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
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[danangmonkey]

23 hours ago, Berta said:

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.  

 

 

Berta ----   here is their IRIS response...I cant blame the VARO...doesn't  look like they sent it to them....  Just for he record, I DID file this as a COMPLAINT...I did use your format for the CUE in the Complaint...

 

Here is their response (PII has been sanitized)

This is in response to your inquiry to the Department of Veterans Affairs (VA) dated March XX, 2016.

 

Thank you for your service to our country.

 

We apologize for the delay in responding to your inquiry. We are currently experiencing a large volume of inquiries and are working as quickly as possible to respond to each in a timely manner.

 

We are unable to accept your request for an appeal via this inquiry system.

 

If you do not agree with our decision, you should write and tell us why. You have one year from the date of the decision letter to appeal the decision. The enclosed VA Form 4107, "Your Rights to Appeal Our Decision”, explains your right to appeal.

 

You begin the appeal process by telling us in writing that you disagree with our decision. We call this note from you a notice of disagreement (NOD). In most cases, you must send us the NOD within 1 year of the date we mailed you our decision.

 

Please use VA Form 21-0958, Notice of Disagreement, when submitting your appeal or NOD. We have enclosed the form for your convenience. Additional copies of VA Forms may be accessed online at http://www.va.gov/vaforms/, if needed. We have provided the contact information, for your convenience, at the conclusion of this response.

 

Thank you for contacting us. If you have questions or need additional help with the information in our reply, please respond to this message or see our other contact information below.

 

Sincerely yours,

 

C. Boyd

National IRIS Response Center Manager

jes

 

[danangmonkey]

Berta??

[Berta]

I sure had better responses than that one....I don't understand why they did not contact your RO.

What is the name of your VARO..I might have contact numbers or a Fax # for their director.

 

[danangmonkey]

Berta...

Muskogee

 

 

Thanks !

[Berta]

Muskogee RO as of June 2015

Director jason.mcclellan@va.gov

No Fax or phone# listed for him

VSCM Tim Clark  918-781-7606   

AVSCM Paul Altman 918-781-7614

AVSCM Callie Beavers-Fillman 9180-781-7680

AVSCM Sandy Psomas 918 781 7600

 

[danangmonkey]

5 hours ago, Berta said:

Muskogee RO as of June 2015

Director jason.mcclellan@va.gov

No Fax or phone# listed for him

VSCM Tim Clark  918-781-7606   

AVSCM Paul Altman 918-781-7614

AVSCM Callie Beavers-Fillman 9180-781-7680

AVSCM Sandy Psomas 918 781 7600

 

Berta:

 

My Apologies...but not quite sure what I am going to say when I call these people?     Not trying to have you hold my hand, and I'm fairly savvy with Federal Agencies, but am a bit nervous about calling some GM15 to discuss my personal case without an invite.  

Rather than beat around the bush, please help me clarify my options so there is no confusion on my part:

1.   Re-Open the case and explain that my IME was ignore don the first go-round, and therefore is "new" evidence.

2.   Re-submit the IRIS complaint, and hope that this time its read by someone that understands the  "CUE" process and takes appropriate action with the VARO

3. Actually contact the VARO (Again, need your help in what to say). I would prefer emailing them if possible as its less intrusive. The goal is to initiate the CUE, not to piss anyone off and make the situation worse.

4.  File a traditional NOD

 

My Preferences are from #1 to #4 in that order ......  I would like to move #3 to #1,  but definitely need some diplomatic guidance from you,

 

Thanks !!