Supplemental Claim Denied w/IMO, High-Level Review Next?

[lawbro]

Hi All

To make a long story short, last year the VA granted my right-knee tendinitis 10% but said my left-knee was NOT service connected. I reached out and obtained an IMO from Dr. Anaise whose IMO opined that either my left-knee tendinitis WAS service connected or that it was secondary to my service connected right-knee. 

I filed a supplemental claim at the end of June and just received the decision back that they stuck with the original decision to not grant me anything for my left-knee tendinitis, stating that it was still not service connected. 

How should I go about the next step in the process? I seem to read a lot that High-Level Reviews are a waste of time and perhaps go straight to BVA. Also, should I also look into getting an attorney for the High Level Review or just wait to see if it goes to BVA or not?

What do we believe is the best way to go about this?

[Buck52]

We need to know why they denied you?  was the denial because they said your condition was not service connected?  but what was their reason for not service connecting this condition?

what did they say about Dr Anise medical report?

can you put up a redacted copy of your denial on here..black out name and Claim #  personal information

[lawbro]

Hi @Buck52 and @broncovet

Attached is the Evidence Letter that states "Letter from David Anaise" not IMO from him... So I'm guessing they either didn't view it or overlooked it completely.

The Denial Decision Letter

IMO Introduction

IMO Conclusion

IMO Medical Opinion.

All in all the IMO was 48 pages so I'm guessing that they didn't read it or didn't pay it any mind. When I have my HLR I'll post how that went and what they said.

 

 

[Vync]

I have a different perspective based on the new document excerpts.

The VA probably did read the letter, but not see any treatment for your injury in your service treatment records:

Quote

The evidence does not show an event, disease, or injury in service... Your service treatment records do not contain complaints, treatment, or diagnosis for this condition.

They are referring to Caluza element #1 and saying they could not find anything:
1. Event/injury in service or current SC disability
2. Current diagnosis
3. Nexus connecting 1 and two

 

Per the letter from Dr. Anise:

Quote

Medical research clearly shows that soldiers are especially suceptible to osteoarthritis after discharge from the service, and that osteoarthritis may manifest itself many years after the initial injury.

The last sentence attributes the issue to a prior injury. The doc's assessment is generalized to service as a whole, but does not relate your current disability to a specific injury in the service. The VA was likely looking for that and could not find one.

If you did have a knee injury noted in your service treatment records, be certain to point that out to the VA (because they obviously missed it).

If you did not have a knee injury noted in your service treatment records, there may be a way to still get SC. If your knee was diagnosed within a year of getting out, I believe the VA may presume it related to service. My memory is still a bit fuzzy, but you probably need to dig around to research the specifics though. Not sure if it applies to everything, but I vaguely recall arthritis to be one of the qualifying maladies.

Hope this helps!

[lawbro]

Hi @Vync

He states in the IMO it's either due to my service OR secondary connected to my right-knee tendinitis which is service connected. I do have records of my right-knee being treated while in the service.

Basically saying that because of my service-connected right knee I favor my left-knee and it even has caused a change to my gait (walking). Wouldn't that count as element #1?

I have also added the VA's decision Service Connecting my right knee.

Edited October 31, 2019 by lawbro

[Vync]

The VA likely focused on the parts I comments on and missed that part entirely

[lawbro]

Understood @Vync. Thank you for your time and opinion on the matter. I'll be sure to highlight that part when I submit my HLR request.