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This has to be a CUE


SPO
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Question

Here is a copy and past directly out of my last decision letter.  They say that there was no connection to service at one point, but in the favorable finding mention a qualifying event in service being reported and a diagnosis by the VA at my initial claim exam in 2009/2010.  Am i missing something or are they wrong?

 Service connection for a chronic right hip strain.
The claim for service connection for a chronic right hip strain is considered reopened. (38 CFR 3.156) However, the evidence continues to show that this condition was not incurred in or aggravated by military service. (38 CFR 3.303, 38 CFR 3.304, 38 CFR 3.306) The Rating Decision dated June 1, 20 l 0, denied service connection for this condition because although you reported symptoms of a right hip condition during service, no chronic disabling condition was found to be related to your military service. The separation examination showed no chronic conditions. The VA medical opinion found no persistent disability. We received your medical evidence which discusses the symptoms of your medical condition.
The VA contract medical opinion dated December 15, 2018, was not based on a review of your claims file or an in-person examination.
The medical opinion we received from the VA contract examination was more persuasive than our private physician's opinion because it was based on an in-person examination and a thorough review of your relevant military and /or personal history and contained a more convincing rationale. (38 CFR 4.6) The evidence does not show that your condition resulted from, or was aggravated by, a service-connected disability. (38 CFR 3.303, 38 CFR 3.304) The evidence does not show that your disease developed to a compensable degree within the specified time period after release from service to qualify for the presumption of service connection. (38 CFR 3.307, 38 CFR 3.309) The evidence does not support a change in our prior decision. Therefore, we arc confirming the previous denial of this claim.

Favorable Findings identified in this decision:
The evidence shows that a qualifying event, injury, or disease had its onset during your service.
You reported symptoms of a right hip condition in service.
You have been diagnosed with a disability. The prior VA examination diagnosed you with a right hip strain.

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12 minutes ago, SPO said:

Here is a copy and past directly out of my last decision letter.  They say that there was no connection to service at one point, but in the favorable finding mention a qualifying event in service being reported and a diagnosis by the VA at my initial claim exam in 2009/2010.  Am i missing something or are they wrong?

 Service connection for a chronic right hip strain.
The claim for service connection for a chronic right hip strain is considered reopened. (38 CFR 3.156) However, the evidence continues to show that this condition was not incurred in or aggravated by military service. (38 CFR 3.303, 38 CFR 3.304, 38 CFR 3.306) The Rating Decision dated June 1, 20 l 0, denied service connection for this condition because although you reported symptoms of a right hip condition during service, no chronic disabling condition was found to be related to your military service. The separation examination showed no chronic conditions. The VA medical opinion found no persistent disability. We received your medical evidence which discusses the symptoms of your medical condition.
The VA contract medical opinion dated December 15, 2018, was not based on a review of your claims file or an in-person examination.
The medical opinion we received from the VA contract examination was more persuasive than our private physician's opinion because it was based on an in-person examination and a thorough review of your relevant military and /or personal history and contained a more convincing rationale. (38 CFR 4.6) The evidence does not show that your condition resulted from, or was aggravated by, a service-connected disability. (38 CFR 3.303, 38 CFR 3.304) The evidence does not show that your disease developed to a compensable degree within the specified time period after release from service to qualify for the presumption of service connection. (38 CFR 3.307, 38 CFR 3.309) The evidence does not support a change in our prior decision. Therefore, we arc confirming the previous denial of this claim.

Favorable Findings identified in this decision:
The evidence shows that a qualifying event, injury, or disease had its onset during your service.
You reported symptoms of a right hip condition in service.
You have been diagnosed with a disability. The prior VA examination diagnosed you with a right hip strain

The event is there as they report, but this sounds like it needs a Nexus to show continuity because they did not connect the dots on their own. Nexus needs to link the event to your current chronic conditions ALONG with a full review of your medical records and such to help tip the scale on the other examiner's opinion.

A concerning part of this decision is when they put "The VA medical opinion found no persistent disability"

Edited by awgv001
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18 minutes ago, SPO said:

Here is a copy and past directly out of my last decision letter.  They say that there was no connection to service at one point, but in the favorable finding mention a qualifying event in service being reported and a diagnosis by the VA at my initial claim exam in 2009/2010.  Am i missing something or are they wrong?

