Claim Denied

[smilen66]

I am empty, hurt, angry ... speechless! I did request my C-F this morning. Attached are reasons for decision.

[cowgirl]

Smilen, please take personal information off of your post. Double check for names and relationship connections that we here at Hadit don't have a need to know.

Best to ya,

Cowgirl

[Berta]

On page 7 it refers to a medical opinion-= was this an independent medical opinion?

There are saying only one cpmplaint noted in SMRs with nothing on the discharge certificate.

Did they overlook critical evidence in your SMRs?

Did you fully support any inservice nexus for this disability?

[smilen66]

Smilen, please take personal information off of your post. Double check for names and relationship connections that we here at Hadit don't have a need to know.

Best to ya,

Cowgirl

Thanks Cowgirl for the heads-up. I marked out most names, the last two was an oversight. Can't get them off. One of them is spelled incorrectly anyway. I will be more careful in the future.

Thanks again!

[smilen66]

On page 7 it refers to a medical opinion-= was this an independent medical opinion?

There are saying only one cpmplaint noted in SMRs with nothing on the discharge certificate.

Did they overlook critical evidence in your SMRs?

Did you fully support any inservice nexus for this disability?

Hi Berta,

Yes, this was my private doctor prescribing meds.

Thanks

[smilen66]

Please help me if you can!

Attached are medical evidences sent to the V.A. from my time in service (1980-1984). Please note I tried to avoid going on sick call and often waited until I had another condition to go. I was not a complainer unless I could not go on any further. Is this not enough for them. I also, submitted twice that (attached) amount of additional evidence from 1985 to present to the V.A.

Thanks

[Berta]

I feel you should copy the "Getting an Independent Medical Opinion" topic here and have your private doctor thoroughly associate the SMR notations to your present claimed disability,

The disability also has to have continuity of symptoms.The doc will need all available treatment and clinical records.

The VA will not connect the dots on claims like this-

Do you have a copy of the C & P exam results?

The C & P could help the IMO doctor to fully assess the condition and it's nexus to your service.

If this was result of an accident or injury, do you have proof of that?

[smilen66]

I feel you should copy the "Getting an Independent Medical Opinion" topic here and have your private doctor thoroughly associate the SMR notations to your present claimed disability,

The disability also has to have continuity of symptoms.The doc will need all available treatment and clinical records.

The VA will not connect the dots on claims like this-

Do you have a copy of the C & P exam results?

The C & P could help the IMO doctor to fully assess the condition and it's nexus to your service.

If this was result of an accident or injury, do you have proof of that?

1. Okay, I will take copy and take the "Getting an Independent Medical Opinion" to private Doctor as you suggested as soon as possible.

2. I sent for Claims Folder today. Are the C&P results in it or is it in a separate location?

3. While in AIT (on the way to Bivouac site) I fell off a 2.5 ton truck when trying to board it. I was in full Bivouac gear (duffel bag and weapon).I fell leaning more to the right than backward landing on my right side.

[smilen66]

Did I die? If so, I hope I'm in heaven. Good night.

[Berta]

The C & P results can be obtained from the VAMC where they did the C & P-just write them a letter for this.

The fall of the deuce 1/2-if this is cause of your problems, VA will need to confirm this inservice event.Do you have this documented-did you get immediate med attention? if not can you get buddy statements to show this occurred?

[smilen66]

Good Morning Berta,

1. Yes, the fall from the deuce 1/2 is the cause of my problem.

2. Yes, I did get immediate medical help 3 days later. I was taken by ambulance to the emergency room. . However, my records say the accident occurred 3 weeks ago and it should have read 3 days ago.

3. This is the exact wording of what my medical record states:

• Dec. 3, 1980- "Injury 3 weeks ago with persistent pain." "Right Thoracic Pain"
  
  
  • Dec. 5, 1980- "24 yo female amb. to er with c/o right thoracic pain-lumbar back pain x1 day. Injured 3 weeks ago-on bivouac"
    

  Thank you for your time!

