Feeling Hopeless - this can't be right.

[YoungMarine24]

Dear Veterans,

I just received another denial letter from the VA for my Left Knee and Sleep Apnea service connection.

I'm currently working with a VA Claims Specialist in Long Island, New York to help me with the claims process. He has told me we will have to file a Notice of Disagreement / De Novo Review for the Left Knee and Sleep Apnea. He also advised me this process could take up to 1-2 years. This is unfortunate and I want to make sure the VA has everything they need to give me the proper decision.  

I've attached pictures of my original claims from July 2013, and the decisions I've received for Sleep Apnea and my Left Knee condition in May 2016.

I originally submitted my Left Knee claim right before I got out in July 2013 and I was denied. I dislocated my Left Knee cap in 2012 while in service. Since 2013 my knee has gotten worse, I've attended many months of physical therapy and I recently had surgery in March 2016. My knee is now worse after the surgery, I'm unable to run and I'm still in physical therapy. All of this is coming out of pocket because the wait times were too long for physical therapy at the VA Hospital, and I didn't trust the VA with surgery. I was unable to submit the surgery to the VA because I received surgery after I submitted. I've submitted two (2) lay statements, a physical therapy report, and VA examination which was requested by the VA. The VA examination explained that I couldn't stand up for more then 15 mins without pain and that my knee would lock up making it difficult to walk. 

I was diagnosed with Sleep Apnea in October 2013, just 3 months after I got out in July 2013. I submitted the claim a few months after because I wasn't sure about the claims process. I've submitted two (2) lay statements from Marines I deployed, lived and served with. I also have the doctors report from the VA hospital sleep study. With all this evidence I was still denied the claim. When I spoke to the VA rep on the phone they told me they didn't have my lay statements, however, the VA Claims Specialist I'm working with said this wouldn't matter because I was diagnosed within a year of discharge.

I'm currently 50% with Anxiety and Depression and I have a special purpose claim for Erectile Dysfunction.

Furthermore, the Left Knee claim is coming up as (New) on eBenefits even though I originally submitted in July 2013. Once I receive a decision will they back date the claim to July 2013 or from when the new claim was submitted?

I appreciate all the help and suggestions you can offer. 

Semper Fi

Edited May 31, 2016 by YoungMarine24
Adding pictures

[asknod]

So the American Legion is your "VA Claims specialist" ? I don't suppose this expert suggested you hire an independent medical specialist to construct an IMO or get your c-file? Since the claim was closed on 9/10/2013, I'm sure he discussed the fact that the time to submit a NOD was not later than 9/10/2014. Your original 2013 claim is now dead in the water. You will have to refile but the claims specialist will hopefully tell you all that. Best of luck sir.

[YoungMarine24]

1 hour ago, asknod said:

1 hour ago, asknod said:

So the American Legion is your "VA Claims specialist" ? I don't suppose this expert suggested you hire an independent medical specialist to construct an IMO or get your c-file? Since the claim was closed on 9/10/2013, I'm sure he discussed the fact that the time to submit a NOD was not later than 9/10/2014. Your original 2013 claim is now dead in the water. You will have to refile but the claims specialist will hopefully tell you all that. Best of luck sir.

Thanks for the reply Asknod. I don't know why it says American Legion, he's a VFW member who works for the county helping veterans. I wasn't informed about why we had to refile a new claim instead of using the old one. That's very unfortunate though. A lot of people on here have a ton of information like yourself and it would be great to finally understand the best solution.

He never suggested hiring an IMO, is that something I should do before filing the NOD? I'm going to the VA Hospital to pick up my c-file. I've sent a form to the DOD for my medical records but the CD they sent didn't have anything from when I was in the Corps, just my initial entry package. Is it possible they lost my medical folder?

I also have a question about the anxiety and depression claim. I believe I originally received 10% in July 2013, then I was bummed up to 50% in April 2015. I only received retroactive pay from February 2015. Am I eligible for retroactive pay from July 2013?

[Gastone]

More info please. What evidence  and when did you supply it to the VA, regarding your SA Claim? Do you have copies of your SMRs indicating treatment for sleep issues? When did you get your official SA DX?

Was your SA part of your original 2013 claim? Are you on Appeal now?

We're all in a hurry, just human nature, VA is not in a Hurry for anything. Some discussion regarding a NOD for a DRO Review, why not a DRO Hearing? You absolutely have to provide the VA with New & Material Medical Evidence, that was not available for the original Rater's review. Without it, your sunk.

How about posting redacted copies of your claims and Denials. Easier to get a grip on your situation. Have your filed a FOIA requesting your complete C-File? Will probably take a year to get, so get hot on it.

Burn a day at your RO, request to view your C-File as a walk-in.  It's the only way to verify what Evidence  is already in the VA's possession.

Semper Fi

[asknod]

21 hours ago, asknod said:

 

He never suggested hiring an IMO, is that something I should do before filing the NOD? I'm going to the VA Hospital to pick up my c-file. I've sent a form to the DOD for my medical records but the CD they sent didn't have anything from when I was in the Corps, just my initial entry package. Is it possible they lost my medical folder?

I also have a question about the anxiety and depression claim. I believe I originally received 10% in July 2013, then I was bummed up to 50% in April 2015. I only received retroactive pay from February 2015. Am I eligible for retroactive pay from July 2013?

There are three distinct areas of records.

1)All Service military and medical records are stored at the National Personnel Records Center in St. Louis. That is the NPRC.

2)All VA medical records are stored in the VISTA computer electronically after 1996. Any before that date are archived and still accessible if asked for. That is the Veterans Health Administration or VHA.

3)Your c-file is maintained by the VA- as in Veterans Benefits Administration (VBA) and are located at the VARO where you filed. It takes time and sometimes dynamite to dislodge them from VA's grip.

Regardless of the resident expert representing you, remember one thing. They have 40 hours of training to get their learner's permit to do claims. I've studied VA law intensely for over 8 years and been filing since 1989 and I still don't know everything. However, it is a basic tenet that you have one year from a decision to object by filing a NOD. That is claims 101 and even a VSO rep with an IQ over 75 should be able to tell you that. I suspect his prowess is less than Specialist 1st Class.

Best of luck on your claims, sir. 

[Buck52]

I had an Employee /Records Clerk from NPRC St Louis mention to me on the phone a while back that some of the SMR's are stored in Ft Knox Ky.

Veteran can call information office at Ft Knox And give his SS# And if the Veteran has records stored there  they will make copies, IF not? they will refer on to NPRC.

As I understand Ft Knox is or was the first place for the records to be stored before being processed through NPRC in St Louis.

jmo

.............Buck