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Claim Denied For No Clinical Diagnosis


highoctane

Question

I was diagnosed with coronary artery disease in 2012 while on active duty, I had 2 stents implanted, then 2 more 6 months later. This is all in my medical records..after 20 years about half of my medical record is from March 2012-dec 2014 when I retired and is related to my heart disease. I even got all my civilian records from when the stents were implanted on 2 different occasions and supplied those to the VA. The claim came back "not service connected".."no clinical diagnosis". This seems absurd to me..what am I missing? What evidence specifically might they want that might not be in my records? I mean the diagnosis was good enough for the insurance to pay for the stents..I'm baffled thanks for any Input.

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You bet. PS is right.

The info on how to do this is in our CUE forum. Google GCY VA Go Cue Yourself VA.....

No reg, I made it up and it has been working for me.

Give me the name of your VARO and I probably have the email for their Director.

I filed 7 CUEs last week on 2 recent decisions and found another CUE as I was talking to my RO director on the phone.

I suggest you file the CUE via IRIS as a complaint as well as sending it to the Director and you sure might want to contact the Under Secretary Ms. Hickey.

allison.hickey@va.gov

VA had not even looked at my 2 claims for 2 1/2 years. No acknowledgement at all.

Due to contacting Ms. Hickey my claims are now at VACO.

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I humbly suggest filing under 38 CFR 3.156 a or c. You do not have to prove "undebateable" error under 3.156. Remember, Veterans get the "benefit of the doubt" in all cases
EXCEPT CUE. You need merely show this is "new" evidence that the Va did not have earlier, and that it is probative (material) to your outcome. So you should reopen with "new and material evidence".

The evidence you suggest was obviously not considered, probably because the VA shredded it.

There are soo many more victims of shreddergate than people imagine, and most of them dont even know it. This is very obvious to me that you are another shreddergate victim.

Edited by broncovet (see edit history)
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Yeah Philadelphia RO is the new Shreddergate ...among others.....

"What's even more bizarre is they granted me a claim that I'm pretty sure was never "officially" diagnosed in my records. My military doctor withheld an official diagnosis."

Weird...I hope the rating was good.

They recently granted my pending CUE claim, but said they didn't owe me any accrued money.

But in CUE award I got in 2012 they did pay me 6 months retro.yet the 1151 issue continued for 22 months as an accrued claim.

VA denies CUE claims right off the bat if there is no monetary value to the claimant.

I raised hell on that decision . The RO director sent the claims to VACO. last week.

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Thank you for any and all suggestions. I've got some research to do, I don't even know what a CUE is, but I'll do some searching and figure it out.

The RO is Winston-Salem, I put a call into the DAV there this morning, since I'm not real sure what to do and I don't want to screw anything up. Haven't heard back from my service officer yet, no idea how long it usually takes them to return calls. It seems ridiculous that I'll likely have to go through some long process, to get something so blatantly wrong, fixed. I could understand if I hadn't given them the records. They denied my hypertension too...and that is all over my records dating back about 8 years that I have to take BP meds...I was in aviation so there is a record of it at least every year for the last 8 that I was in service.

Edited by highoctane (see edit history)
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I humbly suggest filing under 38 CFR 3.156 a or c. You do not have to prove "undebateable" error under 3.156. Remember, Veterans get the "benefit of the doubt" in all cases

EXCEPT CUE. You need merely show this is "new" evidence that the Va did not have earlier, and that it is probative (material) to your outcome. So you should reopen with "new and material evidence".

The evidence you suggest was obviously not considered, probably because the VA shredded it.

There are soo many more victims of shreddergate than people imagine, and most of them dont even know it. This is very obvious to me that you are another shreddergate victim.

So basically I should act as though I didn't already send them the evidence instead of presenting an "are y'all blind" type of case? I agree that they couldn't have considered the evidence I sent. What I also don't get is I was told they have access to our digital military record system...a lot of my records are on the computer...they are trying to go paperless. I know my diagnosis is in there all over the place because every time I had an appointment for a new doctor they would mention my heart disease, ie 'oh we cant give him that medication because of his coronary artery disease' ect. But the records from my stent placements I drove 40 miles and got hard copies to send.

Edited by highoctane (see edit history)
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If the evidence falls under 38 CFR 3.156 that can be accessed here for advise. Search for 38 CFR 3.156.

If the evidence is from medical records and info that you know they had, that was post service, here is the CUE claim you can file:

To your VARO

"This is a request that you call a Clear and Unmistakable error under auspices of 38 USC 5109, on your recent decision , dated.......(date), and prepared by (use the initials that appear in the alphanumeric at the right hand top of the decision.)

The decision contains a legal error,.as a violation of 38 CFR.4.6, because you did not consider my probative evidence sent to you on (dates) (USPS # or copy of proof of mailing), (or cited in your VA med recs. or private med recs you sent to them)

and that legal error
was completely detrimental to the proper outcome of my claim.


