Timeline for Supplemental Claim

[doctorevil]

I recently filed a claim to increase my service connected sinusitis, which is currently at 0%. My claim was filed 14 APR 2019, and was closed/denied  07 AUG 2019. 

Upon reviewing my files, the litany of evidence that I submitted to support my claim, which included records from my PCP and ENT showing were I had been to the doctor multiple occasions over the last two years, and where I was diagnosed with Chronic Sinusitis and Recurrent Acute Sinusitis just disappeared. I had also submitted a sworn statement from my fiance where she detailed my how many sinus infections per year I have experienced, along with describing my symptoms. Keep in mind that sinusits is rated based on the frequency of occurrences; either incapacitating or non-incapacitating. My evidence shows I have enough instances of both to be rated at the 30% level, not taking into consideration extra-scheduler ratings. 

For what ever reason, they did see one document, which was from my ENT, where the diagnosis is very clearly stated and the document contains the same information that would be articulated in a DBQ. 

Nevertheless, the BVA ignored my ENT's statement, and they went with the only other evidence they had, the C&P exam, which was conducted by a GP, not an ENT, and lasted a mere three minutes. 

I was able to have my VSO obtain a copy of their denial on 8 AUG, and I submitted a supplemental claim with the original evidence they lost/failed to review on 9 AUG. 

On 22 AUG, I checked VA.gov and saw that my claim was closed. It now states "The Veterans Benefits Administration made a decision" and under issues states, "Currently on Review - Compensation issue."

To me this seems extraordinarily fast; only 10 working days. I think my case is strong, and at a very minimum I should be rated at least 10%. I would like to think they saw the evidence and adjudicated the case quickly. 

Neither eBenefits or VA.gov has any information. My AB8 has not updated and my rated conditions have not changed. I hoping that eBenefits is slow to catch up, but I'm not optimistic. 

If the VA weighed the evidence properly this would take me from 91%, with a bilateral factor of 2.7 to 100%, as I believe that I qualify for at least a 30% rating based on the frequency of my condition.

Since its the weekend I'm now waiting for the BBE to appear, or not. Hopefully, the VSO can shed some light on what has happened. 

[GeekySquid]

Here is wishing you good thoughts DoctorEvil,,,, there is a bad joke in there someplace..hmmmm

My VSO is useless as tits on a hobby horse... maybe yours is better.

As I posted in a thread recently she told me flat out ".....I work for the VA..." DERP DERP DERP

gee I thought I gave my POA to the American Legion not the VA....you can guess I am not amused.

 

[doctorevil]

Thanks GeekySquid. I'm a college professor, so this is what my students call me, though they do use it as a term of endearment. 

As far as VSOs go, this is the first time that I have ever used one for anything. I used to have DVA and when I asked them for assistance when I filed my first claim 5 years ago, I was less than satisfied.  I now have the VFW and they are slightly better, as they were at least wiling to pull information from my C-file for me. However, they were a little discouraging when it came to file this claim. I believe the words the lady used were, "not very likely to succeed."

Well, I have battled the BVA for 5 years and have gone from 30% to 90%, won 5 claims and 1 appeal without any VSO assistance. I have a decent command on the English language, case law, legalese, and I know my case.   

I think that is the lesson that every Veteran should learn is that no one knows your case better than you, and it is in your benefit to read the rating criteria and present the evidence that supports your claim. I know my evidence in incontrovertible; they just need to read it.  

In any event, I am anxious to see what they come back with in my BBE. It appears this last battle will be all uphill. I appreciate that the AMA appeals seem to be moving quickly, but it appears they may be in too much of a hurry to close cases. 

I will update this thread to keep folks aware of how the appeals process is working. This forum and others have helped me over the years, so hopefully someone will benefit from it. 

[GeekySquid]

11 hours ago, doctorevil said:

I think that is the lesson that every Veteran should learn is that no one knows your case better than you, and it is in your benefit to read the rating criteria and present the evidence that supports your claim. I

I agree.

11 hours ago, doctorevil said:

I appreciate that the AMA appeals seem to be moving quickly, but it appears they may be in too much of a hurry to close cases. 

at least at the RO level I am seeing a lot of quick denials. That is actually why I asked Tbird to start the AMA forum on here so we could track times and results

 

11 hours ago, doctorevil said:

I will update this thread to keep folks aware of how the appeals process is working.

please do.

[doctorevil]

So I got the BBE today. Big fat denial. In their decision letter, they claim that they can only account for 2 instances of incapacitating sinusitis and 0 instances of non-incapacitating sinusitis. 

I find this to be odd because I sent them medical records from the past year where I went to the doctor for my sinusitis issues on 9 occasions.  They make no mention as to what they classify the other 7 instances. 

Further, they completely discounted my personal statement and the statement I had my fiance write about my condition, which again is odd, as a non-incapacitating infection might be one that you do not go to the doctor for, and thus would not generate any medical evidence and could only be supported by lay evidence. 

They also ignored my ENT diagnosis of Acute Recurrent Sinusitis, which is defined as having 4 or more infections per year. 

On Wed, 28 AUG, I went back to my ENT for another sinus infection and had him complete a DBQ while I was there. We spend much longer than the QTC examiner did and he included by entire medical history unlike the VA examiner. 

I submitted a new supplemental claim today with the new DBQ once I got BBE just to ensure it did not contain any surprises. So my clock starts once again. We will see how long or short this takes. 

Edited August 30, 2019 by doctorevil

[GBArmy]

Doctorevil, you seem to be well versed in this VA claim-thing. Did you have a DBQ and/or an IMO from a doc in you submital? You can have a great package put together but when it comes to medical opinions, lay letter etc. just don't carry as much weight. I'm not saying you didn't do your homework, but another doc favorable opinion ("as least likely as not") often is what gets you over the top, only because you are not qualified to offer diagnosis of conditions.

[doctorevil]

GBArmy, I did not have the DBQ in my initial claim or my first supplemental. I thought the evidence I submitted with my first supplemental was quite substantial and that Stevie Wonder would even be able to see the severity of my condition. Keep in mind that the rating criteria is simply a counting exercise, so I submitted 9 instances where I went to the doctor for a sinus infection and I only need to prove 6. Regardless of of the VBA calculates my visits, either incapacitating or non-incapacitating, I should meet the 30% threshold. 

I have also read every board appeal case related to sinusitis and all of them weight lay statements heavily due to the fact that most people don't go to the doctor for incapacitating matter. So, I thought the lay statement would help, which it still might if I have to go to the board. 

In any event, I was anticipating they would screw it up once I saw that Ebenefits did not update when they closed my appeal last week. Therefore, I got my ENT to summarize his last visit notes on the DBQ form. It literally contains the same information, it is just on the VA form for their convenience. He said they are simply not reading or translating his notes accurately.   

I am thinking that he is correct, that they are simply not reading the evidence. I really do not understand how they are coming up with their figures or how they do not understand medical diagnoses.