Secondary Claims

[SergeantQ]

Hello Bertha and all, okay I need some insight on secondary claims.

Sooooo I am service connected for fibroids. Granted oct 2017; However, at the advice of my VSO I filed secondary claim for anemia two years ago (Nov 2015) even though I was not yet svc connected for the first. (This is an appeal so my vso figured filing secondary would be smart - help to cut down on wait time.)

Turns out my secondary claim Was denied because of no svc connection for first. 

last month, after almost 8 years on appeal, I was granted service connection.  So I quickly reopened the anemia (secondary) claim. It was also granted. I am still waiting to hear what rating I will get. 👀

The question is will I get retro for the first date I filed for anemia (nov 2015) or will they only consider my effective date to be Oct 2017 since that’s when I was initially granted Svc connection on first condition? See images below.  

[Berta]

They might give you the date you re-opened the  anemia claim.

 Or the date they felt the medical evidence ( maybe the last C & P exam you had for this condition,) warranted a rating and award. Or the same date as they gave for the EED for the granted claim

But I am confused by the words" re opened"....because you filed in 2015 and then was the anemia claim was awarded...recently----it usually takes VA 2 years to even begin to "re-open" a claim...

You asked a good question. When the decision comes, can you scan and attach it here- as to their rationale for the SCs awarded , the evidence list, and the EED they gave you for the anemia.Cover your C file # and name prior to scanning it.

Since VA granted, I assume the EED as a secondary, should be the same EED as the Prime condition of fibroids...but not sure at all how VA will handle this .......they make MANY EED errors.

What was in appeals for 8 years? I see the fibroids on the 2010 claim - I assume that date ( if this 2010 claim was continuously prosecuted by you- and it appears that it was , the 2010 claim might be your EED. ) 12/16 / 2010. (for the fibroids) but the status thing says 12/1/ 2012 as the fibroid EED....what happened to the other 2 years? maybe they felt it was only "0" SC from Dec 2010 to Dec 2012.

Then again the older decision does reveal the anemia claim as NSC in Dec 2010  and it  is now SC.

If they rated it at least at 10% on that older rating sheet, you might have CUE potential.

But the decision you expect will reveal more.......

Any vet getting SC for the same condition that had been denied in the past should always seek whether a CUE occurred in the past decision.

If the rating was at least at 10% (or should have been based on the medical evidence they had) and it was denied- it is just common sense that many NSC conditions become SC eventually , when we fight them, and those conditions  also usually get worse ,than they were when VA first denied the older claim for the same condition.

Unfortunately there is nothing in 38 USC, or 38 CFR, or M21-1MR to require  the VA to use  plain old common sense.

 

 

 

 

 

 

You have done well on these issues.

 

[SergeantQ]

Thanks for the detailed response. 

Regarded the term ‘reopened’ I’m saying that because when I initially filed the claim for fibroids in 2010 I did not file for anemia as I didn’t know. My primary care provider told me about my anemia and said it was getting worse. Suggested I file it. I’ve always had it and it’s in my svc records. Also in my comp and pen exams, nexus and IME from bash. 

I asked my vso he said go ahead and file for it now. so I filed as ‘new’. Not knowing it should have been filed as secondary. So they denied because of no svc connection for fibroids. So when I finally became svc connection and logged backed into ebenefits, the anemia claim was still listed there. So I chose to ‘reopen’ the claim rather than select ‘new’. Thinking I could get that EED. 

Make sense? 

Okay so u mention the 10% and effective date they listed for 2012. I’m with you- wondering where the heck is the other two years. 👀

I’m  guessing 2010 -2012 will be granted 30% but then after two years they automatically dropped it back down to 10%. For example: 

2010-2012 - 30%

2012 and thereafter reduced to 10%. 

——————

thats the only way I can sleep at night. Guessing and trying to make sense of it all.

My vso said they are still rating it. Said I sure hear something by December 17th. 

 

 

 

[SergeantQ]

 

5 hours ago, Berta said:

12/16 / 2010. (for the fibroids) but the status thing says 12/1/ 2012 as the fibroid EED....what happened to the other 2 years? maybe they felt it was only "0" SC from Dec 2010 to 2012. 

yes. Thats true about the ‘0’ SC from those dates. It’s possible that was their rationale behind it.

I researched the docket decisions on fibroids and usually when they were granted -(very few were granted)  it was granted 30%. Then it looks like the vet was reduced to 10%. I read several places where the vet had to back and ask for an increase after the reduction. But it can go either way. Your right... I didn’t even think about the zero. 🤦‍♂️

Well, thank u for helping me brainstorm.  I will post the decision as soon as I get it. 

Post back... I really enjoy reading your thoughts. 👌

 

[SergeantQ]

Heyyyyyy.... okay so lowballed at 10% for 8 years. Insert sad face here. Retro showed up yesterday. Keeping my figures crossed that the secondary anemia is granted from my EED Dec 2010. Insert doubtful face here. 

My VSO called and told me not to file a NOD after getting the 10%. Said filing for an increase would be best. 

But im not sad. I’m thankful. What will be - will be. 

You all never quit! 

[Berta]

I am surprised that the rep said not to file a NOD-

If you have medical evidence , that VA also had, that would warrant a higher rating, then the NOD would cover asking for an increase.

Has the rep or you received the actual decision yet?

Do you have a copy of the C & P exam they based the 10% on?