Do I Have Grounds To Appeal Denial?

[Porterhaus]

Hello,

I am new to this site and must say that I am really glad to have found you as I find the tangled web we know as the VA to be one big pain in the neck.

I am currently rated at 30% for bi-lateral tinnitus and hearing loss. Over the past couple of years my tinnitus has gotten progressivly worse and the noise in my head makes it near impossible to sleep at night. The VA doctors have me on two different meds to help me sleep but the meds are not considered service connected so they are charging me for them. Because of this, I filed a claim for Service Connection for Insomnia as Secondary to the Service-Connected Disability of Tinnitus.

Here is the response I received back from the VA:

Service connection may be granted for a disease or injury which resulted from a service-connected disability or was agrravated thereby.

At our VA exam, you report insomnia and feel tired. Objective findings show that you take Ambien. You have memory problems and have problems with the retention of highly-learned materials. The rest of the exam is within normal limits. You are competent to manage your own funds. Your Global Assessment of Function is 70 which indicate mild symptoms. Our examiner diagnosed Axis - I insomnia. It is our examiner's opinion that your sleep disorder is less as likely as not secondary to your tinnitus due to your pattern of sleep difficulties in service. It is also our examiner's opinion that your sleep disorder is aggravated by your tinnitus, however the degree of aggravation cannot be determined without resorting to mere speculation. Service connection for insomnia is denied.

Do I have any grounds to appeal this decision? Their own examiner states that in their opinion, it is aggravated by my service connected tinnitus. Any recommendations on how to approach the appeal if I do have grounds to appeal?

Thanks for the advice,

Dale

[*Bergie*]

Hello,

I am new to this site and must say that I am really glad to have found you as I find the tangled web we know as the VA to be one big pain in the neck.

I am currently rated at 30% for bi-lateral tinnitus and hearing loss. Over the past couple of years my tinnitus has gotten progressivly worse and the noise in my head makes it near impossible to sleep at night. The VA doctors have me on two different meds to help me sleep but the meds are not considered service connected so they are charging me for them. Because of this, I filed a claim for Service Connection for Insomnia as Secondary to the Service-Connected Disability of Tinnitus.

Here is the response I received back from the VA:

Service connection may be granted for a disease or injury which resulted from a service-connected disability or was agrravated thereby.

At our VA exam, you report insomnia and feel tired. Objective findings show that you take Ambien. You have memory problems and have problems with the retention of highly-learned materials. The rest of the exam is within normal limits. You are competent to manage your own funds. Your Global Assessment of Function is 70 which indicate mild symptoms. Our examiner diagnosed Axis - I insomnia. It is our examiner's opinion that your sleep disorder is less as likely as not secondary to your tinnitus due to your pattern of sleep difficulties in service. It is also our examiner's opinion that your sleep disorder is aggravated by your tinnitus, however the degree of aggravation cannot be determined without resorting to mere speculation. Service connection for insomnia is denied.

Do I have any grounds to appeal this decision? Their own examiner states that in their opinion, it is aggravated by my service connected tinnitus. Any recommendations on how to approach the appeal if I do have grounds to appeal?

Thanks for the advice,

Dale

Dale,

You have a year from the date of the denial to file a NOD. What you should do with the year is gather independent supporting evidence. Go 1 or 2 outside audiologists work with them to provide an IMO supporting your belief that tennitus is causing your insomnia. Once you gather the info then file your NOD, and ask for a DRO hearing. I like hearings because unlike a DRO review you get to present your evidence in person and you can bring a spouce of significant other who can provide witness statements to support your condition. I've had good results from the hearing process VS the review process. This is just my openion of what I would do so take it as you will.

Good luck,

Bergie

[LarryJ]

Hello,

I am new to this site and must say that I am really glad to have found you as I find the tangled web we know as the VA to be one big pain in the neck.

I am currently rated at 30% for bi-lateral tinnitus and hearing loss. Over the past couple of years my tinnitus has gotten progressivly worse and the noise in my head makes it near impossible to sleep at night. The VA doctors have me on two different meds to help me sleep but the meds are not considered service connected so they are charging me for them. Because of this, I filed a claim for Service Connection for Insomnia as Secondary to the Service-Connected Disability of Tinnitus.

Here is the response I received back from the VA:

Service connection may be granted for a disease or injury which resulted from a service-connected disability or was agrravated thereby.

At our VA exam, you report insomnia and feel tired. Objective findings show that you take Ambien. You have memory problems and have problems with the retention of highly-learned materials. The rest of the exam is within normal limits. You are competent to manage your own funds. Your Global Assessment of Function is 70 which indicate mild symptoms. Our examiner diagnosed Axis - I insomnia. It is our examiner's opinion that your sleep disorder is less as likely as not secondary to your tinnitus due to your pattern of sleep difficulties in service. It is also our examiner's opinion that your sleep disorder is aggravated by your tinnitus, however the degree of aggravation cannot be determined without resorting to mere speculation. Service connection for insomnia is denied.

Do I have any grounds to appeal this decision? Their own examiner states that in their opinion, it is aggravated by my service connected tinnitus. Any recommendations on how to approach the appeal if I do have grounds to appeal?

Thanks for the advice,

Dale

s

Yes, you should file for a DRO review of this decision. In doing so, it would help if you had an outside doctor's statement that it is "at least as likely as not" that your sleep disorder is aggravated by your service-connected tinnitus and then point out the fact that your VA examiner's opinion also states the same and that the rating decision to NOT grant the sought-after benefit is ALSO resorting to "mere spectulation" whereas they should have resorted to the recognized "benefit of the doubt" AND the findings of the VA examiner instead of the mere speculation as shown by the rater in this case.

just sayin..................

(BTW, I suffer from exactly the same hearing/sleep/tinnitus on-going hell as you.)

Edited March 26, 2010 by LarryJ

[john999]

Appeal!

[Porterhaus]

Hi All,

Just wanted to thank everyone that provided advice on how to handle my claim. I just received a letter from the VA stating that my claim was granted and that they have awarded me a 20% increase in my rating. I didn't think I had a chance when they initially denied my claim. I wasn't going to file the appeal. Thank God I found this site.

Thanks again for all of the advice,

Dale

[afoprtr]

Hi All,

Just wanted to thank everyone that provided advice on how to handle my claim. I just received a letter from the VA stating that my claim was granted and that they have awarded me a 20% increase in my rating. I didn't think I had a chance when they initially denied my claim. I wasn't going to file the appeal. Thank God I found this site.

Thanks again for all of the advice,

Dale

Porter,

Congrats, so what new evidence did you submit for the appeal?