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Ethan'sGrandma

How Can I Get My Appeal Out Of Ro & Sent To Bva?

Question

Hello,

Thank you very much for this available forum. I hope somebody on here can clarify some stuff for me which I find very distressing in my dealings with the VA to date. A little background and I will attempt to summarize. I have three denied claims pending: PTSD, Depression, and Skin Disorder. I went to a hearing at the Indiana RO, which turned out to be a waste of time, not to mention expenses, to make it there. Nothing came of it, but yet another denial, another SSOC with just the wording changed a little bit, but still said the same thing as all the others. Still, none of my evidence seemed to matter, nor was my claim ever reviewed previously by a DRO, as per my request, prior to that hearing. The VA's claim was that I never requested a DRO (claimed non-receipt of request), just as they terminated my appeal for failure to respond on time, but re-opened the claim when I showed proof positive that it was, indeed, a timely appeal, since I kept my copy of USPS receipt of appeal sent and received by them when sent overnight express, for better paper trail. So much stuff sent to them claimed as non-received, so it was the only thing I could think of to do, to ensure they could not, again, say they didn't get my paperwork.

My last SSOC was back in Sept., 2009, to which I responded promptly. There were so many errors and assumptions in it that it almost blew my mind as to where do they get their information? Is it even my claim they are truly looking at? I responded to it and added that I wanted my claim to proceed to BVA (I'd previously submitted the required form). They send me the form, again, for that with another SSOC, but this time it omitted the PTSD and depression, but only noted the denial for the skin condition. I sent in the appeal form, noting all the claims/conditions, and expected the claim to be wrapped up and sent to BVA. Instead, in January, 2010 I get a letter from VA that I will be receiving an appointment from my local VAMC for a C&P exam. I actually never got notice of said appointment, but called the appointment phone number and found out there was a pending exam, which I verified by calling the C&P office directly, and I attended in February, 2010. What threw me for more confusion was why they were now sending me for a C&P exam for the mental stuff after I'd sent in the Form 9, since this claim has been pending since 2005? I'm sorry if I sound paranoid, but wondered if they were just fixing up their end before sending to BVA since my claim had, obviously, not been developed properly. I say that because from the start, they knew I have SSDI, but never bothered to send for those records, many dates they came up with on their SSOC's do not jive with reality, even as my records have been made available to them, and even forms in my SMR were disregarded by them, until I pointed them out, once I obtained my own copies of those.

Shortly after the exam, I found out that now they were holding off, awaiting medical records from my SSA files. The exam itself was rather ordinary, lasted about 10 minutes, and I have no clue how the VA doctor could possibly know too much from the information he was asking, mostly family background stuff and continually asking if I was doing much better now, despite my diagnosis'? I go to outside psychs, have done so for a very long time, but still have ongoing mental issues. The exam was pretty much terminated when he asked me again if I was doing much better now, since I've not gone back to the hospital recently, and I responded my phobia about hospitals just make things worse, so am not going voluntarily there again, if I can help it, but have continuing suicide ideations, which my treating doctor is aware of, but have no specific plans. At that point, the VA doctor said we were done with the exam. That left me wondering what exactly he was looking for, but that was the end of that.

So, I sent an IRIS request recently, asking about my claim's status. Today, I receive a response noted to be from one of the managers there (that's the title in the email response) saying my claim is awaiting a "secondary statement of claim to be prepared. The appeals process can be very lengthy. You will be notified by U.S. mail when a decision has been made on your appeal." Actually, I found the wording rather odd, since I believe SSOC stands for Supplemental Statement of Case, but okay, that can't be that important, but coming from a manager there, it still seems rather odd. So, I am assuming this just sounds like another SSOC will soon be arriving, meaning another denial. That's where my confusion deepens with my claim. At what point will the SSOC's stop coming and they will send my claim to the BVA? I've noted that many advice that it's best to keep the claim file at RO for as long as possible, making rebuttals/arguments about facts, but I don't feel like I have gotten anywhere with that, besides finally getting that C&P scheduled. If they are just going to send me another SSOC, it would seem to me that was for naught, also?

I understand, I think, the process as much as possible and the appeal form may be what triggered the exam, but I thought they would send my file to BVA, so it will get on the docket, but that's not what they did. So, I'm searching for some more knowledgeable people on this forum that may offer words of wisdom, so I can better understand how to proceed with my claim. All of my responses, to date, to all their statements have been proven with the records pointed out to them, I think, but this claim has many weird innuendos that makes me wonder what else is going on? For example, when I glanced over at my file when the C&P doctor had it open, I noticed what looked like some type of an alert that said this vet (me) was married to a PTSD vet (my husband).

Previously, when I requested my records from the VA, they erroneously sent me a copy of what looks like a development form from them in which the same thing was noted (I say erroneously because I don't think that was supposed to be for my eyes). Additionally, they noted erroneously that I did not claim PTSD until my husband was diagnosed. Actually, I sent them a copy of medical progress notes where it is noted they assumed erroneous information with that since I'd been diagnosed with it, before the dates they are acknowledging. I've asked them before what my husband's files have to do with mine, but they've not given me a response to that, as yet. I wasn't even married to the man when my in-service events occurred, never mind that I am my own person, served my own duty, so it seems unfair, to boot, that they seem to be looking for some type of link. On the last note, I do have a VSO, but has not been much help with anything, except that he did attend the hearing at the RO with me and did make the statement that the claim should be approved based on the evidence (paraphrased). It was too funny, though, but not in a funny way that he forgot about the hearing date, until I showed up at the RO for it, as previously arranged. So, I am pretty much alone in trying to figure this out. Any knowledge shared by any of you would be greatly appreciated. Thank you very much.

