Appealing Denial of Secondary Claim

[saxman]

Hi All!  So i filed a claim for secondary condition of Arthritis of my hips beginning of June 2016 and just checked ebenefits and seen that it said not service connected. I must mention that Iam service connected for 8 of my major joints  with arthritis for the exact same condition but denied for my  hips.  I didn't have a C&P exam for my hips but did for the other eight major joints that was done in 2014.  When they didn't call me for a C&P for my hips I was thinking that they have all the information they needed other than the doctor notes from my x ray showing that I also have arthritis in my hips.  They have all the other documents in from 2013/2014 claim so I didn't think they needed anything else. I was wrong!  I'm still waiting to get the official notice in the mail.    I need help in understanding  what I need to do in this particular situation.  I will be filing a NOD.  Any advice is welcomed!!   Thanks for reading! One other thing is I do have records showing  I had arthritis of my hips back before I filed the claim for the other major joints but I just didn't file the claim at that time. 

 

[broncovet]

I agree with L.  Order a copy of your cfile, if you dont already have a current one now.  

After you get your decision, you can decide if you want to submit new and material evidence under 3.156, or just file a NOD.  (Sometimes VA has the evidence, but does not read it and just denies it.).  

If/when you file a NOD, you should try to Refute their "reasons and bases" for denial, based upon evidence which you suggest conflicts with the decision, in your file, or, that you submitted as N and M evidence.  

[Gastone]

Always a good idea to file a FOIA request for your C-File, just "Pack a Lunch," could and will probably be 10 - 14 months before you receive it in the mail, on CD hopefully.

Now this worked for me recently and probably deserves some consideration by you. I filed a "Formal Request for CUE Review," (1) month after 04/16 Award letter.  Just got the additional Retro Deposit and Award Letter last week, mid 05 to 08/25, not bad, think. I attached everything, about (12) or so MHV Med Records, that supported my EED Claim.

Your still waiting for the Award/Denial Letter, so your NOD clock is just starting to run. Appears from your post, all your supporting Med Records are already "Evidence of Record." I'd make copies from your personal files of everything supporting your SC Claim, complete a "Sworn Affidavit" or a Sworn SISOC addressing each piece of Evidence, then attach it to your "CUE Review Request."

At your current 80% SC, you need a significant bump % wise, to get to 90%. If Awarded, what's your conservative expectation? If you don't get a "CUE Review" determination within 6-8 months, you still have your NOD locked & Cocked, ready to file.

I didn't see a MH SC listed in your post, that probably takes an IU claim off the table.

Semper Fi

[saxman]

Thanks for the response L and broncovet. I do have a copy of my C-file but it's from 2 years ago and I have filed a few claims since then. The VA has the evidence but just didn't look at it.  It's the same from my other claim and that's why I didn't send it in again.  I just figure they would look at what they have and then decide the claim.

[saxman]

Gastone, I want to file another FOIA, but want to wait until after i file another claim I'm working on, and my hope is that this claim will be like my last one and decided in about 2 1/2 months.  I did receive the denial letter and just started my NOD clock. The VA has the evidence in their possession already but my guess is that they just didn't read it.  I know my STR and civilian medical records contain over 1300 pages and I really don't see them trying to go over all of them to find something.

I'm actually at 82% so I really only need 20% or two 10% to put me at 90%

Yeah, I'm not in the ball park for IU..

Thanks for your advice, and all the other's advice! 

[broncovet]

If you got a claims file from 2 years ago, you could likely piece together a current one, by adding the decisions, the documents, and medical records.  It wont be official, of course, but it should be helpful, depending on how good a job you did keeping everything in the mail or emails the VA sends you.  Hint:  Keep every email, and every letter VA sends you.  You may need that as evidence, later.  

[saxman]

broncovet,  I do have every piece of mail and email the VA sent, because I know how important it is to keep such things. What I'm not sure is how would I piece it together to get IU? 

Edited October 11, 2016 by saxman