diabetes Reason For Denial Need Help Finding Errors

[ruby]

The comp exam was done by a PA--my rheum was the chief of staff MD with 30 yrs. I had an IMO from a dermatologist MD for 30 yrs who provided the literature that connects the 2 and a statement more likely then not.

form 119 report of contact dated feb 5-needed to know what joints

your sc treatment records don't show trmt for reactive arthritis (actually the initial symptoms were there they were not together. had eye issue couldn't find why r/o diabetes-it was, cystitis unknow orgin this was the initial start.) the symptoms were never connected and the disease was most known by rheum docs only at that time.

a letter dated 2/9/08 was sent to you advising you of the vcaa and informing you of what evidence is required to complete processing your claim. This leter also furnished you information regarding disability ratings, factors affecting eval and how the va determines the eed.all reasonale efforts to assist you in pursuing your claim have been exhausted etc.

a review of virtual va records was conducted 4/27/09 the results of this review were negative results for medical records pertinent to your current claim.(it appears they missed records by another rheum doc on 8/08--10/08--2/09 he mentioned the reactive is due to the hs.)

Medical statement, Dr V dated 12/6 includeing progress note, and statement dated 1/15/2008 notes that he believes your recurring cyst is chronic condition called hidradenitis suppurative and that you have reactive arthritis due to hs. In the record dated 12/26/2007, he noted that you are unable to sustain gainful employmnet of any sort due to physical, mnetal, emotional and psychological limitations.

Va examiner addendum dated 4/809 was reviewed. the examiner noted a diagnossis of bilateral knww arthritis, the examiner opined that is less likely as not that your current reactive arthritis of the left knee is due to your sc hidradenitis. The examiner noted the rational is a review of the medical literature revealed that hs is a disease of the aprogra glnd bearing skin etc. The examiner noted that there was no medical evidence in the literature to indicate that hs causes reactive arthritis in myltiple joints. The examiner noted that xrays of the knees revealed early osteoarthritis which is normal for your age. It is the opinion of the examiner that you have multi joint osteoarthritis found on x-ray and no reactive arthriis related information found on medical literature, therefore, your claim of multi joint reactive arthritis is unrelated to and not aggravated or worsened by your hs.

although there is a positive opinion from Dr V that your reactive arthritis is due to hidradenitis suppurative, the examiner did not have access to your entire claims folder including complete service treatment records.

Thats the denial---they did not mention anything else.

In the evidence section they mention an IMO from the Derm doc but nothing about his statements or literature to support this opinion tat hs causes reactive arthritis.

The PA stated to me when I walked in "i see your trying to connect hs to reactive arthritis and your out of luck on that one, its not in my derm book" I ask him out old his book was but he never looked it up. I then ask him how much he knew about reactive and he said "very little"--this was my competent medical person who did a legal comp exam.

The VA takes the word of a PA over 3 MD's who doesn't know the difference from osteo from reactive. This where I might be able to get a new comp exam with a competent physician---This idiot doesn't realize that you can't determine the difference by xray. One of the hall marks of reactive is bone spurs on xray and reactive arthritis looks like osteo---osteo is given if your arthritis started after the age of 50. I have had mine for 30 yrs.

Any flay's with this denial

Since Dr R's notes are not listed in the evidence section and they missed them on there virtual review is that a cue.

they did not use the benefit of the doubt rule----

there rational for not giving any credence to the other md's appears they didn't have the complete file.

they had records that pertained to this issue and they documented those in there letters.

any help with errors would be great.

thanks ruby

[ruby]

Ruby

Someone else can correct me if I am wrong on this, but I think you need only prove you had

SYMPTOMS of a disease suffered in the military and, not necessarily a diagnosis. A diagnosis by a doctor can come later.

An example may be when a military person gets shot. Symptoms of a gunshot wound would be bleeding, shock, etc. That Veteran may never be diagnosed by a doctor with a GSW..he may well die before he gets treatment/diagnosis. Or, it may not be serious enough that he even seeks medical attention. But, he still has symptoms of a GSW while in the military.

