doc25

I'm a VHA employee and from what we were told; was that VA employees will no longer be receiving the covid vaccine, until more is available. The VHA will be transitioning to administering the covid vaccine to veterans only, when it becomes available. No timeline was provided. So much vague.

I have done all you have suggested. The themed rationale is "congenital or pre-existed service" since 2007. My entrance medical exam refutes that rationale. The VBA has obtusely ignored the presumption of soundness that applies to the claim. By not finding clear and unmistakable evidence that congenital flat feet pre-existed service. The burden falls on the government to find such evidence. (An unfavorable nexus based on mere speculation in 2007 is the end all apparently. Then another in 2016 that clearly shows the examiner contradicts himself with stating "at least as likely as not" the veterans claimed condition is related to military service, but in his rationale the examiner merely agrees with the 2007 examiner about congenital flat feet.) Even if the presumption of soundness was rebutted with clear and unmistakable evidence;the second prong is rebutting aggravation of a pre-existing condition with clear and unmistakable evidence that the pre-existing condition was NOT aggravated by military service.

At this point, I've become another statistic of the VA hamster wheel for a claim appeal that has merit for acquired pes planus. This has gone on for far too long and I'm pretty much done with it. I'm not one to give up, but I learned a long time ago to pick my battles. I am 100% scheduler with an FCE looming around February 2021 for PTSD and Depression. If I get reduced afterwards, I might revisit the flat foot appeal with new and relevant evidence that I have. I have until Aug 13 2021 to appeal.

Wonderful news for you. I know my flat feet are rateable at 30%, but knowing how it will go, I probably will get 0%. LOL.

CCK sent that letter with the HLR 20-0996 form. We'll be submitting a supplemental claim for sure. I know in every fiber of my being this claim has not been afforded due diligence. It's an injustice. All the ROs ought to have done in Winston-Salem, NC and Houston use the applicable laws and low ball me with a 0% in 2007 and 2016. Instead, here I am denied again...and because of this injustice. I will continue pursuing it until my last breathe. Some people will say to leave it alone, since I'm 100% already. I will not. It's not my first denial, but this one is a tough pill to swallow. This one is going on 13 years now. I can only imagine what many veterans have gone through and continue to be going through; fighting for their benefits for 20+ years. I know once it gets service-connected first, I have CUEs to appeal the effective date. My apologies for the rant.

HLR review did not go well. Reviewer agreed with the previous denials. It closed and there was no change in ebenefits. Bilateral Flat Feet still remained NOT SERVICE CONNECTED. I'm going to do a supplemental claim because I have new and relevant evidence that was not in the VA's possession over the past 13 years. I barely just found it a few months ago...low and behold electronically; in tricareonline.com. RedactedACQUIREDPESPLANUS.pdf

My thoughts exactly. Thanks.

Here is my entrance medical exam. Hallux valgus is noted above "Normal Archs". I do not contend that hallux valgus is congenital. EntranceExam98 (1).pdf

Unfortunately, it mattered that the daggum PA that did the BDD, flat out lied about that congenital rationale; resulting in my claim being denied. I completely agree with you. Being that the congenital rationale was used, presumption of aggravation ought to have been applied by the flippin' Winston-Salem,NC RO that was assigned to my claim. Then, the Houston RO just went along with that decision....twice. I'm seeking 1. service connection and 2. the appropriate earliest effective date due to CUE for my appeal. Winston-Salem RO should've gotten it right the first time.

Ms. Berta it's always enlightening reading your responses. I did find existing medical evidence of record that was not properly weighed; in my electronic medical records via tricareonline, is that "Acquired Pes Planus" was dated April 19,2007 in my medical problem list. My initial diagnosis for Bilateral Pes Planus was 05DEC2006. I ETS'd 14JUL07. I can provide redacted files to corroborate this for your review.

There was no evidence of congenital or pre-existing flat feet upon medical entrance exam.

1. The claim has been denied 3x already. Still Seeking service connection. 2. The VBA erred in denying my acquired flat feet claim in Oct 9,2007 and the last two attempts for SC. In my case, I believe I should've have been rated at least 10% for acquired bilateral flat feet and the effective date ought to have been 14JUL2007 (ETS)....but I'll take 01NOV2007 since the first denial is dated Oct 9,2007.

