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Steve34

Received Denial. Next step?

Question

Ok so quick catch up.

Filed in November for the following: Migraines, TBI reopen, OSA (CPAP used)

Just received denial on all parts stating not service connected.

I have a current rating for PTSD and was told I should have filed the migraines secondary to PTSD. The Cfile shows that the medical opinion was that migraines are at least as likely as not worsened by my current PTSD. I do have a VA diagnose for the migraines and the OSA (CPAP was issued by the VA)

I was thinking about filing for the DRO review and then getting a IMO/Nexus from Dr Anaise and attaching those as new information. But that can take about 2 years at my local VA (NYC)

If not then I could simply provide the exam results from my Cfile to the VA and file an FDC with all my evidence again and also include the IMO/Nexus letters. This time make the Migraines secondary to my PTSD and also make my OSA secondary to my PTSD stating it is worsened by my PTSD. This would be much faster.

I had provided 4 buddy statements all notarized about a few rocket attacks and IED’s that I was very close to. One knocked me out but I wasn’t medivac and just held at my firebase for eval for a few days, I got better and that was it. 

I know opinions are plentiful but just looking for some advise since there is a chance that someone has had a somewhat similar situation themselves.

Thanks Brothers,

Steve

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Posted (edited)

Virtually "all" of us have been denied.  So dont feel like the lone ranger.  My advice is to file a NOD, opt in to "ramp" and go the supplemental claim route.  The "higher level" is only if you dont have new evidence, and you indicated you did.  

An IMO/IME is necessary if you are lacking in Caluza element 1 or 3.  An Imo/IME wont fix you lacking an "in service event" this would have had to happen in your service.  

In other words a IMO/ime "COULD" DIAGNOSE  AN undiagnosed condition, and it could provide a nexus.  

If you lack one or more of the Caluza elements, go ahead and file the nod, but  dont forget to fix one or more missing or inadequate Caluza elements.  This usually means you need a nexus.  

Advice:  Order your cfile and  Dont guess.  READ your medical records and see if a doc said your PTSD was "at least as likely as not" due to a (traumatic event in service).  It does not mattter what a doc told you, if its not written down in your records, it didnt happen. 

Edited by broncovet

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Broncovet,

I agree most of us were denied before. My PTSD was denied, I appealed and had my congressman get involved, not only did they find they made erroneous mistakes but I was informed by my VA psych that the dr who did my comp and penn was removed. He was found of basically railroading all vets.....and that’s what my psych told me who is his coworker! After my 3 year appeal I was awarded and given 4 years retro with a nice apology letter.

I spoke to DR Anaise just to see what my options are. I was denied since I filed them as their own conditions when I should have filed them secondary to my PTSD. I got my service records from ebenefits. I have the diagnosis for both OSA with CPAP as well as for migraines. The Opine for my migraine DBQ states that my migraines are at least as likely as not worsened by my PTSD. So the secondary condition is there in black and white for being worsened by my SC PTSD. The OSA was denied but could be caused directly by some medications and side effects of them. 

Now I still need an IMO/Nexus and he is willing to do it for his standard fee. Or I can have him represent me which may cost a bit more but be worth it. Since my chances of success will probably be greater with him rather than without him.

Even here in NYC, many doctors I have asked are very hesitant to write the required stuff and/or sound as if they re not knowledgeable with the process at all. Dr Anaise seemed very knowledgeable. The one messed up thing is timelines. Me filing the DRO would most likely go faster than him filing it all on my behalf.

Decisions decisions

 

Steve

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". I got my service records from ebenefits. I have the diagnosis for both OSA with CPAP as well as for migraines. The Opine for my migraine DBQ states that my migraines are at least as likely as not worsened by my PTSD. So the secondary condition is there in black and white for being worsened by my SC PTSD. The OSA was denied but could be caused directly by some medications and side effects of them. "

Ca you scan and attach here their decision? Cover C file # and name,address prior to scanning it.

'I got my service records from ebenefits. I have the diagnosis for both OSA with CPAP as well as for migraines. ' 

Do you mean your SMRs reveal that diagnosis?

 

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I will try to scan them when I get home from work tonight. The stuff I downloaded from ebenefits was my DBQ’s that we’re filled out by the VA dr for my comp and pen appts. I used the wrong terminology when describing it. The VA has diagnosed me with migraines and sleep apnea which they issued me a CPAP for. 

I’ll upload it but from what I’m reading they were denied since filed on their own and my service connection was not sufficiently established. The way it looks to me is if I would have filed the migraines as secondary then it would have been approved. The OSA would most likely be approved with an appropriate nexus letter. 

Honestly, I was infantry, sure I complained of headaches.....and our medic gave me a fistful of Motrin and told me to drink more water. You simply didn’t go to sick call unless it was serious. I also started getting cold sores while in Afghanistan. The battalion PA gave me a cream which is in my service records but not a reason why for the cream, just that it was prescribed. So there’s the med but nothing written why I got it. I preach to guys in service to be certain to document everything and not to make my mistakes in thinking it was already done.

steve

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