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.

[SPO]

Just as a possible point of interest in my appeal. I looked up the person who performed my c&p and they were nurse practitioner  specializing in gerontology.  As far as I know psoriatic arthritis is normally diagnosed and treated by a dermatologist and/or rhumetologist.  How can I use this going forward with an appeal?

[vetquest]

The best way to handle this is to get an IMO from the appropriate doctor and then appeal directly to the BVA.  There the benefit of the doubt would be decided in your favor.

[GBArmy]

Your doc's IMO has to show the connection, if you are claiming secondary, to whatever. You have to have the diagnosis that is current. However he does it, he includes his curriculum vitae, which is his education, work experience, whether or not he is board certified in the desipline of your claimed disability, what medical articles or papers he has written, any professional associations he belongs too, college course he has taught etc., etc. By doing so, he shows that in a tie, his experience trumps the gerontologist's. Did he see you in perso for eval; then he should state that fact. You also want to address the VA's comments why they disapproved, and why their reasoning is wrong by way of your doc's IMO. As Vetquest just commented, BVA probably is a better lane to take, but it may take longer. Good results are better than quicker bad results, right?

[SPO]

Thanks for the advice.  Are you referring to skipping DRO and RAMPS straight to BVA?  

Edited September 3, 2019 by SPO

[GBArmy]

Your question was relative to the qualifications of the doc that performed the C&P, and how to address that.  I would go BVA with supplement lane, providing you have a "more qualified" doc, and your IMO is sound.

[SPO]

Does it make a difference in the process if I request a DRO while waiting for BVA?  Or with the new system, do I have to pick an appeal option and stick with it?

Edited September 3, 2019 by SPO