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Denied service connection

Question

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.

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Kihr make your own thread. So that others that post won't get confused.

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14 hours ago, Kihr said:

This makes me nervous, I was medically separated for Psoriatic Arthritis, extreme swelling in my knee.  I submitted a claim increase/new claim in September last year and I am having issues with more joints than I initially claimed when I got out.  I didn't know what I was doing and I didn't even get my knee (the reason I was separated) included because I didn't realize I had to claim "Psoriatic Arthritis" - Knee....ah young me was an idiot....anyway...  My Hip/Knee are just getting worse with several disabling events / year.  The pain is so bad it keeps me up at night, I really am nervous after reading your denial for this condition, I really could use some good news, feeling burnt out waiting for this claim.  

There is some good news, but please start your own topic so we can point you in the right direction.

I'll initiate some of that good news on here.

#1. Don't beat yourself up over something that you did or didn't do.

#2. All the other issues you are having can be secondary connected to Psoriatic Arthritis, once you get it service-connected.

#3. Since the pain is severe enough that it is causing you to not get sleep that is called Insomnia; you can claim that secondary as well. Is this condition also causing you to have Depression? This can also be claimed, as secondary. The Insomnia and Depression will be combined because both are mental health disorders.

I'll explain further once you create your own topic.

 

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This sounds like the old "competing medical opinions" situation.  The VA physician says your medical records do not support service connection, while your private physician says it does.  In the rating decision, VA favors their own physicians' opinion and will deny service connection.  

Typically, here's how to go about solving this conundrum:

File the Notice of Disagreement.  But - and this is critical - it should be supplemented by a very methodical and claimant-specific professional medical opinion that states whether it is at least as likely as not that the claimed medical condition was caused during or aggravated by military service.  The opinion should be based on the claimant's service records as well as in-person evaluation, and the opinion statement should clearly inform the VA that the physician has in fact reviewed all relevant medical records in formulating their opinion.

Basically, the VA will not approve a claim for compensation until the claimant submits evidence of the claimed condition (diagnosis), evidence of in-service injury or aggravation, and a nexus (link) between the two.  Submitting a favorable medical opinion is the best way to accomplish that.  Do not bother sending pages and pages of WebMD articles, research material, or other outside sources because they are not relevant to your specific condition.

All the best.

 

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