kate7772

I am confused about how things were filed on my husband's claim. He got a denial on several contentions in Sept. 2013. Should have been denied, was filed horribly incomplete. Anyway, my husband filed a reconsideration on two of the claims, PTSD and Tinnitus through DAV in May. The original claim was filed as irritability and anxiety. When the reconsideration with new evidence was done, there was a new diagnosis of PTSD and it was included in the claim for anxiety and irritability. DAV sent everything to Cleveland which is the normal VA for our area but, since his claim was originally heard in Louisville due to part of it being a Camp Lejeune water issue, it apparently should have gone back there. Just last week, it seems to have finally landed in the right place. It is now showing on eBenefits. First went in to "Preparing for Decision", then fell back to "Review of Evidence." There was already a claim in for unemployability which was just recently denied (we were told) but we never received any notification or anything on eBenefits saying so. I understand the denial due to the fact that there were no service connected conditions awarded. Now the current contentions are listed as Unemployability (new) and PTSD (new). So, apparently they threw the unemployability claim back into the mix with the PTSD claim. But, should the PTSD say "new" since it was a reconsideration? They give the date of the original claim as Aug. 1, 2013 which is correct for the unemployability but the PTSD claim was originally filed in 2011, although it was filed as anxiety and irritability which are now symptoms of the PTSD. With the "new" tag, it doesn't sound like reconsideration. BTW, tinnitus is not listed as a contention although it was included in the reconsideration. We are hoping he will at least get an actual C&P this time, since the first time they only looked at the records and decided. I guess what I am asking is does it seem that they should be listed as "new" contentions when it was filed as a reconsideration? Thanks, Kate

So, I wonder if it will go back to the Gathering of Evidence stage when it is discovered that no C&P has ever been done. Can't imagine they would just rely on the diagnosis from VA mental health dept.

This is a reconsideration with new evidence. He has a diagnosis of ptsd through VA but has never had a c&p. Went immediately to review of evidence. I assume they will require a c&p? He didn't have the diagnosis during the original claim.

Is there a particular time when c&p exams are scheduled? My husband's claim is currently in "review of evidence". That seems like a likely place in the timeline to do a c&p. Thanks, Kate

Hello Berta, Good news, finally! Received a huge packet in the mail with C-file as well as SMR. So, now my husband should be able to get his IMO. My husband didn't remember being treated for anything while in but his records indicate he was treated twice for urinary problems which may help with the kidney claim. Also, discovered he was treated several times for skin rashes. He had claimed that in association with agent orange because he has had skin rashes throughout the years. I met him when he was out of service for about 4 years and at that time he was covered with rashes on his arms, neck and chest. On the denial, it was stated that there was no indication while in service. Now, not sure what to do with all this. Reconsiderations? Kate

"The VA doc's notes are now in the record but were not at the time of denial." WONDERFUL!!!! I assume that is what the reconsideration is based on......... did you file for reconsideration or did the VSO, and if he did, did he give you a copy of whatever he filed? I see Dr.Bash's point now as to the SMRs.... Cripes your VSO sounds like, if he had a vet with a TBI claim, he might file it as a shrunken brain claim.... and I hesitate to guess what he would call a ED claim.... a shrunken oooops He he.. I am SO glad you have this evidence and VA did not see it when they made the initial decision. They will have to reconsider now, I am sure. WHEW I am so glad we have this wonderful forum with generous folks who are willing to help with advice. We did not yet file the reconsideration for the kidney. My husband had a PTSD and tinnitus claim that we recently filed a reconsideration on. We also had new evidence on those, including a severe, chronic PTSD diagnosis through VA. We are trying to get all the evidence together on the kidney disease, including the IMO. We really want to get Dr. Bash to do one along with the statement from the VA doctor but without the SMR, it seems to be not happening. We have until Sept., then I assume we will have to file a new claim.

