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How to proceed? Supplemntal Claim from Grand Mal Epilepsy DENIED

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Glenndawson100

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Hi there,
Recently actually yesterday the 21st of February the VA gave me notice that my supplemental claim had been decided and that they had sent out the letter that morning as well (meaning the decision was actually made on the 20th). This of course prompted me to check Ebenefits, where I saw no change in my rating. I'm currently rated at 40% for other issues. And in the past Ebenefits updated almost instantly leading me to believe that this supplemental claim was denied.
I originally submitted my Epilepsy claim back in august, it was denied about 4 months later due to conflicting phraseology given by one of my doctors (mind you i still have a diagnoses of Epilepsy with 15 witnessed Grand Mal seizures at this point). Once i got the original decision letter I contacted my County VSO's office and set up an appointment. After they reviewed everything they we surprised that my claim was denied as it has a clear nexus and on top of that falls under the conditions; that if they manifest within a year its considered service connected (I separated 02/01/2019, first seizure onset was 05/25/2019). They did review the 112 pages of evidence from my civilian doctors and did see the conflicting phraseology. They told me that if I could get my Neurologist to just confirm my diagnoses and say i was and have been under treatment since 05/25/2019 that we could submit a supplemental claim since that's the fastest route. So that's what we did. That brings us to now.
Under the standards for Epilepsy I was looking at a single rating of anything between 80%-100%. An 80% from 40% would have resulted in something Close to 90%. While i'm holding out, since in either case the retro pay (if my claim was awarded) would be greater then 20K that the additional signatures required are slowing down Ebenefits from updating, but as in most cases if the letter has sent and Ebenfits doesn't updated, 90% of the time you Claim/Supplemental/Appeal is denied. ( I mean correct me if I'm wrong).
Whats the moral of the story? No matter how much evidence you have to support you the VA will be the VA. I'm lucky that I'm rated for other conditions so that I can at least have the VA help me cut down on the costs of treatment for Epilepsy, but it would have been nice to have it service connected so that I wouldn't have to wait months on months for Neurology appointments since I don't have priority.
If any one has any information for me that might help moving forward, I'm all ears as once my letter is received and upon reading of the denial ill be filling an appeal.
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On 2/25/2020 at 8:39 AM, Berta said:

That was not what I meant- my point here is for you and others who might need this info,is that the Gulf War presumptives and regulations :

https://www.law.cornell.edu/uscode/text/38/1117

are Different from the Chronic Presumptives. 38 CFR 3.309 as it refers to 3.307.

I linked it above and will make a new topic on that because it is almost impossible to find in our search feature.

Also GW incountry vets might want to find the Radio show I did here on the many infectious illnesses that are also compensatable to GW vets as well as do a search for those regulations under  'more new Gulf War presumptives.'

And they should get into the Gulf War Burn Pit registry as maybe the VA will add burn pit illnesses to the presumptive for GWVs...maybe....

I feel as I stated before that you have a valid claim ,as a Chronic Presumptive claim,under the 38 CFR 3.309 ( to include 307) based on how I understand the info you gave us.

I just hope you or your rep filed the claim properly.

Also the Agent Orange Presumptives are a  completely different set of regulations.

Actually I don't know why I am even opining on this because you have not been denied as far as I know.

Make sure any medical info you gave them from any doctor that directly bears on your disability is something they can read and understand.

And pray that they can

read.

 

Hi, 

I received me letter today, and I was denied. This time the error is clear. The Doctor who preformed my ACE examine said my initial diagnoses was Epilepsy then proven to be pseudo seizures. At the ER and for about one month after I was diagnosed with PNES and not epilepsy. However since I kept experience both petite mal and grand mal episodes and then Epileptic  medication treatment began to WORK I was diagnosed with Epilepsy. My doctor in my record's back dated the diagnoses to the May when the first event occurred. I've attached my letter you'll see that they received my Neurologists note on my treatment since may and confirmed my Diagnoses on 04DEC2019. Pseudo seizures are only mentioned in my records between May2019-June2019. I think this VES contracted doctor saw the diagnoses labeled in may but didn't review(or care) to look at the LETTER AND NOTE DATED BY MY DOCTOR ON 05DEC2019 WITH MY CONFIMRED DIGNOInkedIMG_2756_LI.thumb.jpg.319adcccc2b4773520a2beaf1b138235.jpgSES AND UPLOADED TO THE VA ON 24DEC2019. Opinions? HLR or do I wait 3 months to see my VA Neurologist, as I no longer have Tricare to see my UCHealth DR., and have him confirm the diagnoses... 

