Secondary claims at the Regional office

[KC3]

I am considering filing a claim for Fibromyalgia on a secondary basis. I will have substantial evidence including:

1. IMO/Nexus from Rheumatologist relating FM secondary to my  SC disability. 

2. Lay evidence from a Chiropractor. This will state I have been a patient with musculoskeletal issues for several years. I look for the RO to ignore this and not even review it. 

3. I will have additional evidence as well. 

 

My fear is that even though I have my eggs in a basket that the VA will send me to a C&P examiner that needs to meet their quota for rejects regardless of pending evidence. 

If this is the case will the RO then ignore the IMO/Nexus from my Rheumatologist and deflect like they are known to do? Has anyone had any experience with this or any secondary issue? 

I am trying to avoid a 6 to 8 year process. Thanks

 

 

 

[brokensoldier244th]

FIrst of all there is no "quota for rejects". And, yes, you may still have to go to a C&P, though it may be done by video, or it may just be a records review depending on how well your doctor documented your side of things. Getting sent to a C&P is not "ignoring your evidence". It may be confirming it, again, depending on how well the doctor both documented the condition treatment itself AND how well they rationalized it in their opinion statement. They need to state that they are aware of your military background, or that they have at least seen some of your military STRs in order to write a well formed opinion, otherwise you most likely will have a C&P because C&P examiners have all that to review and a private doctor doesn't always have that unless you take it in to them.  

[john999]

I have never applied for a secondary disability that did not require a C&P exam.  When you go for a C&P you just never know where you may land.  I recently claimed an increase for a secondary condition to diabetes and got an additional 80%.  I was stunned.  Where were these good doctors 20 years ago when I first claimed DMII and PN?  I got the 80% via a contract C&P.  If  your claim is well supported you have little to fear from an exam.  Also, I think the VA does give weight to chiropractors.  The VA uses them, so why ignore them?  You may often have to appeal a decision regardless of how good your claim.  I had a secondary claim for what I concluded was some vein blockages in my legs.  My VA doctor concurred with that and even wrote me a letter on that account.  The VA first sent me to an idiot who said I had zero disability.  I appealed that losing rating and got 60%.  It took about a year.  Not bad for the VA.  Don't be afraid of these VA raters and doctors.  They may be having a good day.

[pacmanx1]

 

 

Quote

I am trying to avoid a 6 to 8 year process

Due to the fact that you plan to claim a secondary claim to an already service-connected condition. Your IMO only need to state your fibromyalgia is as least likely as not (50/50 probability) caused by or the results of your already service-connected disability and then give a good medical rationale. Secondary disabilities are a lot easier to get service connected as long as you have an IMO that properly connects the secondary condition to an already service-connected disability.

With the new AMA appeals, the most you should wait for a BVA, or any VA appeal decision is around six months to a year or a little longer. Those long years and years of waiting for appeal decision are being eliminated with the legacy appeals. Not saying that you will get a granted appeal, but the VA/BVA are trying to move a little faster. The VA may still send you to a new C & P exam but that is part of their process.

Edited August 9, 2021 by pacmanx1

[brokensoldier244th]

That they are. I like working on secondaries. Its easier to find since I have a primary disability I can key off when searching through records and things, and the threshold is lower because most secondaries are pretty well accepted as related to the primary condition unless someone tries to file a claim for something really odd. I've seen one where someone filed a claim for radiation exposure secondary to their flat feet that were SC due, in part, to their length of time working in the galley. Their rationale was proximity to microwave ovens, and because the galley was located below deck the radiation from the engine room had to be an issue too, and their foot pain made them move slower than other people (right?). *shrug*.

But, then again, I did another one where the sailor was a maintenance tech but part of their documented duties was shinnying up the antenna's aboard ship for one thing or another. In that case I wouldn't be surprised if they microwaved their brain- or in this case, their thyroid. 

I don't rate them, I just have to piece together relevant evidence and gather records and stuff. Once I do that and request the exams for things that I can support with caluza its out of my hands. 

 

[KC3]

First and foremost thanks to everyone. Secondly the quota comment was poor choice of words. I had a C&P exam in 2015 for migraines in which military service was no reviewed very well by the examiner. He also told me after the exam that "You are not going to have any problems with this; I agree"; then less likely was on his DBQ he filled out. My wife now attends all C&P exams that I am invited to. 

I appreciate the insight and education on this. Should have mentioned the FM claim is related to PTSD/depression. I have read mixed reviews on this. My Dr. says it is most likely related to my depression, however my rating is based on PTSD due to pyramiding not allowed. 

 

[brokensoldier244th]

18 minutes ago, KC3 said:

First and foremost thanks to everyone. Secondly the quota comment was poor choice of words. I had a C&P exam in 2015 for migraines in which military service was no reviewed very well by the examiner. He also told me after the exam that "You are not going to have any problems with this; I agree"; then less likely was on his DBQ he filled out. My wife now attends all C&P exams that I am invited to. 

I appreciate the insight and education on this. Should have mentioned the FM claim is related to PTSD/depression. I have read mixed reviews on this. My Dr. says it is most likely related to my depression, however my rating is based on PTSD due to pyramiding not allowed. 

 

I apologize as well. I got a bit salty at that and I shouldn't have.