Just because a military doctor failed to diagnosis your conditions properly, does not necessarily mean you dont have any symptoms.

I mentioned this in another post. Cite Roberson vs Principii if you think you have evidence overlooked. http://www.ll.georgetown.edu/federal/judic...ns/00-7009.html

Everyone is always talking about CUE, if you filed a NOD within a year, you dont have to meet the strict CUE standard to win your claim so why make it harder for yourself?

Broncovet,

Thanks for this info, I have an IU on appeal this will help.---I brought up the symptoms that were overlooked actually due to the PA saying there was nothing to support that I had symptoms in the service, there was he just didn't know the symtpms of reactive are.

[ruby]

The thing that caught me was the fact that they did a "virutal review"....ugh. This is where you need to get ALL the paper copies of your records, SMRs, VA, civilian....anything and everything; highlight what the 3 Docs said was wrong, put it all together in a neat package and mail it in.

You have to put the proverbial dots extremely close together for the VA in order for them to connect them. You can't rely on them to look at the important aspects of your medical records...you have to shove it under their nose!!

I called the 1800 number to clarify the virtual review statement they aren't 100% sure what it really means as it is new lingo for them.

[ruby]

While looking at my award/denial letter I realized that nothing had dx codes, so I called the 1-800 and asked them for the dx codes----

My HS was sc as cyst/scars but it is an actual disease process, I asked to have it changed they didn't change it, so that explains to me why I got 0% for it, I should have gotten at least 10%.

So now in my recon/nod I am going to ask for 60% for near constant to constant immunosuppressive drugs. I am on near constant antibotic therapy which will eventually lead to my demise (MRSA,VRE) if the PTSD doesn't get to me sooner.

I really did have a simply no brainer claim the VA has turned into a nightmare.

[halos2]

"I really did have a simply no brainer claim the VA has turned into a nightmare"

THIS IS SO COMMON!!

While looking at my award/denial letter I realized that nothing had dx codes, so I called the 1-800 and asked them for the dx codes----

My HS was sc as cyst/scars but it is an actual disease process, I asked to have it changed they didn't change it, so that explains to me why I got 0% for it, I should have gotten at least 10%.

So now in my recon/nod I am going to ask for 60% for near constant to constant immunosuppressive drugs. I am on near constant antibotic therapy which will eventually lead to my demise (MRSA,VRE) if the PTSD doesn't get to me sooner.

I really did have a simply no brainer claim the VA has turned into a nightmare.

[broncovet]

Ruby

The VA has used the "divide, complicate and deny" motto for decades.

This is the "congressional mandate" from Roberson V Principi:

38 C.F.R. § 3.155(a) (1994) (emphasis added).

The Court of Appeals for Veterans Claims held that even if the VA had a duty to develop all possible claims that are reasonably raised from a liberal reading of the record, Roberson was required under section 3.155(a) to specifically request entitlement to the benefit sought – in this case TDIU. The Court of Appeals for Veterans Claims determined that because Roberson did not make a specific request for TDIU, the VA was not obligated to adjudicate such a claim.

Roberson alleges that Norris v. West, 12 Vet. App. 413 (1999), is applicable and holds that the VA’s requirement that TDIU be specifically requested “loses sight of the Congressional mandate that the VA is to ‘fully and sympathetically develop the veteran’s claim to its optimum before decision on its merits.’” Norris, 12 Vet. App. at 420 (citing Hodge v. West, 155 F.3d 1356, 1362-63 (Fed. Cir. 1998))

(end quote, Roberson vs Principii)

When the VA fails to consider ALL your claims, developed to the maximum, you should call them on this, citing Roberson vs Principii.

[jbasser]

Ruby, my advice to you is to do this.

1; File the NOD and state you dont agree with the decision as the statement about the doc not having medical records is flawed. Ask for a DRO decision.

I feel this one will have to go before the BVA as the RO is ignorant and will continue the denial phase.

Then get an attorney as fast as you can. You most likely will need one as the complexity of this claim widens. (once you get conflicting medical opinions) it makes it complex and it is nothing you did. It is just another move by the VA in the game of Service connection.

Hang in there and keep your wits.

J