Appeal Whlie Waiting Decision On New Evidence

[Signal6]

This site is great, I am so glad I found it. Dealing with the VA is a nightmare and I appreciate the support everyone offers on this site.

Ok, I was wounded in Iraq, April 2005. I filed my initial claim in Dec 2006 as soon as I returned. My initial rating was 30%, but they rated my sinusitis and allergic rhinitis at 0%. I wrote them and sent in additional evidence and they increased it to 10%, 40% total. I filed at notice of disagreement and received an answer from a DRO in Nov 2007. I replied to the answer and said I still disagreed and sent them new medical records from my on going sinus problems. I just sent in more records from the Miami VA and my private doc.

So, my question is did I wait to long to file an appeal for my sinusitis and allergic rhinitis? I sent them 11 records of sinusitis in one year (2005) and also a CT scan revealing polyps in my sinuses (2006) but they ignored both. the DRO only counted 4 records for sinunsitis and said the CT scan wasn't an absolute diagnosis for polyps because a VA doctor at C&P didn't see them during a visit. It would be kind of hard to see poylps within the sinusis with out an MRI or CT scan,but that is what they said.

Second question, if it isn't to late, should i wait until they review the new evidence I sent in (records from 2008 for 8 episodes of sinusitis and another CT scan from VA showing polyps in the sinusis)?

Thanks again

Tom

[Ricky]

Time lines:

from original decision to file a NOD - 1 year

from response to NOD by the DRO to file your form 9 for a formal appeal - 60 days

If the DRO changes your decision and issues a rating decision say from 0 percent to 10 percent then you once again have one year to file a NOD against that rating decision.

However, if your rating decision issued an award of say 0 percent and your submit a NOD and then the DRO continues that decision at 0 percent then you only have 60 days to formalize your appeal via the form 9.

It looks like you missed that 60 day period. However, since you sent in a letter saying you still disagreed - and if you sent in additional evidence after the 60 day period they may re-open the claim if the evidence is new and material.

Or if you have an easy going DRO he/she may have accepted your letter as your formal appeal. Does not happen often but it does happen. As posted below you need to call and find out the status of your claim and then go from there.

Just keep in mind for future reference - one year to file your NOD after the rating and if the DRO continues the denial or same level of award you only have 60 days to perfect your appeal.

[Chuck75]

"CT scan wasn't an absolute diagnosis for polyps because a VA doctor at C&P didn't see them during a visit."

HA! weakest excuse I've heard! When and if everything else fails, this might be a case for CUE. I'd at least get "new evidence" in the form of an IMO and an exam by a rated specialist. What was the C&P drs specialty, and how did the dr do the exam sinus exam. Material evidence of fact outweighs an opinion. Now, if the C&P doctor said it was not service connected, that is a different kettle to fight over.

This site is great, I am so glad I found it. Dealing with the VA is a nightmare and I appreciate the support everyone offers on this site.

Ok, I was wounded in Iraq, April 2005. I filed my initial claim in Dec 2006 as soon as I returned. My initial rating was 30%, but they rated my sinusitis and allergic rhinitis at 0%. I wrote them and sent in additional evidence and they increased it to 10%, 40% total. I filed at notice of disagreement and received an answer from a DRO in Nov 2007. I replied to the answer and said I still disagreed and sent them new medical records from my on going sinus problems. I just sent in more records from the Miami VA and my private doc.

So, my question is did I wait to long to file an appeal for my sinusitis and allergic rhinitis? I sent them 11 records of sinusitis in one year (2005) and also a CT scan revealing polyps in my sinuses (2006) but they ignored both. the DRO only counted 4 records for sinunsitis and said the CT scan wasn't an absolute diagnosis for polyps because a VA doctor at C&P didn't see them during a visit. It would be kind of hard to see poylps within the sinusis with out an MRI or CT scan,but that is what they said.

Second question, if it isn't to late, should i wait until they review the new evidence I sent in (records from 2008 for 8 episodes of sinusitis and another CT scan from VA showing polyps in the sinusis)?

Thanks again

Tom

[Signal6]

Thanks for the all information, I really appreciate it.

The funny part of this, they quoted the primary care PA because he didn't see polyps during routine exam, as the reason for demial. I don't think he even looked up my nose, as if you could see them in the sinuses anyway. The good part is, I am already SC 10% for chronic sinusitis and allergic rhinitis. Now they just need to accept the evidence.

[Signal6]

I can't believe it. I got home today and there was the infamous Yellow Envelope from the VA. Low and behold, they upgraded my rating to 30% for my chronic sinusitis and allergic rhinitis. It appears someone actual read the CT scan report and noted the polyps. I can honestly say this is one of the happiest and most surprising days i have had in a long time.

However, I do have one question. The end of the Supplemental Statement of the Case says, "because there is likelihood of improvement, this evaluation is not considered permanent and is subject to routine future examination in January 2011. I understand this means i will be going back to C&P for an exam in Jan 2011, anything else I should know about this, or what else it means?

Thanks

Tom

[cowgirl]

Congrats! ok, until 2011 more than likely you will be rechecked for a continuing condition of the same. If polyps are mentioned, I suspect as much the thinking there could be medical 'cure' or 'treatment' to help the condition improve (or get worse?). Read, ask questions, could be you disagree, or they missed something. Now is the time to check out what was really decided on your behalf.

Best to ya,

CG'up2009

p.s. you may want to post the decision here, for possible other advice.extra eyes that care.

I can't believe it. I got home today and there was the infamous Yellow Envelope from the VA. Low and behold, they upgraded my rating to 30% for my chronic sinusitis and allergic rhinitis. It appears someone actual read the CT scan report and noted the polyps. I can honestly say this is one of the happiest and most surprising days i have had in a long time.

However, I do have one question. The end of the Supplemental Statement of the Case says, "because there is likelihood of improvement, this evaluation is not considered permanent and is subject to routine future examination in January 2011. I understand this means i will be going back to C&P for an exam in Jan 2011, anything else I should know about this, or what else it means?

Thanks

Tom

Edited January 14, 2009 by cowgirl