Jump to content
Ads Keep HadIt.com Online. Consider Turning Off Ad Blockers to Keep HadIt.com Online! ×
  • 0

Still Need Help And Input On My Claims


68mustang

Question

Please need your advice on this. I received the dreaded envelope a couple of weeks. I was denied the claims for PTSD and for pulmonary fibrosis. I noticed that in the evidence used to deny both claims several pieces of evidence are not listed. Such as some copies of reports from my pulmonary specialist and a CT-scan performed by an imaging clinic, which I faxed to the VA and have confirmation they were received. Both pulmonary reports note that I have mild asbestosis. The PTSD denial has information missing that I discussed with the mental health examiner. I have requested a copy of the mental health exam to look over what the examiner wrote or excluded. I did not have a pulmonary exam because the VA never sent me for one even after I requested one.

I am in the process of obtaining letters from my primary doctor and pulmonary specialist attributing my mild asbestosis to asbestos exposure in my military jobs.

Since the Houston office has not provided copies of the mental health exam, can I file a NOD or what do you all advise I do? Thanks.

68mustang

Edited by 68mustang
Link to comment
Share on other sites

  • Answers 20
  • Created
  • Last Reply

Top Posters For This Question

20 answers to this question

Recommended Posts

  • HadIt.com Elder

Get a copy that is complete of your C&P and you can also go to your Mental Clinic and request that they release copies so that you can use them in your claim.

You might consider asking a Patient Rep to help you get the records that you need. Right now all you have is a denial and nothing to dispute cause you don't know.

Knowledge is Power

Link to comment
Share on other sites

  • Moderator

Pete is correct, as usual, and I would add that you should take the information from your C file and do a thorough job on your NOD. Cite specific examples. For example:

I disagree with the decision dated April 1, 2010 on the issues of Service Connection for PTSD and Pulmonary Fibrosis. I elect a DRO Review (or hearing, your choice). I believe the decision is incorrect for the following reasons:

1. On May, 1, 2009 I faxed a copy of a medical report from Dr. Smith to the Regional Office and have enclosed the fax recipt. This evidence was not listed in the "evidence" section, so the document was either mishandled by the RO, or the RO failed to consider it. If the RO had considered this evidence, but decided to deny the claim anyway, then the RO should have explained in the "reason and basis for decision" why this Veteran favorable medical report still did not warrant an approval of benefits.

2. The RO also failed to give an explanatory "reasons and basis" for denial of the Pulmonary Fibrosis when the evidence supports the Veterans claim. (Then list the medical exams and dates that you think support your claim)

3. There is evidence of "shredding" or mishandling of evidence by the RO. Altho the extent of shredding is unknown, regulations require the VA consider all the evidence before a decision is rendered.

Ima Veteran April 13, 2010

Link to comment
Share on other sites

The PTSD claim will need proof of a nexus-if that is why they denied it-

did they mention if JSRRC attempted to validate your stressor?

Link to comment
Share on other sites

The PTSD claim will need proof of a nexus-if that is why they denied it-

did they mention if JSRRC attempted to validate your stressor?

Thanks to all of you who responded. There was no mention if JSRRC attempted to validate my stressors. Nor did they mention buddy letters that I sent in as evidence. The VA did award 10% for depression due to hearing loss and tinnitus. I really believe the VA took the easy way out by awarding the 10% hoping that I drop the PTSD claim. Thanks.

68mustang

Link to comment
Share on other sites

Did they mention the PTSD claim at all in this decision?

Link to comment
Share on other sites

Did they mention the PTSD claim at all in this decision?

Yes they did. The denial states " The examiner states you do not meet the criteria for a diagnosis of PTSD as stated in the the Diagnostic and Statistical Manual of Mental Disorders published by the American

Psychiatric Association. I was assigned a GAF of 65, however the C&P exam states a GAF of 60. There is not much difference, but it is still a mistake along with the omission of some other details that I told the examiner. Like I stated before I was rated for 10% for depression due to hearing loss tinnitus. I think I was rated for that hoping to keep me from going any further on the claim. Thanks.

68mustang

Link to comment
Share on other sites

Pay attention - if your evidence was not listed on SOC or SSOC, they did not use it...and you were denied because of this omission.

If your ailment was not addressed in the SOC or SSOC, they are ignoring it.

Get it all together again, with your NOD and send it in again with proper return receipt or date stamped copies as proof of receipt. I also sent mine in on a CD in pdf format..if they have one page they have it all because I put all the evidence with the NOD into one PDF file. If you don't know how to do a PDF, find out and do it for you! I will gladly give instructions if you have no closer source for information than me.

Never give up!

AkWidow

Link to comment
Share on other sites

Pay attention - if your evidence was not listed on SOC or SSOC, they did not use it...and you were denied because of this omission.

