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Is claim still open?

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bigoc

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I requested connection for psoriatic arthritis of the right hand, left wrist, and both feet.  In addition to these joints the RO requested a C&P exam of shoulder, hip, elbow, wrist, knee, and ankle.  I have no idea why they did this but it is possibly beneficial to me.  I'll attach this part from my c-file at the bottom on this post.  The VA only decided on the four claimed joints.  The other joints that the VA put in the C&P request were never evaluated or referenced in anyway.  This includes no mention in rating decision letter or during the C&P.  

Fast forward to 2015 I report for a VA requested future exam for the four SC joints.  I made the complaint of joint pain in 11 joints to include the joints stated above from the 2009 C&P.  These were recorded in the results as pain.  In addition to the documentation in the 2015 exam, they VA acknowledged the additional joint pain and suggested I contact them if I wished to claim these.  I stupidly did not see this until recently. 

Would I be able to get these joints connected and EED back dated to 2009 or 2015 based on an inferred issue and that no decision was made on the other joints?

Again the VA is the one that requested the additional joints to be evaluated in 2009 and not me.  Then they were never addressed.  I am interested in this because I have been finding information on claims being considered open if the VA never renders a decision.  While they rarely miss a veteran claim they often miss inferred issues.  This seems like a pretty obvious inferred miss to me.  The VA specifically requested the additional joints. Might be a stretch but this would be significant retro.

 

open joint claim.png

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  • HadIt.com Elder

Was you denied on these condtions? if so when?

&did you keep your NOD Timeline updated?

what was there reason and bases for the denial? 

if your still in your appeal time line  yes you should be able to get a better EED....WHEN APPROVED.

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  • HadIt.com Elder

Call IRIS AND ASK THEM IF THIS CLAIM WAS CLOSED? OR WHAT THE STATUS IS FOR THESE CLAIMS?

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I was connected for the 4 joints I claimed.  The other joints the VA requested a C&P exam for in 2009 were never address and the exam was listed as completed.  This happened even though the joints were not evaluated.  So I claimed 4 joints and the VA requested a C&P for 12.  Only the 4 joints I claimed were evaluated and decided on.

 I can not find any reference to the additional joints until a 2015 C&P that the VA requested as an exam for my existing 4 SC joints.  Interestingly during this exam the doctor recorded these additional none service connected joints as pain on the DBQ.

This was my second stupid miss that I am just catching now.  None the less the additional joints were never addressed other than(your not going to believe this)...the VA tells me to claim these joints that they have found to be attributed to my psoriatic arthritic condition.  

Seems like the VA gave me two opportunities to claim these joints and I missed both until recently.

There is another reference to the exam for the additional joints being completed so I would imagine it is closed.  There was no decision on these additional joints included in the decision letter.  Only the 4 joints I claimed which I expected and did not look for these others until I recently was reviewing my C-file.  

However, the 2009 C&P exam is very detailed on the 4 joints I claimed but has no evaluation information on the additional joints.  The additional joints were not evaluated and recorded on the examiners report.

If the VA requests a C&P for 12 joints even though I old claimed 4 and then the VA only examines 4 do I have a open claim for the additional joints?

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I did not have a NOD as I was connected for the claimed joints.  

I am recently learning about entitlement to service connection from an inferred issue.  Such as a service connection being found or claimed even if not formally requested.  The VA requested the additional conditions be evaluated in 2009 and then never evaluated them or made a decision on the additional joints.  

Then again the joints were evaluated in 2015 and recorded as painful.  Again no decision was made but the VA acknowledged the joints and told me to request the additional joints if wished to claim them.  I missed this.

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I can't say whether or not you have a case but there is a lot of information that may help you here:      https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000014205/M21-1,-Part-III,-Subpart-iv,-Chapter-6,-Section-B---Determining-the-Issues#1d

M21-1, Part III, Subpart iv, Chapter 6, Section B - Determining the Issues

Scroll down until you see the above and start reading.  6.B.1.c looks promising for you.

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Thanks for the info.  This recent change is interesting as well. 


Change Date

  February 28, 2019

III.iv.6.B.1.a.  Recognizing Issues and Claims When Preparing a Rating Decision

 
When preparing a rating decision, the decision maker must recognize, develop, clarify, and/or decide all issues and claims, whether they are
  • expressly claimed
  • within scope of an expressly claimed issue, such as
    • complications of the claimed condition, or
    • unclaimed subordinate issues and ancillary benefits, or
  • compensation entitlement issues that arise based on the Department of Veterans Affairs’ (VA’s) review of evidence, such as 
    • reductions of service-connected (SC) disability evaluation
    • clear and unmistakable errors (CUEs)
    • entitlement under the Nehmer stipulation, or
    • competency reviews.
Note Within-scope issues encompass
  • additional benefits for complications of the claimed condition, including those identified by the rating criteria for that condition in 38 CFR Part 4, VA Schedule for Rating Disabilities, and
  • any ancillary benefit(s) or other unclaimed subordinate issues not expressly raised by the claimant that are related and arise as a result of the adjudication of a claimed issue. 
References:  For more information on

 

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