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Just Got Original Claim Decision, But What Path To Fix 3 Non-awards?
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Thad,
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Are all military medical records on file at the VA?
RichardZ posted a topic in How to's on filing a Claim,
I met with a VSO today at my VA Hospital who was very knowledgeable and very helpful. We decided I should submit a few new claims which we did. He told me that he didn't need copies of my military records that showed my sick call notations related to any of the claims. He said that the VA now has entire military medical record on file and would find the record(s) in their own file. It seemed odd to me as my service dates back to 1981 and spans 34 years through my retirement in 2015. It sure seemed to make more sense for me to give him copies of my military medical record pages that document the injuries as I'd already had them with me. He didn't want my copies. Anyone have any information on this. Much thanks in advance.-
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Caluza Triangle defines what is necessary for service connection
Tbird posted a record in VA Claims and Benefits Information,
Caluza Triangle – Caluza vs Brown defined what is necessary for service connection. See COVA– CALUZA V. BROWN–TOTAL RECALL
This has to be MEDICALLY Documented in your records:
Current Diagnosis. (No diagnosis, no Service Connection.)
In-Service Event or Aggravation.
Nexus (link- cause and effect- connection) or Doctor’s Statement close to: “The Veteran’s (current diagnosis) is at least as likely due to x Event in military service”-
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Post in ICD Codes and SCT CODES?WHAT THEY MEAN?
Timothy cawthorn posted an answer to a question,
Do the sct codes help or hurt my disability ratingPicked By
yellowrose, -
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Post in Chevron Deference overruled by Supreme Court
broncovet posted a post in a topic,
VA has gotten away with (mis) interpreting their ambigious, , vague regulations, then enforcing them willy nilly never in Veterans favor.
They justify all this to congress by calling themselves a "pro claimant Veteran friendly organization" who grants the benefit of the doubt to Veterans.
This is not true,
Proof:
About 80-90 percent of Veterans are initially denied by VA, pushing us into a massive backlog of appeals, or worse, sending impoverished Veterans "to the homeless streets" because when they cant work, they can not keep their home. I was one of those Veterans who they denied for a bogus reason: "Its been too long since military service". This is bogus because its not one of the criteria for service connection, but simply made up by VA. And, I was a homeless Vet, albeit a short time, mostly due to the kindness of strangers and friends.
Hadit would not be necessary if, indeed, VA gave Veterans the benefit of the doubt, and processed our claims efficiently and paid us promptly. The VA is broken.
A huge percentage (nearly 100 percent) of Veterans who do get 100 percent, do so only after lengthy appeals. I have answered questions for thousands of Veterans, and can only name ONE person who got their benefits correct on the first Regional Office decision. All of the rest of us pretty much had lengthy frustrating appeals, mostly having to appeal multiple multiple times like I did.
I wish I know how VA gets away with lying to congress about how "VA is a claimant friendly system, where the Veteran is given the benefit of the doubt". Then how come so many Veterans are homeless, and how come 22 Veterans take their life each day? Va likes to blame the Veterans, not their system.Picked By
Lemuel, -
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Post in Re-embursement for non VA Medical care.
broncovet posted an answer to a question,
Welcome to hadit!
There are certain rules about community care reimbursement, and I have no idea if you met them or not. Try reading this:
https://www.va.gov/resources/getting-emergency-care-at-non-va-facilities/
However, (and I have no idea of knowing whether or not you would likely succeed) Im unsure of why you seem to be so adamant against getting an increase in disability compensation.
When I buy stuff, say at Kroger, or pay bills, I have never had anyone say, "Wait! Is this money from disability compensation, or did you earn it working at a regular job?" Not once. Thus, if you did get an increase, likely you would have no trouble paying this with the increase compensation.
However, there are many false rumors out there that suggest if you apply for an increase, the VA will reduce your benefits instead.
That rumor is false but I do hear people tell Veterans that a lot. There are strict rules VA has to reduce you and, NOT ONE of those rules have anything to do with applying for an increase.
Yes, the VA can reduce your benefits, but generally only when your condition has "actually improved" under ordinary conditions of life.