[carlie]

Good Morning Berta,

1. Yes, the fall from the deuce 1/2 is the cause of my problem.

2. Yes, I did get immediate medical help 3 days later. I was taken by ambulance to the emergency room. . However, my records say the accident occurred 3 weeks ago and it should have read 3 days ago.

3. This is the exact wording of what my medical record states:

• Dec. 3, 1980- "Injury 3 weeks ago with persistent pain." "Right Thoracic Pain"
  
  

  • Dec. 5, 1980- "24 yo female amb. to er with c/o right thoracic pain-lumbar back pain x1 day. Injured 3 weeks ago-on bivouac"
    

  Thank you for your time!

  smilen,

  I am trying to see this in the way the decision maker will look at it.

  1) Was any diagnosis ever made on active duty ?

  2) Do you have any medical evidence that shows continuity of care

  or continued complaints, from 1980 to present ?

  They may see this as a single event that took place (without continuity of care)

  leaving no residual effect.

  If this is the case I feel you will have to have an IMO that states they have reviewed

  your SMR's that show XXX and your condition now of XXX is at least as likely as not

  the result of the injury on active duty.

  Maybe other's will chime in to add more or make correction's to this.

  carlie

[Pete53]

3 days or 3 weeks being taken by ambulance for treatment should verify your claim

Good Luck

[smilen66]

smilen,

I am trying to see this in the way the decision maker will look at it.

1) Was any diagnosis ever made on active duty ?

2) Do you have any medical evidence that shows continuity of care

or continued complaints, from 1980 to present ?

They may see this as a single event that took place (without continuity of care)

leaving no residual effect.

If this is the case I feel you will have to have an IMO that states they have reviewed

your SMR's that show XXX and your condition now of XXX is at least as likely as not

the result of the injury on active duty.

Maybe other's will chime in to add more or make correction's to this.

carlie

1) Was any diagnosis ever made on active duty ?

Hi Carlie,

The diagnosis made while I was on active duty were either myalgia?, muscle strain or overuse syndrome. I went to the clinic at least 10 or more times and received motrin, aspirin, heating pad, balm,tylenol or pain med. and not once was a xray made. All the diagnosis were made mostly by Spec 5 Meddacs not doctors. Physical therapy was suggested by a meddac once but not(from what I can tell from med. record) prescribed The first xray made was not made until 1985, one year after ets. At that time I was a military dependent. I am in the process of sending off for that xray from archived records. Oh yeah, I find it interesting that all visits to the clinic were about pain on the right side. This is the same side I am having problems with more since my stroke (which affected my right side).

This could not be a coincidence!

2) Do you have any medical evidence that shows continuity of care

or continued complaints, from 1980 to present ?

I have some, mostly emergency room visits and xrays at orthopedic clinics. I learned to use a heating pad, take prescribed or over the counter meds. for pain from spasms, achiness and one brother who would massage affected areas. I am creating a chart to show dates and complaints so that I can get a better picture of the evidence.

If this is the case I feel you will have to have an IMO that states they have reviewed

your SMR's that show XXX and your condition now of XXX is at least as likely as not

the result of the injury on active duty.

I believe my medical doctor would not have a problem with this. Do you think it would better to find a orthopedic doctor willing to give his opinion?

[smilen66]

3 days or 3 weeks being taken by ambulance for treatment should verify your claim

Good Luck

Hi Pete53,

Thank for the good luck wish!

If they had only looked at the medical evidence they would know I went to the emergency room for pain in right thoracic and lumbar back! It was in black and white...couldn't be any plainer.

[Tayo]

I also agree with what is being said here. Berta hit on a lot of key points.

I'm at a lost concerning the first three denials, especially after reading you went back more than 10 times. The VA claims chronic,,, well,,, chronic comes with a wide definition.

1. http://apps.who.int/classifications/apps/icd/icd10online/

2. Go to XVIII

3. Read everything especially

4. Go to R50-R60

5. Concentrate on R52

6. Click on your specific ailment.

This is actually a real good site for everyone. ICD-Codes are EXTREMELY IMPORTANT!!!

