Newbie question for denied claim

[beam44]

April 2017 I filed my intent to file and then I did the actual claim a few months later.  I sent in about 20 pages from my medical record to support the claims and they were all denied as not being service connected.  I was never seen by a VA doc for any of the items I had on the claim.  I filed an appeal and that came back the same as the original claim "not service connected".  How do you get denied without ever being seen?  What are my next steps or am I dead in the water without a VSO rep?

[toddt]

Why do you believe your disability is related to your service?  You need to answer that question.  If your answer is viable the you need an IMO/IME (Independent Medical Opinion/Independent Medical Examination) which will link your disability with your service.  You can search this site for the exact phrasing that will be needed.  Look up "Caluza Triangle".   Do you need a VSO?  It dependents on how much time you want to devote to learn about what is needed to win.  The more you investigate the more knowledge you will gain.     

 

[broncovet]

I agree with Todd, and will help you.  You need the Caluza triangle DOCUMENTED!

Caluza Triangle:

1.  Current diagnosis.  It does not matter if a VA doc diagnosed it or your private doc.  

2.  In service event or aggravation.  Your doctor can not supply this, this has to be already documented in your service records. 

3.  Medical nexus, which is a doctors opinion that your (current diagnosis) is "at least as likely as not" related to your "in service event" (or that your condition was aggravated in service).  

Check your file to see if you have all three of these, documented, for each condition applied.  If you dont, it will be denied every time.  If the Caluza triangle is present, you need to appeal and, eventually, you can get a person who can read who will award you benefits.  

If you are missing a nexus, then you may be able to get one from a private doctor (IMO/IME) to complete the required Caluza elements. 

Edited September 20, 2018 by broncovet

[broncovet]

You can/should get a copy of your file (cfile) to see, with your own eyes, if the caluza elements are documented.  A VSO may (but probably wont) do this for you.  They often send you "down the (appeal)  road" without a nexus, which is like sending you to battle with a rubber band gun.  You lose every single time without a nexus and the other 2 caluza elements.  

Edited September 20, 2018 by broncovet

[vetquest]

Broncovet is right but this sounds like a VA tactic of deny claims outright.  You should have at least had a C&P to determine if your claim had standing.  I would refile the claim on a form VA 21-526EZ.  There is information on how to fill this out with the form.  I would also get an RO if you can so that all of the information filed to the VA is recorded.  

[Berta]

Can you scan and attach here their Reasons for the denial?

(Cover C file #, name prior to scanning it.)

Getting denied wthout a C & P exam is unusual but  they might have a good reason.

Did you respond to their letters?

[FMFDOC25]

20 hours ago, beam44 said:

April 2017 I filed my intent to file and then I did the actual claim a few months later.  I sent in about 20 pages from my medical record to support the claims and they were all denied as not being service connected.  I was never seen by a VA doc for any of the items I had on the claim.  I filed an appeal and that came back the same as the original claim "not service connected".  How do you get denied without ever being seen?  What are my next steps or am I dead in the water without a VSO rep?

VSO's aren't perfect, but they do know what forms to use to submit a claim, NOD, etc.

When did you get discharged? Is this your first ever claim that you submitted? What did you claim?These are the questions that will give a baseline of what are the next steps to take.

The other question I have is did you already have a service-connected disability? Reason being is if you did have a service-connected disability after you got out, you may be able to use Secondary-Service Connection if your service connected disability caused or aggravated a current disability.