Denial For Not Being Clinically Diagnosed

[nyc-vet]

Hello fellow vets, first I must say what a great site. This forum has been very helpful in understanding how the va works. I had a question about my wife who is a disabled vet also at 60%. She suffers from fibromyalgia along with other things. They denied here recently for fibromyalgia saying that it was not clinically diagnosed. Over the past 5 or 6 years she has been taken several medications prescibed by the va that relate to fibromyagia. You would think that they would consider that when the the decision was made but they didn't.

We decided to take a chance and go to here primary va doctor and tell him the situation of her claim that it was denied because it was not clinically diagnosed. He turn on his computer and type up a report and immediately made it clinically dianosed.

I was wondering is this enough for us to write a reopening to this claim. Will that be enough to get her a rating. Also what should we write in the letter when we reopen it?

[donews]

Hello!

Welcome to Hadit.

Having your primary care provider diagnose the condition is the first step.

Did he diagnose it as new or did he diagnose it as manifesting years ago?

I would assume as long as there is proof (would be easier if it was some proof other than just related meds) of it manifesting in or within a certain period of service or a nexus to another Service Connected condition you should be ok.

I am not positive if you should do and NOD or a Request for Reconsideration or what as you need to submit this new evidence, but I am sure someone a little more knowledgable about this situation will be along shortly.

Good luck and thank you both for your service!

[rdawg]

Welcome brother and sister.

Is she a gulf war vet (in country, gulf war 1 or 2)? If the answer is yes then the diagnosis is all she needs to reopen her claim, as it is a presumptive condition. If the answer is no then she will need the doctor to review her c-file and then state "it's at least as likely as not" that her condition is related to an in service injury. And of course she would need the fibro to have been diagnosed during service.

Either way, if the evidence is submitted within a year of your last denial then you should keep your earlier effective date.

Edited April 8, 2008 by rdawg

[jbasser]

Get copies of al lthe med records and take them to a MD to get an IMO.

Have the doc state in language the VA can understand that the symptoms of the disease support a diagnosis. Then have the doc write a strong opinion as th the start of the condition by using the evidence available.

The Va will not be able to rebut a well rounded opinion but the opinion must include the diagnosis, information reviewed, etiology and a relation to the current condition.

Best of luck

J

[Berta]

You have to prepare a NOD- on that denial- but better yet-

mark your calendar so that the year of NOD filing time doesn't run out and consider instead filing a Request for Reconsideration.

There is info at hadit as to how one prepares a Recon request- you refer to their statements and then tell them of the information you have and attach copies of it and ask them to reconsider their denial based on this new information from her Primary doctor.There is Reconsider Request here at hadit under the search feature.

If she isnt working I would also suggest she (and maybe you should to0) apply for TDIU.

She can attach the form to the Recon request and refer to it in the request also.

Under # 18 check yes and then if she has not applied for SSA she should-

If she has those records would be helpful to VA and she should under # 25 refer them to separate page, tell the VA what she gets SSA for (this is only if she is unemployed) and also list and tell them of the side affects of her meds, and how they affect her ability to work, and state anything else that they should know.

Be brief in that attached statement though- so that they read it all.

"You would think that they would consider that when the the decision was made but they didn't"

Nope- they never connect the dots.

If you follow jbasser's suggestion- and I agree with him this is a good idea- make sure the doctor follows the IMO criteria here at hadit under the search feature as this way- your IMO doc will connect the dots.

They dont know how to or-even if it is obvious, they wont at the VA.

TDIU form-next post

Edited April 8, 2008 by Berta

[Berta]

File out, attach additional info, sign, copy and mail Priority or Certified to the VA - Attention to the initials on the last letter she got- in the right hand corner over the date.

TDIU is paid at the 100% rate to any veterans whose service connected disabilities render them unemployable-

The VA only sends this form out when the vet reaches 70% (sometimes they forget to) However there is nothing whatsoever in any regulation that prevents a vet from applying for TDIU regardless of their SC %.

Some vet Reps and NSOs still tell vets they have to be 70% to get TDIU-

I would like to find those reps alone in a dark alley sometime-

Because in many cases by telling veterans this- the rep is costing the veteran compensation and they are as wrong as they can be.

TDIU_form.pdf

[nyc-vet]

Thanks for all the replys. The one year date has passed. She was so down about being denied she gave up and didn't want to bother with it anymore. I was recently reread the letter and realized there is still a chance of getting this done. One thing is they only used two year worth of va records. They didn't request all her records from other va hospitals. Her other records will clearly show more evidence. We will be contacting her doctor again also to help make a connection (nexus).

Also she recently applied for SS. We should be hearing something soon. She applied for unemployabilty a few years ago but it was denied because there was no evidence that she couldn't work. I know for sure that the medication that she is on makes her drowsy all day long. I don't know if that along with a state from her doctor will be enough for TDIU