How to proceed? Supplemntal Claim from Grand Mal Epilepsy DENIED

[Glenndawson100]

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.

[Glenndawson100]

16 hours ago, awgv001 said:

3 hours ago, Berta said:

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.

 

Yes, Dr. Martins note was the letter assed as "New and Relevant". The was the confirmation of the diagnosis and treatment. I'm not sure if they ignored it? but because he back dated the diagnoses to the first episode it does look like it goes from epilepsy to PNES seizures. But letter in December should have cleared that up.

Currently requesting a new set of PDF recorders for the full notes.

Establishing a SMR connection shouldn't be too hard but 38 CFR 3.309 is clear any form of Epilepsy is covered within a year of separation.

I was in the UTANG after my discharge until 01/01/2020.

I will attach all the documents I have. NuroNote12.05_Redacted.pdf

 

 

 

SAMMC ED CT REQ_Redacted.pdf SAMMCERINTAKE082015_Redacted.pdf SMRPARA08.2015.pdf

[Glenndawson100]

I also have at least 50 or so pages showing the progression from what they thought was pseudo seizures to my diagnosis of Epilepsy. I feel like the VES dr. looked at like the first couple of pages and just didn't care about the rest.  

[Berta]

I suggest that tomorrow you contact VES and complain:

VES Phone 1-877-637-8387;  https://www.vesservices.com/?page_id=37

Veterans Evaluation Services 
PO Box 924089 
Houston, Texas 77292

That might help  and also send an IRIS complaint or call the WH Hot line .

If more vets would complain to these C & P clowns , and definitely to the White House,  maybe things would change-

and that might alleviate the need for  a CUE claim and even an appeal-as I expect they would give you a better C & P, hopefully by some C & P examiner who is familiar with your disability.

These C & P examiners should be vetted by the claimant themselves.Their name is on the exam and they can be googled.

I still remember the Male vet here whose C & P examiner was a gynecologist. H griped and got a better qualified exam doctor.

 

[Glenndawson100]

On 3/1/2020 at 2:34 PM, Berta said:

I suggest that tomorrow you contact VES and complain:

VES Phone 1-877-637-8387;  https://www.vesservices.com/?page_id=37

Veterans Evaluation Services 
PO Box 924089 
Houston, Texas 77292

That might help  and also send an IRIS complaint or call the WH Hot line .

If more vets would complain to these C & P clowns , and definitely to the White House,  maybe things would change-

and that might alleviate the need for  a CUE claim and even an appeal-as I expect they would give you a better C & P, hopefully by some C & P examiner who is familiar with your disability.

These C & P examiners should be vetted by the claimant themselves.Their name is on the exam and they can be googled.

I still remember the Male vet here whose C & P examiner was a gynecologist. H griped and got a better qualified exam doctor.

 

Just got back my ACE C&P DBQ report, and this general practice geriatrics doctor put on the forum three times that I have a confirmed diagnosis of Epilepsy from a neurologist as recent as December 2019. Final notes the geriatrics doctor left " The diagnosis of Epilepsy came from the veteran report himself but i cannot confirm based on physician notes in the records. Therefore, the only diagnosis I can definitively make is "Psuedoseizures"

I contacted my senator and he put a review in. 

I also put an inquiry in online and over the phone to the White House. 

VES said they would, "note the complaint"

 

attached is my DBQ by VESGlenn Dawson (Disability Benefits Questionnaire-Epilepsy).jpg.pdf 

[Berta]

I am posted this BVA case and the CCK link, as much for myself as for youand I need to read the info carefully-when I get time.....

https://www.va.gov/vetapp18/files8/18123704.txt

https://cck-law.com/blog/va-disability-benefits-for-epilepsy-seizure-conditions

You have not been formally denied yet, so we don't know what to expect-

the C &P doctor's statements conflict-???

Thanks for being proactive in taking our advice - that is how many claims succeed.

 

[Glenndawson100]

3 minutes ago, Berta said:

I am posted this BVA case and the CCK link, as much for myself as for youand I need to read the info carefully-when I get time.....

https://www.va.gov/vetapp18/files8/18123704.txt

https://cck-law.com/blog/va-disability-benefits-for-epilepsy-seizure-conditions

You have not been formally denied yet, so we don't know what to expect-

the C &P doctor's statements conflict-???

Thanks for being proactive in taking our advice - that is how many claims succeed.

 

Sorry i forgot to mention i did receive my denial letter and will link you to that post as I created a separate one. 

The above post has my letter in it. 

I cant begin to thank you enough for all the help you have provided.