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Question About Denied Claim +1 Ago (Left Hallux)

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cojolio

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Hello everyone, Im new to the site and I have to say...great information bank! I wish i knew this existed two years ago when I ETS!... Anyways, a brief 411 on me... I served 7 years as an 11B3P in the ARMY. Got hurt on an airborne jump, broke my tibia, surgery, 4 screws, and 2 years of physical therapy later I got MEBoarded out of the military for chronic ankle pain/arthritis for which I got 20%. (also, the doc who started the MEB mentioned my left toe as being numb and grossly stiff with bad ROM in his report...)

Here is my issue. In my MEB board report (and throughout the 2 years of therapy, and now current VA orthopedic visits) it is noted that my left big toe (hallux I believe the VA calls it) is mentioned as being partially numb, lack of range of motion (can barely bend it!) etc...anyways...is WELL documented in my medical records (both while on active duty and now that I go to the VA and have pain killers for it)....

I put in a claim for my left hallux back in 2008 when I ETS and the VA denied it because "it was not service connected"...back then I knew VERY litle about the system...now, two years later I can see that the VA probably made a mistake because it can EASILY be service-connected due to my airborne injury...after all, my toe was perfectly fine until I snapped my tibia in two places,...now the ankle and big toe has very limited ROM and my toe is numb and cant bend it... since is been over a year for me to write a statement of disagreement, how can I go about pointing it out to the VA that my left big toe is due to my airborne injury...is the current VA medical reports ground enough ("new medical evidence) to write to the regional VA and reopen my claim for the toe? Thanks in advance...

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Just an update and to ask for feedback!!

OK, so I always, I go to the VA Hospital to see the Primary Care Provider, she asks the same questions about what hurts, I give the same answers...she sents me to ortho again. Once in Ortho, the Doc already knows me and always tells me that my condition is not gonna get better, that in fact, with years...it will get worst as time passes by. However, this time, the Ortho Doc sent me to get a EMG to see whats the deal with the toe (which I have been complaining since I had surgury after airborne jump, its on my SMR and on the MEB board NARSUM and other paperwork, and well documented in the VA records.) Anyways, the doctor doing the nerve exam to see why my LEFT big toe is numb and I cant move it said the following.

He verbally told me that the test confirm what I already knew, I had nerve damage. In his report he wrote the following (im ignoring the numbers because I dont know what they mean).

Neuro:

Reflexes: 2+ankle, 1+patella

Strength: right 5/5. Left: Big toe dorsiflexion 3/5, foot dorsiflexion 3/5, plantarflexison 5/5

FINDINGS:

A bunch of Jargon I cant barely understand!!!!!!!!!!!!!!

IMPRESSION:

1-this is an adnormal study

2-there is electrodiagnostic evidence of left peroneal neuropathy at the ankle

3-thank you for the consultation

RECS:

This nerve damage is likely secondary to the patient's fracture and surguries. It is unlikely for this to heal

Now, I have asked about a CUE because I couldnt believe that the VA denied my Left Hallux Condition claim saying they couldnt service connected (but is well documented on my SMR and MEB Board paperwork/NARSUM). I NEVER got a detail explanation saying why it was denied, everytime I ask they sent me the paper that says my ankle is 20%, and left hallux and lower back conditions are denied because service connection couldnt be stablish....however, they never provide me with the detail explanation on how they arrive a those decisions like they have done with my PTSD, tinitus, hearing loss claims!.

So, my buddy (ex soldier of mine actually) who works for American Legion had me filled out a FOIA request, still in phase one on ebenefits since March! After he saw this new evidence, he told me to just go ahead and reopen the claim with new and material evidence for the left toe and get the ball rolling. That the FOIA request can take years for the VA to reply to, but I can open the claim and most likely win because of all the paperwork regarding the toe, and that IF/WHEN i do win, then we can start fighting for an early effective date?

Do you guys think I should go ahead a reopen it with N&M evidence, or just wait for the FOIA request. My plan was to wait and see why the hell they denied it and then file a CUE so I can get an EED and retro? Please let me know what do you guys think since I'm 110% sure people here are more aware/educate about the messy VA system than I am!...

Thanks in advance, and sorry this is kind of long...

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No I didnt see CUE potential Philip and you might be RIGHT!

"(also, the doc who started the MEB mentioned my left toe as being numb and grossly stiff with bad ROM in his report...)"

It makes sense that this doctor was referring to the toe as part of the overall MEB decision to me- but VA doesn't understand what makes sense so I wonder if there is strong enough medical tie -in regarding the MEB report to establish SC for this.

What was the VA's full medical rationale for the denial of the toe issue?

BERTA, the VA never provided me with the full medical rationale for my left hallux and lower back conditions...their letter was just saying that they awarded my ankle claim 20%, but lower back and left hallux were denied becauser service connection couldnt be established... I have been asking for the full rational to make sure they had my MEB Board paperwork and Service records (which clearly shows my toe as being messed up) so I can decide if I can file a CUE or just open it with N&M evidence...

Please read my Update Post below and let me know what do you think? Thanks in Advance...

Edited by cojolio

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BERTA, the VA never provided me with the full medical rationale for my left hallux and lower back conditions...their letter was just saying that they awarded my ankle claim 20%, but lower back and left hallux were denied becauser service connection couldnt be established... I have been asking for the full rational to make sure they had my MEB Board paperwork and Service records (which clearly shows my toe as being messed up) so I can decide if I can file a CUE or just open it with N&M evidence...

