Claim Denied For No Clinical Diagnosis

[highoctane]

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.

[highoctane]

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 March 27, 2015 by highoctane

[highoctane]

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 March 27, 2015 by highoctane

[Berta]

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 March 27, 2015 by Berta

[highoctane]

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 March 27, 2015 by highoctane

[Berta]

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.

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 March 28, 2015 by Berta

[highoctane]

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 March 28, 2015 by highoctane