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Denied Claim For No Diagnoses But Diagnoses In My Medical Records.

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diver

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Hi everyone. I have been working on my claims that were denied for no diagnoses. What I am looking for is some pointers for what to do about it and I do not have the money for a IMO outside the VA. I have been fighting the VA for my chronic hip pain this last denial said that there is no diagnoses. So I made an appointment and went to the ortho dr for an exam. When she looked into the notes he said that I have diagnoses from 2006 of chronic hip pain. I am now getting an MRI done on just one hip. The C&P examiner stated that there are no diagnoses of hip problems and that it is least likely than not ---. In the exam it does show that I have movement problems that would be rated at 10% and 20%. What should I do to counter this and how do I do it. The VA medical records have the diagnoses. When it comes to the VA I have not known what to do and I just through everything at them and see what sticks.

I was also denied for sciatica. The reasoning was also that there were no diagnoses and also that lumbar strain cannot cause sciatica. Again in my medical records there is a diagnosis for sciatica and that I am being treated for it. I have been also diagnosed with DDD at L5 S1 and that is pinching on the nerve causing the sciatica problem.

With this information should I file a CUE because they are stating that there is not something that they have or just do a NOD. Also what about the findings that “ Sciatica is proximately due to or the result of service connected residuals of a lumbar spine injury 38 U.S.C.A. 1110, 1131 (west 2002); 38C.F.R. 3.310 (2005)” Citation nr: 0600049. Does this not show that sciatica can and should be caused by lumbar injuries and that’s what a strain is.

I am new at researching things and I really don’t know what to send and how to do it. I have always just sent in a NOD stating that I disagree and why I believe they are wrong. No quotes or anything.

Thanks for your help in advance.

Diver

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One of the things that I am concerned about is that I never received the brown envelope. I received a standard envelope with the decision and the deferrals but it did not have the standard forms like right to disagree forms and any tdui forms nothing just very quick this is why they made the decisions and a very short list of what evidence they used. Have they changed their process or what. I am waiting for the brown envelope to try to find out in more depth of what they used for the decisions so I can find what is missing and file it with the NOD. Any ideas on this?

Thanks

Diver

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Make sure you include in the NOD any information you have in your medical records that show that you are, indeed, diagnosed for, and being treated for, those conditions. I would think a C&P exam that said you were not diagnosed with a condition that you are being treated for would be inadequate.

"I was also denied for sciatica. The reasoning was also that there were no diagnoses and also that lumbar strain cannot cause sciatica."

Did the C&P examiner say this? Or did the VA make a medical determination that lumbar strain does not cause sciatica on their own?

Do you have copies of all of your medical records, and exam reports? If not, you want to get them and so you can go over them and point out what your record actually say.

You might find this thread useful:

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thanks Free_spirit_etc. what finally happened to your claim for it? and if you were aworded for it what evidence did you finally use?

diver

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diver, if i was you i would go to the records department at your vamc where you see this va doctor. i would do a request for a statement or an opinion to the exact letter the va sent you. get your doctor to make a comment on the part where it says no diagnosis. if you go about a week before your mri then by the time you get your mri results in the doctor has already seen them and it takes about 3 weeks for a va doctor to respond and another 2 weeks for the records department to send you his written statement.

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