"my husband has only one kidney which is assumed to be congenital." Is that the kidney you are trying to get SCed? No I am surprised to see the word 'congenital' in your post here.Sorry it took me so long to answer...I have time restraints this time of year.: We are assuming congenital on the missing/shrunken kidney since it was discovered incidentally while doing some tests for pain after he was out for about 10 years. This should probably never have been included in the claim but like I said, we just went by what the VSO said to do. It is the remaining diseased kidney we are concerned about. My husband has many problems as a result (high blood pressure, edema, erectile dysfuncton.) He can only work approx 16 hours a week due to the fatigue and edema. And with only one kidney, he will likely need dialysis in the future. "Under VA laws and regulations, disorders that are considered congenital and developmental in nature are not deemed compensable diseases for VA purposes. 38 C.F.R. § 3.303© (2003). However, the Board is aware that, under certain circumstances, service connection may be granted for such disorders if shown to have been aggravated during service. See VAOPGCPREC 82-90 (July 18, 1990). In this case, there is evidence of such aggravation." As part of the denial, they stated that people with only one kidney are much more likely to develop problems in the remaining one. I could see this as being valid if the first kidney was due to a disease but apparently my husband lived with one kidney his entire life without problems. http://www.va.gov/ve...les/0332096.txt This seems to be about an issue that was treated while in service. My husband had no known disease while in. As everyone here knows the VA has been caught "gaming the system" That is not only not an appropriate C & P exam report, the veteran has to be present at C & P exams unless they are deceased ( they still do a C & P however on existing records in that case) My husband had no physical C&P or was never even spoken to in any way. "we have not been able to link that condition to your military service as a medical opinion issued by a specialist at the VA Medical Center in Louisville, KY opined on September 13, 2013 that the diagnosis of your kidney condition is less likely as not (less than 50/50 probability) caused by or a result of exposure to contaminated water at Marine Corps Base Camp Lejeune which we have conceded." The Camp LeJeune info here at hadit and googable might indicate this is how LeJuene claims are being handled...without a proper C &P exam.... but I think it is a CUE (Clearand unmistakable error) for the VA to deny like this with a defective C & P exam that your husband was not present at. Then again, was this claim for the congenital kidney? Is the shrunken kidney a different kidney? Have you read the LeJuene training letter and googled for anything else here or elsewhere on how VA is handling these claims? I must admit I am totally confused here due to this past post from you: "I think what I really meant was a Nexus. My husband had planned to get an IMO from Dr. Bash to use in his reconsideration for his kidney issues but needed to obtain his SMR first which is seeming nearly impossible. He was seeing and diagnosed by a private Nephrologist who agreed that the kidney condition was likely caused by the water at Camp Lejeune but refused to give the verbiage VA requires. My husband thought it a good idea to get his condition and treatment on record with VA, so started seeing a VA Nephrologist. The VA doctor said he definitely believes the water to be the cause and had no problem saying so. This is what he put into his notes in my husband's medical record:" "Review of his history makes the development of his disease as likely as not a consequence of exposure to drinking water contaminated with trichloroethylene/benzene while at Camp lejeune as there is some evidence in the literature of an association between hydrocarbon exposure and development of membranous glomerulonephritis." This was stated by the VA kidney specialist. My husband decided to start going to the VA for his kidney problems so it would all be documented. The VA Doc reviewed my husband's private treatment records and biopsy, as well as my husbands timeline of his time at Lejeune. The Doc said he was familiar with the Lejeune water issues and then made the statement based on the particular disease my husband has. We were surprised he said this and when my husband said his private doctor would not make the nexxus this Doc said he had no problem saying so in the record. Should this be sufficient to use for a nexus or will we still need to get an IMO from Dr. Bash? Thanks, Kate" Are these notes in the med recs and did the VA use them as Evidence? The VA doc's notes are now in the record but were not at the time of denial. The VSO my husband had was totally useless (he has since been fired.) He basically said no more than "we are claiming this" with no reasoning, proof, statements or anything. We were stupidly uninformed and just assumed he knew how to do it. I don't see any evidence list here at all. I attached it in the previous post (I'm sorry, I am not really great at this.) This is the evidence from the denial. A ton of it but strangely, when I googled some of it at random, it seems to support the claim instead of the denial. Can't help wondering if they just copied and pasted a bunch of references they already had. They said the time they took was 1:45 hrs. It would have taken a lot longer to research this. If your husband was at Camp Lejuene , by evidence, during the time frame they concede the bad water was there....I dont see why SMRs would even be needed....... Dr. Bash said he needs it to reference he saw it. My husband said there is likely not much in it since he never went to sick bay or for treatment while in. It shows in his records where he was at Lejeune for about 15months during the required timeframe. Unless he is trying to get a pre existing congenital condition SCed as to aggravation due to the bad water..... .The missing/shrunken kidney is not the one being claimed. My husband found out about that after he was out of service for approx. 10 years during tests for something else. Have you contacted Dr. Bash yet and read all the above links? We spoke with Dr. Bash several months ago and he said from what we told him that my husband would likely have a claim but he needs to review his SMR as part of the IMO. I have read so much, not sure of the ones you included but will check them out now.

