Supplemental claim

[Usmc_Aj]

I have been following hadit for about a year now since I got my denial for sc. I have a question that I hope can be answered. I was denied for adjustment disorder and now I submitted a supplemental claim, however my diagnosis are for anxiety and depression so being that I was denied for mental health I was unable to submit the anxiety and depression as a new claim. I spoke with a few vso and was told I should not worry about it as the va combine all mental health issues as one. Is this true or should I look to get a diagnosis for adjustment disorder as well. When I call to check the status of my claim anxiety and depression is never mentioned only adjustment disorder but when I bring the anxiety and depression I get told not to worry and the va will look at it. 

[flow1972]

I think what brokensoldier is saying is, a "Nexus" is the "event" you're stating caused/worsened your condition in service.  That event should be laid out in your IMO by the person writing it.  It should be definitive in diagnosis and how that event plays in to the diagnosis.  The event should then be "provable" by your military records and/or buddy statements. 

You never said what your denial stated.  Why did they deny you?  That's what you need to be addressing with the additional evidence you're submitted on the Supplemental Claim.

[brokensoldier244th]

Always fight the denial word for word, or as much as possible. It keeps you focused. 

[Usmc_Aj]

On 1/14/2021 at 8:15 AM, flow1972 said:

I think what brokensoldier is saying is, a "Nexus" is the "event" you're stating caused/worsened your condition in service.  That event should be laid out in your IMO by the person writing it.  It should be definitive in diagnosis and how that event plays in to the diagnosis.  The event should then be "provable" by your military records and/or buddy statements. 

You never said what your denial stated.  Why did they deny you?  That's what you need to be addressing with the additional evidence you're submitted on the Supplemental Claim.

I was denied for not having a diagnosis of adjustment disorder 

[LightofSolitude]

Pacmanx1 gave great advice on how you can “win your claim.” I would not recommend submitting the document from the social worker as evidence because it is not a nexus statement. The reason why is because it lacks a definitive medical opinion and sufficient rationale. The VA would quickly deny your claim if you submit that document as evidence. Since your claim is still pending, you still have time to supplement the record with an IMO that meets all of the criteria required for service connection. Take a few minutes to read Ms. Berta’s post regarding IMO’s:

 

 Do not rely on the VA scheduling a C&P exam as more often than not, they will try to deny you without even giving you one. This is especially true if you are lacking one or more of the three elements required for service connection. Instead, take matters into your own hands and invest in getting a sufficient IMO which will make your claim denial proof. Hang in there and keep us posted.

[brokensoldier244th]

2 hours ago, LightofSolitude said:

Pacmanx1 gave great advice on how you can “win your claim.” I would not recommend submitting the document from the social worker as evidence because it is not a nexus statement. The reason why is because it lacks a definitive medical opinion and sufficient rationale. The VA would quickly deny your claim if you submit that document as evidence. Since your claim is still pending, you still have time to supplement the record with an IMO that meets all of the criteria required for service connection. Take a few minutes to read Ms. Berta’s post regarding IMO’s:

 

 Do not rely on the VA scheduling a C&P exam as more often than not, they will try to deny you without even giving you one. This is especially true if you are lacking one or more of the three elements required for service connection. Instead, take matters into your own hands and invest in getting a sufficient IMO which will make your claim denial proof. Hang in there and keep us posted.

A C&P exam can't be given unless all three elements are met- that is a legal requirement, not something we do just to mess with your life or get a denial. We don't benefit either way- there is no mythical points board that we are all on with the number of grants or denials. If your initial claim and evidence doesn't meet all three elements, we cannot schedule an exam. period. full stop. If your IMO doesn't address an in-service event, current symptomatology, and some connection between the two with some justification or rationale to support it it won't contribute towards receiving a positive decision. I see IMOs every day that are a few sentences, written by doctors or practitioners that either don't know what they are supposed to be providing, or weren't told by you, the veteran, what it is that is necessary. It isn't that difficult to create a solid claim- the things necessary for every rating percentage are freely available on the internet and its the same schedule of ratings percentages that we use every day.

We aren't working from some different playbook. Try asking your insurance company sometime to see the manual and criteria they use to evaluate disability claims sometime. It won't happen. I know because I have, even through discovery with a lawyer. 

[LightofSolitude]

3 hours ago, brokensoldier244th said:

If your initial claim and evidence doesn't meet all three elements, we cannot schedule an exam. period. full stop. If your IMO doesn't address an in-service event, current symptomatology, and some connection between the two with some justification or rationale to support it it won't contribute towards receiving a positive decision.

Agree 100%. That was the point that I was trying to make. The lack of any one element of the caluza triangle will result in a denial of benefits, every single time. I was denied several times without a C&P exam when one was clearly warranted by the evidence of record. Those decisions were overturned once I constructed a compelling argument on appeal while citing CFR's, court precedents, the M21 Training Manual, my own evidence, etc.