Question About Denied Claim +1 Ago (Left Hallux)

[cojolio]

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...

[cojolio]

Below is the letter that I got back in 2008, and every time I ask the VA to send me the detail reasoning for their decisions, i get the same letter all the time. I filed a FOIA to see if I get different results but still pending. Let me know what you think Carlie

(attachment deleted)

Edited September 18, 2011 by cojolio

[carlie]

cojo,

This is your notification letter.

Please post the Rating Decision that came with it as that contains the

Evidence and Reasons and Bases Section.

[cojolio]

cojo,

This is your notification letter.

Please post the Rating Decision that came with it as that contains the

Evidence and Reasons and Bases Section.

Carlie, this is all I have regarding the claim. That is the only paperwork they sent me back in 08, and twice since then when I asked for the detail reasoning for their decisions....

[carlie]

Carlie, this is all I have regarding the claim. That is the only paperwork they sent me back in 08, and twice since then when I asked for the detail reasoning for their decisions....

Go to your VARO and tell them you want a copy of the Rating Decision dated XX/XX/XXXX.

BUT -

I have a very strong feeling you already have it and haven't dug enough to find it.

JMHO

[cojolio]

Carlie i wish i was wrong, but Im 110% sure that I dont have it. I have never seen it...not when they sent me this letter in June of 08, and every time I call them they send me the same letter (and I tell me them that I have such letter i just need the detail rating decisions they used to denied my claims). Thats why I file a FOIA to see if I get different results. But like you said, I might just go ahead and reopen the claim with N&M evidence instead and worry about EED and the FOIA later on....?

I was trying to find the code for Numbness of the Left Hallux and I cant find it, can you point me in the right direction?

[cojolio]

Carlie, just to update you in this issue. I called today and finally got through and these are the diagnostic codes they gave me.

DC 9411 : 70% PTSD

DC 5010 : 20% Degenerative arthritis left ankle

DC 6260 : 10% Tinnitus

DC 6100 : 0% Bilateral hearing loss

DC 7801 : 0% surgical scar (I NEVER knew about this, not even on the notification letter from 2008?!).

Now I am more than eager to wait for my FOIA to get process to see how they got my DC 7801 since I never claim that, or if they included my numbness of the left hallux on my DC 5010 claim...

Besides that, no updates on my FOIA request...just that they get worked on in the order they are received :-/

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