Sinus Condition denied due to pre-service surgery?

[Retired USAF 1st Sergeant]

First post/question . Advance thanks to ALL my fellow Veterans.

I retired November 2004 with 21+ years service (USAF). I'm now 56.

I filed my initial VA claim in Oct 2005 with no VSO or any other guidance whatsoever.

Received an initial SC rating of 70%, - 50% OSA, 20% BPH, 10% L Knee, 10% R knee. I was Fat, Dumb and Happy...

I was denied SC for Sinus condition due to a pre-service surgery for deviated septum/removal of polyps.This surgery was ~3 years prior to enlistment (~1980) and was disclosed during MEPS/Inprocessing. I started having sinus issues (multiple recurrent infections) and subsequently two sinus surgeries (~1995 & ~2000). I still have recurrent yearly sinus infections that require treatment with antibiotics and steroids. 

Fast forward to January, 2019. All of my SC issues have  gotten worse over the years. 

I signed up with a VSO who was highly recommended by a Veteran friend. He reviewed my In-service Medical Records. While reviewing my records. he noted that the sinus issues were "all over my records and asked why hadn't I claimed them?" I told him that I had claimed the sinus condition in my initial claim back in 2005, and it was denied. He then pulled up and read my initial rating decision letter and said, "They screwed you on this. We need to file a reopen". The VSO filed a new claim for this and other conditions 01/09/2019. I"m expecting another denial. Do I have a legitimate basis to disagree or appeal?

Edited March 7, 2019 by Retired USAF 1st Sergeant
spelling correction

[broncovet]

Of course, I have not read your records.  However, it sounds like this qualifies under Caluza element number 2, "In service event OR AGGRAVATION".  

Remember, tho, VA math is not in your favor MATH.  An additional 10 percent or maybe even an additional 20 percent "does not always" result in an increase because of VA math.  

You could use the disability calculator, and check the critieria and see, but, why fight the VA for nothing??  That is, if its unlikely to mean more money in your pocket, I would not bother. Some may disagree, but you are unlikely to die from a sinus condition...

[Retired USAF 1st Sergeant]

Thanks for the guidance Broncovet. I really appreciate it.

An additional 20% (of the remaining 30) would get me to 80% SC. And I've requested increases for BPH and both knees.

I'm really looking for an answer to the question,  Was it correct/legitimate for the VA to deny the original claim due to the pre-service surgery?  

[broncovet]

No, its not correct.  They have to rate "aggravation" to the extent your condition got worse in service.  You dont get paid for the part you had before service.  What I dont know if the worsening of symptoms is significant or not.  You know that better than I do.  

Edited March 7, 2019 by broncovet

[ShrekTheTank]

Here is what I found out. The US government bought you the way you were and your condition got worse, so from what I understand they own this part of you also. 

I had a condition prior to service and it was aggravated by other conditions or was made worse in service so they own all of it. 

The prior part you will get nothing. 

Also I don’t think it is a waste as your other conditions could go higher also. 

Edited March 7, 2019 by shrekthetank1

[Retired USAF 1st Sergeant]

Thanks shrek, that helps. 

I may be wrong, but the reason I think they're going to deny again is because I haven't been scheduled for a C&P exam for the sinus condition. 

I already had the C&P exams for the requested increases on BPH and both knees, and have another C&P scheduled next Tuesday for Hearing/Tinnitus

Also completed one for lab work (blood & urine)

I guess I'll just have to wait and see... 

[doc25]

4 hours ago, Retired USAF 1st Sergeant said:

First post/question . Advance thanks to ALL my fellow Veterans.

I retired November 2004 with 21+ years service (USAF). I'm now 56.

I filed my initial VA claim in Oct 2005 with no VSO or any other guidance whatsoever.

Received an initial SC rating of 70%, - 50% OSA, 20% BPH, 10% L Knee, 10% R knee. I was Fat, Dumb and Happy...

I was denied SC for Sinus condition due to a pre-service surgery for deviated septum/removal of polyps.This surgery was ~3 years prior to enlistment (~1980) and was disclosed during MEPS/Inprocessing. I started having sinus issues (multiple recurrent infections) and subsequently two sinus surgeries (~1995 & ~2000). I still have recurrent yearly sinus infections that require treatment with antibiotics and steroids. 

Fast forward to January, 2019. All of my SC issues have  gotten worse over the years. 

I signed up with a VSO who was highly recommended by a Veteran friend. He reviewed my In-service Medical Records. While reviewing my records. he noted that the sinus issues were "all over my records and asked why hadn't I claimed them?" I told him that I had claimed the sinus condition in my initial claim back in 2005, and it was denied. He then pulled up and read my initial rating decision letter and said, "They screwed you on this. We need to file a reopen". The VSO filed a new claim for this and other conditions 01/09/2019. I"m expecting another denial. Do I have a legitimate basis to disagree or appeal?

Read this BVA citation. It will provide you some insight on what you'll need to do. This service member's pre-existing condition worsened during service and service connection was granted on the basis of aggravation.

 

https://www.va.gov/vetapp08/files2/0814999.txt