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    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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      All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

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      Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.


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      Examples:

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      I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?



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      I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?



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AF_Comm_Vet

Need some guidance -scratching my head on a denial

Question

-  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 by AF_Comm_Vet
qeqweqww

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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 by AF_Comm_Vet

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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?

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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?

 

 

 

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2 hours ago, Berta said:

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?

 

 

 

 

 

Berta:

 

After reviewing 500+ pages from the C-File I found a statement that their was no evidence of a MVA (Motor Vehicle Accident) that occurred in-service that could have affected the upper back injury in the same manner as the MVA that injured the lower back.  The Claim was denied.

Basically they Denied the claim because of a lack of evidence of a MVA  occurred.  I checked the evidence submitted with the claim (and clearly available within the C-File), it contains the complete Emergency Room report of the MVA and a IMO clearly defining the NEXUS between that MVA event and the Cervical injury.    So they not only ignored the IMO, they also ignored the evidence of the MVA event; by denying that the MVA occurred any subsequent IMO based on that MVA became irrelevant.

 

Bottom Line:  

1. The ER Report of the MVA was not considered or listed in the Evidence List

2. The IMO was not listed in the Evidence List or mentioned in the denial letter

3. The basis for the denial was lack of evidence of a MVA occurring in-service

 

I agree that clear documentary evidence submitted was not reviewed, and that the non-reviewed evidence submitted clearly would have resulted in a different outcome. 

 

So this is obviously a CUE situation,  I still have some confusion on the regulatory mechanics of a CUE, can you fill in some details? 

A. Is a CUE a formal  process such as a NOD or require filing a motion ? 

B. You mention filing an IRIS for the CUE?  Is that initiating/triggering the CUE process internally within the VARO? How should I word such a request using IRIS ?  

C. The only Template/Example I could find follows:  (is this "template" something that is mailed to the VARO, or submitteded via IRIS?  

 

Obviously the IRIS process would be the fastest method to get the VA to "CUE themselves",  but I want to be careful to do this right, and not get in over my head and cause problems for any appellate review down the road.   Are you talking about simply and informally submitting a IRIS On-Line and pointing out the error without invoking the formal appeal process?

 

 

By the way, I started this thread using the account "AF_Comm_Vet", I replied using my old account "danangmonkey".  These two accounts are the same person, I had a technical problem initially with the first account that has now been corrected.

 

 

 

Edited by danangmonkey
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    • How to get your questions answered...


      All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

      Tips on posting on the forums.

      Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.


      Knowledgable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title. I don’t read all posts every login and will gravitate towards those I have more info on.


      Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.


      Leading to:

      Post clear questions and then give background info on them.

      Examples:

      A. I was previously denied for apnea – Should I refile a claim?


      I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?



      B. I may have PTSD- how can I be sure?

      I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?



      This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.

      Note:

      Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview.

      This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
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