Please read my Update Post below and let me know what do you think? Thanks in Advance...

cojo,

If your timeframe to appeal the denial has expired then I would re-open the claim with your N&M evidence.

Keep in mind that the decision maker that denied the earlier claim, had to adjudicate with the evidence of record

that they had, at the time the decision was made.

If that evidence was inaccurate and/or incomplete - that does not equal a CUE.

If and when you are able to get this issue SC'd, if it is accomplished by consideration of evidence SMR/STR's,

or PEB/MEB evidence - then your argument for an EED would still not be a CUE - it would be a request for

EED under 3.156c.

http://ecfr.gpoacces...1.60.65&idno=38

Also, I would find out by calling 1-800-827-1000, what Diagnostic Codes (DC's) your VA disability's

are rated under. I would then check out the DC for the 20% for your ankle, just to be sure your

toe wasn't considered in this percentage evaluation - it may have been - I don't know.

Also, read the award letter over again a couple of times - especially the Reasons and Bases Section

and the Evidence Section.

JMHO

Carlie passed away in November 2015 she is missed.

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cojo,

If your timeframe to appeal the denial has expired then I would re-open the claim with your N&M evidence.

Keep in mind that the decision maker that denied the earlier claim, had to adjudicate with the evidence of record

that they had, at the time the decision was made.

If that evidence was inaccurate and/or incomplete - that does not equal a CUE.

If and when you are able to get this issue SC'd, if it is accomplished by consideration of evidence SMR/STR's,

or PEB/MEB evidence - then your argument for an EED would still not be a CUE - it would be a request for

EED under 3.156c.

http://ecfr.gpoacces...1.60.65&idno=38

Also, I would find out by calling 1-800-827-1000, what Diagnostic Codes (DC's) your VA disability's

are rated under. I would then check out the DC for the 20% for your ankle, just to be sure your

toe wasn't considered in this percentage evaluation - it may have been - I don't know.

Also, read the award letter over again a couple of times - especially the Reasons and Bases Section

and the Evidence Section.

JMHO

Carlie, thanks for the fast reply!

That is a good idea, I will call monday and ask for the code regarding my ankle to make sure the toe is not included. The award letter I have (for the ankle claim back in 2008) doesnt have a Reasons and Bses section. Its just a few pages saying that my left ankle was approve 20% for arthitis, and lower back and left hallux denied because serv connection couldnt be established. I filed a FOIA to get the detail paperwork you mentioned, but Im sure its going to take forever and a day to get it. But thanks for the input, never though about calling and asking the code for the ankle (and I will ask the toe and back as well). Thanks again.

One last thing Carlie....I know they VA had to based their decision based on the info the had a the time..but if I was MEB Boarded about because of my ankle, and the board and NARSUM mentions my left hallux conditions...wouldnt the VA have this paperwork since it would have been in my Service records?...Im sure they did because they had to use the same info to rate my 20% (which is the same 20% the MED Board gave me)...right? Then again...I dont know what info the did use since I never received the explanation behind their reasoning...

Edited by cojolio

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Carlie, thanks for the fast reply!

That is a good idea, I will call monday and ask for the code regarding my ankle to make sure the toe is not included. The award letter I have (for the ankle claim back in 2008) doesnt have a Reasons and Bses section. Its just a few pages saying that my left ankle was approve 20% for arthitis, and lower back and left hallux denied because serv connection couldnt be established. I filed a FOIA to get the detail paperwork you mentioned, but Im sure its going to take forever and a day to get it. But thanks for the input, never though about calling and asking the code for the ankle (and I will ask the toe and back as well). Thanks again.

One last thing Carlie....I know they VA had to based their decision based on the info the had a the time..but if I was MEB Boarded about because of my ankle, and the board and NARSUM mentions my left hallux conditions...wouldnt the VA have this paperwork since it would have been in my Service records?...Im sure they did because they had to use the same info to rate my 20% (which is the same 20% the MED Board gave me)...right? Then again...I dont know what info the did use since I never received the explanation behind their reasoning...

cojo,

They may or may not have had that evidence.

I can't imagine that a VA Rating Decision dated in 2008 wouldn't have a Reasons and Bases Section,

it's mandatory !

You post that your decision only states:

"that my left ankle was approve 20% for arthitis, and lower back and left hallux denied because serv connection

couldnt be established."

Please post exactly everything word for word that it states.

The above sure reads like a Reasons and Bases Section to me.

Also, did you have a C&P for the claim of the left hallus condition ?

If yes - I would certainly review a copy of that specific C&P.

Also, in the portion of the decision where they discuss the ankle and why it is granted and why a 20% evaluation was assigned

re-read it (and post it if you want) - to be sure the left hallus condition wasn't addressed in there.

JMHO

Carlie passed away in November 2015 she is missed.

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cojo,

They may or may not have had that evidence.

I can't imagine that a VA Rating Decision dated in 2008 wouldn't have a Reasons and Bases Section,

it's mandatory !

You post that your decision only states:

"that my left ankle was approve 20% for arthitis, and lower back and left hallux denied because serv connection

couldnt be established."

Please post exactly everything word for word that it states.

The above sure reads like a Reasons and Bases Section to me.

Also, did you have a C&P for the claim of the left hallus condition ?

If yes - I would certainly review a copy of that specific C&P.

Also, in the portion of the decision where they discuss the ankle and why it is granted and why a 20% evaluation was assigned

re-read it (and post it if you want) - to be sure the left hallus condition wasn't addressed in there.

JMHO

Carlie I will Scan and post the letter they sent me back i 2008. Give me a couple of mins please:-)

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