Denied without actually looking at medical records

[11bjohnny]

Good afternoon, 

I am hoping for some advice on how to proceed or what I need to do and how to do it.

Back story:
I spent 5 years in the Infantry with one tour to Iraq. I broke my leg and that lead to me getting an MEB. I submitted a claim for pes planus and hypertension due to issues that have been getting worse for some time. Because I couldnt figure out how to add attachments to the claim in Ebenifits, I printed the form and mailed it along with my first and entry and exit physicals (to show that I had developed flat feet while in the service), blood pressure readings and a prescription history for blood pressure meds issued while in, and one statement each to support the claims. (These were to the affect of, we rucked a lot and carried heavy loads overseas for my feet, and explaining that I have been borderline hypertensive since I was 20 while in the service and I pointed to dates for BP readings from service and shortly after discharge...)

The initial claim was denied because I submitted using an outdated form (that I printed autofilled with all my claims info from EBenefits the day I put it in the mail ... go figure that one...). After getting the denial, I called to see what I had done wrong, and was told that I could resubmit online, but I didnt need to resubmit the supporting documents as everything had been scanned into my file when the first iteration was received (they were even able to read me off some of the info that I had sent). So I resubmitted online through the new va.gov website. 

This time the process went from new claim to denial in just over a week! The denial letter came stating there is no current diagnosis for pes planus (a VA doc JUST (within the past three months) provided me insoles to treat this condition...), and that neither event was shown to have occurred in service by a review of my Service Medical Records. This is correct because I thought having foot pain went with being a grunt and the BP meds came from the psychiatrist and the PA refused to ever address the issue. 

My questions, I know that I need to file a NOD. I have been waiting for my C-File since May of this year... Should I wait until I receive my C-File to submit the NOD? Submit a NOD now stating that I disagree with the two denials?

I feel that had the evidence I sent been reviewed, they would have at least sent me to get C&P exams.... 
The last question... Should I just find a DR to complete a DBQ for me and file a claim to reopen these denials?...

Thanks for any advice. 

[Oceanbound]

VBMS cost the VA a billion dollars, like Bronco said only lawyers/agents can view the system where it puts your record on chronological order while you c-file is the spaghetti monster and you then have to make a index in Libra office spreadsheet. 

Mine took 8.5 months to receive.

Maybe maybe in 30 years it would be available to us after much say from the public to congress to give us access. But then we would be in a South America "war" 15 years prior to having it finally granted to us.

[vetquest]

Broncovet's advice is good.  On your denial they are supposed to list all of the evidence they used in deciding your claim.  If the records submitted are not there you should file them with a supplemental claim.  Do you have 1. evidence in your STR's of injury  2. a chronic condition and  3. a nexus by a doctor or VA doctor?  Without these three you will lose.  You can hope to get the nexus in a C&P but this does not always happen.  Remember C&P doctors work for the VA.  Try to get on VBMS, as long as the VA does not pull the trick they have done on me.  My POA cannot review my VBMS because it is marked at the sensitive level.  As Broncovet said the VA is not your friend.

[11bjohnny]

12 hours ago, vetquest said:

On your denial they are supposed to list all of the evidence they used in deciding your claim.  If the records submitted are not there you should file them with a supplemental claim. 

The denial letter said that they reviewed my current medical records and my service records as well as letters dated ____ and ___ but those dates correspond to letters they sent me so I do not know for certain that the evidence I sent was "reviewed". After researching a bit more, I am appealing and sending the evidence again only for the next person to say "this was already here and the person before me looked at it, no need for me to do their work again." 

Quote

Do you have 1. evidence in your STR's of injury  2. a chronic condition and  3. a nexus by a doctor or VA doctor?  Without these three you will lose.  You can hope to get the nexus in a C&P but this does not always happen.  Remember C&P doctors work for the VA.

My evidence was only in the form of my first and last physicals showing my arches had falled, and although I never see hypertension listed in my in service records, I found that nearly every one of my BP readings in the last 2 years of service were elevated and I was prescribed BP meds twice while I was in (both the BP and meds are in my service medical records). As for the nexus, no I do not have that as I have only used the VA for my healthcare since I was MEBed. I was hoping to get a C&P, to me it is pretty clear that both conditions have been present since I was in service and are still issues I deal with... 

If someone doesnt have a primary care doc other than the VA, how does one go about getting a nexus letter? I imagine it would be a little off putting to the Dr if I went in the very first time and asked them to fill out lots of paperwork for me (DBQs) only to probably never come back to them....

I am going to file the NOD today. Am I correct in understanding that the NOD really just needs to state that I do not agree with the decisions on (condition 1) and (condition 2) decided on <date>? As @broncovet mentioned the 2 routes for appeals above, I only see "Decision Review Officer (DRO) Review Process" & "Traditional Appellate Review Process". Are these the HRL & SCL reviews? 

With the "new" claims processing, will it hurt me to submit all the evidence again, physicals, prescriptions, and BP readings, if they already have it in VBMS? If the answer here is maybe, I will work on finding a VSO who can help me review VBMS. 

Thank you all for the very helpful replies!

[vetquest]

Bronco sums it up pretty well.  You can not go wrong if you follow his advice. 

Getting the C&P exams is where you need to go.  In the C&P the reviewing doctor is supposed to say at least as likely as not or not service connected.  If the say not service connected then you need an IMO.  Search for a specialist that does IMO's, they know what to say.

If they used the evidence you provided in your denial that means they have it.  Even so I always like to resend important information.  The VA does not like that but I do not agree with some of the things they do, like not reading all of the evidence.  It is not funny how many times the BAV remands cases telling the RO to redo it, do it right this time.

You are right many doctors will not see you and then write an IMO.  Here are some that will.  You need to provide them with your STR's and current records so they can say the reviewed all of your medical records. Good luck. 

http://www.independentmedicalexaminer.com/IMEdirectory.htm

https://www.imenet.com/

[11bjohnny]

1 hour ago, vetquest said:

http://www.independentmedicalexaminer.com/IMEdirectory.htm

https://www.imenet.com/

Thank you so much for these resources! 

I think I have a plan of action now. 

1) Attempt to find a VSO who can help me get access to view VBMS to ensure that the evidence I submitted was there, or go up to the VAMC and request my records (I dont think mailed evidence would be there would it?)
2a) If the evidence is there, appeal for a HLR citing the evidence that I submitted.
2b) If the evidence is not there, or I cannot gain access to VBMS, appeal again attaching the evidence I sent with my original paper claim. 
3) Reevaluate once more action happens. (is it sad that I wanted to type "reevaluate after contact with the enemy"?)

[Oceanbound]

VSOs don't have access to VBMS. VBMS is non-extent to us. Lawyer up and or Learn 38.CFR.

Gotta wait for your c-file. Find a regular physician (md or do or pa) that you want to keep for ten years. Our parents didnt have Google, just word of month or darts in the dark. Hell back then Docs couldn't "advertise" because it wasn't allowed. Even if the "doc" doesn't have a website try to find that one, there out there but you're going to do some work.