opposing opinions

[SPO]

I'm not sure if my title makes sense, but here we go. In other threads I mentioned I was denied for lack of diagnosis for a secondary condition.  After speaking to the DAV I learned a little more about my claim decision.  I will try to make this as understandable as possible.  I submitted a DBQ from my doctor which provided a diagnosis and stated "more likely than not" connected to my primary condition.  The VA then requested a medical opinion of their own.  They received an opinion from a specialist in that medical field that says my condition that states "at least as likely as not" connected to my primary condition with medical rationale.  The VA then sent me to an in person exam.  I believe the only thing requested was range of motion testing.  The nurse practitioner, for whatever reason, provided her opinion saying that she couldn't diagnose me with the condition (i don't remember the exact wording).  The VA weighed the last exam opinion of everything else and denied the claim based on no clinical diagnosis.  If she was not instructed in the  C&P exam request to make a medical opinion on the diagnosis is it even a valid basis for denial?  Also, she is the least qualified of the 3 exams to make that diagnosis.  The DAV recommended doing a higher level review pointing out the first medical opinion they requested was favorable and the one that should have been used to make service connection .  Also the second C&P was intended for range of motion testing for rating percentage purposes only.  Thoughts?

Edited September 18, 2019 by SPO

[broncovet]

In my example, above, one of your buddies may be able to write a letter that he was there, with you, when the decapitation occurred.  This letter could suffice as documentation of an in service event.  

[broncovet]

If its secondary, you dont need an in service event.  You need, instead:

1.  Current diagnosis of secondary condition, and:

2.  Doc opinion that your (primary condition..service connected) caused your secondary condition.  

     Now, the decision says you dont have a diagnosis of psoriatic arthritis.  Thats a problem.  

     You may need a lawyer to sort this out.  

 

[SPO]

There is my issue,  I submitted a DBQ from my doctor with a diagnosis and a letter stating that I have been under his care since 2016 for psoriatic arthritis (the claimed condition) and psoriasis.  It seems that their first medical opinion  upholds this diagnosis, or at least provides good medical rationale for the link between the primary and secondary.

Edited September 19, 2019 by SPO

[Buck52]

I agree with broncovet

Also I never knew this condition your trying to get S.C. was secondary claim?

secondary to what? ..................................

if you already have  service connection established, then this changes things....you may need to get a second opinion meaning a qualified Dr needs to read your records and examine you and give his professional medical opinion that   ''it is likely as not ''your condition your claiming is related to your service connected condition of?  and give a detail report on it

On the reasons and bases of your denial   you would actually need the same thing to rebut this Dr Opinion  I'd get a  (Specialist) , in that case you would need an in service event as broncovet mention    if you don't have documentation of the event (it happen while in the military)  then you will more than likely be denied   because if a Dr can't read that part he has nothing to back up his '' it is likely as not opinion

''The Dr is putting his reputation on the line here  and they are not going to fabricate anything.

This is why a Dr  (specialist)must say he has read your medical records and  examine you..so if you already have Service Connection establish for a condition that could cause you other medical problems   then this is what you may need to do,  others can chime in here  I know NO other way for you to get this claim secondary to what your other S.C. Condition is!

[GeekySquid]

3 hours ago, SPO said:

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.

1st .. please redact and upload the documents. these cut and paste jobs leave out relevant information that YOU may not realize affects any advice given.

2nd... the above is the main problem I see in what you did copy and past.

they are claiming your personal doc did not review your military medical history. If they didn't then the VA is right, if they did and their IMO states they did, then this statement is the point of contention.

 

 

[SPO]

Based on what I know and what I am reading from everyone here, it seem a supplemental with some more solid diagnosis information from my doc would be the more appropriate route.  I apologize if things are a bit vague, the va is dragging their feet to get me my copy of the c-file.  I am working off what the DAV has told me they read in the file.  I attached a copy of my decision.  Is it just me, or is it odd that they would ask for a medical opinion (the one they date december 15) without having that doctor at least review my file?

decision.pdf

Edited September 20, 2019 by SPO