Need some guidance -scratching my head on a denial

[AF_Comm_Vet]

-  Filed a year ago for a lumbar spine condition caused by a severe auto accident in-service. After an initial denial, the claim was finally approved after doing a re-open and submitting an new IME.  The NEXUS was made between the Lumbar spine injury and accident based on civilian ER reports where I was transported.  Was scheduled for a C&P exam prior to decision, and the C&P physician actually rated higher than I expected (after doing X-rays) at 40%. 

-  Several years ago I started having headaches, neck stiffness, and occasional  Pins & needles in the arm, not severe or constant so blew it off.  Four months ago it became severe, started missing work left and right, and pain prevented even sleep without heavy meds. Was referred to an Orthopedic doc and later an Ortho Surgeon.  MRI's and X-rays were accomplished in Jan with bad news, severe degenerated discs and cervical bone structure.  The Surgeon said this was pretty severe for my age, and after describing the accident he agreed it was likely the cause of the damage which had been brewing for years. 

- Filed a FDC for Cervical  Spondylosis and degenerative cervical disease.  I referenced the earlier evidence of the accident in-service. I also had a thorough IMO done by one of the Physicians mentioned in the forums often (not including the name), the IMO was very thorough with a NEXUS statement and citing previous cases.  Submitted the FDC in Early Feb.

 

 Well, I after I saw the FDC move from Review to Decision process les than tend days after submitting I became concerned. Sure enough, it was returned denied as "Not Service Connected".    

 

OK, I get it....an IMO doesn't guarantee anything, but based on my evidence and previous related injury  I thought I would at least be granted a C&P before the case would be tossed back in my face.    Any thoughts?? 

 

Thanks

 

 

Edited March 13, 2016 by AF_Comm_Vet
qeqweqww

[Buck52]

I realize each veteran is different  has different ratings  ect,,ect,

They added this in my award letter

Entitlement to special monthly compensation is warranted  in this case because criteria reguarding  housebound have been met

Note: ''The percentages assigned  for each of your conditions may not always add up to your combined rating evaluation. We do not add the individual percentages of each condition to determine your combined rating. Instead, we use a combined rating table that considers the effect from the most serious to the least serious conditions''

[Berta]

Yes, you are right, Buck , but even with no Reasons or Bases part, they  still must give a clear rationale for the denial,

based on all medical evidence of record and conformance with existing regulation.

I think they should attach a copy of any C & P right to every denial because there are many vets out there who do not even know how to get a copy of their C & P exams.

[Buck52]

usually 2 weeks after the C&P if the VA does the exam.  and usually after a decision is made if contracted outside the VA...QTC BEC ect,,ect,,

However after 30 days I believe the veteran can get his/her C&P Exam from  VBA  Veterans Benefits Administration) Office.

But not 100% sure?   I got mine back from VBA I BUT  I had decision.

 

............Buck

[AF_Comm_Vet]

1 hour ago, Buck52 said:

usually 2 weeks after the C&P if the VA does the exam.  and usually after a decision is made if contracted outside the VA...QTC BEC ect,,ect,,

However after 30 days I believe the veteran can get his/her C&P Exam from  VBA  Veterans Benefits Administration) Office.

But not 100% sure?   I got mine back from VBA I BUT  I had decision.

 

............Buck

 

Nope....   I went down that dead end three weeks after my QTC conducted C&P was complete, I initially tried pulling it using the VHA Blue Button System, and later via direct call to the VBA.   I was told that the QTC exam is not part of my medical history, it is strictly evidentiary (I'm paraphrasing) and that it must be requested as part of the C-File in its entirety.   I asked if I could view my C-File directly at the regional office (a short two hour drive, no problem for me),  that request was met with laughter and was informed (by the Peggy Mafia)  that they "don't do that".   

Only two options to obtain the QTC exam results remained - Standard Snail-Mail request and through the FOIA process.  I determined that FOIA would be the fastest route and submitted the request in mid-July.    After seven months of waiting I finally gave up and submitted my claim (after the IMO was complete).  My claim made a magical transformation from "Review" on a Monday to "Notification" in a span of only seven days.  The same day the decision was made (Denied) the status of the FOIA request also moved to "Notification"; amazing coincidence.   

 

At this point I'm being repetitive and don't have anything new to add until I have the denial letter (or C-File) in-hand.  Just wanted to add my two cents on my experience in trying to pull a QTC exam.

Edited February 22, 2016 by AF_Comm_Vet

[danangmonkey]

BERTA ***

 

Just go the denied ratings decision in the mail..

 

Just to refresh your memory-  This was for a cervical injury caused by an in-service vehicle accident. I'm already rated for the lumbar spine by the same accident that was SC from that accident. I am currently suffering with  severe degeneration of the cervical spine. I had an IMO by one of the 'famous "IMO" docs, he produced and extensive IMO letter with NEXUS (to the vehicle accident) as well as applicable exhibits supporting his opinion.

All of this was filed as a FDC during the first week of Feb. The VARO processed the entire claim and sent a denial in the short time frame of 5-7 days from filing (!!!!)....   

You wanted me to post the evidence list when I received the denial letter.

Here is the list (I redacted a bit):

1.  VAMC Outpatient treatment records

2.  VA 21-526EZ FDC

3. Private treatment records from my Orthopedic Surgeon

4. STR

5. Letter (Affadavit) from the Veteran

Please note that MISSING is the IMO, and since the IMO was the entire basis for the Service Connection, its omission made this a easy denial.  I also received my CD with my C-File, it INLCUDES the IMO, so they cannot deny that it was submitted with the FDC

 

 

Whats the next move Berta??  Can I simply re-open as a CUE?

[Berta]

This is not a re open situation, it is definitely a CUE.

The CUE they committed is violation of 38 CFR 4.6.

There are some templates here for this type of CUE....

I filed one  probably the day after I got the decision last year, posthumous AO HBP claim......

I filed it in email to the of my RO as well as an IRIS complaint.

Make sure you state the initials in the alphanumeric code on the top right hand side of the decision...that is the last person who handled the claim.

There is plenty of info in our CUE forum on getting VA to call a CUE on themselves.

38 CFR 4.6 works when the VA completely ignores probative evidence that they have.

If they do mention that type of evidence with some BS to reject it, that is not basis for this type of CUE, filed during the appellate period.

Are RO employees really that stupid to ignore IMOs (often costly)that can turn the tide for a veteran?

Or are they ordered to ignore them?