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inferred claims inferred claims-need a better understanding 10-31-2018
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GeekySquid
I need to learn more about inferred claims and how they are decided/spotted by the va raters and acted on.
The situation is I was rated 70% PTSD in 2013 around july was that C&P. In april 2013 I had a C&P for Bilateral Hearing loss and one for Sleep apnea.
I knew nothing about secondary conditions, inferred claims, etc and by this time my VSO was awol dealing with pancreatic cancer (so I don't blame him).
This year in July I was notified about a Review PTSD C&P, and that started me on the information hunt.
I learned that ED, which was well documented in my VA med records before the first C&P, was/could be a secondary to PTSD.
I also learned the Sleep Apnea was/could be a secondary to PTSD and my Sleep Study produced a CPAP and diagnosis of OSA and my Epworth Sleepiness Scale: 20/24
Since I knew nothing about secondary claims then I did not file for them then.
With the PTSD Review this year I filed a claim for SMC-K for the ED. Today when Ebenefits was unaccessible I called Peggy who told me the claim was partially complete and a letter had been/was being mailed out today. The only issue left was on dizziness. This was in the A.m.
Around 1 p.m. I tried ebenefits again and it was up.
Under my disabilities tab it shows that I am 0% for ED Service Connected and awarded SMC-K1 with an effective date of 20 Aug 2018 the date I filed that claim
I have filed an ItF on the SA claim but was waiting until this cleared.
What I need to find out are the boundaries on "inferred claims". Meaning what does and does not need to be in the record for me to claim an EED back to the date of my PTSD claim.
The ED was in my record before the PTSD C&P and the doc and I discussed it. He did not opine either way and the benefits award letter is completely void of any reference to it. Is it likely to be worth the trouble trying to file a claim for the EED on this? the evidence is there but no statement tying the two together back then, but I feel i should have been inferred by the rater.
The SA claim is the same but a little different. The VA recently changed its requirements for granting service connection for OSA. It used to be, until this year, that being prescribed the CPAP was considered to be sufficient to read as "being medically necessary", but the new regs require that specific statement in the file. For this claim I know I have to have the diagnosis made as service connected as a secondary to PTSD so what I would like opinions on are what the value of asking to have the VA decide based on the old standard as I was unaware it was even a ratable condition. No one at the VA mentioned it. The rater on my initial Claim did not comment on it in the Award Letter. I believe this should also have been inferred.
the two items are all over my records as being present months before the C&P and I am hoping that the Duty to Assist which includes a Duty to Infer will cover my claims.
Any thoughts?
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