Sent an IRIS request a couple days ago.

Berta, Can you please take a look at my last post where I answered your request for posting the denial? Thanks.

I have come to realize (through this forum) just how much we need to stay on top of things. We got some very bad and inaccurate information from my husband's previous VSO and now also apparently from the DAV. We do need to get these records pretty quickly because my husband needs to get an IMO to file for a reconsideration and has until Sept. to do so. I know the IMO can take a while also, so need to get it going. We've been trying to get the file for some time, including the SMR which Dr. Bash will need for the IMO.

We just did it the way DAV said to do it. Is it okay to now send a request another way? Would it mess things up and confuse the system somehow, causing more delays? What address (or online) would we send it to? Thanks

Is there a good contact number to check on the status of a FOIA request for claims file? My husband submitted the request through DAV on Mar 5. Receipt was acknowledged but have heard nothing since. Thanks, Kate

>>Can you post the denial that was on the VA's letter head ,the part that contains Reasons and Bases and then an Evidence list.<< Here is the denial from VA. The evidence list is in the above post. The part about the "shrunken kidney" was put there by the VSO because my husband has only one kidney which is assumed to be congenital. kidneydenialva.pdf

Congrats! That has to be such a relief to qualify for the CHAMPVA. Kate

>>Did the doc give a hyperlink or treatise citation for his nexus statement?<< No, unfortunately he did not.

Berta, here is the denial. My husband claimed renal toxicity which is on the Camp Lejeune list. The reviewer included a long list of references he said he used. Strangely, some of these same references were ones I pulled in support of the claim. They also called this a C&P exam but my husband never saw or spoke with anyone.vadenialedit.pdf

Thanks Berta, The original request was through the archives, made by the VSO. The second request was made using the privacy act. We received an acknowledgement from Louisvlle that they received it and would send out. this was about 6 weeks ago. When my husband called Louisville to check if they had received his reconsideration claim, he asked about the medical service records and was told they have no record of a request and that the SMR was not there. Louisville was who denied my husband's claim for benefits and are currently deciding an unemployability claim (which should have not been filed, but, that is another story.) So, should they not have the SMR? The denial was in Sept. 2013.

