Advice on First NOD

[sleepysurf]

I filed my first claim and recently received va decision. 10% awarded for tinnitus, sleep apnea denied, wrist tenosynovitis denied, and hearing loss denied. I have county VSO but I know they are very busy and want to put paperwork in good order before I file the NOD with them. I was only given audio exam from VA but no other exam.  

I retired from the Air National Guard and have twenty years of service. The service history is convoluted but I have all the records involved 3 DD214's (Active Duty Army and Air Force), Title 10 orders for (Air Guard), and NGB22 (Air Guard and Army Guard). My career was Infantry to start and Flightline Avionics for the latter part. I have my Air Force medical records. What I don't have is my Army medical records covering Active Duty Army (including initial entrance exam) and Army National Guard. Somehow Army records never crossed over into the Air Force but I located (after many requests) the records in MO and have requested 8 months ago. The recently confirmed that received the request but said it would be about 2 more months...I was not able to provide any Army medial records with my initial claim. I have request my C-file last week by fax and certified mail so hopefully I will receive soon.  Just wondering what else I should be doing while I wait for those records to show up.

Sleep apnea: The denial letter stating the sleep study date was wrong, I had it 10 years previous to the date they mentioned.  So I figure I would point that out first thing. Also believe I will have evidence in Army medical records to back up the claim but there is the waiting game.

Wrist Tenosynovitis: For this I have complaints on webHA and civilian medical records but it was aggravated by fall from helicopter. Stupidly I did not file an incident report, wrist hurt but also was embarrassed and just want to "shrug it off". I did have witness and maybe I could get lay statements....but this was also preexisting condition, but also aggravated by regular flightline work. 

Hearing Loss: I was told that I that I have left ear hearing loss but i didn't show service connection. I remember being told by Army medical on exam that I had hearing loss related to gunfire and that "I would want to keep these records.". I was very young at the time and was ignored it but now those are the records in MO that I am waiting on. 

I was also recently diagnosed with severe and recurring depression and prescribed medication and have long history of diagnosed sleep disorder and medication. I don't know weather to purse these as separate claims or as part of sleep apnea, which are symptoms. 

I do qualify for both gulf war exam and burn pit registry exam due to Kuwait deployment I and am wondering what the difference between those two are and if they are worth pursuing? I had throat surgery for diverticulum and diagnosed with barretts esophagus that could be related as well as forest fires in Idaho (Army) as well as fires during LA riots (Army Guard) and breathed in massive amounts of dust driving personal carrier in Mohave desert during 4 Ft. Irwin rotations. 

Once all my C-file and Army medical records show up I was considering going to the Ellis Clinic for exam and report to file with NOD...I figure I could fly out and pay for exam less than $1000 and was wondering if anybody else thought it was worth it?

Sorry, that is a lot info to throw out there but I'm trying to figure my way through this claim process and would just appreciate any advice form the community. 

Thanks!

 

 

 

[broncovet]

Well, yes that is a lot of questions.  Here is how you file a NOD the right way.:

1.  With your decision in hand, as well as your medical records, try to rufute the reasons and bases for denial.  For example, if your decision states the date (for sleep apnea is incorrect), then provide documentation of the exact date your sleep study occurred.   Something like this:   "While the VARO decision stated the sleep apnea was denied because of an incorrect date",  Dr. P did a sleep study on 11/13/2016 confirming the date of the sleep study.  There is no evidence to refute the date of this sleep study, other than the study itself"   Then enclose the documentation of the sleep study.  

2.  On your wrist issue:  Do you have the caluza elements:  current diagnosis (with symptomes), in service event, and nexus or medical link between these?  If you do not you will have to decide if your symptoms make it worth while to persue this issue.  I simply dont know how bad your wrist is NOW, only you can decide that.  If its all healed up, then I would forget it.  

3.  Hearing loss:  What were the reasons the decision sated for denial of service connection for hearing loss?  Are you using hearing aids?  Hearing loss, unless it is severe, rarely results in a disability percentage.  Its most often zero percent.  I got zero percent even tho I used hearing aids.  Your hearing loss may not be severe enough to qualify, I would need to know your numbers (decibel loss) to know this.  If you post your maryland CNC hearing loss numbers, I can tell you.  You may need another hearing loss exam if that one was inadequate.  

4.  If you have depression, and you can link the caluza elements explained in number 2, then by all means appeal the denial of depression.  

   Dont forget all the stuff above needs to be documented by a medical professional.  Your exposure to hearing loss does not need to be documented by a professional.  You dont have to be standing nexgt to a doctor when the gun went off and say, "gee doc would you documnent that gun noise".  Infantry and flight avionics are both MOS's which suggest the military caused your hearing loss.  Both airplanes and guns are very noisey.  

