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.

[broncovet]

You need to obtain, and read your medical file and cfile.  As always, it takes 3 Caluza elements for Service connection.  If you dont have all 3 of these, it will be denied.  

1.  Current diagnosis.  

2.  In service event or aggravation.

3.  Nexus or medical link between number one and 2.  You need a doctor to say that your medical condition is "at least as likely as not" due to x event(s) in medical service.  

Now for secondary service connection.  You need only 2 elements for that, since your "in service event" is already documented with the primary condition.

1.  Current diagnosis.

2.  Nexus, or doctors statement that your high blood pressure is "at least as likely as not" related to your diabetes.  

Now I will mention "presumptive" service connection.  There are certain conditions that are "presumptive".  For example, if you served "in Country" Vietnam, then you will be presumptive for certain conditons, such as those related to Agent Orange.  

Get your service records and medical records and read for yourself it the above is DOCUMENTED.  If its not documented, it does not exist.  

There are 3 possibilities here:

1.  You actually had the applicable evidence in your cfile and VA never bothered to read it.  (highly possible).  I think your claim turns on the "nexus" especially since you are already service connected and seeking secondary conditions, and you apparently have the applicable diagnosis of hbp.  If you lack the nexus documented, you need to obtain said nexus, it will be fruitless to appeal, absent a nexus. In this case, you appeal and cite the doctors report in your appeal.  For example, you state something like this:  While the VARO decision stated " (copy the part of the denial)", Dr. xx on a medical exam dated August 3,  2005, stated, "The Veterans high blood pressure is at least as likely as not the result of his diabetes."   

2.  Your file does not contain the evidence, but you have it, in a docs report, but that report  is NOT in your Cfile.    In this case submit or resubmit the doctors report containing your nexus as New and material evidenece, 39 CFR 3.156.  B or C.  

3.156 C is for Service records, and 3.156 b.  is if you have a pending claim, which apparently you do.  

3.  You do not have documentation of a nexus, that is, there is nothing in your file where a doc says your high blood pressure is secondary to diabetes.  In this case you will need a nexus statement added to your file from either a VA doctor (sometimes they do that, but often they wont), or an IMO/IME.  After you get the applicable nexus, submit it as "new and material evidence" 38 CFR 3.156b. 

 

[joevet]

It is obvious I have been too passive concerning filing for VA benefits. I am going to have to become more proactive and aggressive instead of relying on some VSO to handle my claim. One problem concerning hypertension is it has been so long and I have had three doctors during the twenty plus years. The current doctor does not have the actual medical records from when I finally started medication. I am scheduled to see the VA eye doctor tomorrow. He keeps a 'check' on my eyes because of the glaucoma and cataracts. He has me on Latanoprost eye drops with one drop in each eye every night. I am going to try and get something out of him. The VA had previously had me visit another private eye clinic and I have a copy of their report concerning glaucoma and cataracts. But it does not mention any possibility of these ailments "at least as likely as not" due to diabetes. I probably need to go back to them on my own and see what I can get from them. Of course being closely connected to the VA they may refuse to commit themselves. The eye doctor that originally advised me to get the quack doctor I was seeing at the time to prescribe medication for diabetes and HBP because both of these ailments would cause problems with my eyes is still in practice but working only a few days a month. His son runs the practice now, but they should still have my medical records.

There is one thing I am sure of, the VA is not in the business of helping veterans. They will do everything possible against a veteran to deny a claim and never advise, or assist, in obtaining what needs to be done to help a veteran.

[Berta]

"There is one thing  I am sure of, the VA is not in the business of helping veterans. They will do everything possible against a veteran to deny a claim and never advise, or assist, in obtaining what needs to be done to help a veteran."

You are absolutely right.

Although things seem to be changing at VA with the new VA Secretary, what you said is something Every claimant should realize.

It often takes a real doctor ( non VA doctor) with expertise in the field of the specific disability(s) the vet has, to provide an IMO/IME that follows the IMO/IME guidelines here in that forum, to properly obtain direct and secondary SC ratings.

Within the next two weeks the WH and/or the Sec's office will give me feedback on 2 letters I sent already with ways to reduce the backlog and other stuff the Secretary didnt know of  and also this is something, if I did not mention in my letters,

I will add that ....

the BVA holds proof of the incompetence of C & P doctors-forcing many vets and widows to pay high fees for IMOs from real doctors, whose pay check is not from VA or a contractor with VA....solely to obtain what the RO could have awarded. I see that in many cases---I think I DID mention that.maybe when the WH Hot line called me...my only BVA case was an award and then a remand. It could have been awarded many years sooner, but I guess the VA hoped I would croak before that happened.

This is why Tbird started this great web site and why hardcore claimants like me here have practically had to become lawyers and doctors to deal with the ludicrous war of the words VA plays on us, in order to deny claims that are fully supported by documented medical evidence.

Some of the best people I ever met ,since 1984 , work for VA .I did as a VA volunteer and my husband also worked for them. But these good and smart dedicated people work side by side with idiots or those who are lazy , even watching porn on VA PCS as Shulkin refered to on TV, per a whistleblowers complaint, or are  just waiting for their retirement date for their FERS check, while they spin on their thumbs at a raters desk....not interested in properly adjudicating their workload.

If this was the way SSA ran their show, the grateful nation would be in an uproar.

Our grateful nation continues to remain long overdue in paying their debt of gratitude for the sacrifices all of you men and women have paid. That isnt the fault of veterans. The VA caused all the problems we have.

 

 

 

 

Edited June 12, 2017 by Berta

[joevet]

You are so correct. If a young solider had diabetes, hypertension, glaucoma, cataracts, etc........while in service, they would have kicked his/her butt out so fast their head would spin. When the VA deny a claim with a fully documented medical evidence of the veteran having these ailments with the standard excuse that the veteran had no report on his military service medical record of the ailment(s) while in service is a complete cop-out to screw the veteran. The VA has never denied that I have these medical conditions only that my military service does not show I had them while serving. As has been stated on this forum, they want an IMO paid for by the veteran stating that "as likely as not" the secondary ailment could have been caused by the primary disease. The VA doesn't know this nor does any doctor know for sure except medical research has been accepted as reliable indicating these other ailments can be secondary effects of the primary disease. The VA is a governmental agency and should be there to serve the veterans and not to screw them. During a C&P the VA doctors could save a veteran the expense and trouble of trying to obtain a letter from an IMO stating what they could easily do themselves.

[Berta]

Are you a Vietnam Vet?

If you were not incountry, what ship were you on in the Pacific fleet during the war..it could an AO presumptive ship....I could look it up with her name 

Edited June 12, 2017 by Berta

[joevet]

I am a Vietnam veteran. AO exposure has already been established in 2003. VA just will not accept that my ailments are SC to diabetes.