Hope this helps and PLEASE,,, pass this information on to everyone

[BoonDoc]

Hi Pete53,

Thank for the good luck wish!

If they had only looked at the medical evidence they would know I went to the emergency room for pain in right thoracic and lumbar back! It was in black and swhite...couldn't be any plainer.

It seems like the raters don't look at the complete medical record's evidence, or have a totally alien view of connecting it all together.

I believe that the VARO hires off the street to fill the raters position, this would make sense if you were trying to limit the amount of claims approved.

Sorry for the bad news, but hang in there and keep moving, and gain ground on your claim.

Best wishes to ya,

BoonDoc

Edited August 29, 2009 by BoonDoc (see edit history)

[smilen66]

I also agree with what is being said here. Berta hit on a lot of key points.

I'm at a lost concerning the first three denials, especially after reading you went back more than 10 times. The VA claims chronic,,, well,,, chronic comes with a wide definition.

1. http://apps.who.int/classifications/apps/icd/icd10online/

2. Go to XVIII

3. Read everything especially

4. Go to R50-R60

5. Concentrate on R52

6. Click on your specific ailment.

This is actually a real good site for everyone. ICD-Codes are EXTREMELY IMPORTANT!!!

Hope this helps and PLEASE,,, pass this information on to everyone

Wow Tavo, what a wealth of information! Lot of it is way over my head but nevertheless seemingly a great resource. So how did you use the codes? Also, thank you so very much for sharing!

[smilen66]

It seems like the raters don't look at the complete medical record evidence, or have a totally alien view of connecting it all together.

I believe that the VARO hires off the street to fill the raters position, this would make sense if you were trying to limit the amount of claims approved.

Sorry for the bad news, but hang in there and keep moving, and gaing ground on your claim.

Best wishes to ya,

BoonDoc

Hi BoonDoc, I'm in complete agreement with you, they either came off the street or some back alley! You know, they even changed the date the decision was made from July 17 to Aug. 14....maybe that was a typo...maybe I sent too many Iris'...maybe I asked too many questions. Then to top it off they sent me a benefits book (Iris) maybe that was a present to smooth over the denial, perhaps a v.a. requirement, coincidence...who knows. Well what they didn't know is adversity has always been my best friend and it will take more than one denial before I give up. So it is on! I'm working day and night on getting my duckies in a row! Thanks for your comment and best wishes!

[Jayg]

You're up against a stubborn and dirty fighter, VA. I promise you they don't bother to read plain black and white. On a denial they stated how they read and reviewed all the records. Then they proceeded to deny my claim by rewording it. I had claimed knees and back as secondary to ankle and feet. THEY said I claimed a knee injured in service. Since there was no record of injury in service (because my knee hadn't been injured in service) everything was denied. Doesn't matter that at best, they royally screwed up or at worst blatantly falsified government records, (something they are really good at :D ) I still had to file an NOD and go back into the system for another round of delay, and delay...

Be prepared to write and write, wait and wait only to get stuck again and again.

[smilen66]

You're up against a stubborn and dirty fighter, VA. I promise you they don't bother to read plain black and white. On a denial they stated how they read and reviewed all the records. Then they proceeded to deny my claim by rewording it. I had claimed knees and back as secondary to ankle and feet. THEY said I claimed a knee injured in service. Since there was no record of injury in service (because my knee hadn't been injured in service) everything was denied. Doesn't matter that at best, they royally screwed up or at worst blatantly falsified government records, (something they are really good at :D ) I still had to file an NOD and go back into the system for another round of delay, and delay...

Be prepared to write and write, wait and wait only to get stuck again and again.

Thanks for sharing and I do believe what you are saying. I never it they could play so dirty, even though I heard/read it first right here!

I'm sorry to hear about your negative experience and what has happened with you and others should be against the law. It goes to show anyone dealing with the V.A. realizes some of these raters aren't qualified for their job.

Personally, I've decided to take it to the top, the President of USA (I have a link), my congressman, I will get IMO and a VSO and I have hadit.com. All I have is time and I will get er done!