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3rd Denial Letter


Question

Aftyer six monthes of waiting for an ADMIN Review of my case it seems clear that VARO employees can't read.

They seem to have no understanding of the rule on a "presumptive period". They admit that in a previous denial letter that they have records of me being "hospitalized" for my claimed condition within a year of discharge from active duty. Yet they claim I have to have been diagnosed with this condition while on active duty.

Is it just me or does that argument for denial totally ignore the reason for having a "presumptive period".

And of course they are still claiming that I didn't list a specific stressor although I did list that an illness that almost killed me - left me unconscious for 3 days , in constant pain for over 14 years and my insides totally screwed up - that is listed in my service emdical records.

My VSO (that I trust) said this is just a case of some idiot trying to save the VA money instead of doing their job - after reading posts on this forum I believe it.

Isn't there some way to sue these idiots that are purposely ignoring the evidence and rules? Interfering with a federal investigation or something?

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  • HadIt.com Elder

Rogus,

"Aftyer six monthes of waiting for an ADMIN Review of my case it seems clear that VARO employees can't read"

What do you mean by an ADMIN review? Do you mean a review of your case by a Decision Review Officer (DRO)?

"They seem to have no understanding of the rule on a "presumptive period". They admit that in a previous denial letter that they have records of me being "hospitalized" for my claimed condition within a year of discharge from active duty. Yet they claim I have to have been diagnosed with this condition while on active duty"

Are you claiming a disability that falls under §3.309? If not, then the VA cannot by law apply the presumption rule. So if this is the case, being hospitalized within a year after discharge for a condition not listed under §3.309 is pretty irelevant. And if you are not claiming a condition under §3.309 you need to have an actual diagnosis of your claimed disability, or be able to show a "Chronic Condition" while in service. If your SMR's show an actual disagnosis of a disability while in service, then you don't need to show a "chronic condition" while in service or continuity of treatment after discharge. This is stated in §3.303, which specifically notes in (B) and (d);

"Chronicity and continuity With chronic disease shown as such in service (or within the presumptive period under §3.307) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. This rule does not mean that any manifestation of joint pain, any abnormality of heart action or heart sounds, any urinary findings of casts, or any cough, in service will permit service connection of arthritis, disease of the heart, nephritis, or pulmonary disease, first shown as a clearcut clinical entity, at some later date. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “Chronic.” When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim....

Postservice initial diagnosis of disease Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service Presumptive periods are not intended to limit service connection to diseases so diagnosed when the evidence warrants direct service connection. The presumptive provisions of the statute and Department of Veterans Affairs regulations implementing them are intended as liberalizations applicable when the evidence would not warrant service connection without their aid"

"And of course they are still claiming that I didn't list a specific stressor although I did list that an illness that almost killed me - left me unconscious for 3 days , in constant pain for over 14 years and my insides totally screwed up - that is listed in my service emdical records"

Are you also claiming PTSD because of an incurred illness? If so, I don't think VA will grant a PTSD claim because of this type of stressor!

"My VSO (that I trust) said this is just a case of some idiot trying to save the VA money instead of doing their job - after reading posts on this forum I believe it"

If what I have posted above is correct with your situation, it looks like the VA probably doesn't have the evidence to grant your claim! I'm sorry I'm going to have to disagree with your SO, there isn't anyone at your RO intentionally trying to deprive you of your benefits! There isn't a RVSR saying "Ok, how can I deny Rogus today with his claim, I need to save the agency some money." If you have the three components of a claim, or the evidence for a presumptive claim, you'll receive yor deserved benefits. From what you've stated, it doesn't look like you have the evidence at VA to where they can grant your claim.

If I have missed something I apologize. Also, this post isn't meant to flame you in any way, I'm just tying to help you with the information you have presented!

Vike 17

Edited by Vike17
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  • HadIt.com Elder

I filed an Administrative Review with VACO in Washington DC-in 1996.

Within a week a deputy VACO attorney called me up and we discussed the review-

They reacted to it quickly-but then I learned that general counsel, along with the FTCA matter-would handle the VACO Administrative Review issue-

It is a very unusual for a claimant to use this procedure-(but the regs do not exclude claimants) usually VA employees request this on behalf of a claimant.

Vike is correct-

As I recall -the VA CUed itself in your case on a prior decision they had made.

They cannot ask you to pay them back-which is a good thing- that is quite a bit of comp you received-

"And of course they are still claiming that I didn't list a specific stressor although I did list that an illness that almost killed me - left me unconscious for 3 days , in constant pain for over 14 years and my insides totally screwed up - that is listed in my service emdical records"

This is not a PTSD stressor as Vike said-

You can claim any inservice illness that has caused you continuous and documented medical disability.

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We sent Sec. Nicholson a request for an administrative review on an issue. We received a letter back from his assistant stating our request had been forwarded to the VARO for review. And, of course, we never heard another word. That was last year.

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Berta & Vike - As you can probably guess I was aliitle steamed when I wrote that posting. Sometimes I vent without realizing that other people aren't aware of the full situation to which I am refering. For which I apologize.

Unless I went into a lot of background into my personal life - which I won't do here - my situation is relatively hard to understand.

I am claiming aggravation of a pre-existing condition which I was treated for as an outpatient between the ages of 16 and 18. When I was 22 I joined the military admitting that I had had past problems but was deemed fit for service. I sought help for these problems (which i thought I had resolved) approxiamately 4/5 monthes after joining the USAF. I went to the mental health clinic on base for these problems - which is documented in my military records as being treated for depression.

I listed the illness as an aggravator to my condition because of the constant physical pain that it has left me in ever since. I am sure that you can understand that when you mix depression with constant physical pain other psych problems are going to emerge - at least that is my understanding.

Both my C&P exams concluded :PTSD, Chronic Major depression with Psychotic features. For 3 years prior to enlisting between the ages of 19 - 22 I had none of that. I held a steady job, had my own place, paid my own bills and even travelled.

There are a number of other stressors involved here which were examined during my C&P exams. I guess the over simplification of my case is: I was deemed fit going in and when I came out I was suicidal, and diagnosed as having PTSD, Chronic Major depression with Psychotic features which 2 seperate VA C&P doctors - 4 years apart - attribute to my experiences in the military.

My training is in computers not psychology. I have to assume that these doctors that are telling me this have some clue as to what their talking about.

I realize that I often don't explain myself well. For that I apologize. Also I would like to thank Berta and Vike for all their help.

By the way I asked for Admin Review because I mistakenly thought they would specifically address why I was wrong in putting for the arguments that I did. Obviously I was mistaken.

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