NoZZZ's

I have just gone through the HLR process myself, and having the opportunity to speak to the rater to clarify inconsistencies that I thought were in the denial was helpful, and resulted in my claim ultimately being approved. It can't hurt, as long as you are not too close to your year date where you will loose your filing date if the HLR is not finished. You said that "that statement" was the primary reason for the denial. Are there other reasons for the claim to be denied, in the absence of that statement? If so, you should make sure there is medical evidence in your file that will overcome them as well, that you can bring attention to when you speak to the rater. If not, perhaps you will need to take time to gather that evidence and choose the appeal option that will allow for submission of new evidence. Good luck.

While UC can go into remission, there is no cure. You can be asymptomatic for many years, but can have flare-ups of your symptoms. If you have been treated for UC, then you should have medical records that you can use to document your treatments, and establish the chronicity and frequency of your symptoms, as well as what was being done to control them, to counter the reduction in rating. The rating would not be reduced because it "should" be better. There would have to be evidence that the VA is using to show that it actually was better. Were you experiencing a period of remission? If so, that could possibly lead to a reduction, as long as you were not symptom free because of treatment you were receiving (i.e. your remission was not a result of ongoing medical treatment). If, however, you did not have a period of spontaneous remission, or if your condition has worsened, you will need your medical records to show what your symptoms were, when you were experiencing them, and what was being done to control them. Basically, you have to prove, with medical records, that the condition never went away. From your post, it sounds like you were recently diagnosed with UC. Are you service connected for it, or was the 20% rating for other abdominal issues? If you are not working with a VSO, I would recommend that you do. It can help make the process less overwhelming, especially since you have other issues you wish to file for.

I just recently received the decision...30% for allergic rhinitis with sinusitis. This is based on regular, recurrent sinus headaches and crusting (and persistent post nasal drip) however, and not the retention cyst. The cyst was not mentioned in the rating decision, so I am not sure how its presence effected the claim (if any), other than as a symptom affirming that I have sinusitis. Cysts are not mentioned in the DBQ for sinusitis. I had filed two separate claims, one for AR and one for Sinuses, but they were combined into one rating. I am assuming the AR would have been 0% if it had been rated separately. It sounds like you are experiencing multiple retention cysts. What are the symptoms (and importantly, the functional impact) you are experiencing as a result? Sinus pain/pressure? Discharge? That is what you will be rated on. A doctors opinion would be required to equate your mucous retention cysts to polyps, as was the case in the BVA decision I cited in the first post. That would be helpful if you were service connected with allergic rhinitis, though. The mere presence of tissue growths is not rateable under sinusitis (at least, it is not in the DBQ) from what I have found. The rating criteria for Sinusitis, from militarydisabilitymadeeasy.com: If the sinusitis is constant or near-constant with headaches, tenderness to the touch, and the discharge of puss or crusting after repeated surgeries, or if a radical surgery was performed and there is ongoing infection in the facial bones (osteomyelitis), it is rated 50%. If there are 3 or more incapacitating episodes each year that requires 4 to 6 weeks of antibiotic treatment, or if there are more than 6 episodes (not incapacitating) each year of headaches, tenderness and the discharge of puss or crusting, it is rated 30%. If there are 1 or 2 incapacitating episodes each year that requires 4 to 6 weeks of antibiotic treatment, or if there are 3 to 6 episodes each year of headaches, tenderness, and the discharge of puss or crusting, it is rated 10%. Anything less is rated 0%. So, the cysts can be an affirmative symptom that you have sinusitis, but it is the symptoms quoted above that would determine any rating you would receive. That is my understanding of it, at least.

Willy P, from reading your posts, it seems like your problem has a simple solution, although simple does not necessarily equate to easy. The denial letter stated that you lacked a nexus to an in-service event. So, you need to have a medical opinion that links your current SA to the symptoms you were experiencing while on active duty. Those symptoms (i.e. the Dr. visit) can be your in-service event. Although the C&P doctor had given you an opinion of "at least as likely as not," he did not give a sound medical rationale for it. If the C&P Dr had said that the in-service sleep complaints you had included in your claim were evidence that you had begun to experience sleep apnea while in service, and that the SA you were currently experiencing was a continuation of that same SA, then you would have had the nexus which would have likely led to service connection. The medical rationale could have been something as simple as referencing Mayo clinic research on the symptoms of sleep apnea. So, a new IMO will have to connect those dots so that the rater can follow them to service connect. The below list of sleep apnea symptoms is from the Mayo clinic. Loud snoring Episodes in which you stop breathing during sleep — which would be reported by another person Gasping for air during sleep Awakening with a dry mouth Morning headache Difficulty staying asleep (insomnia) Excessive daytime sleepiness (hypersomnia) Difficulty paying attention while awake Irritability Are there any other instances in your medical records where these symptoms come up, that you can include in your claim, to support a continuity of symptoms? Lay statements, as has been suggested by several posts, can also play an important role in supporting your claim, even if you do get an IMO. Anyone that had witnessed any of the above symptoms during your active duty service, and is willing to write a statement about it, can help strengthen your case. An IMO can certainly be expensive. But, if it helps you win your claim, it may be worth it. It is hard to bite that bullet, though, not knowing the outcome. You wouldn't happen to be service connected for anything that you could secondary connect SA too?

Did you have any event in service where you had an injury/sick call visit/complaint regarding your neck? If not, are you service connected for anything that may have caused the neck issue (i.e. secondary service connection)? How long has it been since you left active duty? You will need a Dr. to provide a letter stating that your current neck issue is a result of something that happened while you were in service, and provide a sound rationale for that opinion. You should also look through your medical records to find times where you sought treatment for the neck issue since you left active duty, to establish chronicity of the condition, and not a new injury.

