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Can someone Give me advice?

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ronnieusmc0311

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Ok, So I called the VA regarding my Supplemental Claim for Acid Reflex secondary to Multiple medications for Multiple service connected disabilities. As I spoke to the gentleman on the phone, we got along and talked about infantry stuff etc. After our chit chat, he told me my claim was finished and a decision was made as of today. He said a packet would be out tomorrow. I said "well, usually I see something on Ebenefits, so I guess its not a good decision", he said "legally I cannot tell you anything because you don't have the packet, but if you disagree with it you can always appeal". I took that as, I was denied, even after All the information from my PMC, a note from a specialist and a positive phone exam from a Dr.. I called the VA last week and they said my claim was pushed back to the developmental phase because they wanted a opinion from another DR. At that time I figured they were trying to deny me. So, what is my next step in this process? Do I go straight to BVA?

Last question, I just had an MRI for my Lower back, turns out I have Spinal Stenosis (narrowing of the spine) which is causing pain everyday and incapacitation episodes every few months (I am service connected for Lumbar degenerative disc disease 10%). I believe I rate an increase so should I go the supplemental claim route? Also, Back in 2014 I was trying to get my Sciatica service connected due to my back, well I was denied as the examiner said it wasn't service connected, I was dumb and younger and didn't really bring info or disagree with the decision. My Specialist for my Back says it is related to my L5s1 injury which is already service connected and she is writing me a letter, Do I also do a supplemental claim on that? thank you, I know its alot.

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  • HadIt.com Elder

Ronnie It is very important that she "dumbs it down", seriously. The VA is always looking to prevent a veteran from getting into the 100 club, so make it really clear.You want a medical opinion that says she has treated you for ...(time).; she has observed a deteriation of ....(new condition) as witnessed by ...(medical records, mri' xrays, etc.) that in her medical opinion based on years of experience and observation, that the ...(technical parts) are at least as likely as not  been caused by ...(service-connected disability.) If she is Board Certified she should state those facts and include her Curriculum Vitae, which is her education, clinical study, any residence she did, where she has worked as a doc, published articles if any, etc. My advise is do a rough draft for her so she has a guideline to follow and offer to pay her a fee ($100.00?, or whatever) for her professional opinion. Also, emphasize that without her documentation and help, it will most likely result in a denial of your sought after disability which will result in significant financial loss to you. I'm not saying this is going to work, but it has a much better chance that what you have now.

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  • HadIt.com Elder

ronnieusmc0311 Well it doesn't sound good, I admit. Don't see the reason why a rep would have a dialog with you and then set you up impling a denial. But they really aren't supposed to tell you anything before you get your letter. In any case , you have to see what is in your letter for your next move, as pacmanx1 suggests. It could be supplemental or, BVA. Personnally, I doubt HLR would work, but then I haven't seen the denial letter either. As long as you keep within 1 year, no need for an intent to file; not needed. What happened in the process, going back and forth isn't so unusual. Happens a lot and ebenefits isn't reliable anyway on reporting status, so it is what it is. Get your letter. On your back issues, yes it is supplemental for an increase, and also if you were denied once before. Just remember, you need medical evidence from a doc that they are service connected. Once you get a denial on something, you need new evidence from a doc, not your opinion, that it is "at least as likely as not" s-c, and why. So you want your specialist to have rationale that your condition is related to your L5s1, since that was already shot down.

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Your post is a little confusing, first you said that you talked to Peggy today (Peggy is anyone at the 1 (800) 827-1000) , then later you stated you called Peggy last week and she said your claim was pushed back to development. You can either file an intent to file a claim or you can go the supplemental claim route, it is your choice. In reference to your acid reflux claim, unfortunately, wait for the rating decision before you get too upset. As for your back condition, keep in mind that with a new IMO will come a new effective date unless you can prove you had this same ratable condition with medical evidence proving it back in 2014.

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24 minutes ago, pacmanx1 said:

Your post is a little confusing, first you said that you talked to Peggy today (Peggy is anyone at the 1 (800) 827-1000) , then later you stated you called Peggy last week and she said your claim was pushed back to development. You can either file an intent to file a claim or you can go the supplemental claim route, it is your choice. In reference to your acid reflux claim, unfortunately, wait for the rating decision before you get too upset. As for your back condition, keep in mind that with a new IMO will come a new effective date unless you can prove you had this same ratable condition with medical evidence proving it back in 2014.

What I meant was, I spoke to "Peggy" today and she told me a packet is on the way, kinda hinted it was denied and ebenefits shows nothing. I also mentioned I called last week and they said it was back in the developmental phase, which is quick because they went from Developmental phase, to decision, back to developmental phase to completion within a week. In refernce to my back, when you say "a new effective date" do you mean that the date will be when the new claim was filed? and what is the problem with that? Thank you!

 

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6 hours ago, GBArmy said:

ronnieusmc0311 Well it doesn't sound good, I admit. Don't see the reason why a rep would have a dialog with you and then set you up impling a denial. But they really aren't supposed to tell you anything before you get your letter. In any case , you have to see what is in your letter for your next move, as pacmanx1 suggests. It could be supplemental or, BVA. Personnally, I doubt HLR would work, but then I haven't seen the denial letter either. As long as you keep within 1 year, no need for an intent to file; not needed. What happened in the process, going back and forth isn't so unusual. Happens a lot and ebenefits isn't reliable anyway on reporting status, so it is what it is. Get your letter. On your back issues, yes it is supplemental for an increase, and also if you were denied once before. Just remember, you need medical evidence from a doc that they are service connected. Once you get a denial on something, you need new evidence from a doc, not your opinion, that it is "at least as likely as not" s-c, and why. So you want your specialist to have rationale that your condition is related to your L5s1, since that was already shot down.

The Spine Specialist has agreed that my Sciatica is indeed connected to my L5-S1 narrowing and which is putting pressure on the nerves. She has said she will state that my sciatica on both legs is "more likely than not" due to my Spinal Stenosis (narrowing of spine and disc deterioration). My lower back injury is service connected at 10%, if she says my sciatica issues are the caused due to my lower back injury, is that enough or does she need to say "service connected" as the VA already knows about my service connected lower back.? thank you.

Edited by ronnieusmc0311
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