. I clearly put down on the form what I was challenging and still have it uploaded to my file, which…
Last reply by john999, -
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After this last denial , I had enough and told myself I was done. I decided to actually read the denial letter and under the evidence section othing I submitted is included as evidence. Is this nornal? How should I move forward with this. I included a recent sleep study as well as a IMO and private medical records tha was NOT submitted originally. Theres also a couple of items I have no idea what they are. I highlighted them on the letter I uploaded. Thanks
Last reply by relatively happy camper, -
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I am 100% P&T. Just approved for Housebound. Denied for SMC K. Below is the denial. I see a private psychiatrist for meds and treatment. I discussed my SMC K claim with her and she told me one of my medications is causing the issue. The medication is Pristiq. The only problem is she refuses to write a nexus letter linking it to this medication. I feel like the only other option I have is to go to the Ellis Clinic here in OKC and have him write it for $500. I'm seeing a new PCP at the VA the end of the month but I'm not confident in them doing anything for this because in my records they have been giving me sildenafil which doesn't work. Will the VA do any "workup" as …
Last reply by broncovet, -
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- 2 followers
- 5 replies
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I was denied for Erectile Dysfunction and SMC K even though I am service connected for Diabetes II and take lots of medications for my Depression which can cause this condition. Does anyone have any guidance? Would a nexus letter from my Endocrinologist help in an appeal? 3. Service connection for erectile dysfunction smc k as secondary to the service-connected disability of diabetes mellitus type II. Service connection may be granted for a disease or injury which resulted from a service- connected disability or was aggravated thereby. The evidence does not show that erectile dysfuncation smc k is related to the service-connected condition…
Last reply by Dustoff1970, -
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I been researching the Internet to try and find doctors or organizations to assist me in getting an independent medical opinion so I can appeal my denied claim. I believe I filled out a form online with an organization called Veterans Benefits Evaluations. I received a call from a lady in a call center in the Philippines, who told me she received my information concerning my denial for disability claim, and that for them to help me the first step was to gather basic information me about my claim or the next step would be a free consultation, with more detailed advice concerning my appeal of the denied claim and the help that this organization could provide at that time. B…
Last reply by Chief1997, -
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- 1 follower
- 8 replies
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Good afternoon folks I was diagnosed with sleep apnea in 2010 (after service) and in May of 2018 I submitted a claim for Sleep apnea and was denied (see attachment). I gave up because I could'nt show service connection and I just did'nt kn ow any better. I was again diagnosed with severe sleep apnea in Oct. 2022. By this time I had been rated 70% for PTSD that occurred while in service for incidents that happened prior to any sleep apnea diagosis. I got an IMO and submitted that for Sleep Apnea secondary to PTSD. I got a letter a couple of weeks later (see attached) saying I was previously denied sleep apnea and ai needed to submit my new claim on ba different form. …
Last reply by Dustoff1970, -
- 1 follower
- 1 reply
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Was denied tinea pedis (athletes feet) gulf war vet/PACT ACT/TERA Was wondering what steps should I take to appeal/fight this. Ima little confused from the denial letter I appreciate anyone who takes the time to read this, thanks for any help or advice - denial letter for tinea pedis- 2. Service connection for tinea pedis (claimed as athlete's foot) as due to an undiagnosed illness. The "Persian Gulf War Veterans' Benefits Act" authorizes VA to compensate any Gulf veteran suffering from a "qualifying chronic disability," resulting from an undiagnosed illness or combination of undiagnosed illnesses, appearing either during active duty in…
Last reply by Dot09, -
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- 1 follower
- 9 replies
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I’m a gulf war veteran that was exposed to particular matter during military service in southwest Asia under the new pact act. My exposure in the golf war area is acknowledged by the VA and I am considered a veteran exposed to particulate matter in the new presumptive list has melanoma and any head face or neck cancers listed as presumptive conditions. I had a melanomas and a basal cell carcinoma removed from my right and left for head’s. The melanomas removed in 2013 and the basal cell carcinoma was removed in 2009. The VA has denied me service connection for the scars associated to these two cancers their reasoning for the denial is they requested an examination with me…
Last reply by pacmanx1, -
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Hello, Last year I filed two supplemental claims for GERD, tinnitus, and bilateral radiculopathy for legs, and later filed an increase for low back strain and a new claim for neck condition. For some reason, all claims were combined in one decision letter, and they were all denied. I immediately filed a HLR and requested an informal conference. I never received a call, but a decision was made denying all claims again in August 2022. There were so many discrepancies with the letter. I was overwhelmed and put off addressing the decision due to other life matters. Between moving overseas and traveling for work, I finally caught a break to focus on gathering what I…
Last reply by Rattler, -
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I submitted a claim for increase from 10% to 60% based on DC 7806, Constant therapy including phototherapy, in which I began receiving UVB treatments 3 x week since 2019 when the phototherapy unit was issued. Attached is a “sanitized” copy of the skin DBQ with “REASONS FOR DECISION” page. For ease of finding information in the DBQ, the areas of interest are enclosed by red rectangles, On page 13 of the DBQ (not included) the physician’s specialty was Internal Medicine. dbq.pdf
Last reply by broncovet, -
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