We are trying to get my husband's service medical records so he can get an IMO. Apparently, the person doing the IMO needs to say he has looked at the SMR? My husband's VSO sent for them and only received back a single sheet of paper with literally nothing on it pertaining to medical. They said the rest of the records were somewhere else but did not indicate where. I tried to get them from Defense Personnel Records Information Retrieval System online and they said his record is not held in the database. My husband has an open claim in Louisville, KY. Could they be there? And, if so, is there a way to get them? We were told they can only be in one place at a time. Amazing that they do not have copies or computerized? We need them soon as we are trying to file a reconsideration and we only have until Sept. to do so and it will likely take time to get the IMO. My husband says there should really be very little in the records anyway since he never went to sick bay but I guess it is a requirement for the IMO to say the doctor saw them. Thanks, Kate

I think what I really meant was a Nexus. My husband had planned to get an IMO from Dr. Bash to use in his reconsideration for his kidney issues but needed to obtain his SMR first which is seeming nearly impossible. He was seeing and diagnosed by a private Nephrologist who agreed that the kidney condition was likely caused by the water at Camp Lejeune but refused to give the verbiage VA requires. My husband thought it a good idea to get his condition and treatment on record with VA, so started seeing a VA Nephrologist. The VA doctor said he definitely believes the water to be the cause and had no problem saying so. This is what he put into his notes in my husband's medical record: "Review of his history makes the development of his disease as likely as not a consequence of exposure to drinking water contaminated with trichloroethylene/benzene while at Camp lejeune as there is some evidence in the literature of an association between hydrocarbon exposure and development of membranous glomerulonephritis." Should this be sufficient to use for a nexus or will we still need to get an IMO from Dr. Bash? Thanks, Kate

We got an answer back to the IRIS request. Here is what they said: "After review of your VA file, we do not see that a claim has been opened for you for post-traumatic stress disorder (PTSD), hearing loss, or tinnitus. We do see a note in your VA file from a representative from the National Call Center on April 30, 2014, forwarding a request to the Louisville Regional Office to initiate a claim for you for PTSD. Generally, it takes approximately 21 days for a claim to be established. We suggest that you contact your Disabled American Veterans representative and see when your request was submitted and where it was submitted. This should have been sent to Louisville." Does this mean that they don't have the claim (with the letters in support, etc.) that DAV filed? We were told they were filing with Cleveland,OH VA since that is our regional VA. My husband originally filed and was denied through Louisville since he was filing for kidney issues from Camp Lejeune water. All Camp Lejeune water issues go to Louisville. He has not filed a reconsideration on the kidney yet due to getting an IMO together. When the original service officer filed for the kidney, he lumped the tinnitus/hearing and anxiety, irritability into the same claim so it all went to Louisville. Now, my husband is asking for reconsideration on the anxiety as PTSD due to a recent diagnosis through VA. We assumed this would not go back to Louisville since it is not connected to the water issues at Camp Lejeune. Were we and DAV not correct in this? And, I wonder if we should file it again ourselves through eBenefits?

My husband's hasn't either. We thought it was just his. He had a Nephrologist appt. on April 10th and no notes in for that along with several other ones. Interesting to see if it is the same for others.

Thank you, I sent an IRIS. We'll see. Kate

Is there a way to find out for sure that it is where it is supposed to be? I worry about things like: lost in the mail, lost at VA, etc. I know the whole process is a long one but I at least want to be sure it is started. I also realize that the organizations like DAV who are there to help, can have issues also.

My husband filed for reconsideration on a previously denied claim about a month ago. This was done through DAV. Shouldn't we get some kind of confirmation that the claim was received? He called the VA regional office last week and they said they have no record of it but DAV says they can see it in the system. Nothing on eBenefits at all but according to what is said on here, that is not unusual. It just worries me that some time down the road they may still not have a record of it so would at least like to know it is in their system. Thanks, Kate

On the presumptive diseases listed her, what are the requirements? For instance, do they need to be diagnosed within a year of discharge, etc.? §3.309 Disease subject to presumptive service connection http://www.ecfr.gov/cgi-bin/text-idx?type=simple;c=ecfr;cc=ecfr;rgn=div8;idno=38;q1=3.309;sid=8810eabd3a17b04d69a91436c1460478;view=text;node=38%3A1.0.1.1.4.1.66.117 Thanks, Kate