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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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georgia126532

Help with appealing a denied claim

Question

Hello,

I'm currently service connected for PTSD with specific phobia and alcohol use disorder at 50 percent. I also have a diagnosis of alcoholic cirrhosis. I recently requested service connection for the cirrhosis and some secondary conditions that were caused by the cirrhosis.  All claims were rejected as non service-connected.  My understanding was that the cirrhosis should be service connected since the alcohol use was related to my PTSD diagnosis. 

Below  I've listed excerpts from my PTSD C&P exam and my claim denial letter. Please let me know if this claim should be service-connected and if so,  and what I can do to remedy the situation. Would you recommend requesting a higher level review?  If you have additional questions, please let me know.

Any assistance would be appreciated.

Quote

 PTSD: psychological/physical reactivity to salient triggers, avoidance, persistent negative mood, feeling cut off from others, self-harm, hypervigilence, sleep disturbance, decreased concentration Alcohol Use Disorder: Excessive use of alcohol despite medical complications. Secondary to PTSD and Specific Phobia Diagnoses are mutually aggravating conditions. 

 

Quote

 b. For the indicated occupational and social impairment, is it possible to differentiate which impairment is caused by each mental disorder? [ ] Yes [X] No [ ] Not Applicable (N/A) If no, provide reason: Disorders are mutually aggravating conditions. Depression is considered secondary to Specific Phobia and PTSD as it poses significant social and occupational impediment. Alcohol Use Disorder represents Veteran's attempt at self-medication. 

 

Quote

 b. Indicate type of exam for which opinion has been requested: Initial PTSD/Mental Disorders TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness.  c. Rationale: Veteran is diagnosed with PTSD and Specific Phobia (driving) both secondary to deployment stressors noted earlier in this report. PTSD symptoms and impairments are considered mild. Specific Phobia symptoms and impairments are considered severe. Alcohol Use Disorder is considered secondary to these conditions and represents an attempt by Veteran to self-medicate. Alcohol Use Disorder symptoms and impairments are considered moderate to severe. All disorders are mutually aggravating conditions. 

 

Quote

 7. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [X] Yes [ ] No If yes, describe: excessive alcohol use, decreased motivation, loss of interest/pleasure

 

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Good job, you posted the reasons and bases.  So here is what YOU need to do to "refute" this denial.  

1.  I suggest you file a nod.  

2.  Order a copy of your service records (cfile) or, better yet VIEW a real time copy at your VSO's or attorney's office.  

3.  You need to "fix" the problem suggested by the decision, that is, lack of a nexus between PTSD and cirrhosis.  There are 2 possibilities:

a)  You already have this evidence in your file, but the VA did not read it.  In this case, I suggest a HLR appeal.  

b)  You dont have evidence that states (by a doctor) that your cirrhosis is "at least as likely as not" due to self medication from PTSD, that is is secondary to your ptsd.  You need this nexus, or you will continue to be denied.  

     You may need an IMO to provide the nexus I mentioned in b) above.  You do have choices on which appeal route..HLR, SCL, BVA (with or without a hearing) etc.  I cant make those choices for you.  As an example, I dont "do hearings" because Im severely hard of hearing so a "hearing" would be non only unproductive, but a source of stress for me.  I could have a representative do the hearing for me, but, Im currently represented by DAV and Im convinced they dont have a clue.  They dont even return phone calls.  I knew this, but needed to get an attorney "off my POA"  which I couldnt seem to do except through granting another POA.  Im not mad at the attorney, I just dont want to go through the hassel of paying her when I did all the work and trying to get my money back because she is on my POA.  I fixed that.  I knew the DAV does not return calls or emails, but at least I dont have to pay them.  

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I agree with broncovet

get a private medical opinion from a specialist   a bit pricey BUT WELL WORTH IT.. MOST OF US HAVE HAD TO DO THAT,    its about the only way you can beat this examiner/'rater that mention this condition was not caused by your military service or secondary to your PTSD /Alcohol Drinking 

The specialist can give his pro medical opinion that your condition your claiming''' is likely as not ''the cause or related to your   50%S.C. PTSD

when  we  have another Dr to rebut a VA Dr  it helps this Dr be a board certified specialist in the medical field your claiming. VA WILL USE  the specialist over the VA Dr  70% of the time so this specialist needs to give a good detail  or Impression of why he thinks this is related or caused by  ect,,ect,,,

(jmo)

Edited by Buck52

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Aside from all of the good advice that you have been given by broncovet and Buck, I would look at the CFR that they used to deny you.  It states that an injury caused by alcohol will not be considered line of duty if it incurred in active duty.  You are looking to secondary connect an injury that occurred due to PTSD post service.  That CFR is wrongly noted.

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Yes there have been many BVA decisions and a few court decisions granting veterans alcohol abuse service connected secondary to their SC PTSD but like most of us you are forced to appeal these issues.  Good advice from the others here.  YOU can go to BVA website and on lower right side (column) of their home page is a link to search their decisions.  You can type in the words  PTSD, Alcohol, secondary, granted and then check off the block years of decisions you want to search.   In the block for words never to be found type in denied, affirmed and remanded.  One can learn a lot from CAVC court and BVA decisions as to how they word their reasonings for both granting and denying a veteran claim and then use their wording and explanations in your appeal to the BVA along with as much documented medical evidence as possible to support your appeal.

I have been told by experienced IMO private doctor that an HLR appeal is a good way to get a fast denial as in my case.  I should have gone the supplemental appeal route instead so that I or you can add additional evidence at the last minute.

Try to find an accredited motivated full time VSO officer (DAV, VFW, Legion, etc.) located at a VA regional office in person or by phone to assist you in this matter.  The above is not legal advice but only my personal opinion and experiences as just another vet filing my own claims and appeals to the VA.

Edited by Dustoff 11
correction

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