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Can I add Additional Denial Rebuttable While In NOD?

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SgtE5

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Filed for ankle and knee problems that both are documented in my SMR. I was denied with a reason stating that both were acute problems. I filed a NOD. I requested my c-file, received it on Monday. Had a c&p from a contracted VA doctor so was not in my medical file as it was a contractor. The c&p doctor that did the ankle and knee exam opined the claimed condition was at least as likely as not (50 percent or greater probability) incurred in or caused by the claimed in-service injury, event, or illness. Her rationale: Veteran had no issues related to the claimed CONDITION prior to military service. Onset of the condition was during service, documented in the Service Medical Records. There is evidence of current, chronic and continuous treatment and care. A nexus has been established.

I don't understand why I was denied if the c&p doctor opined claimed conditions was related to service and I have met all 3 elements.

Even though her opinion is in the record, can I add a statment arguing the c&p doctor provided nexus? Or just wait for the SOC as I know it will be denied again and argure to the BVA?


SECTION III – MEDICAL OPINION FOR DIRECT SERVICE CONNECTION
Choose the statement that most closely approximates the etiology of this claimed condition.
X 3a. The claimed condition was at least as likely as not (50 percent or greater probability) incurred in or caused by the claimed in-service injury,
event, or illness.
3b. The claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event,
or illness.
3c. Provide rationale:
Veteran had no issues related to the claimed CONDITION prior to military service. Onset of the condition was during service, documented in the
Service Medical Records. There is evidence of current, chronic and continuous treatment and care. A nexus has been established.

Edited by SgtE5
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Thanks again Berta. The c&p doctor examined both my knee's. The right one was worse in all the tests. She only examined my left ankle as that is what I claimed. Not both. I will try and edit her opinon and attach them to another post.

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Your problem here is that the c&p examiner is not the VA claims examiner. Please note in 3a on both exams that the examiner said yes it more likely than less likely. With that said, a c&p examiner is not the last word. The rater has an in-house doctor/ARNP/ RN at the RO who reviews everything and makes that decision. They do not rely on what your c&p examiner says as to etiology.

Many Vets think a DBQ is the gold standard of a claim. In fact, I'm getting VA letters for some of my clients listing a download for the proper DBQ for the condition and a suggestion to take it to the Vet's private doctor, if any, to be filled out. A DBQ essentially lists where you are right now like a snapshot (photo). The c&p examiner is just a medical employee who records what you say and what s/he sees or discovers. In that sense, a DBQ is useless as an IMO.

When I obtain an IMO for my clients, it has far more info and discusses history as well as peer-reviewed articles about the problems my clients suffer. A DBQ is like an office visit. It doesn't go into history and the examiner is not allowed to diagnose service connection in spite of what you see in Box 3a. I refuse to use or depend on DBQs. Attached below is what I use. Dr. Rivero's Curriculum Vitae (CV) is four or five pages long, too and discusses her qualifications for opining on the client's condition. She views the exact same set of records (VBMS, STRs, current med recs and the c-file. This is where 99% of you lose. If your IMO doctor doesn't specifically state they reviewed those records I mention, you're going to lose.

Remember, VA invented DBQs. They could just as easily be called CYA forms.

And that's all I'm going to say about that.capture-was-here-e1535647298505.jpg.af98b2c111e07f43837279034ce15731.jpg

 

 

Humphrey IMO redacted.pdf

Edited by asknod
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I think the issue here is acute vs chronic...

Not that I agree with, but what they are saying is your issues resolved while in service.

I had 3 or 4 issues that where denied because the resolved while in service and or have not residual effects post service.

Every issue that I have that is chronic is golden.

You need someone to opine that what you are claiming is a chronic condition related to you service.

FWIW,

Hamslice

 

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Left ankle LHI opinion – GOLDEN!!!

Make sure you also claim the bilateral patella syndrome that the LHI examiner found in your STRs.!!!

 

The Knee C & P opinion is also GOLDEN except for one thing- I do not see what knee they are referring to.

The CUE I wrote can be tweeked, to make sure the claimed disabilities are exactly wht you claimed and by all means, claim the bilateral patella syndrome, but fdo that as separate from the CUE.

I will l try to find the bilateral patella syndrome ratings and will post here.

Your nexus was established by the examiner- she actually looked over your STRs.

And good for you- you have some evidence with you at the exam.

 

 

 

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