Denied service connection

[SPO]

I posted this same info in another thread, longer, thread in C&P exams, but I'll put this here to see if anyone has any ideas.

I apologize in advance for the length of this, but here is an excerpt from my decision letter, I'll try to upload the whole thing later. Most of my contentions have an explanation just like this, or very similiar.

"Service connection for psoriatic arthritis of the left shoulder is not established. Service connection may only be granted for a chronic disability which began in military service or was caused by some event or experience in service.

The evidence does not show an event, disease or injury in service. (38 CFR 3.303, 38 CFR 3 .30~). Your service treatment records do not contain complaints, treatment, or diagnosis for this condition. The VA medical opinion found no persistent disability. 

The medical opinion we received from the VA contract examination was more persuasive than your private physician's opinion because it was based on an in-person examination and a thorough review of your relevant military and /or personal history and contained a more convincing rationale. (38 CFR 4.6) The evidence does not show that your condition resulted from, or was aggravated by, a service-connected disability. (38 CFR 3.303, 38 CFR 3.304) The evidence does not show that your disease developed to a compensable degree within the specified time period after release from service to qualify for the presumption of service connection. (38 CFR 3.307, 38 CFR 3.309)

 The VA contract medical opinion dated December 15, 2018, was not based on a review of your claims file or an in-person examination. 

Service connection for psoriatic arthritis of the left shoulder is denied because the medical evidence of record fails to show that this disability has been clinically diagnosed. (38 cfr 3.303)"

I can make sense of this.  I submitted a DBQ from my doctor with a diagnosis, but the say its not clinically diagnosed.  Also CFR 3.07 and 3.308 are presumptive conditions, I did not claim this as a presumptive condition, its a secondary to psoriasis.  I don't have the copies of the opinion and exam yet.  Also they say the medical opinion was not based on my claim file or an exam, how is that valid for anything? 

Also the VA got a medical opinion in December 2018, and an in-person C&P exam in April 2019.

[broncovet]

As always, you need to file a nod, and keep the reasons and bases handy to refute them.  Always cite "evidence" to refute VA reasons and bases.  

The good news is that these were specific reasons and bases, and, if you can refute them, you should prevail in an appeal.  

This may mean another IMO.  The VA can select the opinion of one doc over another, but must give a reasons and bases for doing so.  This is what they did.  You should answer their "complaints" such has having your IMO state that he read your file.  

You could also argue "equipose" as doc a said yea, and doc b said nay.  It would be especially helpful if you can cite doc c who also said yea.  You may already have that, and it would take a review of your file to know.  

[ShrekTheTank]

First off is this condition in your medical records from the Military?  If it is not in there then the denial is correct.  

Next you said the condition was secondary to psoriasis?  If this is so then you need to claim it as secondary to this condition (did you claim it as primary?).  You then will needs a NEXUS from your doctor to show how it is aggravated by your service connected condition.  

Also please upload the denial and cover your information.  sometimes there are things missed which can show you what they are talking about.  

[broncovet]

As always, you need to file a nod, and keep the reasons and bases handy to refute them.  Always cite "evidence" to refute VA reasons and bases.  

The good news is that these were specific reasons and bases, and, if you can refute them, you should prevail in an appeal.  

This may mean another IMO.  The VA can select the opinion of one doc over another, but must give a reasons and bases for doing so.  This is what they did.  You should answer their "complaints" such has having your IMO state that he read your file.  

You could also argue "equipose" as doc a said yea, and doc b said nay.  It would be especially helpful if you can cite doc c who also said yea.  You may already have that, and it would take a review of your file to know.  

One thing to know:  Most VA denials are incorrect.  The proof is at the BVA

chairmans report, who says that about 20 percent of claims are denied by the BVA, which means the other 80 percent are either remanded or awarded.  (Its a mix between remands and awards, with remands usually higher than awards).

See for yourself: (scroll down to statistics page, about page 31, 32, 33) on the 2018 report.  Particularly troubling is the amount of Board denials increasing, substantially, in 2018.  This means the board is rushing through them to clear the backlog by denying.  This is already resulting in a backlog at the CAVC.  

https://www.bva.va.gov/Chairman_Annual_Rpts.asp

 

[ShrekTheTank]

1 minute ago, broncovet said:

As always, you need to file a nod, and keep the reasons and bases handy to refute them.  Always cite "evidence" to refute VA reasons and bases.  

The good news is that these were specific reasons and bases, and, if you can refute them, you should prevail in an appeal.  

This may mean another IMO.  The VA can select the opinion of one doc over another, but must give a reasons and bases for doing so.  This is what they did.  You should answer their "complaints" such has having your IMO state that he read your file.  

You could also argue "equipose" as doc a said yea, and doc b said nay.  It would be especially helpful if you can cite doc c who also said yea.  You may already have that, and it would take a review of your file to know.  

One thing to know:  Most VA denials are incorrect.  The proof is at the BVA

chairmans report, who says that about 20 percent of claims are denied by the BVA, which means the other 80 percent are either remanded or awarded.  (Its a mix between remands and awards, with remands usually higher than awards).

See for yourself: (scroll down to statistics page, about page 31, 32, 33) on the 2018 report.  Particularly troubling is the amount of Board denials increasing, substantially, in 2018.  This means the board is rushing through them to clear the backlog by denying.  This is already resulting in a backlog at the CAVC.  

https://www.bva.va.gov/Chairman_Annual_Rpts.asp

 

Bronco is right on!

[SPO]

Ok, so how should I go about refuting them.  I already gave them a clinical diagnosis, its not part of a presumptive condition, and it developed well after I got off active duty (as a side note, its medically known that this condition develops, on average, between the ages of 30-50 (i'm 35) and about 10 years after onset of psoriasis.  I first had psoriasis in 2005, and diagnosed with psoriatic arthritis in 2016) .  Aside from filing a NOD I'm not sure what to actually provide or say in rebuttal.   shrekthetank1, I did claim it as a secondary.  My doc included a statement in the DBQ that said it was more likely than not caused by/connected to psoriasis.

Edited May 21, 2019 by SPO

[ShrekTheTank]

4 minutes ago, SPO said:

Ok, so how should I go about refuting them.  I already gave them a clinical diagnosis, its not part of a presumptive condition, and it developed well after I got off active duty (as a side note, its medically known that this condition develops, on average, between the ages of 30-50 (i'm 35) and about 10 years after onset of psoriasis.  I first had psoriasis in 2005, and diagnosed with psoriatic arthritis in 2016) .  Aside from filing a NOD I'm not sure what to actually provide or say in rebuttal.   shrekthetank1, I did claim it as a secondary.  My doc included a statement in the DBQ that said it was more likely than not caused by/connected to psoriasis.

So I made this mistake on one of mine.  It kinda sounds like this RO is just saying it was not linked to service instead of being aggravated by your psoriasis.  I made the mistake of saying it caused this other condition with out any proof.  File the NOD, but plz post their reasoning here as you will need to refute what they are saying. 

There are a bunch of things you can do, but we need more information to give you help.