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

[Berta]

I hope you hear back from, IRIS soon (or your VARO)

I am so busy these days that I missed this until today

 "I could have hade a buddy letter from Sun Tzu, doesn't do any good if they don't read your submitted evidence. "

YEAH...you are right! I studied a little of Sun Tzu at AMU and still have one of his books.

Just like if a vet had a PTSD diagnosis from Sigmund Freud...after 2010 new PTSD regs came out ,.they still want a VA doc to make that diagnosis.

That is why, as a civilian,I graduated from a military school. In 2007. and the VA paid for the 30 college credits I needed for my degree, under Chapter 35. Ha Ha!!!!

That enhanced my ability to succeed in my claims and hopefully help others here realize we are on a true  battlefield, and are in combat over a war of the words.

 

 

 

[danangmonkey]

On ‎3‎/‎15‎/‎2016 at 10:17 AM, Berta said:

I hope you hear back from, IRIS soon (or your VARO)

I am so busy these days that I missed this until today

 "I could have hade a buddy letter from Sun Tzu, doesn't do any good if they don't read your submitted evidence. "

YEAH...you are right! I studied a little of Sun Tzu at AMU and still have one of his books.

Just like if a vet had a PTSD diagnosis from Sigmund Freud...after 2010 new PTSD regs came out ,.they still want a VA doc to make that diagnosis.

That is why, as a civilian,I graduated from a military school. In 2007. and the VA paid for the 30 college credits I needed for my degree, under Chapter 35. Ha Ha!!!!

That enhanced my ability to succeed in my claims and hopefully help others here realize we are on a true  battlefield, and are in combat over a war of the words.

 

 

 

Berta:

Just  received a reply to my IRIS (Three weeks later)...

Well, typical response, they misunderstood the intent of my CUE request, instead they interpreted my request as a formal intent to appeal the decision (NOD).  They sent me plenty of information on how to "Properly" appeal a decision..!!

 

So now that the "CUE via IRIS" route is closed....I do have one more option to try, would like your thoughts:

--  I am going to RESUBMIT my IME as "NEW EVIDENCE" and RE-OPEN the case..... Since the RO NEVER reviewed the IME or listed it as evidence I think I am on solid ground re-opening the case based on new evidence.   To prevent confusion I will submit a sworn statement with some verbiage explaining that WHY the IME is considered new evidence even though it was submitted with the original claim.

 

What do you think?

 

[Berta]

If you tell me what RO this is I might have contact info for their director.

 

Was the IRIS request filed as an IRIS complaint?

I filed my last CUEs with the Director via Fax and as an IRIS Complaint as well. You are right that you could submit the IMO again as 'new evidence' but that adds time to an error that they can and should corrected.

I will try to find the template I used for this maneuver and post it here

 

[danangmonkey]

31 minutes ago, Berta said:

If you tell me what RO this is I might have contact info for their director.

 

Was the IRIS request filed as an IRIS complaint?

I filed my last CUEs with the Director via Fax and as an IRIS Complaint as well. You are right that you could submit the IMO again as 'new evidence' but that adds time to an error that they can and should corrected.

I will try to find the template I used for this maneuver and post it here

 

 

 

Yes Berta...Was filed as a complaint...that's why I rolled my eyes when they replied that I need to file a NOD...

I will PM the RO/VARO info when I get home from work..

 

THANKS!!!

[Berta]

File the IRIS as a Complaint (they have a pop down box there for complaints) as I found this to be far better than just  a regular IRIS request.

IRIS complaints as far as I know, go to VA Central, so they cant ignore them.

State :this is a request for the ( name) VARO to CUE their recent decision dated (date), under the auspices of 38 USC 5109A ,prepared by (put  the initials here that appear in the alphanumeric thing on the decision), because the VA has violated 38 CFR 4.6 (copy off the part of this regulation that should be readily available here under a search,as the decision does not consider the IMO they have from Dr......, dated, that supports my contentions. The VA also ignored:

(in this part explain what you referred to here:"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.")

Say that in your own words as to the proof of the injury as well as the probative IMO ,which are all in VA's possession (per the screen shot) were completely ignored by VA in violation of the above regulation 38 CFR.4.6 and this error has caused a detrimental manifested outcome ,due solely do to VA's clear and unmistakable error.I fortget if you can even attach the screen shot to an IRIS...???

Thanks for perusing the info on CUE here.....You sure  know this is a CUE yet many vets think they have a CUE basis but never read all the stuff available here.

 

 

 

 

Edited April 4, 2016 by Berta

[Berta]

I would fax a copy of the IRIS complaint to the director of your VARO as well....I sure did that

I have lists of RO Directors etc but have to leave the site because the snow storm is messing with my access....

Others here should have a copy of the VBM by NVLSP that holds those contact numbers in it and hopefully can give you a recent access Fax number...as I expect to be unable to get back here due to weather.