38 CFR 4.6

4.6 Evaluation of evidence.
The element of the weight to be accorded the character of the veteran's service is but one factor entering into the considerations of the rating boards in arriving at determinations of the evaluation of disability. Every element in any way affecting the probative value to be assigned to the evidence in each individual claim must be thoroughly and conscientiously studied by each member of the rating board in the light of the established policies of the Department of Veterans Affairs to the end that decisions will be equitable and just as contemplated by the requirements of the law.

https://www.law.cornell.edu/cfr/text/38/4.6 "

List the evidence you sent that is missing from the decision's evidence list.

Copy, sign and mail the CUE claim with Proof of mailing, to your VARO.

They might act very fast or try to piss away your NOD deadline by not acting on this.

I had both experiences , resolved in mere weeks and some in YEARS ,and I think 38 CFR 4.6 as well as 38 CFR 3.156 are the cat's meow.

These regulations can sure work for us when VA tries to manipulate the regulations against us.

A CUE request does not stop the NOD clock.

You can also send this as a complaint Via IRIS or via email to the Director of your VA.

But follow that up with a formal letter of above that includes copies of what they had but didnt use in the decision.

I paid for 53 USPS tracking slips that I copied and were accepted into House Vet Affairs sub committee testimony years ago.Not to mention all the PC paper and additional copy fees I incurred.

Copies of stuff they kept saying they didnt get or completely ignored acknowledging them.

Some were 4 thousand bucks of IMos from Dr. Bash, and I had sent my husband's autopsy 12 times, by 12 separate USPS priority mailings.

This is the stall scam of the VA. And one way the ROs have caused the backlog at the BVA.

Edited by Berta (see edit history)
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Thanks for the info. I hand carried the civilian records from 2 different hospitals (1 where I had the stents placed, the other where I did cardiac rehab)to the local VA office where my BDD claim was filed, along with a copy of my paper service medical record, which is procedure here for BDD claims. I literally have probably 100+ pages just related to my CAD. The civilian records are not listed as evidence, but my SMRs are listed. Again, when I took the paper copies in I told them that most of my record for the last few years is electronic, they said don't worry about it, the VA has direct access to the electronic SMR...and I know my CAD is WELL documented there. I really want to e-mail or call someone and ask how they could have made such a blatant error...but I want to be sure they in-fact had the information, or at least had access to it. I feel they must have because like I said they gave me service connection for another condition that was even less well documented in my SMR, and was never officially diagnosed (because if diagnosed it was an automatic ticket to a med board and I was close to retirement).

Sad thing is like I told my wife...now I am going to end up having to tie up some VA workers that could be doing other claims to unscrew something that should have never happened. I understand that some claims get NOD just because the vet thinks he didn't get what he deserved percentage wise..and sometimes it seems that the percentage subjective..but I NEVER DREAMED they would completely deny my CAD...never even entered my mind as a possibility. I mean if they had given me 0%...I'd have really been fine..but denided? Someone pinch me...I must be dreaming. Halfway makes me wonder if someone has a sick sense of humor and was like.."how can we really blow this guys mind and shock him with our decision". I'm going to see what the DAV Service Officer says before I jump in with both feet. They are in the RO building...hoping she can give some insight maybe?

Edited by highoctane (see edit history)
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That might be a Big maybe.

I had a vet rep who, because I called CUE on them (2006)showed up at the double DRO review they gave me.

The continued denial in the DRO SSOC showed that he ,(the rep who had an office in the VARO building )either lied to me about presenting my evidence to the DRO again , or she simply refused to accept my IMO they had ignored many times (from Dr. Bash).because she told him, (as he said ) she could not read it.

But she said she could read the results of another C & P she ordered that same day ,because she could read that. :wacko:

BS and VA spin.

I couldnt wait to get to the BVA and they awarded the claim.

That was when I used CUE then, but these days I am far more aggressive with my own CUE claims,won some since, and I personally will never depend on any vet rep anymore.

The BVA award in 2009 brought a multitude of ancillary benefits to me and I sent this vet reps org lawyer

the run down and amount of award they could have bragged about , (6 figures) to their boss, the Governor of my state) but they didn't have a clue on what they were doing and were working against me

even though I handled some claims as a volunteer for them, after I gave them my POA.

"They" included this rep, the local rep here,at the VA complex, other reps they had and also the Director of this vet org.

All of above are no longer employed as vet reps.or directors.

You might get lucky. Many vet reps will be willing to handle this stuff right away at the RO level.

Many however wont do a thing about errors like this and will just say file a NOD.

I hope it does work out OK for you.

Edited by Berta (see edit history)
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Thanks. I plan to gauge her attitude when I talk to her and go from there. I talked to a local rep here who has filed a lot of claims, he helped with mine and he knows what was submitted, he said It was obvious error, he theorized they are rushing and making mistakes. He mentioned that whether they make mistakes or not the claim still counts as completed in X number of days. He said that the first thing the service officer should suggest is asking for a reconsideration? Hadnt heard that term before but he made it clear it was not an NOD. He also said it wasn't a CUE, and that because that(CUE) is a "legal" process it can drag out. Just repeating what I was told. Does this sound accurate?

He also said the service officers at the VARO tend to try to be more politically correct and won't be quick to present a how the heck did you miss this approach. In his words they try to catch flies with honey.

