Secondary questions

[Bluslim]

Hi, and thank you all for any help. I am currently at 40%  and recently applied for Insomnia as a secondary condition. The CP exam ruled in my favor, but the VA said the Insomnia is caused by headaches which is a current secondary condition.I was denied. And to make matters a bit worse,  I asked for an increase for my headaches and sent in medical paperwork to show it got worse.  The CP exam there showed in my favor they were getting worse, yet the VA sent me a request for evidence to continue the rating. I wrote on my statement I have headaches, but its the tinnitus which keeps me up.  My doctor wrote some additional stuff, and said he doesn't know who reviews these things, but sometimes they reach. As far the headaches go, I don't think they even looked at what I sent. 

So my question is:   If my headaches are a secondary condition and they are part of another condition it is not rated? I mean the tinnitus is the epicenter of the causes. Any help or insight

[broncovet]

Welcome to VA where you have to fight for every nickel.  You will have to appeal this by filing a nod.  I suggest you read your file to know which path of appeal to take.  

1.  "If" you already have the Caluza elements (only 2 are needed for secondary SC, current diagnosis and nexus to your primary SC), then you may be able to get by without new evidence, but, remember, you dont know what evidence is "actually in your file" in real time except by viewing your VBMS file.  

2.  Or, if some of your evidence is missing, then you will have to appeal with new evidence.  

     In either case, my advice is to go to the BVA and skip the HLR or SCL, but you are welcome to try those also.  

[GBArmy]

Bluslim I think you should redact your personal info,name etc., and post it to this string. We need to see the wording on your decision letter. For a successful claim for a secondary condition, you must have a IMO from doctor, a specialist is best, that provide the rationale that x causes y. The doc has to provide sound medical evidence, like studies from sleep studies, medical journals, etc. and he has to state what degree of confidence that this pertains to you. Assuming that headaches cause insomnia (I have no idea), unless you already have a s-c disability that doesn't get you a pyramid effect, you should have a case. But we just can't do much with the info you have provided.

[trun10tion]

23 hours ago, Bluslim said:

Hi, and thank you all for any help. I am currently at 40%  and recently applied for Insomnia as a secondary condition. The CP exam ruled in my favor, but the VA said the Insomnia is caused by headaches which is a current secondary condition.I was denied. And to make matters a bit worse,  I asked for an increase for my headaches and sent in medical paperwork to show it got worse.  The CP exam there showed in my favor they were getting worse, yet the VA sent me a request for evidence to continue the rating. I wrote on my statement I have headaches, but its the tinnitus which keeps me up.  My doctor wrote some additional stuff, and said he doesn't know who reviews these things, but sometimes they reach. As far the headaches go, I don't think they even looked at what I sent. 

So my question is:   If my headaches are a secondary condition and they are part of another condition it is not rated? I mean the tinnitus is the epicenter of the causes. Any help or insight

Hi well we first need to know what are your primary conditions. Then i can try to.help you

My self i got up 70% with out a lawyer. Once i got a lawyer v.a. said opps we made an error

An bump me up to 80% before the lawyers papers ink dried. Lol on my profile is my email

If you want advise and diy or i can shoot to u me vet lawyer no fee unless win

Shes good.

[flow1972]

I'm not aware of a regulation that states an SC'd "secondary" cannot be SC'd to another condition that it causes or aggravates.  For example, I am SC'd for PTSD.  I'm SC'd "secondary" on IBS/GERD.  GERD is causing Esophageal spasm which I currently have a claim in for.  As long as the rating structure is followed and not pyramided, I can't see how it can be denied.

[broncovet]

Yes, flow1972, you can "daisey chain" secondary's.  Example:

You are sc for diabetes.  This can lead to secondary conditions for high blood pressure, which can lead to secondaries to kidney problems, which can lead to peripheral nueropothy, which can lead to loss of use of a foot.  

[flow1972]

6 minutes ago, broncovet said:

Yes, flow1972, you can "daisey chain" secondary's.  Example:

You are sc for diabetes.  This can lead to secondary conditions for high blood pressure, which can lead to secondaries to kidney problems, which can lead to peripheral nueropothy, which can lead to loss of use of a foot.  

Yep, this is what I found:  Federal law under 38 CFR 3.310 governs these claims, and once granted, the secondary condition is considered a part of the original condition.