If I did not mention this, file the NOD on the applicable form. https://www.vba.va.gov/pubs/forms/VBA-21-0958-ARE.pdf

Edited June 20, 2017 by broncovet

[Buck52]

Great advise from broncovet!

[sleepysurf]

Thanks so much for that info broncovet :)...it's quite  a learning process.

With regard to my wrist the pain never clears up....it is always at least a little sore, and sometimes quite a bit along with cramping the really screws up the dexterity, which is actually more annoying the pain...so I will probably follow up on NOD.

For my hearing loss the denial letter says that "although left ear hearing loss is not shown in-service, acoustic trauma or military noise exposure my constitute injury of the ear. Medical expertise is needed to establish a link between your current hearing loss and in-service military noise exposure. However, due to this date, we have received no medical records showing that your left hear hearing loss is due to service. ". I think this is because none of my Army medical records were considered for this, so I will follow up on NOD but regarding percentage I would guess it is 0% based on everything I have read. I did not ask for any specific rating on my initial claim so I don't think I will be specific on the NOD, just that there is hearing loss. I would rather have 0% than none.

I did not claim depression, that diagnosis came after retirement and my initial claim. I honestly don't If I claim it as symptom of sleep apnea or as part of GWI. I have had a very long diagnosed sleep disorder as well but never with military diagnosis  (although I put on did disclose on several webHA reviews while I was in) but have on civilian medical records. I guess my question here is if it is worth filing new claims while appealing initial claims....or just finish the initial claim process first. That is what the VSO was leaning towards.

[broncovet]

You posted:  

Quote

although left ear hearing loss is not shown in-service, acoustic trauma or military noise exposure my constitute injury of the ear. Medical expertise is needed to establish a link between your current hearing loss and in-service military noise exposure. However, due to this date, we have received no medical records showing that your left hear hearing loss is due to service. "

This is VA speak for "you have no nexus", that is, you are missing a statement from an audiologist something very close to:

"The Veterans hearing loss is at least as likely as not due to noise exposure during military service".  

Without this nexus, your appeal will be denied..again and again.  Have you had a VA hearing test?  GET one.  Be ready to explain that your were in infantry and flightline (tell em your MOS) and explain, TO YOUR AUDIOLOGIST, that you were exposed to excessive noise from guns and aircraft, IF this is the case, and it sounds like it is.  Guns are noisey and so are airplanes.  EXTREMELY noisey.  

There are 2 somewhat similar types of noise induced hearing loss.  The first is if a bomb or something blew up near your ear.  (Acoustic trauma).  The second is loud noise exposure over time.  In other words you had to fire guns or work on loud airplanes repeatedly over time.  If either of these apply, then you should be able to obtain a nexus, or medical statement, especially if you can demonstrate an MOS in infantry or something to do with aircraft.  

Always answer questions honestly.  Dont even think of trying to fake the hearing loss test.  I think its interesting they granted tinnitus, but not hearing loss.  This indicates you were exposed to noise that caused tinnitus, unless you had another cause such as medications.  Meds can sometimes cause ringing in the ears.  

Do be ready to tell your audiologist about the equipment you worked on, such as the guns you fired, or aircraft you worked with.  Also, the audiologist may ask what was your occupation after service.  If you did similar noisey work, or operated noisey equipment after the service, then that may be a problem.  However, if when you got out you were a salesman, or paper pusher, with no noise expousre its easy to see that noise exposure from the military was likely the cause of your hearing loss.  

Edited June 20, 2017 by broncovet

[sleepysurf]

I did do a VA hearing test and was awarded Tinnitus for right ear based on MOS and AFSC...that is why I don't understand the denial for left ear? I'm hoping that the Army medical records which included a hearing test at ETS from active duty will show the hearing loss. That would be another reason for me to get an IMO/IME but I'm guessing I am better of waiting another two months or so before I submit the NOD and supporting Data. I still have about 9 months before the NOD deadline.

[broncovet]

Well a typical BVA appeal takes four to five years..from the time you submit a nod.  If you wait 9 months it will be nine more months for you to wait.  Instead, file the NOD.   You can send the new evidence later, after you got an IMO/IME.  

Audio IMO's are easy to get.  Just ask an audiol,igist for a hearing test.  They gladly do those, its a chance for them to sell you hearing aids.  You can tell them you are a veteran, and ask them if the noisy military likely caused your hearing loss.  If they respond affirmatively, ask them to put it in your record in this format.  

"I have examined, (your name) on xxx date.  (Your name's hearing loss results are attached.)  You have a bilateral noise induced hearing loss.   Since you do not currently work in a loud enviroment, it is at least als likely as not that your hearing loss was due to noise exposure during the military (guns, aircraft, etc).  There is simply no other explanation for the hearing loss as the Veteran is currently an accountant, who indicated he has no hobbies consistent with hearing loss.