Va Bull Crap

[Fat]

I filed a claim for chronic sinusitis in May 2012.

I attended a C&P exam in late February 2013. The x-ray came back as normal; however the doctor stated, "you have inflammation in your nose".

I scheduled an appointment on March 5th with a private ENT doctor. A CT Scan was performed and the results were "mucosal thickening in both maxillary and right sphenoid sinuses"

I immediately forwarded the information to the regional VA.

The claim was denied in June 2013.

The claim denial read, (a) in lieu of a in service chronic sinusitis diagnosis, no residuals have been noted since and (b) in lieu of similar or like conditions, no chronic disability has been cited since.

I was furious; however I planned to attack the denial with medical evidence.

I requested a reconsideration of the decision, VA never acknowledged the reconsideration, however I filed the NOD in November 2013.

During the 21 month wait, I have 20+ documented visits for sinusitis treatments and one CT SCAN/ 2 x-rays all validate the diagnosis (mucosal thickening in sinus regions). My doctor even filled out a DBQ certifying pansinusitis.

Recently (July 25th), I received a letter (dated 7/23/15) stating we are working on your claim, please forward treatment notes (various doctors). If information isnt received, case could be decided within 30 days.

I forwarded information by VSO on July 28th and uploaded information to system on August 1st.

I received a letter dated July 31,2015 (Statement of Case) that the claim for chronic sinusitis had been denied.

WTH.................

Basis for denial was I was treated for sinus congestion, not sinusitis. In addition, C&P EXAM in 2013 showed sinuses to be normal.

They conviently forgot to include the chronic sinusitis diagnosis (IN SERVICE) in the NOD denial letter and even more the initial denial letter cited the chronic sinusitis diagnosis.

I am so mad I cant think straight. When I was initially scanning through my medical records I specifically saw chronic sinusitis as one of the issues I was treated for on active duty. Thats why I claimed the disability.

This is the why there is a backlog and why so many veterans are upset with the VA and its compensation process. Employees have to read material and make a determination based off of the evidence.

I guess I'm gonna file a Form 9 and get the issue before the VBA.

I already filed it out and Im including the waiver of regional office consideration form.

I'm going to see VSO this week to make sure everything looks good. I'm also gonna press them to file the Form 8 so the appeal wont stagnate.

I hope others better luck in the claims process and NEVER GIVE UP...........

[Navy04]

Same thing happened to me bud over the last 2 years. I got tired of fighting it, even though the VA ENT Doc put me on 2 different Meds. Sorry to hear of your issues bud, good luck

[Vync]

Hearing about cases like this make me fuming mad. They did the same garbage to me too. The raters at the RO are far too eager to look for exact wording. However, what they don't realize is that physicians in service often just jot down very vague amounts of information, like "sinus problems", "back strain" and so forth as a diagnosis instead of specific terms like "sinusitis" or "degenerative disc disease". Relative equipoise would be the appropriate response I would hope to expect.

[Berta]

I would ask them to CUE that SOC decision.

I got a CUE awarded in 2005 for a SOC decision.
but that claim took 6 years.But it never went to the BVA for many more years of waiting.

More recently I filed CUE on a Jan 2012 decision Within appeal period, and then also filed timely NOD 3 months later.

The CUE takes precedence over the timely NOD that way

Today, finally, due to my enfilading warfare maneuver ( meaning my flanking fire was not only evidence but also the regulations themselves,) on the paper War of the Words battlefield I am on again,DUE TO the VA , the VA called 2 hours ago with 2 concessions for all that and an apology that they sent my dead husband on Saturday, a letter he was asked to respond to, within 30 days.

VA said my CUE claim issue might be resolved by Friday because they ordered the audit I demanded, but I think they meant next Friday.

I am a civilian but graduated from a Military school in 2007 ( Run by the USMC) so believe me that experienced enhanced my persistence and ability to get thumbs out of butts.

An appeal to BVA with or without a remand can take at least 2 years if not 3 or 4 years to get decided on.

I just hope, if you have a CUE basis (and it appears to me that you do if the condition is at a ratable level).the VA does not put you through what the past 7 months have been like for me. (Not to mention the decision I got over 3 years ago.)

Which was really no worse than the past screws ups they made in my claims.
I won those claims anyhow.But these types of errors should not happen in the first place.

VA isn't our enemy. Time is.

If you have a rep and mention this tactic ( CUE filed during appeal period) he can find out whow to do that by reading my stuff on that in our CUE forum.

Edited August 4, 2015 by Berta

[lotzaspotz]

Sinusitis is a difficult rating to have approved and when you do, it's usually at 10%. We went through the exact same experience you did through appeals. We initially filed a claim in 1993, appealed the denial to the Board in 1994, went back and forth between the Board and the RO on several remands, and the Board approved it in 2005 retro to 1993. You just have to stick with it and don't give up out of frustration.

[Berta]

Need to clarify, the VA acted on the 2005 CUE right away and I got a double DRO review. My vet rep however, acting in my behalf at the review, screwed everything up. The evidence they had ignored, he said he would make sure the DRO got. I reported this to the OGC and he was demoted and could not handle claims anymore.but I don't know if my complaint caused that demotion.

[Fat]

Thanks for the encouragement.

Visited my VSO and he was appalled about the errors.

Rating officers and supervisors are doing a poor job at their level.

Ignoring evidence right in front of them.

Considering all options: Reconsideration, NOD, Form 9, etc.............

NEVER GIVE UP