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supplemental claim or no?


oldtimer92

Question

First let me apologze for this long post. I had a NOD that was submitted in 2016, I opted into RAMP in 2018. I had a c&p done in my hometown by an outsource company called LHI. Exam was very detailed and i think that was due to the fact the examiner was prior military and she suffered the same conditions i filed on my claim. i thought the exam was for both claims because we discussed both conditions. I was requesting an increase for migraines and the other was for a secondary condition from the botox injections given for the migraines. i thought it went ver well, the examiner asked me to keep in touch and let her know how everything came out. I was estatic because I felt like I was finally getting heard. Fast forward, I get my decision and both claims are denied. The letter listed all evidence reviewed, all favorable evidence with diagnosis for each condition. The denial letter said the increase was denied because examiner only stated one episode per month and the secondary was denied because examiner did not find a connection to migraines. I was baffled and lost. But I also know how exams can go great and denials come later, so my next step was to get VSO to file an appeal. Fast forward again, Im in out at the grocery store one day and the examiner seen me and walked up to asked how things were going. I wanted to say a few choice words, but I politely told her the claims were denied and the letter stated due to VA exam findings. She told me that she remembered me and my claims because she had the same conditions. She said that was not what she put on the forms and she receiving nothing in regards to the secondary condition. She said she received a questionnaire to evaluate the migraines and a medical opinion for the migraines only. She told me to request a copy of the exam and to come see her once I received it.  When I got the copy, i took them to her and she read them and wrote a statement on my behalf concening both conditions. I also had VSO to help me with my statement to include with her statement. I was told by an ex-claims rater that this may not be considered new evidence.

So my question: will this be considered new evidence under the supplemental lane? Or should I have done an appeal?

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With evidence of this sort I would go straight to the BVA.  That is just me.  If you select the Supplemental Claim lane then you might get the decision overturned.  If you get denied at the supplemental claim you can still appeal to the BVA. @Buck52 or @broncovet may disagree with me so give them a chance to chime in.

This is once again a reason to treat everyone nice until they show themselves to be unfitting that treatment.

Edited by vetquest (see edit history)
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Vetquest it seems to me that the examiner has provided new and relevant evidence. The VA can see that at a minimum, the fact that she has provided statements that contradict what they had developed from her initial exam, something was "wrong." They have to carefully reconsider what she clarified. As you already stated, if you go Supplemental lane, you can still go to BVA if needed later. Why throw away a free pass; go supplemental first is what I would recommend, and if denied, you go again. Its supposed to be 125 days max, a reasonable cost for an "extra" chance.

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You also have HLR (Higher Level Review) before going to the BVA, I am using this route since I do not have new evidence. I must admit I find it interesting that the LHI examiner wrote a statement in support of the claim after the denial, I like that she was willing to do that. But I wonder what the VA will think? Just wondering is all.

There are a lot of caring contracting (LHI, QTC, & VES) doctors out there and unfortunately a few crappy ones too.

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Thanks everyone . I was wondering the same thing in regards to her writing the statement but she volunteered to do it so I’m assuming she isn’t afraid of any backlash from VA. I do know one thing she really wanted to address was the fact that they denied the secondary claim based on the exam findings and the secondary condition was not listed anywhere to be evaluated by her. But she did address it due to our conversation and put on the medical opinion that the secondary condition was at least as likely as not (50% or greater probability) due to or the result of the service connected condition and they still denied the secondary condition. Diagnosis, connection and favorable findings. So I don’t know what really happened here. 

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