Claim Denied. Please help. Confused

[USMC_SawGunner]

Apologize for the length(a lot you can just skim over) but I want to put this all out there because I am stunned right now. After 60 days, my claim was abruptly denied. No C&P exam requested. Please tell me how anyone can possibly defend what you are about to read. I have carefully redacted all personal information about myself or my doctors.

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Below, I have just copy and pasted these sample entries from my bluebutton report. There are many more examples over the course of seeing my VA doctors for over a year but I just grabbed a few entries to give you a clear idea of what they have been writing down in my file. These are just some of the recent entries as you can see by the date. I also have a medication list that is over 2 pages long of drugs I have tried since getting help from them. I am still continuing to see my doctors and receiving treatment.

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Mar 15(VA Psychologist): Diagnosis: Major Depression

Quote

"Client states his level of back pain has become significant enough where he withdrew from job."

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March 15(VA Psychiatrist): Dx: Major depressive disorder, recurrent, severe; Insomnia disorder with non sleep mental comorbidity; adjustment disorder with anxiety

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"mood and physiological pain continues to cause significant impairment in employment, and social/interpersonal functioning. He continues to report minimal improvement in mood or chronic pain with his current medication regimen. chronic low back pain from service"

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March1(VA Psychiatrist): Dx: Major depressive disorder, recurrent, severe; Insomnia disorder with non sleep mental comorbidity; adjustment disorder with anxiety.

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"Veteran's mood continues to cause significant impairment in employment, emotional, and social/interpersonal functioning. He continues to report minimal to no improvement with medications for mood, anxiety, or pain."

"client reports engaging in pain management for lower back pain. Client reports some significant discomfort and chronic pain. Talked about the effect of chronic pain and how it can exacerbate his level of depression."

 

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Jan 04 (pain management doctor): Chief complaint: low back pain

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"Mr XXX male with PMH significant for depression that presents today for f/u for low back pain. He reports no improvement of low back pain. Also reports lower extremity weakness with legs giving out after back tensing up."

 

 

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Sep 13 Last year(Older VA Psych who retired): DX: depression, chronic low back pain.

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"Vet continues to struggle with back pain. He expects that he may never work again, have no quality of life."

 

 

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October 22 Last year(Older VA Psych who retired): DX: Unspecified depressive disorder; unspecified anxiety disorder with panic attack, Insomnia, unspecified.

 

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"Veteran continues to report experiencing depression, anxiety irritability, panic attack and insomnia secondary to chronic low-back pain that is constantly 8/10" Veterans mood and symptoms continue to cause mild impairment in employment, and significant impairment in social and interpersonal functioning. Has experienced little improvement in symptoms. MEDICAL ROS: Chronic low-back pain from service"

 

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In addition to these notes, I went out and got TWO seperate DBQ's filled out by my local doctors. They are both board certified psychologist.

 

Here are the DBQ's with all personal information redacted:

 

 

https://imgur.com/a/ztSD9SS Private board certified doctors DBQ #1 

 

https://imgur.com/a/XDF4kTC Second Private board certified doctors DBQ #2 

 

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Lastly, I included in my FDC package 3 buddy statements from family members and co-workers indicating how my lower back has affected my life and job and how it has manifested into depression due to chronic pain.

 

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Everything you see above, resulted in this:  https://imgur.com/a/9NmbYMd     60 days and not even a C&P exam request.  

 

My mind is BLOWN right now. How.

 

EDIT: I have worked manual labor construction my entire life, due to how bad the back pain has gotten and now the depression I have been out of work for over 6 months. I will now be applying for food stamps. God Bless the VA.

[JKWilliamsSr]

From what I can tell it looks like he is service connected for his back.  He has 40% for arthritis in his spine and intervertabral disk syndrome.  The denial I believe is for depression secondary to his back issues.

[USMC_SawGunner]

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"back pain" is a generic term- everybody has back pain at some point in their life.

What is the medical diagnosis ?

 

 

 

 

Hello,  were you not able to see the link I provided at the end of the post?   I am 40% service connected for lower back lumbar, and 20% radiculopathy secondary to that.  Does that suffice as evidence for "in service back pain"?   The chronic nature is that I have been in an out of the VA being seen for my back for years(many MRI taken and on record at the VA of herniations that have taken place specific to that area), just a week ago I was bedridden for about 10 days from a "flare up" and I saw the VA doc and this was noted in my file. 

 

When you are 40% service connected for degenerative arthritis of the spine and intervertebral disc syndrome and 20% radiculopathy associated with that,  it's safe to say you aren't just walking around fine, its safe to say that that rating comes with it an obvious and constant source of chronic pain like I have.  

 

Each time my psychiatrist or psychologist at the VA references "Back Pain" in their doctor notes they are referencing the 40% service connection and 20% radiculopathy. obviously.  

 

How about now rising to the level of a fully developed claim?

 

The denial letter has not come yet so I am unable to provide the information you requested as of this moment.

 

Thank you for taking the time to reply. 

 

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Edited June 1, 2019 by USMC_SawGunner

[USMC_SawGunner]

2 hours ago, doc25 said:

The DBQ's are not sufficient evidence for a nexus of opinion. They are only good to give the rater a better picture of your symptoms.

If you were not provided a C&P exam, this might fit in as "failure to apply the Duty to Assist".

APPEAL this, because it's well known in the medical community that back conditions, especially chronic pain, can cause mental disorders.

