Help with Rhinitis claim

[LT Haylo]

Hello,

Can you all please help me understand the results of my recent C&P examination. I asked for an increase of my service connected rhinitis and went from a 0% to a 10% but I believe it should be rated 30% based on the fact that my CT scan showed a 3x5mm Polyp. The CP examiner noted that my CT scan showed a polyp and then he marked no on the polyp question! I provided a DBQ from my personal family doctor that indicated I have a nasal polyp but I think that since the CP examiner was an ENT doc they trumped my family doctor. They also denied my secondary claim for chronic sinusitis secondary to my rhinitis. My CT scan also showed chronic sinus disease. Any help is greatly appreciated! I'm working on going from 90-100% schedular. 

Edited November 4, 2018 by LT Haylo

[vetquest]

Please redact and post your exam.

[LT Haylo]

Vetquest, 

I added the exam for you review.

[vetquest]

The doctor noted the polyp and then said there were no polyps just as you said.  This in itself is dismaying.  Do you have the SOC yet?  It would be interesting to read how they denied you.  Yes your doctor is not an ENT but his DBQ should be considered.  After reading the SOC we may have an idea how to proceed, I am sorry I did not ask for that earlier. 

[broncovet]

Well, I hope there is more to it than this.  However, my vision is not that great, and Im on pain meds from surgery, but, here goes:

I saw a diagnosis, but did not see a nexus (link to service).  Of course, I dont know you may already be sc for rhinitis and are seeking an increase, so those things wont matter if already sc for rhinitis.  

However, unless there is a statement similar to "the Veterans rhinitis is at least as likey as not due to military service", then this may not fly.  'This said, you apprently had a diagnosis of rhinitis in service, so, there may be some who connect the dots.  Its not the best to have "grey areas" like this in your claim but rather have a clear cut diagnosis (you have) a clear cut in service event (diagnosis in service), and a clear cut nexus.  

 

If denied, you will likely need a IMO/IME with a nexus statement.  I would give you about 50/50 odds for sc.  Normally, it would be much lower without a nexus, but some of them may "count" your in service diagnosis as a nexus.  

[63Charlie]

That is just "one" of the many ploys the VA uses to wrongfully deny claims.

The C&P examiners are trained VA employees.

The examiners are highly aware of the FACT  that if a box doesn't get a check mark in it, the vet loses, even when the opinion/rationale clearly indicates the evidence is favorable for approval of the claim.

In your case it is just the opposite.

The VA relied upon the ENT examiner's statement which is unfavorable for your increase to 30% rating.

The exam is inadequate because the examination contradicts the imaging results and the primary doctor's diagnosis, and the ENT does not address/dispute the prior findings in forming his rationale and the VARO rater failed to do their job and find this exam is inadequate because the opinion is contradictory to factual, established medical evidence..

Welcome to the Hamster Wheel.

Appeal the decision.

The VA usually fabricates a reason to deny benefits

You shouldn't have been given a C&P exam period.

Sufficient evidence was there to grant an increase.

The VA sent you to one of their hired gunslingers to develop a denial.

They call these people C&P examiners.

Edited November 4, 2018 by 63Charlie

[LT Haylo]

Thanks for the replies everyone! I'm working on fighting it to get the appropriate rating of 30%. The C&P exam was a complete joke compared to the exam that my Doctor completed. He even said he didn't have the appropriate equipment to do the exam because the VA doesn't provided the specialized equipment like he has in his personal office.