Need advice on denial and appeal

[joevet]

I filed for VA benefits secondary to diabetes related to Agent Orange exposure for glaucoma, cataracts and hypertension. I am receiving 70% for diabetes and stents in my heart. The VA has denied my filing for secondary aliments because they say I have no proof that they are caused by diabetes. In their words they are "at least as likely not caused" by diabetes. My question is how does one prove that they are at least as likely caused by diabetes since all medical evidence reports they can be caused by diabetes? I have my claim under NOD. Any advice would be appreciated. Thanks.

[Gastone]

If you have a CAD DX that predates your SA DX, file a New FDC for SA Secondary to CAD. An SA SC of 50% on CPAP, would get you to 95, rounded to 100% SC, if your actual SC's currently total 89 - 94%.

My Non-VA, Board Certified Neurologist opined in his Treatment Notes. that my MSA (DX 2010) was "More likely than not, caused by my 01/2006 CAD DX & B-pass surgery. Awarded 50% SC 2010, recently bumped to SA 100% 12/16.

As to Individual Unemployability (IU), If you're determined by the Rating Dept to meet the IU Award Requirements, which I believe you do, the IU Award would pay you at the 100% Comp Rate. You have nothing to lose by filing the claim and a lot to gain.

My personal opinion, you really don't need a VA or VSR to file the SA and IU claim. Start both Claims as FDC's on your E-Ben site, just don't hit the Submit Button right away. You have 365 days from the day you Start the claim. If you have questions, we'll get them resolved.

What are that exact dates of your CAD and SA DX's?

Semper Fi

[Gastone]

Sorry about missing the 70 Vs 90, just caught it.

Nothing really changes in regards to filing the New FDC's for SA & IU, actually makes them more important, considering your age/expiration (?) date.  The SA 50% Award will only get you to 90% CSC if your current actual CSC is 69 - 74%.

I think you can request your New claims be expedited due to your age, I'll check out the requirements you need to follow.

Semper Fi 

[joevet]

57 minutes ago, Gastone said:

If you have a CAD DX that predates your SA DX, file a New FDC for SA Secondary to CAD. An SA SC of 50% on CPAP, would get you to 95, rounded to 100% SC, if your actual SC's currently total 89 - 94%.

My Non-VA, Board Certified Neurologist opined in his Treatment Notes. that my MSA (DX 2010) was "More likely than not, caused by my 01/2006 CAD DX & B-pass surgery. Awarded 50% SC 2010, recently bumped to SA 100% 12/16.

As to Individual Unemployability (IU), If you're determined by the Rating Dept to meet the IU Award Requirements, which I believe you do, the IU Award would pay you at the 100% Comp Rate. You have nothing to lose by filing the claim and a lot to gain.

My personal opinion, you really don't need a VA or VSR to file the SA and IU claim. Start both Claims as FDC's on your E-Ben site, just don't hit the Submit Button right away. You have 365 days from the day you Start the claim. If you have questions, we'll get them resolved.

What are that exact dates of your CAD and SA DX's?

Semper Fi

Again, thanks Gastone for your input. Sorry to say, but I don't follow what CAD, Sa, DX, FDC, means. I don't fully understand the IU. Is this based on age? Where can I find the IU Award Requirements so I can read it? I have just recently started trying to learn about all this VA filing and how to proceed. I have relied too much on the local VSO to handle my claim. All of this has been my fault by not being more proactive. I started medication for diabetes in 1997 but I didn't file for VA benefits until 2003. I filed only for diabetes but the VA denied hypertension as a secondary after reviewing my medical record. Why would they deny something I didn't even apply for? They must know that hypertension can be a secondary to diabetes to jump the gun and deny it. I didn't think anything about it. Didn't file an appeal or anything. When I had my heart problem, I went to the local VSO after another veteran told me I should file. The VSO filed for my heart and hypertension, glaucoma and cataracts. The VA denied everything except the heart. Their denial was based on that I had never complained about or had these ailment while in the military. The VSO never advised that I should get an IMO or anything else. Just left me hanging. I am glad I found this Internet site where you guys have already been through this jungle and can provide some assistance.

[Gastone]

Joe, just eyeballed the VA M21-1 part III change date 4/6/15. You have to be 85 for an Age expediting of your claim. See the AskNod 08 attachment for much more through discussion of Expediting Criteria and required Evidence.

There appears to be no actual VA form for requesting the 'Expediting" of a claim based on being or about to be homeless, Financial Hardship, imminent Death or Age. You submit a 21-4138 (Statement in Support of Claim) along with the supporting Medical and/or Financial Evidence.

IU is not aged based. Your current 60 + 20 + 10% SC's make you VA Scheduler eligible to file for IU, which if Awarded would pay you at the 100% Comp Rate. You need to do some IU Requirements Reading. As of today, over the past 12 months, have you had "Earned Income" in excess of the VA SGI amount of $11,400 (Vet's over 65)? What about 2014 & 15?

Not considering your Age or the fact your on SSI, do you believe that your current SC's make it impossible for you to do "ANY and ALL" types of work? Even doing "Sedentary Work" like sitting at a desk for 5 or 6 hrs a day?

38 CFR § 20.900(c) Hardship Claim _ Asknod Veterans Claims Help.html

[Buck52]

I will take a gander at this

''Again, thanks Gastone for your input. Sorry to say, but I don't follow what CAD, Sa, DX, FDC, means. I don't fully understand the IU.''

I believe Gastone means =

CAD (coronary artery disease) Sa (Sleep Apnea) DX (Diagnoses) FDC (Fully Developed Claim)

A lot of us vets don't fully understand the IU  its intended to help the veterans that are below the scheduler 100%  that can't work due to their S.C. disability's to be paid at the 100% level.

As Gastone has mention above as REQUIRED to get the IU.

Edited June 24, 2017 by Buck52

[Gastone]

Joe, when was your last VMC Echo-Cardiogram? Have there been any changes Noted from the pre-1215 Echo's?

If you haven't already done so, stop in at your VMC Med Record Dept and request a CD copy of your complete VMC Med Record. That will include all the Radiology Results and Clinician's interpretations.

There just may be something lurking in your Echo tests that could get you a CAD bump to 100%.

I just tried to open the AskNod attachment, sorry about that, hard to read.

Semper Fi