Help needed- Where do I go from here?

[Marineleo]

I am absolutely dumbfounded by the VA's inability to read !  My husband filed a disability claim for the removal of 1/3 of his Intestine (and the large painful residual scar) that was done WHILE ACTIVE DUTY. (The resection was specifically filed as 38 CFR § 4.114 - Schedule of ratings -digestive system.   7329 - Intestine, large, resection of:  With symptoms, objectively supported by examination findings). They denied it, so we added supplemental information which included copies of his Service Treatment Records (Attached) that clearly show they did a Hemicolectomy, AKA Resection of Large Intestine.  We later submitted an Independent Medical Opinion from his primary care Dr that stated that he has ongoing symptoms and that these symptoms were "more likely than not" a result of the resection of his large intestine which occurred in service and also submitted color photographs of the very large abdominal scar with and without scale.  They denied it again so we filed a CUE. They finally after 2 years sent him for a C & P exam at which he handed the examiner his service treatment records.  She wrote that she thought he "may have had a resection of his SMALL intestine" (which is a totally different procedure name than the Hemicolectomy cited in his operative report).  They also requested a medical opinion from another one of their own Dr's who wrote "It appears the Veteran had surgery in 1982 prior to enlistment".  Wait, What??!! Nope, He never had any kind of surgery before enlisting in 1984- as evidenced on his enlistment physical records.  She also stated that "There is no evidence in the Veteran's Service treatment records consistent with any intestinal issues or a partial colectomy".  And now they've denied it AGAIN !

The denial letter reads; Service Connection for Intestinal Bleed & Colon removal, claimed as Resection of Large intestine is denied since this condition neither occurred in nor was caused by service.  

Your service treatment records do not contain complaints, treatment, or diagnosis for this condition.  

We did not find any link between your medical condition and military service.

Your VA Medical Opinion stated the claimed condition was likely than not (less than 50 % probability) incurred in or caused by the claimed in service injury, event, or illness.  All of your medical records were reviewed. There is no evidence of any intestinal issue that would lead to surgery during active service.

The VA exam conducted on April 12, 2019 diagnosed you with resection of the small intestine, GI bleeding with Polyps.  

Service Connection for Scarring, residuals of Resection of Large intestine is denied since this condition neither occurred in nor was caused by service.  

Your service treatment records do not contain complaints, treatment, or diagnosis for this condition.  

We did not find any link between your medical condition and military service.

The VA exam conducted on April 12, 2019 for scars and disfigurement diagnosed a linear scar on midline abdomen, residual of partial colectomy.  

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In the evidence listed that they considered is his service treatment records, the DBQ, THEIR Dr's medical opinion, but conveniently did not consider the CUE letter (with attachments) we filed, the IMO from his primary care Dr, or the photographs we submitted of the scar.

So we filed another CUE and a request for a higher level review.  My question is what else can we possibly do?  The VSO straight up told us to hire an attorney but it seems ridiculous to give them the $ when the information is right there in black & white IN HIS SERVICE TREATMENT RECORDS!!!   Anyone have any suggestions at all?   I was thinking about going to the VARO (Bay Pines) and submitting information on nearby literacy classes for them since they clearly can't read??

*See attached service records- (Identifying info redacted- the copies we gave the VA weren't)

 

Service Records Redacted and Highlighted .pdf

[Carl the Engineer]

We'll, it looks to me that it occured in service, the surgery anyway.  Something doesn't add up, that's for sure.  Did your man join when he was 17 years old?  Just curious by reading dates.

If you keep getting denied, you might want to consider a lawyer.  80% of something is better than 100% of nothing, everyday.  

Have you used a service organization or rep?, and what do they say?

Something is amiss.

Hamslice

 

[Marineleo]

That's all he filed for was the actual surgery/ resection and the question is HOW/ WHY can they deny it when we've literally even given them copies of the service records and they say there are no records showing this?!!  Yes, he was 17 at enlistment, turned 18 in boot camp.  

