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.

[Gastone]

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

[Berta]

"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 March 29, 2015 by Berta

[saints13]

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!

[highoctane]

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..

[Berta]

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.

[highoctane]

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 September 19, 2015 by highoctane