[GBArmy]

flow1972 You are correct. Once a "secondary is s-c, then it no longer is "secondary; it is just like a direct disability.It is a disability. If you then get a "secondary" to that newly defined disability, it's the same thing. You can keep going on that forever. I would make a suggestion, and this is just my opinion. If you are submitting a claim for a direct s-c disability, don't submit too many secondaries  connected to the first claim at the same time. Maybe I'm wrong, but it seems that the VA makes you work a little harder on approval if they see that the total amount of comp will be that much bigger if they approve the direct one. For example, say you are putting in for PTSD. I wouldn't also claim GERD as secondary due to meds you take for the MH condition, and sleep apnea due to weight gain because of the meds. I'd go for the MH disability, get it approved, then go to the others. Like I said, it's just my opinion.

[pacmanx1]

35 minutes ago, flow1972 said:

I'm not aware of a regulation that states an SC'd "secondary" cannot be SC'd to another condition that it causes or aggravates.  For example, I am SC'd for PTSD.  I'm SC'd "secondary" on IBS/GERD.  GERD is causing Esophageal spasm which I currently have a claim in for.  As long as the rating structure is followed and not pyramided, I can't see how it can be denied.

The problem is you are already service connected for IBS/GERD and I am not sure if there is a separate rating for Esophageal spasms.

https://ecfr.io/Title-38/Section-4.114

 

[trun10tion]

1 hour ago, GBArmy said:

flow1972 You are correct. Once a "secondary is s-c, then it no longer is "secondary; it is just like a direct disability.It is a disability. If you then get a "secondary" to that newly defined disability, it's the same thing. You can keep going on that forever. I would make a suggestion, and this is just my opinion. If you are submitting a claim for a direct s-c disability, don't submit too many secondaries  connected to the first claim at the same time. Maybe I'm wrong, but it seems that the VA makes you work a little harder on approval if they see that the total amount of comp will be that much bigger if they approve the direct one. For example, say you are putting in for PTSD. I wouldn't also claim GERD as secondary due to meds you take for the MH condition, and sleep apnea due to weight gain because of the meds. I'd go for the MH disability, get it approved, then go to the others. Like I said, it's just my opinion.

Flow1972 i concur with GBArmy. Va more than often low balls or plainly denies proof. Not saying its right but must consider we still at war and new veterans hitting the system. I got out in 2012 and as i stated before, i only got to 50% from army then finally to 70% on my own. Without an attorney its hard. Dont stop appealing, you then have to start from 0. I dont know if you know but just in case bounce your injuries with the
38 CFR Book C, Schedule for Rating Disabilities online. It is very detailed 

Yet after a certain point id get a vet no fee lawyer. Before v.a. considers you for a reduction in compensation. 

Also as GBArmy stated go for the

MH and get private pysch eval to add to evidence. I did and won

But again i got that Attorney.

 

Knowledge Is power.

Remember we live in an unfair

World.

Blessings and peace

Edited July 22, 2020 by trun10tion (see edit history)

[flow1972]

57 minutes ago, pacmanx1 said:

The problem is you are already service connected for IBS/GERD and I am not sure if there is a separate rating for Esophageal spasms.

https://ecfr.io/Title-38/Section-4.114

 

There is.  It's 7204 Esophagus, spasm of (cardiospasm). 

It doesn't fall under the "inclusive" codes for IBS/GERD 7319 and 7346 (7301- 7329, 7331, 7342, and 7345-7348 are inclusive in this schedule)

 

[flow1972]

1 hour ago, GBArmy said:

flow1972 You are correct. Once a "secondary is s-c, then it no longer is "secondary; it is just like a direct disability.It is a disability. If you then get a "secondary" to that newly defined disability, it's the same thing. You can keep going on that forever. I would make a suggestion, and this is just my opinion. If you are submitting a claim for a direct s-c disability, don't submit too many secondaries  connected to the first claim at the same time. Maybe I'm wrong, but it seems that the VA makes you work a little harder on approval if they see that the total amount of comp will be that much bigger if they approve the direct one. For example, say you are putting in for PTSD. I wouldn't also claim GERD as secondary due to meds you take for the MH condition, and sleep apnea due to weight gain because of the meds. I'd go for the MH disability, get it approved, then go to the others. Like I said, it's just my opinion.

I didn't purposely follow your advice, but I didn't want to waste my time on submitting the secondaries until I got the SC for the PTSD.  I submitted those 2 months after.  I just missed the Esophagus code when I did.  I kept thinking it was part of the "severity" list for IBS or GERD; but realized later it was a separate code with a separate rating.

So I got my SC for the PTSD

Secondary to it, I was able to get Raynaud's Syndrome, IBS/GERD, and Supraventricular Arythmia immediately after the SC for PTSD.

I'm SC'd on Asthma, HSV1, Allergic Rhinitis, and Tinnitis as well.  Medications for Asthma or Allergic Rhinitis could easily secondarily affect Raynaud's or any one of the others as well.  More than one way to skin a cat per se.