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Need Opnions; Supplimental Claim denied with possible clear error?


Glenndawson100
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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. Initially at the ER (and my week long hospitalization after) 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 civilian 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 about my treatment since may and then 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 THEN 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'm only 5 months away from all this stuff lasting a year and getting really fed up with the VA. My first denial was also because of the phraseology used by my ER and Hospital doctors after the first event in may. Hint that's why I had my specialty neurologist who had been seeing my since June confirm my Epilepsy diagnosis... uuuhhhggg.

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Lets back up to "the basics".  

1.  Do you have a current (not in service, but current) diagnosis?

2.  Do you have an "in service event" or aggravation, that you allege caused seizures?  (I dont know what that would be..not sure). 

3.  Finally you need a nexus, which is a doc's opinion that your seizures are at least as likely as not related to your (documented) event in service or was aggravated by service.  

     It will take a review of your file to know this.  

     Right now, I would appeal, and not "raise the bar" to CUE.   Getting VA benefits is hard enough without having to jump over the "undebatable" hoop of cue.  My further advice is to take this to the BVA, and make sure all 3 of the above are documented.  

      Sometimes buddy letters will suffice to document an "in service event".  

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At this time there is no rush even if you file a NOD, it may take VA awhile before you get to the HLR.   Your rating was just rated and you have a full year to appeal.  Not sure exactly what was in your doctor's notes but the phraseology you are looking for is that your  condition is at least likely or not caused by or as a result of your military service.  Make sure you don't miss your deadline.

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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" 

 

Attached is my DBQ by VES. Glenn Dawson (Disability Benefits Questionnaire-Epilepsy).pdf

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This is what I see so far in the decision, but I will have to find your original topic-

it pays to stay in one thread.

The Letter from UC Health is in question.

Is that the letter from Dr Martin?

They are questioning your nexus to your service.

Their final statement just states Pseudo epilepsy, not Epilepsy.

It looks to me like you will need a strong IMO/IME that follows the IMO/IME criteria here at hadit.

The IMO/IME doctor will need a copy of your SMRs (even though VA admits it was originally epilepsy), the fact that the VA diagnosis  changed will need attention from the IMO/IME doctor- to correct it.

 

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Your other thread says:

“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).”

That I true if it falls to a disabling degree of 10% within that first year after service and after the claim is filed.

I believe I posted the Chronic Presumptives regulations here before.

That 10%( or more)  needs to be determined by the IMO/IME doctor with a full medical rationale even though this condition sure  did not happen overnight. The IME/IMO doctor can add excerpts from well known medical treatises or abstracts to bolster the 10%.

You could even give the doctor ( and the VA ) evidence that you need accommodations from your employer for that) and the IMO/IME doctor also should seek a direct service nexus in your SMRs that could reveal acronyms or medical notations that would also support a direct  SC nexus.I hop you also have your 201 file, as that too can contain evidence to support a direct SC  claim

What VA questioned is that your disability is not “persistent”- either from service or from the claim you filed within one year of service.

That is the word your IMO/IME  doctor needs to focus on.VA is  looking for chronicity as persistence.

Then the IMO/IME doctor must explain that you have Epilepsy, as well as the pseudo epilepsy component if that,in fact, is part of the Epilepsy.

Somewhere here or on the other thread I believe you said VA had over 100 pages of your medical issues to read over.

I bet they didn’t even get to page 2-and besides you have had no one in my opinion, at the VA, who could possibly understand your medical condition.

You could again contact the C & P place and see if they have anyone at all ,who is qualified to do the exam properly.  But then again I got 2 VA opinions from an Endocrinoliogist for my DMII claim and 

she did everything she could ( and even lied) to deny my claim.

Apparently I knew far more about endocrinology han she did, because after a brief email to Dr Bash, he called me to say if you have what you said you have, this is a Good case.

I sent off his fee and a cover letter and a stack of the medical records etc, and within a week or two he had prepared an Excellent IMO, then needed to do one more, and I also had a Neuro freebee, and I won.

Others will chime in.

I hate to tell a vet to get what could be a costy IMO/IME but often that is the best investment a vet could make.

I feel you have a winner but unfortunately I am not a doctor and cannot prepare IMO/IMEs.

Please feel free to share my opinion here on the decision, with your VSO.

 

 

 

 

 

 

 

 

 

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