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usmcman001

Denied connections and pyramiding...

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Posted (edited)

I just received a letter from my VSO and it shows that I was only rated for 3 out of 15 conditions I applied for. This is ridiculous IMO. They also combined knees, shin splints and ankle condition into one? Is this common practice? They were submitted separately. My C&P exam said I should be connected for most of these especially my back, ankles and heel spurs. Xrays show the conditions and they are called out in the notes from the Dr. 

Also, I noticed that the Dr. only put 1 of 4 scars are painful which is false. Three are in the same area and the whole area is tender to push or touch on. What should I do here? 

Hypertension is stage one in the civilian sector but just below in terms of the VA as far as what my BP ratings average were during the exam. 

I have headaches/migraines and listed these under GW unexplained but was denied. I have not been seen for these by the doctor but was asked in the exam about it and whether I had migraines or headaches frequently. I said yes and explained the conditions. 

Need help! 

Direct from my C&P notes:

SPURS: c. If any test results are other than normal, indicate relationship of abnormal findings to diagnosed conditions: The xrays of the ankles done by me at the time of this exam show mild to moderate posterior calcaneal spurring and the right shows mild posterior calcaneal spurring. These both indicate inflammation in the inferior attachments of the achilles tendons of the ankles. Therefore, early degenerative changes

BACK: Findings: There is trace retrolisthesis of L5 on S1, in combination with mild disc space narrowing and mild to moderate facet arthropathy at this level. There is also moderate disc space narrowing at T11/12 with superimposed osteophytosis. Minimal endplate degenerative changes are noted at L1/2. Vertebral body heights, disc space heights, and vertebral body alignment are otherwise maintained. Visualized portions of the abdomen appear grossly unremarkable. 
Impression:
Degenerative disc disease at L5/S1, T11/12, and L1/2. 

 

 

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Edited by usmcman001

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3/15 is about 20 percent, and about 85 percent of first time claims are denied, so you did well.  

Focus on the other 12 claims where you have:

1.  current diagnosis

2.  In service event or aggravation

3  Nexus, or doctors opinion that 1 and 2 are related.  

     You need to file a nod on the disputed conditions, obtain or show documentation of the above, and fight for this in appeals.  

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Thanks, bronco vet. Any idea on why they would like knee condition, shin splints and ankle conditions into one rating? Is this to dodge rating each to keep total percentage down?

In my C&P exam notes it says only one of my four scars is painful. This is false and I said all three on the thigh are sore and hurt to be pushed on or touched. What do I do about this?

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There are 3 ways to "fix" this problem, other than "doing nothing".  

1.  Get your erroneous medical records corrected.  Read this: https://www.law.cornell.edu/cfr/text/38/1.579

2.  Get another VA doc to offer a more favorable opinion.  

3.  Get an IMO/IME refuting that unfavorable opinion.  This is probably best, but its also the most expensive.  

 

     As far as why they are lumped into one rating, the short answer is, "I dont know", but this is an appealable issue if you felt your rating should be higher seperately.  This means you file a nod on that issue, as well as other denials.  

    You can also dispute the disability percentages on the claims that were awarded, if you feel the rating should be higher.  Look up the criteria for each condition and see if you think the rating is correct.  

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