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. 

[brokensoldier244th]

3 hours ago, LightofSolitude said:

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.

The point was, you don't always need a C&P exam. It depends on what your denial letter said as the reason(s) for denial. It may have had nothing to do with a C&P, or lack thereof. I don't know. I'm just putting out there that not getting a C&P exam is not the end all/be all, time to appeal and lawyer up situation that some people make it out to be. I worked with 2 veteran files last week that did not get, nor need, C&P exams, and they weren't based on presumptive conditions. Their record of care at their respective VAMCs, plus private treatment that they had received looked to be enough, so I sent it to a rater for a review before submitting it to rate, and they agreed, so off it went to rating. 

[LightofSolitude]

11 hours ago, brokensoldier244th said:

The point was, you don't always need a C&P exam. It depends on what your denial letter said as the reason(s) for denial. It may have had nothing to do with a C&P, or lack thereof. I don't know. I'm just putting out there that not getting a C&P exam is not the end all/be all, time to appeal and lawyer up situation that some people make it out to be. I worked with 2 veteran files last week that did not get, nor need, C&P exams, and they weren't based on presumptive conditions. Their record of care at their respective VAMCs, plus private treatment that they had received looked to be enough, so I sent it to a rater for a review before submitting it to rate, and they agreed, so off it went to rating. 

Noted! Thank you for clarifying that for me. I hope my lack of understanding regarding this matter has not sidetracked the original posters topic too much, as that was not my intention. Much respect!!

[Usmc_Aj]

On 1/17/2021 at 2:40 PM, brokensoldier244th said:

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. 

Thank your very much for your insight. I have another question, my Dav rep said the va has ordered another mental health provider to further look at my case. This is after my therapist submitted my records. What could this possibly mean. Instead of ordering an c&p exam.

[brokensoldier244th]

Either the first guy didn’t address something required in the exam, or there could be a potential conflict of medical evidence between your IMO and your treatment record. 

[Usmc_Aj]

19 minutes ago, brokensoldier244th said:

Either the first guy didn’t address something required in the exam, or there could be a potential conflict of medical evidence between your IMO and your treatment record. 

The thing is I never submitted the IMO after the advices I got from here. So I’m a bit lost but most likely it’s the first of what you said. 

[brokensoldier244th]

I see it more than I would like. We'll order an exam package for service connection that, by law, has to have both a DBQ and an opinion from the examiner. We'll get back the DBQ for the exam, but not the form for the opinion, so we have to request a re-work, which they hate- because they are time sensitive, and they don't get paid for reworks. LOL. Im the rework xxxxxxx of my group. I like to lean on them pretty hard because its a waste of my time to go through your claim to make sure the last guy that touched it didnt forget something, then see that there exams returned, then go to read the results and see that 1/2 the exam wasn't returned. Its not a timing thing- we DO get DBQs back that don't have the requisite opinion- yet, but they are coming later. But when I log onto the provider portals and see the exam marked off as completed yet part of it is missing I get a little hot. Now, not only did I spend time going through your claim, and the exam results to make sure they are complete, now I have to log into a separate place to demand a rework of the exam with rationale as to why. Its frustrating, and by the time I do it all im 30-40 minutes in, with 20 more cases to go for the day. So, cleaning up their messes makes 'me' look worse on my end because my productivity stats suffer. It usually averages out, but im on the mid to slower side of my team because ive only been there almost a year so there are things I don't know fully, yet, and I like to take my time and try to get to know who im looking at a little bit. 

Im not making a christmas card list or anything, or selling your information to the Nigerians, but I do like to read the medical records, muster reports, deck logs, etc, and 4138s, and even 0781's (though not nearly as much, those). The running joke in my family is that Ill get PTSD from YOUR PTSD someday. Those are the harder days. Most of the time its pretty run of the mill stuff, though.