If your ailment was not addressed in the SOC or SSOC, they are ignoring it.

Get it all together again, with your NOD and send it in again with proper return receipt or date stamped copies as proof of receipt. I also sent mine in on a CD in pdf format..if they have one page they have it all because I put all the evidence with the NOD into one PDF file. If you don't know how to do a PDF, find out and do it for you! I will gladly give instructions if you have no closer source for information than me.

Never give up!

AkWidow

Thanks for the response and for the hint. My son should be able to help me with PDF format.

68mustang

Link to comment
Share on other sites

Get a copy that is complete of your C&P and you can also go to your Mental Clinic and request that they release copies so that you can use them in your claim.

You might consider asking a Patient Rep to help you get the records that you need. Right now all you have is a denial and nothing to dispute cause you don't know.

Knowledge is Power

I finally got copies of the C&P exams for PTSD, ED, and Depression due to hearing loss and tinnitus. The first mental health exam I had I found some omissions on the PTSD exam. Some questions that the examiner asked and I answered yes in detail were listed as answering no. The GAF was listed as 60 in the C&P exam and in the denial it was listed as 65. Don't know if it makes a lot of difference, but it was a mistake on the rater's part. Plus some questions that asked if my condition affected my work were listed as having answered no. I don't work due to my being retired and I told the examiner that my conditions affected my everyday life, but there are no notes about that. The examiner wrote in the report that I did not meet the criteria for a diagnosis for PTSD.

The second exam I had was for ED and a different examiner wrote that the medical opinion was that my Ed " Is as least as likely as not (50/50 Probability) caused by or a result of PTSD". The examiner also wrote " Rationale for opinion given: PTSD is known to cause erectile dysfunction; therefore, it is at least likely as not that erectile dysfunction is caused by PTSD". The Ed claim was deferred and the VA is waiting for additional information from the VA examination. I think the rater noticed the contradiction and is trying to find a way out of it.The second exam for ED contradicts what the first mental health examiner wrote that I did not meet the criteria for PTSD. Plus no mention was made of the diagnosis my private doctor made for PTSD.

The third exam was for depression caused by hearing loss and tinnitus and that was approved at 10%.

Does anyone have any advice on what to do on my next step? Sorry for the long post.

68mustang

Link to comment
Share on other sites

  • HadIt.com Elder

I think that you were shafted. The only answer I can think of for a bad C&P is an outside medical opinion. That means you have to find a Doc to review your medical records, see you and write an opinion that you have PTSD and include a verifiable stressor.

Good Luck but I think that it will be a miracle if VA gives you anything off that.

A tip on communicating with VA Types never use the word retired use can't work

Link to comment
Share on other sites

I think that you were shafted. The only answer I can think of for a bad C&P is an outside medical opinion. That means you have to find a Doc to review your medical records, see you and write an opinion that you have PTSD and include a verifiable stressor.

Good Luck but I think that it will be a miracle if VA gives you anything off that.

A tip on communicating with VA Types never use the word retired use can't work

Thanks for the reply.

68mustang

Link to comment
Share on other sites

  • HadIt.com Elder

The exam doctor says you don't meet the criteria for a PTSD DX. You need to get an IMO to defeat this denial. You don't want to appeal this thing without getting more evidence. What are you basing the PTSD claim on? You know you need a verifiable stressor unless you have combat awards. You need a DX of PTSD and you need to verify the stressor.

Link to comment
Share on other sites

The exam doctor says you don't meet the criteria for a PTSD DX. You need to get an IMO to defeat this denial. You don't want to appeal this thing without getting more evidence. What are you basing the PTSD claim on? You know you need a verifiable stressor unless you have combat awards. You need a DX of PTSD and you need to verify the stressor.

Thank you for the reply. There were some incidents that happened while in the Navy and I have buddy letters verifying that they took place. My private doctor did a diagnosis of PTSD and I am presently being seen at a VA clinic. I am checking on Mental doctors that my insurance covers who I can a diagnosis from.

68mustang

Link to comment
Share on other sites

  • HadIt.com Elder

Hang in there Mustang, looks like good advice for you.

Thoughts regards word 'retired' are similar - can't work. Are you retired = 'disability retirement'? SSDI? or did you retire normally but on your resignation state health conditions ? or specific health conditions?

When you NOD consider targeting specific statements "quoted" from the decision page. In a NOD I quoted their statement, told them they were wrong, quoted part of the regulation on same, showed where the c&p examination they requested and other medical statements listed important information they missed. Facts, dates, conditions by medical name.

Best to ya,

Cg

Link to comment
Share on other sites

Hang in there Mustang, looks like good advice for you.

Thoughts regards word 'retired' are similar - can't work. Are you retired = 'disability retirement'? SSDI? or did you retire normally but on your resignation state health conditions ? or specific health conditions?