Read this:

https://www.medicalnewstoday.com/articles/314493.php

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)12479-8/fulltext

https://www.practicalpainmanagement.com/resources/news-and-research/international-study-finds-back-pain-mental-health-closely-tied

 

You can provide these articles as additional medical evidence. You don't have to be a medical professional to provide evidence of what's already been researched and linked by actual medical professionals. 

 

Thanks for taking the time to reply.

 

Regarding the DBQ's.  I am around vets often, participate in group therapy, and get around online a bit to the different forums.  I know of no one I have ever talked to who went out and dropped $400 EACH for two separate independent DBQ's from board certified doctors to submit with their initial claim. No one.   Like you said, if they simply give the rater a better picture of my symptoms, good enough.  I want my symptoms as fleshed out as possible and on the record. I did not expect to get an immediate rating based purely off the DBQ's.

 

I have posted this same question elsewhere with lines such as this from the head Pain Psychologist(MD) specialist at my local VA and somehow they are invalid and do not meet the level of creating a "Nexus" and at MINIMUM trigger a C&P to evaluate "nexus". Below is what she wrote and what is in my file right now:

Dx: Major depressive disorder, recurrent, severe; Insomnia disorder with non sleep mental comorbidity; adjustment disorder with anxiety.  

"Veteran continues to report experiencing depression, anxiety irritability, panic attack and insomnia secondary to chronic low-back pain that is constantly 8/10" Veterans mood and symptoms continue to cause mild impairment in employment, and significant impairment in social and interpersonal functioning. Has experienced little improvement in symptoms. MEDICAL ROS: Chronic low-back pain from service"

So get rid of the DBQ's, Get rid of the lay statements, get rid of ALL the other VA doctor notes and submissions(for the sake of argument and discussion).  Let's just examine this one simple submission in my bluebutton.

What we have is a DX, a medical diagnosis of Severe Major Depressive Disorder, from the VA Pain Psychologist(MD).   That's very clear... I hope.     Now, let's look what they said after they made that diagnosis.  "depression, anxiety irritability, panic attack, and insomnia SECONDARY TO CHRONIC-LOW BACK PAIN."     

 

Explain to me, please, how just that... and that alone is not a form of nexus?  how much more clear could the doctor have put it. She is a MEDICAL DOCTOR, she is not, nor any other medical doctor at the VA, going to utter the phrase "is at least as likely as".   She is clearly indicating the association between her own diagnosis of Major Depression and the origins of it, SECONDARY TO CHRONIC-LOW BACK PAIN...   For which I am 40% service connected. 

 

Remember, we arent talking about ratings right now..  WE ARE TALKING ABOUT NOT EVEN MEETING THE THRESHOLD FOR A C&P.   

 

Thank you for the links to chronic pain and depression but it probably the second most obvious cause of mental health in the world.  It's not even remotely debatable to provide evidence of that.  I don't need to prove or substantiate that.  It's known fact.  

 

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Edited June 1, 2019 by USMC_SawGunner

[USMC_SawGunner]

6 hours ago, vetquest said:

Unfortunately you need an event in service that lead to your back problem, proof of chronic back problems and a nexus tying your service to the back problem.  Without these you will not be able to get service connected for your back and then secondary depression.  You need to search your SMR's for a time when you went to medical professionals after an event that caused your back problems.  Unless you are less than a year of separation you will not win without this.

I have responded about three times now in this thread but each and every post has been just sitting here because it needs to be "approved by a moderator" /

Interesting forum situation you guys have here.   Fantastic means of communication.   I literally have a response that is 10+ hours old that has not posted(been approved) to this thread yet, meanwhile I am getting comments from other people, unable to respond.   

 

Been on the internet a long time, since it was invented in fact, and have NEVER seen this level of forum scrutiny and moderation.  With every single post needing some other person, who I guess will get to it when they good and ready, having to read each one and then give their personal blessing before allowing it to be posted. 

 

 

I am service connected at 40% lower back(which as you know is about as high as you can get it rated) and 20% radiculopathy secondary to the lower back as well.   How does that work for you for an in-service event related to my back and the chronic pain associated with such a rating?  You would agree that having a flexion of less than 30 degrees(40% back) and pain and numbness to the point of not feeling your toes(20% radiculopathy) would meet your threshold for a situation of chronic pain? correct?  

 

If you respond to this and ask a question know that hopefully I will hopefully get back to you by tomorrow or early next week when the moderator approves of it. 

 

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Edited June 2, 2019 by USMC_SawGunner

[vetquest]

Looks like I missed something.  As Berta said please post your denial and we can see what we can assist you with.  Unfortunately getting denied is just the beginning of the VA process.  You need to file an NOD and appeal.  If they did not read relevant evidence this might be an avenue for a QUE.

Edited June 2, 2019 by vetquest

[doc25]

8 hours ago, vetquest said:

Unfortunately you need an event in service that lead to your back problem, proof of chronic back problems and a nexus tying your service to the back problem.  Without these you will not be able to get service connected for your back and then secondary depression.  You need to search your SMR's for a time when you went to medical professionals after an event that caused your back problems.  Unless you are less than a year of separation you will not win without this.

Sawgunner is already SC for  a back condition. He's trying to secondary connect MDD to SC Arthritis of the Spine and Intervertebral disc syndrome.

The established fact is he was denied secondary connection.