 Service connection for a chronic right hip strain.
The claim for service connection for a chronic right hip strain is considered reopened. (38 CFR 3.156) However, the evidence continues to show that this condition was not incurred in or aggravated by military service. (38 CFR 3.303, 38 CFR 3.304, 38 CFR 3.306) The Rating Decision dated June 1, 20 l 0, denied service connection for this condition because although you reported symptoms of a right hip condition during service, no chronic disabling condition was found to be related to your military service. The separation examination showed no chronic conditions. The VA medical opinion found no persistent disability. We received your medical evidence which discusses the symptoms of your medical condition.
The VA contract medical opinion dated December 15, 2018, was not based on a review of your claims file or an in-person examination.
The medical opinion we received from the VA contract examination was more persuasive than our private physician's opinion because it was based on an in-person examination and a thorough review of your relevant military and /or personal history and contained a more convincing rationale. (38 CFR 4.6) The evidence does not show that your condition resulted from, or was aggravated by, a service-connected disability. (38 CFR 3.303, 38 CFR 3.304) The evidence does not show that your disease developed to a compensable degree within the specified time period after release from service to qualify for the presumption of service connection. (38 CFR 3.307, 38 CFR 3.309) The evidence does not support a change in our prior decision. Therefore, we arc confirming the previous denial of this claim.

Favorable Findings identified in this decision:
The evidence shows that a qualifying event, injury, or disease had its onset during your service.
You reported symptoms of a right hip condition in service.
You have been diagnosed with a disability. The prior VA examination diagnosed you with a right hip strain.

Basically saying that your current condition/disability cannot even be rated at 0%. Did VA grant you a service connected rating greater than 0%?

Edited by pete992
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@pete992 they denied his service connection outright. No SC, No %.

Edited by awgv001
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One of the things that confuses me about VA decisions are how they are based.  Depending on how a veteran files his/her claim can kill the claim in development.  When a veteran files a claim, VA should consider all relevant avenues of service connection,  whether the veteran files presumptive,  secondary, and or directly service related.  I have known veterans that have filed claims under undiagnosed illness and get denied and turn around and filed a claim for direct service related and get granted, of course VA would use the direct related effective dates.

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Can you clarify this:

"The VA contract medical opinion dated December 15, 2018, was not based on a review of your claims file or an in-person examination."


"The medical opinion we received from the VA contract examination was more persuasive than our private physician's opinion because it was based on an in-person examination and a thorough review of your relevant military and /or personal history and contained a more convincing rationale. (38 CFR 4.6) ".

Is the"our  private  physician's opinion"" a typo and 'our' should be 'your' private drs opinion?

Were there two contract VA medical opinions?

Can you scan and attach the denial and the evidence list?

(38 CFR 3.307, 38 CFR 3.309) in the decision- these are the Chronic presumptive regulations,yet this claim should be for direct SC.

 

If you had an IMO /IME did that doctor establish a nexus he/she found in your SMRs?.

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Berta,  The "our" is probably a typo,  I submitted a DBQ from my Doc.  This stems back to my original claim in 2009 where they again stated there was evidence in my medical record and I reported hip issues.  I didn't specifically ask for this claim to be based on presumptive conditions, just the existing medical record.  My doc has since provided a nexus that it is psoriatic arthritis, linked to service connected psoriasis, diagnosed in 2016.  However, in the 2009/2010 decision said the doc called it less than 50/50 not sure why since there is evidence in my SMR.

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"My doc has since provided a nexus that it is psoriatic arthritis, linked to service connected psoriasis, diagnosed in 2016.  However, in the 2009/2010 decision said the doc called it less than 50/50 not sure why since there is evidence in my SMR."

By  "My doc and then "the doc" do you mean here, the same doctor?

Can you scan and attach here what your Doctor wrote to support the nexus? ( Cover C fie tc names, prior to scanning it.

The VA's favorable findings do not jive with their denial.

Is it possible they just used your doctor's DBQ and not his subsequent nexus statement?

 

 

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Forgot to add......

Was the claim filed due to an established  SC disability that aggravated an additional NSC disability-"right hip condition in service" that caused the hip disability to garner a ratable service connected award?

Aggravation of a NSC disabiity caused by an SC disability:

https://www.benefits.va.gov/warms/docs/admin21/m21_1/mr/part4/subptii/ch02/ch02_secb.doc

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The initial claim in 2009 was diagnosed by a VA doctor (direct claim).  in 2016 my private doctor more specifically diagnosed it as psoriasis arthritis (secondary claim) to psoriasis.  I think psoriatic arthritis was the actual issue all along, but didn't know that in 2009.  Honestly his nexus was lacking in my most recent claim.  His simply said it was as least likely as not connected to/ caused by already service connected psoriasis in the remarks section on the DBQ.  He didn't provide much more than that.  The more times i read through this stuff the more I realize where I was lacking originally.

I don't think the VA doc provided a nexus, or at least not a good one.  I guess they assumed because it didn't come up at my separation exam that it went away or something.

The excerpt I put in to the initial topic is from a secondary claim from last year.  So I was denied in 2009/2010.  So I reapplied with a diagnosis and nexus for psoriasis arthritis on the same joint, and denied again.

Edited by SPO
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