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3 answers to this question

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When you get your decision send in Form 9 and ask for hearing from BVA. You can have a personal hearing or just written review. I would take the hearing. If you go to BVA you are going to be waiting for two years, and then it may get remanded back to your RO. Maybe you ought to hire a lawyer to help with this maze.

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Do you get SSDI for any or all of the conditions that you seek SC for?

If so make sure-by contacting SSA yourself ,that VA does get those records.

Do you have copy of results of the last C & P exam?

Has the VA questioned either the stressor for PTSD claim or the inservice link to the depression?

They wont award comp on more then one mental condition.

Why have they denied-up to this point?

Can you tell us their exact wording for denial in the last SSOC or scan it and attach it here (cover the personal stff)

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Thanks for the responses...really appreciate it.

Berta,

As I remember, my SSDI included the depression, but can't remember if the PTSD was included. I got approved on the first round, so did not have to go into any further details with that claim. The VA had never sent for those records before now, but it made me wonder, after the fact, and after the C&P because the VA doctor did ask about any physical medical illnesses and I do have diabetes now. However, I was not diagnosed with that when I applied for SSDI, but it made me wonder if VA was now interested in those records, to verify what my SSDI involved. Actually, my doctor believes the meds I was taking for the mental stuff could be a contributing factor to the diabetes, but that is not part of any claims. The SSA claim was only for the mental, so nothing else is on there, including the skin condition, since there would have been no reason for me to include that in a SSA claim.

The VA did question the stressor because they failed to look in my SMR for the "other" evidence allowed on my type of claim. Mine is an in-service continuous assault, not reported to the command, but symptoms were addressed to the Troop Clinic I was assigned to go to, also noted in my exit exam, but never specifically treated, since I left the service soon after. Some of the "other" evidence they will accept is in my file, which I pointed to them when they were not considered part of the evidence because I did not have my copies at the time I made my claim. Once I received my copies, I see where the evidence is in the SMR. I don't know if that's finally why the last SSOC I received no longer had the PTSD, nor depression, noted...only the skin condition. Shortly after that is when they sent me for the C&P, but no, I have not as of yet obtained the exam copy. I never applied for anything with them over the years because I'd heard just how difficult the system was, so did not want to be distressed further, plus did not have a need until now.

The VA did not appear to do a thorough review of my file, nor anything I'd sent to them because they refused to even acknowledge my treatment in civilian life time frame, even though they had access to those records, but the time frame they were looking at did not jive with the file. I've been in treatments not too long after I left the service, but mostly through military service, since I married my now husband and was using military care as a spouse for many years. My outpatient records for all that period are gone, I don't have them, nor does the records center have them. However, over time I was able to track down some inpatient records from military spouse times, going back many years, which does show the continuity for a long time, so they acknowledge the mental health treatment going back for years, but then still denied, even though I was then able to prove that my treatment was in fact began at a much earlier period than they had acknowledged in prior SSOC's. One of the basis for their denial on the first SOC was that I could not prove that I'd received mental treatments prior to 2002, which was definitely not the case and they had access to those medical records from my present civilian provider, which I've been going to since around 1994,up until I lost my health insurance. At that time, I started going to the VA clinic for my health care, which is where I gather they got the 2002 time period, then went back to the civilian provider when I had insurance again.

Those copies of the inpatient records through military health care became part of the record at the time of my hearing at the RO, which was shortly after I was finally able to obtain them, through my VA primary doctor, from the records center. The wording they used for the denial in the last SSOC was that, although, some items (such as a request for re-assignment) were in the SMR, and my active duty medical files has notations of complaints of depression/anxiety during the claimed periods, I was not diagnosed prior to my exit from the service. Actually, I went there and the triage PFC never sent me to the doctor/psyche, only treated me for "headache," even as she made the notation in my file of the symptoms I was complaining about. The protocol back in the day, at least for us, was to go to the TMC, triaged by the medics there and one did not get to see the PA or anybody else, unless referred by them. So, the next best thing that I thought to do was submit for a re-assignment overseas to remove myself from the situation of trauma that I was under, but it was denied due to staffing levels. It never occurred to me to take my problems to the command, more out of fear/shame of what I don't know, in hindsight. Shortly after that, I left the service on a hardship discharge not related to the in-service stressor and removed myself from my assaulter. The VA seems to be looking for other areas that don't fit me, as if the entire paragraph of the law for accepted "other" evidence for in-service personal assaults has to fit, before they will allow it, although much of that did not/does not apply to me.

For example, drugs/alcohol nor problematic behavior, or criminal actions have never been a part of my life as an adult, but they included it in their wording. At my age, I've never even had a traffic ticket, but have had continuous mental issues/treatments, never been/felt the same since that period on active duty, so I don't get that they assign behaviors to everybody the same. Actually, the person I tend to disregard is myself, not the authorities. Additionally, they worded that I did not have requests for leave as, obviously, they could not have reviewed my 214, since it clearly notes that I was charged with excess leave upon my leaving the service. There was no other leave to be had. In my rebuttal, I highlighted the item on my 214, highlighted other material I sent them, but have gotten no other acknowledgment of anything, besides the notice for the C&P and now their message through the IRIS system. I cannot scan the actual SSOC because my scanner is not working at the moment, but I've paraphrased what they'd said in the denial. Everything that I searched for as needed has been sent to them, so that's why I don't know what more to do with my claim. That is the reason why I thought I would post on here and see if anyone had any ideas. Again, thank you very much for your responses.

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