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  • 14 Questions about VA Disability Compensation Benefits Claims

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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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    • 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.

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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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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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on the most recent claim you submitted did you include the imo with the submission or was it just in the record?

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Huh ???   How would it get into the record unless I submitted it? 

Yes, it was submitted, hence the statement in the previous post that said: "The IMO/NEXUS I submitted "

 

 

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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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    • 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.
      • 2 replies
    • Exams that were being sent strictly to contractors before, due to VAMCs not being open, are starting to be routed back to VAMCs. This is going forward from last Friday- not sure if prior scheduled exams will be re-created for VAMC vs vendor.
      • 7 replies
    • Mere speculation in your VA C and P exam

      M21-1, Part III, Subpart iv, Chapter 3, Section D – Examination Reports III.iv.3.D.2.r. Examiner Statements that an Opinion Would be Speculative Pay careful attention to any conclusion by the examiner that an opinion could not be provided without resorting to mere speculation (or any similar language to that effect). VA may only accept a medical examiner’s … Continue reading
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      • 11 replies
    • It's time to ask for help from the community. If you can help with a gift it would be very appreciated.

      Fund HadIt.com Veteran to Veteran LLC


      Give a financial gift to help with the upkeep of HadIt.com. HadIt.com is NOT a non profit. Gifts are not tax deductible, they are just gifts. 
      • 11 replies
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