Edited by highoctane (see edit history)
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Denials, what to do? File your NOD yesterday, get you NOD date on record for whatever form of Hearing you choose. Hearings are schedualed 1st come 1st served. 2+ to 5 yr wait isn't unusual. Have you requested to review your C-File and get a copy of it? May or may not give you a better idea of what the Raters used against you. In your VA Decision Letter, what did the rater list as evidence used? You do have copies of your SMR showing a DX while in service of CAD, right?

There is always the VARO Automatic Claims review based on receipt of New & Material Evidence being received prior to your actual scheduled DRO or BVA Hearing. Never know, you might get a reversal just by getting all of what you thought they had resubmitted. The review is conducted by a Senior Rater or actual DRO with deference given to the original decision. The Quality of your Evidence is all important and must be something that wasn't available to the original rater.

Semper Fi

Gastone

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"He mentioned that whether they make mistakes or not the claim still counts as completed in X number of days. "

That's right. There is no incentive at all for them to do it correctly.

"He said that the first thing the service officer should suggest is asking for a reconsideration? Hadnt heard that term before but he made it clear it was not an NOD. "

That is a good idea when a vet rep supports this type of request. And right about the NOD deadline.

If they dont award the recon request, within a few months after getting it, they will hope they can piss away your NOD time frame.

Many vet orgs have a form you can use for a reconsideration request.DAV does.

"He also said it wasn't a CUE, and that because that(CUE) is a "legal" process it can drag out. Just repeating what I was told. Does this sound accurate?"

Technically, it is,sometimes I had 2 separate CUES ,filed in 2003 and 2004 and they didnt award them at the RO level until 2012. They never went to the BVA.

I filed the type of CUE I suggested to you (GCY)in the second week of Dec 2011. They awarded that claim in mere weeks.

In Dec 2011 I received by far the most ridiculous denial I have gotten yet.I filed that GCY claim via IRIS,as a complaint, via FAx to the RO director, and and then I got a call from VA Central and they fixed it fast and awarded the claim.

I got 2 bogus denials recently from my VARO, found 4 CUEs in each denial, and I raised lots hell and those claims are now at VACO , not BVA -VACO)

As Gastone stated:

"There is always the VARO Automatic Claims review based on receipt of New & Material Evidence being received prior to your actual scheduled DRO or BVA Hearing. Never know, you might get a reversal just by getting all of what you thought they had resubmitted. The review is conducted by a Senior Rater or actual DRO with deference given to the original decision. The Quality of your Evidence is all important and must be something that wasn't available to the original rater."

That is always possible as well, with a reconsideration request because they did not consider all evidence they had.

"He also said the service officers at the VARO tend to try to be more politically correct and won't be quick to present a how the heck did you miss this approach. In his words they try to catch flies with honey. "

I think he means the vet reps that are at the ROs are scared to Death to rock the bed...ooops I mean boat....

2 decades ago local vets here,dealing with my RO too, would say some of the the Vet reps seemed to be in bed with the raters.....

I guess that isn't politically correct to say anymore.

He sounds just like a vet rep I had years ago.

.

Edited by Berta (see edit history)
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Mrs. Berta, I admire how knowledgeable you are and the patience you must have and the success you have had even after all you have been through. I understand your still fighting even more on issues. I pray and hope you get everything you deserve. I believe all wives, mothers, children, etc to service members to vets go thru as much pain and suffering if not more than the service member/vets. Thank you for all your time, help and support, it is greatly appreciated!!!!! May good fortunes always come your way! Hope that you have a great day!

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Well I finally was able to talk to my DAV Service Officer (not knocking the I know they are swamped...it just adds to the frustration). They looked at my records and agreed all the evidence to support my claim is there plain as day...BUT suggested that I get a letter from my doctor and submit it as new evidence and as for a "reconsideration", versus filing a NOD and telling the VA they screwed up. They said the reconsideration process is months where as the NOD could take years..

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With their support it might only take months.

But a recon request does not stop the NOD clock so make sure to mark your calender.

By all means try to get that letter and if from a private doctor, makes sure it conforms to the IMO/IME criteria here at hadit.

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Well I submitted a reconsideration with a letter from my military cardiologist mid may 2015. The VA sent me to a C&P exam with a VA doctor who estimated my MET at 3-5 (60%). A couple weeks later(yesterday) my claim was at prep for notification. Today it went back to review of evidence but also says "decision letter sent". That confused me, I expected it to go to complete. So I started looking around and noticed that on the disabilities page my Coronary Artery Disease is now listed as service connected at 10% where as before it was listed as not service connected. So it seems that they went against their own doctors determination of the severity of my condition?? What I still do not understand is why the claim went back to review of evidence? Any one seen this before? And if so what does it mean?

 

Edit-it just occurred to me what the VA might be doing...stringing me along until my NOD time runs out. They couldn't outright deny my claim...the evidence would not allow that. And the couldn't just complete it at 10% with the VA doctor saying I am at 60...because I would obviously turn right around and file a NOD (right?) so I'm betting its some type  of temporary rating pending more C&Ps...it took me four months to get the last C&P...they are just trying to run out the clock on me aren't they?

Thanks for any advice.

Edited by highoctane (see edit history)
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