IInkedIMG_2757_LI.thumb.jpg.e6ea35ca7f88e26a76ca6aae2deaaf62.jpg

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20 minutes ago, Glenndawson100 said:

Hi, 

I received me letter today, and I was denied. This time the error is clear. The Doctor who preformed my ACE examine said my initial diagnoses was Epilepsy then proven to be pseudo seizures. At the ER and for about one month after I was diagnosed with PNES and not epilepsy. However since I kept experience both petite mal and grand mal episodes and then Epileptic  medication treatment began to WORK I was diagnosed with Epilepsy. My doctor in my record's back dated the diagnoses to the May when the first event occurred. I've attached my letter you'll see that they received my Neurologists note on my treatment since may and confirmed my Diagnoses on 04DEC2019. Pseudo seizures are only mentioned in my records between May2019-June2019. I think this VES contracted doctor saw the diagnoses labeled in may but didn't review(or care) to look at the LETTER AND NOTE DATED BY MY DOCTOR ON 05DEC2019 WITH MY CONFIMRED DIGNOSES AND UPLOADED TO THE VA ON 24DEC2019. Opinions? HLR or do I wait 3 months to see my VA Neurologist, as I no longer have Tricare to see my UCHealth DR., and have him confirm the diagnoses... 

I

You don't have to wait 3 months for the scheduled appt. - You can either do a walk-in, or call and schedule, or use MHV to set up an earlier appt.

Yes, they seemed to latch onto the other diagnosis and avoided the 05dec2019 documents. Looks like you need an IMO/Nexus to further solidify your claim. Armed with that you can decide how to move forward. Ensure they include medical rationale so they dont dance around with the other "nonsense". Best of luck bud, I have had a terrible time myself dealing with Neuro, and Neuro-related claims so I sincerely hope they can get you the help you need.

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2 minutes ago, awgv001 said:

You don't have to wait 3 months for the scheduled appt. - You can either do a walk-in, or call and schedule, or use MHV to set up an earlier appt.

Yes, they seemed to latch onto the other diagnosis and avoided the 05dec2019 documents. Looks like you need an IMO/Nexus to further solidify your claim. Armed with that you can decide how to move forward. Ensure they include medical rationale so they dont dance around with the other "nonsense". Best of luck bud, I have had a terrible time myself dealing with Neuro, and Neuro-related claims so I sincerely hope they can get you the help you need.

Currently the wait time in Cheyenne is 2 1/2 months, my appointment is in May.

I pushed for presumption, but my civilian doctor said (in medical notes sent to the VA) that " Military medical records show an episode of syncope taking place in AUG of 2015. I am more then likely suspicious that this might have been the patient's first seizure as on boarding paramedics describe a state of unawareness and that patient was found on the ground". 

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Is Dr. Martin's statement on the Evidence list, dated in December 2019, the letter they ignored?

If so can you redact any personal info in the letter and scan and attach it here?

"I pushed for presumption, but my civilian doctor said (in medical notes sent to the VA) that " Military medical records show an episode of syncope taking place in AUG of 2015. I am more then likely suspicious that this might have been the patient's first seizure as on boarding paramedics describe a state of unawareness and that patient was found on the ground". 

The VA did not find a service nexus-(this claim will need a direct inservice link) 

However, the above doctor ,( was that Dr. Martin?)

obviously read your SMRs and VA didnt ,or did not associate the syncope or info on the paramedics to your current issues.

You might have a basis for CUE here, within the appeal period and that could alleviate the need for a NOD etc.

I will find the contact # for VES-you are sure not the first vet this happened to and  will also provide you it the White House Hot Line # but we need more info.

Why did you lose TRICARE? I don't understand why you were eligible for it-but maybe you had 2 periods of Military service? or additional lengthy reserves time?

Does your discharge certificate reflect the syncope incident?

Is this documented well in you SMRs?

"on boarding paramedics describe a state of unawareness and that patient was found on the ground".

what happened after the medics found you on the ground?

We have had other vets here with Epilepsy claims, and if I have time I will find those posts because ,in my opinion, the VA C & P contractors  probably don't have a clue on this disability.

(and that opinion goes for many of them ,on Many disabilities)

Those contractors are also diagnosing and treating vets all over the country at VAMCS because good VA doctors are leaving the VA.It concerns me because they do so many C & P exams so poorly, how can they possibly diagnose and treat vets properly? Their exams cost the VA 800-900 bucks each because they are not employed by the VA. Something is drastically wrong with that picture.

With more info from you, as I requested ,  I will go over the whole thread again, and if I see what would warrant a valid CUE I will write it for you and post it here, after I get home from church later today.

 

 

 

 

 

 

Edited by Berta
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