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SPO

Diagnosis change

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So I have plenty of questions trying to get this straightened out.  My original diagnosis from the VA was Dermititis (the decision letter says   "minimal erythematous slightly scaly patches (claimed as skin condition)"  Since being out of the military it has been officially biopsied and diagnosed as Psoriasis. I filed and claim and I am going in for a new C&P for increase.  Should or will they adjust these conditions on my claim.  They both have the same rating criteria.  However I want to file for a secondary condition of Psoriatic arthritis eventually.  Is this going to be a problem with previous compensation and the increase.  My current medical records don't reflect the same condition as the decision letter.

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SPO , is the diagnostic code the same for the newer diagnosis?

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I've notice that in some cases the diagnoses can be different & some have there own diagnoses, in other words they can use the same diagnose codes for other disability's

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yeah, they can determine an analogous code.

This involves CUE Buck , this vet needs help, but his CUE is good.

A Cue can occur if the VA uses the wrong diagnostic code to a veteran's detriment but I think this change of diagnosis might involve the same  analogous disability they rated in the decision he is cueing, and then it might be OK, the way the CUE stands.

More input from others is needed here.

 

 

 

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The code is different. The one I was awarded is 7806 and the new diagnosis would be 7816.  However, in the decision letter they noted a history of psoriasis(7816).  The increase claim suggested a Dbq for 7806, but my doc will only do 7816 because that's the proper diagnosis.  They both fall on the skin diseases dbq.  These 2 conditions are commonly confused.

Edited by SPO

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I kind of dont see it that way.   The reason is Roberson.  It is not the Veteran's job to identify the diagnostic code, nor is the Veteran competent to self diagnose his own maladies.  

According to Roberson, the VA has a duty to maximize the Veterans claim.  They have to assume he is seeking the maximum benefit allowable by law.  

There are 3 criteria involved for a claim.  

1.  The claim has to be IN Writing.  

2.  The claimant must identify that he is seeking BENEFITS, not just treatment.  

3.  The claimant mus "identify the benefit sought."   

 

     The courts have been liberal at allowing the Veteran much lattitude in "identifying the benefit sought".  Veterans come in all education levels.  Some are not always literate in the English language, and many, if not most do not have a background in medical terminology.  Very few are doctors capable of diagnosing illnesses.  

      You dont need a precise diagnosis and diagnostic code to get benefits.  You can simply point to the part that hurts:  "I want to appy for benefits for my knee, it hurts" should suffice.  You dont have to know if its arthritis/bursitis, a fracture, a compound fracture, and, you dont need to know whether its the tibia/fibula fracture or joint, or if its the patello/tibia joint that is the problem.   To get benefits, you need only "identify the benefit sought" by stating you hurt your knee jumping out of airplanes, and that made the other knee hurt, also.  

      Yes, I know the VA tries to get away with this.  Especially if the Veteran applies for patello/tibia arthritis, when the doctor actually diagnoses bursitis of the tibia/fibia joint.  

       The Veteran is simply not required to identify "tibia patello" or the name of the joint of the benefit sought.  Instead, the VA is required to assist the Veteran, and if his diagnosis was inaccurate, and a doctor corrected him, the VA is not supposed to make the Vet start all over.  It happens anyway.  

        The bottom line is you appeal the denial.  Here is a case on Roberson (also Servello) :

http://www.va.gov/vetapp10/files2/1014708.txt'

The term "claim" or "application" means a formal or informal 
communication in writing requesting a determination of 
entitlement or evidencing a belief of entitlement, to a 
benefit.  38 C.F.R. § 3.1(p).  "Date of receipt" generally 
means the date on which a claim, information or evidence was 
received by VA.  38 C.F.R. § 3.1(r).  

An informal claim is any communication or action, indicating 
an intent to apply for one or more benefits under the laws 
administered by VA, from a claimant, his or her duly 
authorized representative, a Member of Congress, or some 
person acting as next friend of a claimant who is not sui 
juris may be considered an informal claim.  Such informal 
claim must identify the benefit sought.  38 C.F.R. § 
3.155(a).

VA is required to look to all communications from the 
appellant which may be interpreted as applications or claims, 
formal and informal, for benefits.  In particular, VA is 
required to identify and act on informal claims for benefits.  
38 U.S.C.A. § 5110(b)(3); 38 C.F.R. §§ 3.1(p), 3.155(a); See 
Servello v. Derwinski, 3 Vet. App. 196 (1992).  All that is 
required is that the communication indicates an intent to 
apply for one or more benefits under the laws administered by 
the Department, and identify the benefits sought.  Rodriguez 
v. West, 189 F.3d 1351 (1999).  

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