The VSO (FDVA) said hire an attorney.  We talked to several and everyone wants to try and make it a TDIU case because he already has 70% for another condition but he is still working.  I get that 80% is better than nothing but it seems like such B.S when it's literally right there in black and white.  

Wish there was a way to get even 5 minutes with a rating officer to hand them those records and ask them to explain how they feel there is no documentation that this happened!

[doc25]

49 minutes ago, Marineleo said:

I am absolutely dumbfounded by the VA's inability to read !  My husband filed a disability claim for the removal of 1/3 of his Intestine (and the large painful residual scar) that was done WHILE ACTIVE DUTY. (The resection was specifically filed as 38 CFR § 4.114 - Schedule of ratings -digestive system.   7329 - Intestine, large, resection of:  With symptoms, objectively supported by examination findings). They denied it, so we added supplemental information which included copies of his Service Treatment Records (Attached) that clearly show they did a Hemicolectomy, AKA Resection of Large Intestine.  We later submitted an Independent Medical Opinion from his primary care Dr that stated that he has ongoing symptoms and that these symptoms were "more likely than not" a result of the resection of his large intestine which occurred in service and also submitted color photographs of the very large abdominal scar with and without scale.  They denied it again so we filed a CUE. They finally after 2 years sent him for a C & P exam at which he handed the examiner his service treatment records.  She wrote that she thought he "may have had a resection of his SMALL intestine" (which is a totally different procedure name than the Hemicolectomy cited in his operative report).  They also requested a medical opinion from another one of their own Dr's who wrote "It appears the Veteran had surgery in 1982 prior to enlistment".  Wait, What??!! Nope, He never had any kind of surgery before enlisting in 1984- as evidenced on his enlistment physical records.  She also stated that "There is no evidence in the Veteran's Service treatment records consistent with any intestinal issues or a partial colectomy".  And now they've denied it AGAIN !

The denial letter reads; Service Connection for Intestinal Bleed & Colon removal, claimed as Resection of Large intestine is denied since this condition neither occurred in nor was caused by service.  

Your service treatment records do not contain complaints, treatment, or diagnosis for this condition.  

We did not find any link between your medical condition and military service.

Your VA Medical Opinion stated the claimed condition was likely than not (less than 50 % probability) incurred in or caused by the claimed in service injury, event, or illness.  All of your medical records were reviewed. There is no evidence of any intestinal issue that would lead to surgery during active service.

The VA exam conducted on April 12, 2019 diagnosed you with resection of the small intestine, GI bleeding with Polyps.  

Service Connection for Scarring, residuals of Resection of Large intestine is denied since this condition neither occurred in nor was caused by service.  

Your service treatment records do not contain complaints, treatment, or diagnosis for this condition.  

We did not find any link between your medical condition and military service.

The VA exam conducted on April 12, 2019 for scars and disfigurement diagnosed a linear scar on midline abdomen, residual of partial colectomy.  

-------------

In the evidence listed that they considered is his service treatment records, the DBQ, THEIR Dr's medical opinion, but conveniently did not consider the CUE letter (with attachments) we filed, the IMO from his primary care Dr, or the photographs we submitted of the scar.

So we filed another CUE and a request for a higher level review.  My question is what else can we possibly do?  The VSO straight up told us to hire an attorney but it seems ridiculous to give them the $ when the information is right there in black & white IN HIS SERVICE TREATMENT RECORDS!!!   Anyone have any suggestions at all?   I was thinking about going to the VARO (Bay Pines) and submitting information on nearby literacy classes for them since they clearly can't read??

*See attached service records- (Identifying info redacted- the copies we gave the VA weren't)

 

Service Records Redacted and Highlighted .pdf 16.53 MB · 2 downloads

Your anger and frustration is understandable, but turn that into righteous rage. It appears your husband is going to require a veteran's lawyer for an obvious appeal. 

