Claim Denied

[smilen66]

I am empty, hurt, angry ... speechless! I did request my C-F this morning. Attached are reasons for decision.

[smilen66]

smilen,

I am trying to see this in the way the decision maker will look at it.

1) Was any diagnosis ever made on active duty ?

2) Do you have any medical evidence that shows continuity of care

or continued complaints, from 1980 to present ?

They may see this as a single event that took place (without continuity of care)

leaving no residual effect.

If this is the case I feel you will have to have an IMO that states they have reviewed

your SMR's that show XXX and your condition now of XXX is at least as likely as not

the result of the injury on active duty.

Maybe other's will chime in to add more or make correction's to this.

carlie

1) Was any diagnosis ever made on active duty ?

Hi Carlie,

The diagnosis made while I was on active duty were either myalgia?, muscle strain or overuse syndrome. I went to the clinic at least 10 or more times and received motrin, aspirin, heating pad, balm,tylenol or pain med. and not once was a xray made. All the diagnosis were made mostly by Spec 5 Meddacs not doctors. Physical therapy was suggested by a meddac once but not(from what I can tell from med. record) prescribed The first xray made was not made until 1985, one year after ets. At that time I was a military dependent. I am in the process of sending off for that xray from archived records. Oh yeah, I find it interesting that all visits to the clinic were about pain on the right side. This is the same side I am having problems with more since my stroke (which affected my right side).

This could not be a coincidence!

2) Do you have any medical evidence that shows continuity of care

or continued complaints, from 1980 to present ?

I have some, mostly emergency room visits and xrays at orthopedic clinics. I learned to use a heating pad, take prescribed or over the counter meds. for pain from spasms, achiness and one brother who would massage affected areas. I am creating a chart to show dates and complaints so that I can get a better picture of the evidence.

If this is the case I feel you will have to have an IMO that states they have reviewed

your SMR's that show XXX and your condition now of XXX is at least as likely as not

the result of the injury on active duty.

I believe my medical doctor would not have a problem with this. Do you think it would better to find a orthopedic doctor willing to give his opinion?

[smilen66]

3 days or 3 weeks being taken by ambulance for treatment should verify your claim

Good Luck

Hi Pete53,

Thank for the good luck wish!

If they had only looked at the medical evidence they would know I went to the emergency room for pain in right thoracic and lumbar back! It was in black and white...couldn't be any plainer.

[Tayo]

I also agree with what is being said here. Berta hit on a lot of key points.

I'm at a lost concerning the first three denials, especially after reading you went back more than 10 times. The VA claims chronic,,, well,,, chronic comes with a wide definition.

1. http://apps.who.int/classifications/apps/icd/icd10online/

2. Go to XVIII

3. Read everything especially

4. Go to R50-R60

5. Concentrate on R52

6. Click on your specific ailment.

This is actually a real good site for everyone. ICD-Codes are EXTREMELY IMPORTANT!!!

Hope this helps and PLEASE,,, pass this information on to everyone

[BoonDoc]

Hi Pete53,

Thank for the good luck wish!

If they had only looked at the medical evidence they would know I went to the emergency room for pain in right thoracic and lumbar back! It was in black and swhite...couldn't be any plainer.

It seems like the raters don't look at the complete medical record's evidence, or have a totally alien view of connecting it all together.

I believe that the VARO hires off the street to fill the raters position, this would make sense if you were trying to limit the amount of claims approved.

Sorry for the bad news, but hang in there and keep moving, and gain ground on your claim.

Best wishes to ya,

BoonDoc

Edited August 29, 2009 by BoonDoc

[smilen66]

I also agree with what is being said here. Berta hit on a lot of key points.

I'm at a lost concerning the first three denials, especially after reading you went back more than 10 times. The VA claims chronic,,, well,,, chronic comes with a wide definition.

1. http://apps.who.int/classifications/apps/icd/icd10online/

2. Go to XVIII

3. Read everything especially

4. Go to R50-R60

5. Concentrate on R52

6. Click on your specific ailment.

This is actually a real good site for everyone. ICD-Codes are EXTREMELY IMPORTANT!!!

Hope this helps and PLEASE,,, pass this information on to everyone

Wow Tavo, what a wealth of information! Lot of it is way over my head but nevertheless seemingly a great resource. So how did you use the codes? Also, thank you so very much for sharing!

[smilen66]

It seems like the raters don't look at the complete medical record evidence, or have a totally alien view of connecting it all together.

I believe that the VARO hires off the street to fill the raters position, this would make sense if you were trying to limit the amount of claims approved.

Sorry for the bad news, but hang in there and keep moving, and gaing ground on your claim.

Best wishes to ya,

BoonDoc

Hi BoonDoc, I'm in complete agreement with you, they either came off the street or some back alley! You know, they even changed the date the decision was made from July 17 to Aug. 14....maybe that was a typo...maybe I sent too many Iris'...maybe I asked too many questions. Then to top it off they sent me a benefits book (Iris) maybe that was a present to smooth over the denial, perhaps a v.a. requirement, coincidence...who knows. Well what they didn't know is adversity has always been my best friend and it will take more than one denial before I give up. So it is on! I'm working day and night on getting my duckies in a row! Thanks for your comment and best wishes!