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Need some guidance -scratching my head on a denial

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AF_Comm_Vet

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
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1 hour ago, danangmonkey said:

It wouldn't have mattered in my case ...... I could have hade a buddy letter from Sun Tzu, doesn't do any good if they don't read your submitted evidence.  

The IMO/NEXUS I submitted (which was obtained at great expense) and the initial ER room report (which caused the injury) were not listed as evidence being considered.

Even more laughable was their statement that there was no evidence of the accident .....  Even though I have a screen shot of those same reports uploaded to their system and attached to the claim, and found both documents contained within my C-File.

 

did you submit them again with the new claim?

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8 hours ago, SemperFiGeek said:

did you submit them again with the new claim?

Not sure what you mean by new claim?   This was a claim that was denied because critical evidence submitted was not read/considered. 

Perhaps you are suggesting that I re-open the same claim and re-submit the "unread" evidence? Not sure if that would be proper, the IME and ER report are not new evidence, they were submitted/uploaded but were missed by the RO.  I think Berta is correct on this one, this is obviously a CUE situation.  I will wait and see how they respond to the IRIS "CUE yourselves" submission, as Berta said perhaps they will correct the error on their own, if not will be heading down the formal appeal process.  The ball is in their court for now.

Edited by danangmonkey
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apologize for any confusion but was just making sure you submitted the imo document itself with each claim because many times lazy folks at the VA won't go back and really read the record so submitting everything again helps and not just new evidence.

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I would definitely appeal. I would appeal for DRO decision and if you lose appeal to BVA. Most of us have to appeal. Good evidence usually wins out eventually. Perhaps get another IMO as well. Patience is the key.

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