Unless you contacted the VA within 72 hours of your medical treatment, you may not be eligible for reimbursement, or at least that is how I read the link, I posted above. Here are SOME of the rules the VA must comply with in order to reduce your compensation benefits:
https://www.law.cornell.edu/cfr/text/38/3.344
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Question
Thad
I don't know how to go now: NOD vs appeal vs hearing vs CUE vs whatever, for the following problems:
1) When is an informal claim not a claim?
2) How better to connect left knee to right knee & flatfeet?
3) Conditions that VA deferred?
What would you suggest as an approach to resolving these issues, and should I try to correct just 1) and 2) related to the current award, or go after 3) at the same time? Does sending in new information help or can I only do that based on which appeal route I go? Seems like what I want them to ask them to do is to use all the SMRs and IMOs provided, instead of blowing them off.
Have been DITY so far (not working with a VSO, local one didn't seem too interested). Sorry for the long post: dind't want to ask 3 separate questions in case what to do altogether was different than if there was only one issue.
MANY thanks, Thad
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1) When is an informal claim not a claim?
In Jul 2008 I sent in a short, two-sentence form 21-4138 saying that it was an "informal" claim per 38CFR3.155 requesting "service-connected disability compensation", without listing any specific body parts or conditions, and said that I was collecting and would submit the needed records and evidence. It pretty much matched one of the short examples in the "Vet's Survival Guide" book. VA replied referring to my "application for benefits" and my "application for compensation" and told me to complete a form 21-526. They received the formal claim (within 12 months) on 5/27/2009; their award letter 6 months later uses that formal claim date as the effective date, saying "Your previous form 21-4138 filed 7/3/2008 did not specifically list your claims and does not constitute an informal claim for benefits. 38 CFR 3.155 states that any such informal claim must identify the benefit sought...your attempt did not name which compensation and disability benefits were being sought." Getting the extra year is important, since it includes 6 months of 100% post-hospitalization time.
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2) How better to connect left knee to right knee & flatfeet?
They awarded 30% right knee (osteoarthritis, post-TKR) and 0% bilateral pes planus as direct service-connected based on SMRs, but denied left knee (osteoarthritis, post-TKR). I documented 5 during-service bilateral knee pain visits (for which orthotics were repeatedly prescribed). Reason VA cited was that only right knee needed surgeries during service and left knee was never formally diagnosed with osteo during service. In addition to general words about parachuting and knees and whole-body-effect of osteo, I had 2 IMOs from post-service ortho dr and from podiatrist both stating that knees were service-connected. VA said those opinions looked at SMRs but not service x-rays and were just conjecture; C&P exam dr said he had no service x-rays so any conclusion would be conjecture, and that the left osteo could have just hit post-service. I thought the original IMOs were clear enough or would get the benefit of reasonable doubt in the vets favor, but the VA decision says the IMOs conclusion of SC is not in agreement with the C&P opinion that concluding SC would be conjecture. It would be possible to ask both ortho and podiatrist to write new IMOs specifically connecting left knee to right knee and flatfeet, now that those are SC (going secondary instead of direct SC?). Getting the left knee is important, since it would put me at 60% total with the bilateral.
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3) Conditions that they deferred?
I also claimed cervical and thoracolumbar IVDS, and VA just says that decision is deferred "for further development" and "because we need additional evidence". I sent in SMR/CMRs on that and a third "is service-connected" IMO. The C&P dr didn't seem to know what IVDS stood for, and would only do the thoracolumbar ROM (then didn't record it in his notes). I had already sent in both ROM testing from a civilian dr certifying that they had used the mil/VA ROM testing guidelines. I think VA has enough to go on, and just want them to issue a decision using what's already there.
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Teac
Thad, You need to pay close attention to the reasons for denial. All denials tell you what you need to get a claim approved. Also an IMO is not worth spit if the doctor writing the opinion has not
LarryJ
Wrong. The "benefit of the doubt" applies ONLY when the evidence IS balanced. Thereby giving, to you, the benefit of the doubt. If, as you say, the majority of the evidence is in YOUR favor........
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