Your service treatment records from the IED incident may include a reference to a neck/cervical spine injury/issue. These should be in the C-file (as broncovet has rightly advised you to get), since you are already service connected for the TBI. You should keep a copy of your STR's anyway (all of your medical records, actually). Depending on what your records say, to include any treatments or complaints about your neck since the IED (from all sources, not just STR's, including private docs), you can decide to file for direct connection, or secondary to another service connected condition (or both). Of course for secondary, you would have to have sound medical reasons for the connection, provided by a medical professional. If the neck issue is new, get yourself to a Dr. and get a diagnosis/treatment. They can help you figure out if it is a result of the IED (direct connection) or TBI/migraines (secondary connection), which will help you decide which direction you can take with your claim (if any-you may decide it is not related to your service, if it had not been an issue in the past).

What neck condition are you diagnosed with? If you do not have a diagnosis, speak to your Dr., describe what is going on, and see what they say is the issue. You can file a claim for "cervical strain," which is general neck pain, but it would be to your benefit to have a diagnosis first, as that is one of the Caluza elements: 1. Current diagnosis 2. In-service event (or something to secondary service connect to...) 3. A link between #1 and #2. And, more importantly, you can start getting treatment for the condition. No reason to suffer.

I read this as meaning that for secondary service connection, you do not need the above to happen while in service. You do need the diagnosis, etc., at some point in order to claim it as secondary, but just not while in service (as long as you have something to secondary service connect it to).

Did you appeal to get a higher rating, or was the new C&P for a new claim for increase?

It is difficult, but not impossible. Secondary service connection, as in Pattons case, is slightly easier from a service connection perspective because the time since service is not as much of an issue, as long as you have a sound medical nexus linking your already service connected issue to the secondary claim (as Patton had done, and it still took years of appeals). You do not need the in-service event for secondary connection, because you already have the service connected issue you are deriving from. For direct service connection you will need something tying your current neck problem with an in-service event, like visits to sick call, or an accident involving your neck, etc. A DBQ will not establish the nexus for service connection. You most likely will have a C&P ordered that will ask the examiner to determine if "X event" in service is as likely as not causing you current neck problems. But you have to have the "X event" established first. Buddy letters can help support evidence that is already in a claim, but those alone will not likely lead to service connection. At least it will be much more difficult.

Is there evidence that you had neck and back issues (sick call visits, an injury or accident, a diagnosis, etc..) in service (an "in-service event")? I second the likely need for a medical nexus opinion connecting your current condition to the "in-service event," particularly since there has been so much time since your active service.

You may need (or want) a medical opinion (nexus letter) linking the radiculopathy to the currently rated condition, and not another issue that may not be service connected (if there is one). This can be from the Dr that treats you for the back issue, if they are willing to say it is "at least as likely as not" causative, and the reason why. You do not have to have an EMG, but most likely will. You can still be rated with radiculopathy even if the EMG shows no nerve damage, as it can be caused by intermittent nerve impingement, and not just nerve damage/paralysis.

You will have to determine three things to file a claim for compensation: 1. An in-service event (things like a diagnosis, or sick call visits, complaints of lung issues, documented exposure to toxic chemicals, etc.) 2. A current diagnosis of asthma or other lung issues. 3. A "nexus" between 1 and 2. You have to show that what happened in service (#1) caused or made worse your current medical issue (#2). This can be the most difficult part, especially if a lot of time has passed since discharge. For direct service connection, you have to show that what happened to you then is causing what is happening to you now. Often times, you will need a medical opinion linking these together, if you are outside of the one year presumptive period after discharge. (For secondary service connection it is a little different, but you still need to show, with medical evidence, that another current service connected issue is causing your asthma. I assume you are trying for direct connection, though). Some questions to ask yourself, that can point you in the right direction: Were you diagnosed in service? If not, how long after discharge from active duty were you diagnosed? Do you have your MEPS physical showing no asthma prior to service? Do you have any treatments for lung related issues in service, if you did not have a diagnosis? Visits to sick call, especially while deployed? Is there evidence of continuous treatment to the present? Look into the burn pit registry. If you were deployed to any of the locations it covers, your exposure to burn pits can possibly support your claim for service connection. You should also be thinking about how the asthma impacts your life (your ability to work/creates a functional loss). That is the reason you are compensated, after all. Write a statement about this, to include with your claim.

Chronic pain (i.e. somatic symptom disorder 9422) is a mental health claim. You are being rated on the symptoms the pain is causing. For example, you have pain daily arising from "lumbosacral strain." This pain causes you to feel depressed and you have difficulty concentrating at work, thus decreasing your quality of life, and your earning potential. The severity of the depression and concentration symptoms, and their impact on your life, will determine your rating, in accordance to the rating schedule for mental health claims. Otherwise, pain is taken into consideration in musculoskeletal disorders in how it impacts range of motion, and therefore, functional loss of the effected body part. If pain is present, but does not effect ROM, then the lowest compensable rating is awarded. In either case, the pain is resulting in a condition which leads to a functional loss, either physically or mentally, which is why it can be compensated for.

One last thing...you will need a Dr. (best if it's the one that prescribed the CPAP) to state that the CPAP is necessary (not just recommended) to treat your SA. This is important for reaching the 50% threshold. The argument that "they wouldn't give it to me if it wasn't necessary" does not suffice, as correct as it may be.