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Denied Claim


jstone1950
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Question

I submitted a claim to be reopened in January of this year on issues that were claimed in 1994. I received a denial letter August 27th of this year. In this letter, VA states that this is a new claim for benefits; whereas this claim specifically states that it is an attempt to reopen a previous claim. The issues were gastroenteritis and stress/depression. VA stated that they denied the gastroenteritis because my condition was not considered chronic, though I had been treated at least three times while on active duty beginning in Vietnam over a period of six years because of flare-ups. I submitted information from a Gastrointestinal Specialists indicating evidence of the gastrointeritis. They also denied the issue of stress/depression. I submitted VA medical records indicating a diagnosis of major depression. They responded that I was being treated for a dysthymic disorder and have a past medical history of depression, anxiety and stress and no service treatment records show no treatment or diagnosis of these conditions. While in Vietnam and also I submitted the service records indicating such, I was diagnosed with tension headaches and also in 1976 while on active duty, I was diagnosed as a remote depressant. It seems to me that VA just conveniently ignore what is submitted in support or otherwise just say anything to deny your claim with glaring evidence. My question is how many times should you have been seen in the military for an issue to be considered chronic and what are my options when VA erroneously indicates that my service records shows no treatment or diagnosis of a condition even when the evidence is submitted. Additionally, do you think I should get an attorney for my case.

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Under the new regs you can obtsin an attorney as soon as you file the NOD. They get 20% of any potential retro.

When you re-opened the claim in January the VA was supposed to send you a VCAA letter telling you exactly what evidence they needed and also they were to enclose an election response form.

"I submitted information from a Gastrointestinal Specialists indicating evidence of the gastrointeritis." I assume you got an independent medical opinion from a specialist- did this doctor state as likely as not or more than likely this had a nexus to your service?

Did this doctor have your SMRs as well as your VA med recs when they opined?

"I submitted VA medical records indicating a diagnosis of major depression. They responded that I was being treated for a dysthymic disorder and have a past medical history of depression, anxiety and stress and no service treatment"etc-

did you fully explain any nexus you had from Vietnam to these conditions?

Did the specialist state there was any association between the gastrointestinal problems and the depression ? (possibly secondary due to the mental disabilities)-

I am surprised that you didnt mention PTSD- has the VA or any private doctor ruled out PTSD? Anxiety, dysthymic disorder ,stress and depression can all go hand in hand with PTSD.The GAstrointestinal problems could definitely be secondary to these other conditions-

I am baffled as to their denial here- Did they list all of the evidence you sent to them in the denial and then did they refer to it all in the narrative?

It almost looks to be like they never even considered your SMRs and medical evidence.

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  • HadIt.com Elder

To "re-open" an old claim - from 1994 - you must have "new and material" evidence. Evidence that has never been seen before, and if it had been seen, then it could or would have made a difference in the outcome of your claim.

Did you, in fact, have such evidence?

Did you refer back to your claim in 1994 and word your "NOD" (notice of disagreement, in this case your notice of disagreement with the final outcome) like your original claim in 1994?

Have you a copy of your SMR's (Service Medical Records)?

Have you a copy of your C-file (Claims File)?

Is it up-to-date?

Have you a copy of your VA medical records?

Are they up-to-date?

Can you provide, through these various records and any records of "outside" or "civilian" treatment, a "continuity" of treatment for the conditions that you are claiming?

When you say,

"I submitted VA medical records indicating a diagnosis of major depression. They responded that I was being treated for a dysthymic disorder and have a past medical history of depression, anxiety and stress and no service treatment",

it indicates, to me, that you either did not take them by the nose and point out to them that you do HAVE a copy of your VA medical records and that, on the 16th of June Doctor so-and-so, in his treatment records for the 16th of June, says "the veteran has MDD and it is caused by........".

You can do this, without a lawyer. Think of it as writing yourself the same check that the lawyer COULD get, if you did, in fact, hire one.

I would not have prevailed in my claim for Permanent and Total Disability had it not been for my TWO psychiatrists at the VAMC. The VARO "rater" came up with some really "silly" reasons why I did not qualify for TDIU. I got to thinking, you know, this turkey is coming up with HIS own diagnosis of my symptoms and turning the medical treatment records all around, to suit HIS diagnosis, thereby creating a false picture of my condition. So, I trot myself, post-haste, to the VA Medical Center......and, as luck would have it.....caught BOTH of my doctors walking down the hall, together.....wow, LUCK.....anyway, I just walks up to them, hand them copies of the "rater's" medical opinion of my disease......asked them to read it and see if they agreed with "the doctor/rater at the VARO in Waco"?

They didn't, and it didn't take but a couple days for me (and the rater in Waco, I'm sure) to find out what my REAL doctors' opinions WERE.

