Supplemental claim was closed?

[XIbodybag]

Hey fellow vets.  I filed a supplemental claim with an IMO tying my sleep apnea to my ptsd on sept 21st.  In mid october it went to prep for decision and today the claim is reading "closed" but not "the va has made a decision".  I looked up the meaning for it saying "closed" and the va website states that if it says closed it may mean this

Your Supplemental Claim was closed

We closed your Supplemental Claim. This may be because you didn’t take an action VA requested.

 

I dont get it.  I've been in constant contact with the VA 1800 number (as in calling weekly) and they kept saying prep for decision and nothing further was needed...so why would it be closed with no decision?  Of course I cant call the VA today because they are closed in observance of the holiday.

[brokensoldier244th]

Your doctor provided no rationale to support his contention other than saying "im a board certified sleep guy....". The examiner that wrote your original exam laid out exactly why, in his opinion, the two were not connected. Your IMO did not address any of that. The IMO needed to address those points and rebutt them with citations to evidence to the contrary.

 

[broncovet]

The VARO decision is "bogus".  It "assumes" that an in service event is required, however, an in service event Is NOT required when a condition is secondary to an already SC condition.  (PTSD).  

    The decision does not give a valid reason, which is likely, as Broken soldier said, the sleep doc failed to cite studies or other medical evidence which links PTSD to OSA.  

    While there is a relationship between OSA and PTSD, its "not enough", because you have to show YOUR OSA is related to YOUR PTSD, not the participants in the study.  

    Unfortunately, this IMO did not suffice.  An adequate IMO/IME SHOULD HAVE:

1.  THE DOCTORS CV to demonstrate competence to render a professional opinion to include the number of years of education and experience treating sleep apnea/PTSD.  

2. The doc statment that "its at least as likely as not" due to PTSD, but then give a rationale as to why.  (medically) he makes that opinion. 

Generally, I dont send IMO's to the VARO.  I send them to the BVA upon appeal.  Its far more likely that the board will award; about 3/4 or more of appeals to the BVA are either awarded or remanded.  Only about 10-25% of board decisions are denied.  Source:  BVA chairmans report: (scroll down to the statistics page).  https://www.bva.va.gov/chairman_annual_rpts.asp

However, "most" va decisions at the VARO are denied.  Only about 10-30 percent are awarded at the VARO.  

Mostly it does not help much to keep going back and forth at the VARO with stuff like HLR and SCL, instead, get it to the BVA ASAP.  

Remember, the VA is not especially keen on GS 5's, GS7's or even GS 11's etc, signing documents which result in six figure retros.  (100,000 or more).  Instead this usually takes a judge, so the rating specialist simply denies it like the last guy, and keeps his boss happy.  

Res Judicata prevents Vets from keeping on SCL over and over until they find a Vet friendly rating specialist who will award.  

That is why you need to get it to the board.  I certainly agree that IMO was insufficient.  

 

[broncovet]

The real reason you were denied was "not" as the decision stated, but probably because there was no medical rationale.  (The decision stated it was because there was no in service event, which is bogus, as its not required in Secondary service connection, since the "in service event" is already established in the primary condition (PTSD).  

[brokensoldier244th]

GS5's, GS7's and even many GS11's don't go near signing retros like that- they never have. Its completely outside their responsibility. You can't even become a rater until you are at least GS10 about 90% of the time- that 10% is only authorized at GS9 if there is an extreme need and usually its approved only if they already have someone in mind at the GS9 level as a VSR that especially on top of things. 

 

[broncovet]

Exactly.  Before you get a rating that results in big retro, you either have to have a Vet friendly GS12 or GS13, or a judge.  

They just dont let GS5's sign off on 100k retro checks.  

Lots of the time, I speculate, a GS12 or 13, wont even ever see your claim, its already denied by GS 9's, GS10's or GS11's.  

So, you dont have much chance of an award.  "New" GS11's dont want to raise any red flags, that means they deny them.  

You need to be a HHIC (head honcho in charge) to sign off on big retro.  

But, they can teach GS'5 to rubber stamp "denied" and cut and paste some reasons for denial..most of which dont make sense.  

Edited January 11, 2022 by broncovet

[brokensoldier244th]

Well, maybe GS10's or 11's. GS9s are rare enough that their work is reviewed by someone higher up anyway, at least in my RO- I recently applied for 1 open GS9 RVSR position. It was the first one they had had in at least 5 yrs, and I was told up front that if I was chosen I would be a full RVSR but my ratings would be subject to more scrutiny. GS5's barely have a Bachelor's degree are not anywhere close to being a VSR unless they are coming in from somewhere else with considerable federal service already behind them.