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Reopen Claim


JayBrown1

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I would like to know if anyone has information on reopen claims. I was contacted by the VA via IRIS stating that I can't have two reopen claims at the same time, 'Is this true?" They also stated that they lumped the two reopen clams together and are working on completing the claim, however the claimsare two totally different things, sleep apnea and auto allowance. Also can anyone tell me what the term "loss of use" means and would bone fusion be considered loss of use?

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I would like to know if anyone has information on reopen claims. I was contacted by the VA via IRIS stating that I can't have two reopen claims at the same time, 'Is this true?" They also stated that they lumped the two reopen clams together and are working on completing the claim, however the claimsare two totally different things, sleep apnea and auto allowance. Also can anyone tell me what the term "loss of use" means and would bone fusion be considered loss of use?

Can anyone tell me something about this?

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Jay in the big picture of the VA you only have ONE claim. That is the original claim that you file. Everything within that claim is a seperate ISSUE. Lets say you file your original claim in 1995 and you request SC for Hypertension, Sleep Apnea and lower back pain. You have the one claim open with three seperate issues. Now move forward to 2007. You have some new issues you want to claim. Lets say DMII and PN. You now have a re-opened claim with two issues. Does this make sense? In quick summary everything you claim is consolidate within your ONE claim. so yes what they have done is correct.

Loss of use is described in 38 CFR 4.63 as: Loss of use of a hand or a foot, for the purpose of special monthly compensation, will be held to exist when no effective function remains other than that which would be equally well served by an amputation stump at the site of election below elbow or knee with use of a suitable prosthetic appliance. The determination will be made on the basis of the actual remaining function of the hand or foot, whether the acts of grasping, manipulation, etc., in the case of the hand, or of balance and propulsion, etc., in the case of the foot, could be accomplished equally well by an amputation stump with prosthesis.

To me this means that if the foot or hand is no better than an artifical one the loss of use exists. I do not think bone fusion would qualify - it would be the function left in the limb after the fusion was completed.

JMHO

Edited by Ricky
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When you reopen a claim it means you have been denied and you now have new evidence to reopen a claim that was a new claim. If you have a claim and you are asking for an increase you do not need new evidence to go forward. You are simply saying your condition is worse and you want more compensation. This is my understanding of it. Did you have two claims that were denied, or do you have claims you are requesting increases for? There is a big difference in regards to your burden of proof etc.

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When you reopen a claim it means you have been denied and you now have new evidence to reopen a claim that was a new claim. If you have a claim and you are asking for an increase you do not need new evidence to go forward. You are simply saying your condition is worse and you want more compensation. This is my understanding of it. Did you have two claims that were denied, or do you have claims you are requesting increases for? There is a big difference in regards to your burden of proof etc.

In 2003 I was diagnosed with sleep apnea, I put in a claim as secondary for this. I never got a decision for this claim. In 2004 I was issued a CPAP with full mask, 2006 I again requested a rating for sleep apnea as secondary to left knee fusion with depression(40), lower lumbar(40), right knee(20),left foot(10), right hip(10),and scars(10),Nov 2006 received a letter that they reopened my claim for sleep apnea. 2006 I requested a review of previous claim for auto allowance which was down graded to adaptive equipment only. I challenged the term "loss of use" on a legal stand point, not to mention the doctors wrote in my medical file that I have loss of use of my left leg and on the fact that it would cost more than the auto allowance to have my car adapted to my service connected disability, almost $16,000. Auto allowance is 12500, it would be beneficial for them to do the auto allowance for me.

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You original claim should still be open if you never got a decision. That means they should not have reopened it and you may have retro coming to you when they decide it.

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I would just like to add that in terms of your "fusion" the VARO adjudicating on the claim may not view it as "loss of use" by VA regulatory definition. However, it should definitely qualify under "loss of function", as outlined by

§ 4.40 Functional loss: Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like.

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Ricky, got time for feedback and advice once again? thanks. As I read your reply something triggered a thought in me. I originally applied for several disability issues on my first claim, using advice given during retirement outbreifing. At that time I did not have a VSO and submitted the claim using my own wording, meaning "non-medical" terms to describe issues. Now I truly beleive I have recently rewarded disability issue that was denied from on that original claim. Should I pursue this "probability" or accept current status? Thanks a bunch,cg

------your post said......... big picture of the VA you only have ONE claim. That is the original claim that you file. Everything within that claim is a seperate ISSUE. Lets say you file your original claim in 1995 and you request SC for Hypertension, Sleep Apnea and lower back pain. You have the one claim open with three seperate issues. Now move forward to 2007. You have some new issues you want to claim. Lets say DMII and PN. You now have a re-opened claim with two issues. Does this make sense? In quick summary everything you claim is consolidate within your ONE claim. so yes what they have done is correct.

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cg - what was the origingal claim and what do you feel they recently awarded which is the same issue as on your initinal filing?

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cg - what was the origingal claim and what do you feel they recently awarded which is the same issue as on your initinal filing?

In my original claim, several years ago, I listed several items under the "nature of sickness, disease or injury", where and when treated. Although I didnt use the word "depression" I did list three items as psych related and or treated. There is a VA note for disabilities claimed in my cfile, consolidating the very items I submitted, with thier word "depression" as a claimed issue. My recent approved rating for depression is directly relates to the earlier items. So I wonder, - can I reopen or ask for reconsideration or am I on the wrong wave length? thanks,cg

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Ricky or ?

In my original claim, several years ago, I listed a few psychological disability issues but didnt use the word "depression". There is a VA note for disabilities claimed in my cfile, consolidating the very items I submitted, with thier word "depression" as a claimed issue. I am now SC for depression directly related to the earlierissues. So I wonder, - can I reopen or ask for reconsideration or am I on the wrong wave length? thanks,cg

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Here is what happened in my case:

[old post]="I submitted a claim for multiple disabilities including that of cardiac pacemaker implanted due to bradycardia (slow heart beat; mine was down to 20). My question does not involve nexus issues, but terminology.

QUESTION: Should I forward an additional document to the VA citing SICK SINUS SYNDROME as the cause of bradycardia?"

RESULT: Without any futher word from me (i.e., I never submitted additional documents citing SICK SINUS SYNDROME) my claim was approved and the summary of rating DID include the SICK SINUS SYNDROME even though I never used the term in my claim. I don't know of course if this would be applicable in your case.

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