Nice that we got all that straightened around, right?

You CAN do this.

Really.

Do your VA treatment records say "major depressive disorder" "major depression" "MDD" or do they say "dysthymic disorder"?

Did you claim MDD or did you claim something else (obviously you DID NOT claim "dysthymic disorder).

You know, here is just a suggestion. Just a SUGGESTION (NO, DAMN IT, I DID NOT SPEND THE NIGHT IN A HOLIDAY INN EXPRESS!).

File a claim for dysthymic disorder.

Should be a slam dunk.

You already got the "diagnosis" from the rater.

Right?

he-he, sometimes I jist cracks meself plum up!

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  • HadIt.com Elder
To "re-open" an old claim - from 1994 - you must have "new and material" evidence. Evidence that has never been seen before, and if it had been seen, then it could or would have made a difference in the outcome of your claim.

Did you, in fact, have such evidence?

Did you refer back to your claim in 1994 and word your "NOD" (notice of disagreement, in this case your notice of disagreement with the final outcome) like your original claim in 1994?

Have you a copy of your SMR's (Service Medical Records)?

Have you a copy of your C-file (Claims File)?

Is it up-to-date?

Have you a copy of your VA medical records?

Are they up-to-date?

Can you provide, through these various records and any records of "outside" or "civilian" treatment, a "continuity" of treatment for the conditions that you are claiming?

When you say,

"I submitted VA medical records indicating a diagnosis of major depression. They responded that I was being treated for a dysthymic disorder and have a past medical history of depression, anxiety and stress and no service treatment",

it indicates, to me, that you either did not take them by the nose and point out to them that you do HAVE a copy of your VA medical records and that, on the 16th of June Doctor so-and-so, in his treatment records for the 16th of June, says "the veteran has MDD and it is caused by........".

You can do this, without a lawyer. Think of it as writing yourself the same check that the lawyer COULD get, if you did, in fact, hire one.

I would not have prevailed in my claim for Permanent and Total Disability had it not been for my TWO psychiatrists at the VAMC. The VARO "rater" came up with some really "silly" reasons why I did not qualify for TDIU. I got to thinking, you know, this turkey is coming up with HIS own diagnosis of my symptoms and turning the medical treatment records all around, to suit HIS diagnosis, thereby creating a false picture of my condition. So, I trot myself, post-haste, to the VA Medical Center......and, as luck would have it.....caught BOTH of my doctors walking down the hall, together.....wow, LUCK.....anyway, I just walks up to them, hand them copies of the "rater's" medical opinion of my disease......asked them to read it and see if they agreed with "the doctor/rater at the VARO in Waco"?

They didn't, and it didn't take but a couple days for me (and the rater in Waco, I'm sure) to find out what my REAL doctors' opinions WERE.

Nice that we got all that straightened around, right?

You CAN do this.

Really.

Do your VA treatment records say "major depressive disorder" "major depression" "MDD" or do they say "dysthymic disorder"?

Did you claim MDD or did you claim something else (obviously you DID NOT claim "dysthymic disorder).

You know, here is just a suggestion. Just a SUGGESTION (NO, DAMN IT, I DID NOT SPEND THE NIGHT IN A HOLIDAY INN EXPRESS!).

File a claim for dysthymic disorder.

Should be a slam dunk.

You already got the "diagnosis" from the rater.

Right?

he-he, sometimes I jist cracks meself plum up!

WOW, thsse new meds are GOOOOOODD.

Now, if I could just find my bedroom, I'd go lay down.......if the deck would quit tilting back and forth........whoa Nellie........oooops

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Make a copy Larryj's suggestions. Highlite the specific areas.

According to the National Health Interview survey a condition that has persisted for 3 or more months is considered chronic.

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  • HadIt.com Elder

jstone1950,

Did you submit any specific report from a doctor who reviewed the entire medical record and determined that your current condition is more likely than not the result of the diagnoses and symptoms that are a matter of record while you were on active duty or withion one year of discharge? This is the type of statement the VA needs to service connect. PTSD would be an option if you have such a diagnosis.

Did you have a C&P. If not, they did not associated any diagnoses in the military with your current condition. You might be able to get a C&P by appealing and specifically stating what conditions you think are related to service. If you cannot get a C&P to establish a nexus then you need to get your own doctor. Some vets have been able to get these reports from VA doctors. However, the VA docs do not always get involved. Thus, private doctors can become the only option.

I did not see anything in your post that indicates that the issue of nexus between in service symptoms and current symptoms was addressed by a doctor. It appears the RO shot from the hips and denied your claim without developing any evidence. Developing evidence requires that they acquire medical opinions based on the entire record.

This is complex. Get a good SO or an attorney.

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