I hired Chisholm and Chisholm law firm and I'm not going to pay anything upfront, unless my claim is granted. Hill and Ponton is another law firm that deals alot with veteran's appeals. Chris Attig law firm, as well.

#1. The presumption of soundness was not properly applied to this claim. Clearly and Unmistakably the record shows he went in healthy and was discharged with a bowel problem.

#2. The VBA blatantly lied that the condition was not incurred or caused by military service.

#3. The C&P examiner's credentials must be challenged. Was the examiner a GI specialist? A General practice Dr? A Physician's Assistant? Nurse Practitioner? The unfavorable nexus of opinion by the examiner and the favorable nexus of opinion from his Dr. is equipoise, meaning there is a tie in the nexus of opinions. A tie must go to the veteran.

You and your husband have every right to be upset, but the VA is going to fight tooth and nail. No matter how angry you are. Higher level Review might not get this claim granted at the Regional Office. It might have to end up at the BVA or even the CAVC for it to be granted.

To me, this claim was denied; just to be denied out of malicious intent. That's just my point of view.

 

I'm having a similar experience with my flat foot claim from 2007. But, I'm not going to give up on it. I suggest y'all don't give up either. There's work to be done. 

[doc25]

19 minutes ago, Marineleo said:

That's all he filed for was the actual surgery/ resection and the question is HOW/ WHY can they deny it when we've literally even given them copies of the service records and they say there are no records showing this?!!  Yes, he was 17 at enlistment, turned 18 in boot camp.  

The VSO (FDVA) said hire an attorney.  We talked to several and everyone wants to try and make it a TDIU case because he already has 70% for another condition but he is still working.  I get that 80% is better than nothing but it seems like such B.S when it's literally right there in black and white.  

Wish there was a way to get even 5 minutes with a rating officer to hand them those records and ask them to explain how they feel there is no documentation that this happened!

That would be awesome. I have some choice words for the raters that have committed an injustice to my claim over the past 12 years. Sheesh.

[Berta]

"I am absolutely dumbfounded by the VA's inability to read !"

After 20 plus years dealing with my VARO, that was the prime problem I had with them- over and over again-

Can you scan and attach their most recent  denial, as to their rationale , and also the evidence list they used?

I considered sending my RO copies of "Reading for Dummys", and thought about attaching my IMOs they refused to read to the inside cover of a few Pizzas for the rating board. Then I thought maybe I could get rolls of toilet paper for their bathrooms printed with my IMOs on them.

What I did do was fight back aggressively- and CUE sure helped me and even my daughter's first and only VA claim.

They should be rating the scar as well as any ratable residuals from the surgery- 

 

CAn you also attach the last CUE you sent them? Cover you C file #, name, prior to scanning it.

One of my CUES ( I have had many- all awarded , but with 3 more in process,now)fil ed long ago was never addressed at all by my RO, until I re-opened my claim, and they had to contact the VA Regional Counsel to verify my FTCA stuff. 

Regional Counsel read through my entire C file, found the CUE and my evidence for it, and cued them himself and ordered them to pay me.

I also deal with a RO director who does not know VA case law.She tried twice by phone to get me to accept something that was absolutely ridiculous. I cued that decision as well. 

My pending CUEs are all on award letters.

If we can see their decisions and the evidence list they used , we can help more.

 

Something is drastically wrong here and it might well all boil down to the illiteracy many of us have  had to face with ROs. 

 

 

[ShrekTheTank]

Doc is right as for taking it to the next level of the BVA.  The BVA has their stuff more in line than a local RO who can't read.  I had an RO try to just get rid of me by giving me some BS rating under the wrong coding.  It took the BVA to say this is not correct and then told RO how to rate my condition and now looks like 60% instead of 10%.  The RO typically is there to just push it through and get rid of it.  I am guessing the RO did not read the entire file as this is very blatantly there and in service.  

Also Berta brings up a good point to post the denial as they can hide things in there.