verbiage At Least As Likely As Not - Denied SCD

[Mr Anxiety]

Hi all,

New to submitting, but have been a passer by for quite some time.

I got out of the Navy in 2010, with SCD disabilities for many things. What I'd like to talk about here is my lower back (surgically repaired and rated 20%), and my right knee (rated 10% and 10%).

Back in January of this year, I submitted a claim for my left knee, which was made worse by my RIGHT knee. The VA Doc gave me a "less than likely" for nexus, so claim was denied.

I then opened a new secondary claim in October of this year, saying my left knee condition was caused by my lower back. In either case, right knee or lower back, it's an accurate statement. My gait has been altered and it has dramatically and significantly affected my right knee. 

At the second C&P, the results were positive. "At least as likely as not" which if I understand correctly is the terminology necessary for rating, as like in baseball, the tie goes to the runner (vet). Along with this left knee claim, I claimed my left groin and shin splits in my left leg. By the way, my left leg IS service connected for sciatica due to my back trauma.

They denied the groin & shin splints, which isn't a huge surprise to me (even though "at least as likely as not" was used there, also). The big, irritating, frustrating surprise to me is they denied service connection on my knee. 

I do NOT understand what I am doing incorrectly. I have the used the correct forms. I have a positive DBQ from a VA doctor. I have private health records proving my knee is an issue, I have x-rays, I have shown nexus on two different occasions, and I even have buddy lay statements. Yet, the VA still says no.

I need help.

Thanks,

Frustrated Veteran

Edited December 19, 2019 by Mr Anxiety

[broncovet]

Mr. Anxiety:

    Many, if not most of us have been denied "even when" there is favorable evidence.  This happens for several reasons:

1.  OFTEN, the VA decision maker does not read our entire file.  Berta noticed that,  I have noticed it also.  Its faster for rating specialists to just mark "denied" than to read through sometimes thousands of pages of evidence.  (My cfile is about 1400 pages..and no doubt longer now, and many are bigger than that.  I think Alex said his was 3 times that size)  

2.  Even if they do read our file, there are "built in incentives" for VA to delay or deny us.  Frankly they have a financial incentive to delay or deny us.  

3.  Its just faster and easier to deny, and there is no accountability.  However, if a rating specilist signs 60 Veterans with 100 grand Retro's, watch him get called into the oval office and be sent packing.  

    My advice is to appeal.  If you KNOW what is in your cfile, and you are certain of the evidence, then appeal using HLR.  If you need more evidence, the use SCL.  Get ready for a long fight..its what VA does..

    Persistence on your part should eventually win your benefits, but giving up almost never will.  

[broncovet]

Mr. Anxiety:

    Many, if not most of us have been denied "even when" there is favorable evidence.  This happens for several reasons:

1.  OFTEN, the VA decision maker does not read our entire file.  Berta noticed that,  I have noticed it also.  Its faster for rating specialists to just mark "denied" than to read through sometimes thousands of pages of evidence.  (My cfile is about 1400 pages..and no doubt longer now, and many are bigger than that.  I think Alex said his was 3 times that size)  

2.  Even if they do read our file, there are "built in incentives" for VA to delay or deny us.  Frankly they have a financial incentive to delay or deny us.  

3.  Its just faster and easier to deny, and there is no accountability.  However, if a rating specilist signs 60 Veterans with 100 grand Retro's, watch him get called into the oval office and be sent packing.  

    My advice is to appeal.  If you KNOW what is in your cfile, and you are certain of the evidence, then appeal using HLR.  If you need more evidence, the use SCL.  Get ready for a long fight..its what VA does..

    Persistence on your part should eventually win your benefits, but giving up almost never will.  

[GBArmy]

Mr. Anxiety

Bronc's advise is spot on. Sadly, the VA raters seem to forget how to read. Or, just don't read. As Bronc said, if all the evidence is there, submit a HLR. No new evidence. If you have doubt, post their decision (redact your personal info first) and we can see what's wrong ,if anything. You can always add new evidence, maybe additional dbq or IMO and appeal thru the Supplemental claim if the HLR doesn't work.But don't just give up; if you have s disability caused by the service, you work it until you get it approved. 

[Mr Anxiety]

1 hour ago, broncovet said:

Mr. Anxiety:

    Many, if not most of us have been denied "even when" there is favorable evidence.  This happens for several reasons:

1.  OFTEN, the VA decision maker does not read our entire file.  Berta noticed that,  I have noticed it also.  Its faster for rating specialists to just mark "denied" than to read through sometimes thousands of pages of evidence.  (My cfile is about 1400 pages..and no doubt longer now, and many are bigger than that.  I think Alex said his was 3 times that size)  

2.  Even if they do read our file, there are "built in incentives" for VA to delay or deny us.  Frankly they have a financial incentive to delay or deny us.  

3.  Its just faster and easier to deny, and there is no accountability.  However, if a rating specilist signs 60 Veterans with 100 grand Retro's, watch him get called into the oval office and be sent packing.  

    My advice is to appeal.  If you KNOW what is in your cfile, and you are certain of the evidence, then appeal using HLR.  If you need more evidence, the use SCL.  Get ready for a long fight..its what VA does..

    Persistence on your part should eventually win your benefits, but giving up almost never will.  

Thanks Bronco. That all makes a lot of sense - also never thought about the "inverse accountability" (as I'll call it). A part of me definitely understands that, since I'm 91% (compensable 90, obviously), that a bilateral 20% pushes me to 100. Therefore, I kind of assumed the fight would be long and arduous although I will admit today felt like a big defeat when I saw the rating. 

Once I get my letter in a couple days, I'll redact the PII and post here. I have reached out to a VSO, although I cannot meet with him until January 8th. I'll admit I'm not the most patient person, but I do want to do this right. I'm not "looking for 100" like I know some are, I just want them to rate me appropriately for a knee caused by a service connected disability.