This is the letter CCK sent for my appeal. Does it suffice to make a strong arguement for a CUE?? CUE.pdf

§4.114 Schedule of ratings—digestive system. Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. Unfortunately, this statute would rebut your CUE, to seperate the combined IBS and GERD; but there's some good news. My understanding of the bolded part, is that if a single rating is going to be assigned; the highest rating must be given from either 7319 and 7346 depending on the severity of the symptoms. What does this mean? The highest rating of the two diagnostic codes would fall under 7346 Hiatal Hernia [GERD is assigned this code]at 60%. (That is the highest that is allowable.) 7346 Hernia hiatal: (hiatal hernia) Here is a case where the veteran was granted 60% for combined GERD and IBS. Please read carefully. This case outlines exactly how the board used the medical evidence and the LAW to get it granted. You may have a CUE for getting assigned the highest rating. https://www.va.gov/vetapp09/files2/0919318.txt I apologize if this isn't what would be ideal to hear, but I believe I found a way for attaining a higher evaluation, under your circumstances.

I had to read it over and I could see how it would be confusing. No worries.

If your C&P was administered at a VA facility you would have access to it within 3 to 10 days in myhealthevet in your VA electronic record (Blue Button) If it was done with QTC,VES, or LHI...then you wouldn't have access to that C&P exam immediately.

I concur.

That's how I meant it to be read. But, it's always good to be fact checked. Which is always appreciated. Secondary connection still requires this criteria to be met: #1. Current Diagnosis #2. Service-Connected Disability #3. Nexus of Opinion linking #1 to #2 and a rationale present.

Buck, I'm sure you're correct, but allow me to explain. I'm talking about SECONDARY CONNECTION....not DIRECT SERVICE CONNECTION which would need all that I mentioned to be present IN-SERVICE. A veteran still requires a diagnosis, sleep study of OSA, and issuance of of a medically required CPAP after service plus a Service Connected disability that could link OSA, on a secondary basis. But, if you require that I reference the CFR. I'll go back and do my homework. I'll follow up after I'm done. I appreciate the fact checking.

You don't require a diagnosis, sleep study of OSA or issuance of a medically required CPAP in-service if you are secondary connecting it to a service connected disability such as certain mental health disorders, respiratory conditions, heart conditions, diabetes, etc. You do require a diagnosis, sleep study, and a medically required CPAP issued in-service to direct service connect. Although, the reasonable doubt doctrine has been occasionally used to grant direct service connection for OSA based off of buddy letters or family letters.

Makes sense.

What was your MOS? If you were a groundpounder, you might have a small chance to use that. It's a stretch, considering you DID NOT seek treatment in-service, but it's worth a shot. If you were a POG/Admin, then there's zero chance. Which I don't think you were, since you mentioned you would PT 5 days a week. I agree with getting a buddy letter. In addition, it would help if you had your C-file or service medical record. Once you tell me your MOS i can begin to research some medical literature for you and give you my findings.

At the very least you should have been granted hypersomnia at that time. Depending on the severity it can be rated under 8911 petit mal seizure. No, hypersomnia is not a seizure, but if you suddenly lose consciousness or fall asleep this is not good. As it can put you and others in danger. See my point? You probably should re-open if it's over one year or claim hypersomnia. BEWARE: if you claim hypersomnia you MIGHT lose your earliest effective date. But, if it was diagnosed during that exam and you were afforded a favorable nexus I don't see why you would lose that earliest effective date. If you're still feeling tired, despite using your CPAP, there may have been a possible progression of worsening from OSA to Central Sleep Apnea.

There's some good news. Sleep Apnea can be Secondary connected to Mental disorders; in your case, your anxiety disorder. It's tough, but doable. Below is a medical research that links Sleep Apnea to Psychiatric disorders. Be advised, going the secondary connection route will re-start the effective date; meaning you'll lose the original effective date because it will be considered a new claim. Sorry to be a debbie downer. Weigh the risks. Vasovagal syncope can worsen Sleep Apnea, according to some studies,but you are not service-connected for it. If you're not service connected, you can't use it to secondary connect. SecondarySleepApneaArticle.pdf