Ten Year Old Forgotten Claim Now In Administrative Review.

[leadbelly1981]

Hi I served three years in the Army from 2000-03 as a 11c with an honorable discharge. I ets from camp casey korea and had filled a claim during my exit exam for my left knee and left shoulder. Both were approved for tendonitis and i was rated at 20 %. At the time of my exam i also complained of lower back and hip pain on my left side. I belived it was due to my left knee. We were road marching and running a lot in korea, thats what the infantry does. In 2004 when i got my 20% rating for my knee and shoulder the claim for lower back and hip pain were deferred.Fast forward in jan 2013 i went to the county vso and had them help me file for an increase for my shoulder it has continually gotten worse. The claim took a year and at the end i was granted 30%. The weird thing is when i received my rating in the mail the old claims were addressed stating we see that your claims for lower back pain and hip pain in nov 2003 are unreloved sorry for any inconvenience. Online on e benefits the claims for lower back pain and left hip pain just appeared one day and are in administrative review. My question is what do i make of this what do i do?

[leadbelly1981]

I could not afford insurance so i have no documentation in addition when i told my doctor at the va about my pain he said ice and Ibp so i gave up on the va helping me with this issue.

[Berta]

I responded in a different way then the posters here in the other topic you posted th4se questions at.......

Posted Today, 07:58 AM

"The weird thing is when i received my rating in the mail the old claims were addressed stating we see that your claims for lower back pain and hip pain in nov 2003 are unresolved, sorry for any inconvenience. Online on e benefits the claims for lower back pain and left hip pain just appeared one day and are in administrative review. Also online the claim date Changed now to 2013 instead of 2003. "

"My question is what do i make of this what do i do? "

Say Yippee!

If the medical evidence warrants awards for the lower back and hip disability, the VA did the right thing in noticing these claims were never adjudicated.
That could possibly mean, as I understand this, ten years of retro.

You certainly could not have filed a Notice of Disagreementon the back and hip claims because they were never adjudicated and were not denied.

I feel that,if VA awards SC for the back and hip problems, your earliest effective date should be 2003. the date of the original and unadjudicated claim.

Many here have fought for better EEDs and have succeeded.

I believe if they SC the hip and back problems, they might do a staged Fenderson rating from 2003 to the present.

Lower back pain and left hip pain are pretty vague terms.

What is the actual diagnosis. do you have an established nexus to your service for these problems and do you have consistent and current treatment records for these problems.as well.."

I also added one or two more points as well that might help you.....

It pays to keep the same topic in the same forum to get fast answers.

Edited March 7, 2014 by Berta

[Berta]

sorry ,wrong link, it was in this post:

[leadbelly1981]

Ok so i think at this point i need to go see a doctor andcget a diagnosis for my hip and back . At that point what should i do send it to my regional office? I believe my i.jury is from heavy lifting of mortar tubes and other heavy equipment while i was in a mechanized infantry unit that wgen i started noticing the pain at my first duty station.

[Berta]

I hope others chime in here to help.........

How was the original claim worded?

Do you have a copy of it and if so, can you scan and attach it here( Cover the personal identifying info first)

We need to determine from the older claim, if VA considers this as a direct SC claim or as a secondary claim.

A direct claimwould need an inservice nexus (proof of cause of the problems) ,but a secondary claim has an already established nexus....if a VA C & P doctor agrees with that.

If the backand hips are not documented in your SMRs , VA could easily deny. They dont use common sense or try to consider these issues might be directly due to the service connected disabilities.(therefore secondary)

VA will surely set you up for a current C & P exam for the hip and back problems.You could raise both theories of entitlement to the C & P doc, if they listen.

In my opinion the results of that C & P exam will determine if you need an indepedent medical evaluation and IMO.

The actual wording of the original claim is what the VA will hang their hat on.

I dont suggest amending it at this time to include secondary because that could alter the EED.

You can always appeal their decision if it is incorrect.A strong IMO would be great at that time.

I assume the older C & P does not have anything in it to help with the pending claim..or does it....do you still have a copy of the original C & P exam?

In about 20 years I have seldom seen an issue like yours. But it happens.

In my opinion, the way the claim was worded long ago is what they are focused on. Hope you still have a copy.

An IMO (IME) that supports it's actual wording would help you, of course!

but I would hate to see you spend money on an IMO that a C & P exam might reveal you dont even need.-

or worse yet a C & P opinion that would require another IMO.

-------------------------------------------

How about some other opinions here?

Edited March 8, 2014 by Berta

[FormerMember]

I see VA doing the usual, Berta. If he submits new evidence they will instantly grant (even though they should have in 2004). The logic will be "Claimant has now demonstrated an entitlement on March 8th, 2014 by submission of N&M E proving his contentions. However, there was no evidence prior to this in the file which could support an earlier effective date. Therefore his effective date for this condition is March 8th."

My suggestion is not to submit one thing until you get an up or down on it. It's blatantly obvious they dropped the ball in 04. If you submit so much as a fart in an envelope, they will use it against you. Sit tight. They have plenty of rope to hang themselves with. If they want more or order a new C&P, LB81 will have to comply if he expects to prevail.