When you NOD consider targeting specific statements "quoted" from the decision page. In a NOD I quoted their statement, told them they were wrong, quoted part of the regulation on same, showed where the c&p examination they requested and other medical statements listed important information they missed. Facts, dates, conditions by medical name.

Best to ya,

Cg

Cowgirl thank you for going back and reading my post.

68mustang

Link to comment
Share on other sites

  • HadIt.com Elder

I officially retired when I got my Service Connection. When I am asked when I retired I use my effective date,

Link to comment
Share on other sites

  • HadIt.com Elder

mustang,

Secondary evidence of a stressor is defined for cases of unreported personal assault in the M-21. Un=reported assaults are very difficult to establish the stressor. Read this section of the M-21 to see if you have any evidence in your medical file or personnel file that meets the requirementsd.

The C&P exam stating no disagnosis of PTSD is a major road block. However, the lack of a verifiable stressor is also a big problem.

The types of evidence in the personnel file would include low evaluations. Poor performance and many others are indicated in the M-21 . Check out the M-21. I will see what I can find on the BVA and post it.

Link to comment
Share on other sites

mustang,

Secondary evidence of a stressor is defined for cases of unreported personal assault in the M-21. Un=reported assaults are very difficult to establish the stressor. Read this section of the M-21 to see if you have any evidence in your medical file or personnel file that meets the requirementsd.

The C&P exam stating no disagnosis of PTSD is a major road block. However, the lack of a verifiable stressor is also a big problem.

The types of evidence in the personnel file would include low evaluations. Poor performance and many others are indicated in the M-21 . Check out the M-21. I will see what I can find on the BVA and post it.

Hoppy thanks for responding I will look up the M-21.

68mustang

Link to comment
Share on other sites

  • HadIt.com Elder

Mustang;

I went to the BVA search engine at the link below

http://www.index.va.gov/search/va/bva.html

I typed in the phrase "personal assault" including the quotations. The quotations are important if you do not use quotes it will find claims with the word personal. You want both personal and assault in that order. The quotes will cause this type of search. I got over 150 cases from 2010 alone.

Read the cases below. They are very interesting. There are many more you could keep reading for days.

http://www4.va.gov/vetapp10/files1/1003302.txt

http://www4.va.gov/vetapp10/files1/1001073.txt

Edited by Hoppy
Link to comment
Share on other sites

Hoppy thanks again for the response.

Which do you all recommend I go to a psychiatrist or psychologist for another diagnosis for PTSD? My insurance has some that I can use to get checked out again versus what the C&P examiner wrote. Thanks.

68mustang

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now


  • veterans-crisis-line.jpg
    The Veterans Crisis Line can help even if you’re not enrolled in VA benefits or health care.

    CHAT NOW

  • question-001.jpeg

    Have Questions? Get Answers.

    Tips on posting on the forums.

    1. Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery instead of ‘I have a question.
       
    2. Knowledgeable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title.
      I don’t read all posts every login and will gravitate towards those I have more info on.
       
    3. Use paragraphs instead of one massive, rambling introduction or story.
       
      Again – You want to make it easy for others to help. If your question is buried in a monster paragraph, there are fewer who will investigate to dig it out.
     
    Leading too:

    exclamation-point.pngPost straightforward questions and then post background information.
     
    Examples:
     
    • Question A. I was previously denied for apnea – Should I refile a claim?
      • Adding Background information in your post will help members understand what information you are looking for so they can assist you in finding it.
    Rephrase the question: I was diagnosed with apnea in service and received a CPAP machine, but the claim was denied in 2008. Should I refile?
     
    • Question B. I may have PTSD- how can I be sure?
      • See how the details below give us a better understanding of what you’re claiming.
    Rephrase the question: I was involved in a traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?
     
    This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial of your claim?”
     
    Note:
     
    • Your first posts on the board may be delayed before they appear as they are reviewed. This process does not take long.
    • Your first posts on the board may be delayed before they appear as they are reviewed. The review requirement will usually be removed by the 6th post. However, we reserve the right to keep anyone on moderator preview.
    • This process allows us to remove spam and other junk posts before hitting the board. We want to keep the focus on VA Claims, and this helps us do that.
  • Most Common VA Disabilities Claimed for Compensation:   

    tinnitus-005.pngptsd-005.pnglumbosacral-005.pngscars-005.pnglimitation-flexion-knee-005.pngdiabetes-005.pnglimitation-motion-ankle-005.pngparalysis-005.pngdegenerative-arthitis-spine-005.pngtbi-traumatic-brain-injury-005.png

  • VA Watchdog

  • Can a 100 percent Disabled Veteran Work and Earn an Income?

    employment 2.jpeg

    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

×
×
  • Create New...

Important Information

{terms] and Guidelines