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.

[Berta]

There is plenty of medical evidence that shows the link:

https://www.medicalnewstoday.com/articles/323672.php

https://www.psoriasis.org/about-psoriatic-arthritis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4206220/

https://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/symptoms-causes/syc-20354076

It is well know in the medical community but a strong IMO/IME eeds to refer to the best links and abstracts a doctor can find, to boldster their opinion.

You can win this. 

 "My doc included a statement in the DBQ that said it was more likely than not caused by/connected to psoriasis."

The doctor has to give a full medical rationale, by using excerpts from the above links, and if they are a dematologist they might have even stronger information.

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

What was the medical background of the C & P examiner? Have you googled their name?

It pays to give an IMO/IME doctor a copy of any negative C & P exam, so that they can attack it, and refute what it says.

SPO, they might have committed CUE- in the decision, can you scan and post it here? 

Cover your C file #, name, etc prior to scanning it.

[Berta]

These claims can succeed.
"ORDER

Entitlement to service connection for nonspecific 
inflammatory polyarthritis and/or psoriatic arthritis is 
granted.

Entitlement to service connection for psoriasis/eczema is 
granted."

https://www.va.gov/vetapp09/files3/0925539.txt

What the Hell do they mean here:

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

That right there, if they somehow used that opinion against the claim, might well be a CUE.

Is VA paying these contracting firms real money to do deficient C & P exams? YES!!!!!!!!    Read the lastest GAO report I posted here yesterday- 

I am going to write another Bill to send to the H VAC on this.

Vets are being screwed and tattooed by very deficient C & P exams.

It is an unjustice that causes multiple denials.

 

 

Edited May 21, 2019 by Berta

[SPO]

Can I include medical information (not specific to me) that says that the two conditions are connected.  It seems the statement from my doctor wasn't enough proof for them.  I've never had to deal with this so I'm not sure what I need to provide them, a full nexus letter in addition to the DBQ maybe?.  What other information would be helpful to you?

So far I think I can refute:

1. the presumptive condition issue, by saying its secondary to a service connected condition it doesn't need to have onset during active duty, or withing a certain period after discharge or be  in my service medical record. (I also thought that there was a specific list of presumptive conditions, and this isn't one of them.  let me know if I'm wrong.

2. They were provided a clinical diagnosis in my DBQ by a licensed doctor.

3. the first line says there was no event, disease, or injury in service.  The primary is Psoriasis, which was incurred on active duty and already service connected

I don't know how to refute the fact that they didn't chose my doc's opinion over the C&P exam yet, because I haven't read it yet.  Please let me know if I'm on the right track.

I will scan in the whole decision letter tomorrow.  Thanks in advance for all the help

Edited May 21, 2019 by SPO

[broncovet]

You refute them with evidence that conflicts with VA decision "reasons and bases", that's how.  

For example, you can, in your NOD, that VA erred by not considering your claim as secondary to psoriasis, and cite that dbq.  

The VA is required to consider all methods of sc.  Its not the Veterans job to determine if his condition is on the presumptive list, or if its primary or secondary.  

See, for example, 38 CFR 4.6.  

I like "attacking" VA decisions on multiple fronts, and let the decision maker decide which one is probative.  

So, you could argue that VA did not consider Secondary SC to psoriasis AND, there may well be another doc who opined favorably for you in your file.  You need to get your file and read it to see if there is already evidence, OR just go and pay for an IMO.  

[broncovet]

If your condition is not on the presumptive list, then dont bring that term up.  It does not support your claim.  Just argue the reasons FOR sc, and, based on what you posted, presumption isnt one of them.  

[Berta]

YES SPO you are on the right track.

It is a Valid secondary condition.

Our IMO/IME forum might give you a better idea of what you need from a real doctor- a non VA doctor.

A real doctor with expertise in this condition.

But the most important thing you need is medical rational to support that this is secondary to the psoriasis-

If a real doctor gives you tht rationale and also uses some excerpts from good medical web site like the ones above-to support their diagnosis of this as secondary, the VA will not be able to adequately refute that.

This might be another CUE within the appellate period.

They can go so fast, there might be no need for a NOD.

 

Edited May 21, 2019 by Berta