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

Quote

"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.

Quote

"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

Quote

"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.

Quote

"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.

 

Quote

 

"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.

[ShrekTheTank]

Doc and Berta are correct.  We need to see you denial letter (minus personal info) so we can see exactly why they denied you.  Next you need a medical Nexus to show the link.  Doc gave some great articles to help with this, but having a nexus goes much further!  Then a NOD is your next step to fighting them.

[Tbird]

@USMC_SawGunner your account has been upgraded so your posts will show immediately

[USMC_SawGunner]

13 hours ago, vetquest said:

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.

 

I have not received it yet to provide you with that information(I estimate sometime next week, but it is the VA so could be christmas).  I can tell you I wont be submitting anything, my lawyer will be though. 

 

 

[vetquest]

@USMC_SawGunner, I will be offline for a few days but most anyone here, especially Buck52, Berta, and Broncovet the moderators, can help you.  If you have an attorney he will be most likely filing an NOD and then a submission to BVA.  Good luck sir.   

[Fat]

I agree.

The road map is:

1. Inservice sickness or injury

2. Current diagnosed sickness or injury

3. Continuous care of #1 and #2 or nexus statement connecting current issue to military service.

 

NEVER GIVE UP

[JKWilliamsSr]

@USMC_SawGunner  Based on the information I see so far it appears the rater for your claim could be completely clueless.  It all depends on what your claim was for.  I did not see the actual claim in your original post.  Now with that being said, to me it seems clear that you are claiming depression because of the pain caused by your back.  However the rater is having difficulty applying it to your claim. 

What was your claim request for?  I am going to assume that you made the request for depression due to chronic pain. 

You have to spoon feed the VA for anything you are claiming for and they make behind the scene changes to make it harder.   There was a recent change to the M-21 (VA Rater Bible) that allows the rater to request additional information in order to adjudicate your claim if you are not specific enough.  If you do not respond within 30 days they will proceed with the claim which I am pretty sure will be a denial. 

M21-1 , Part III, subpart iii,  Chapter 1, Section B, 1. Requesting evidence from claimant  states: 'Whenever the disability claimed is not clearly identified, ask the claimant and authorized representative to clarify the issues to ensure appropriate development and accurate decision-making."   

M21-1 on requesting additional evidence.

The VA is not required to show proof of delivery. All they have to do is show proof that they mailed correspondence to you and they say you never responded.  Crappy but true.