Weird claim question: Is it open, closed, or what?

[Vync]

This is a weird situation...

Earlier this year I requested claims for Cushing's and heart condition. I recently received a decision letter for the Cushing's (denied due to no diagnosis). I called 1-800 and talked with them about it. I will be sending in a supplemental claim request with evidence and release auth forms on Monday. However, the lady said my heart claim was closed at the same time as my Cushing's claim. She asked if I received the decision letter. I indicated I received it, but it made no mention of anything to do with my heart. She then opened up their copy of the decision letter and confirmed what I saw. She sent an inquiry over to let the team who worked my claim know about it.

=== It is obvious that the presumption of regularity was broken here ===

Is my claim really closed?

Should I send in a Supplemental Claim Request or just a Statement in Support of Claim on Monday?

 

[vetquest]

Great response broncovet.

[GeekySquid]

4 hours ago, Vync said:

I think he has iatrogenic cushing's from long term steroid use and should be kept on lowest doses of steroids when treating asthma/COPD/DJD due to long term complications of chronic steroid use.

 

I am curious @Vync , were those external records submitted with your claim or gotten by the VA?

If not, do you think that doctor will write a stronger statement than "I think"? There are a lot of studies on PUBMED and at NIH concering cushings and iatrogenic outcomes. That Dr should be able to pull out a few and say "here is the support for why this is more likely than not"

As for the "deemed denial", the VA is supposed to address every direct claim made, even if they say there is no need to investigate because it could not be service connected.

 

[Vync]

21 hours ago, GeekySquid said:

I am curious @Vync , were those external records submitted with your claim or gotten by the VA?

If not, do you think that doctor will write a stronger statement than "I think"? There are a lot of studies on PUBMED and at NIH concering cushings and iatrogenic outcomes. That Dr should be able to pull out a few and say "here is the support for why this is more likely than not"

As for the "deemed denial", the VA is supposed to address every direct claim made, even if they say there is no need to investigate because it could not be service connected.

I uploaded those records electronically via ebenefits, but mysteriously the VA somehow lost them.

I would get the doc to try and rewrite, but she has since moved across the country.

[paulstrgn]

3 minutes ago, Vync said:

I uploaded those records electronically via ebenefits, but mysteriously the VA somehow lost them.

Vync you should check ebenfits to see if it shows the documents you have uploaded under "My Documents" (it is on the left hand side right below dependents) and see if you see them there. I would not be surprised if you see them there.

[Vync]

5 minutes ago, paulstrgn said:

Vync you should check ebenfits to see if it shows the documents you have uploaded under "My Documents" (it is on the left hand side right below dependents) and see if you see them there. I would not be surprised if you see them there.

I checked. They are not there. When I asked the lady at 1-800 about this, she said that I had originally filed an online "intent to file", but once the 21-526 form was received, any documents attached to the online intent to file were deleted. However, I look under "Work In Progress" and can see a line item for the intent to file under "Inactive Intents to File". Sounds fishy to me...

Edited June 17, 2019 by Vync

[paulstrgn]

1 minute ago, Vync said:

she said that I had originally filed an online "intent to file", but once the 21-526 form was received, any documents attached to the online intent to file were deleted. Sounds fishy to me...

That makes no sense to me at all. But with that said I filed an Intent to File in February but when I actually submitted the claim online it showed the date of filing as the effective date which was May. I have already filed a HLR with screen shots showing I started my Intent back in February which should be enough to get me an EED. It seems when the VA changed their processing the system might have had a glitch...JMO