Condition secondary to more than 1 service connected disabilities.

[mwillis71]

Hello,

I am service connected for sleep apnea, ptsd, anxiety and more. I have GERD which I believe is secondary to anxiety, ptsd and sleep apnea.  However, when applying for a secondary condition, you can only link it to 1 existing disability. My chances of getting it approved would be higher if I could link it all together. Is there a way to do that or should I file multiple claims for secondary to each disability? 

[Whodat]

I guess that I am a little confused as well. It true that you can only claim a secondary to an already serviced connected disability. When I filed my secondary claim, let use hip for an example, I filed it as secondary to my serviced connected knee condition. But I am also sc,d for foot, lower back as well. So when I filed, I did use knee as primary and hip secondary to knee. I also added the statement " secondary to other service connected disabilities to see which on VA will bite on and they did. 

In the past, I tried to get migraines, secondary to tinnitus. Got denied of course, but got tied in with my sc,d PTSD if that makes any sense. 

[Vync]

@flow1972 I definitely agree with you that it is not  100% required to have that before filing, but it can really help if you get it sooner than later just like you did for your PTSD claim. One can also do an intent to file and get 12 months to formally open their new claim/supplemental while protecting their effective date. During that time, they can get the nexus/IMO/IME and collect whatever other records they need without having to feel rushed or pressured. Of course, they can file away as a new claim/supplemental and roll the dice with the VA C&P examiners... 

What @broncovetmeant is that the Caluza elements must be satisfied for SC. For a secondary conditions, there must be a proper nexus connecting it to the SC disability or side effects of medication used to treat it. Some non-VA docs are skeptical about writing opinions for the VA which is why the VA allows "as likely as not" to mean 50/50 certainty (i.e. the minimum VA requirement of relative equipoise). The VA also accepts "more/most likely" as 75% certainty and "caused by/due to" as 100% certainty levels. Not too long ago, the VA yanked all the DBQs from their web site under the guise that they had enough C&P contractors to handle the workload. They were sorely wrong and took a lot of heat because many vets did not trust the VA C&P examiners to get things right the first time. Eventually, the VA re-posted the public DBQs. The only problem is that they only include a section for the examiner's remarks. The DBQ's performed by the VA C&P examiners also include separate sections for the SC nexus which is why many non-VA providers might not understand what to do properly. 

The part about "Only a VA Dr's diagnosis of PTSD will be accepted" is still accurate for PTSD. Of all the MH diagnosis', that one must be validated or verified by the VA's MH examiner. It has been like that since around 2012 or 2013 when the VA changed the way PTSD cases are weighed. By you already having the DBQ and nexus, all the VA provider had to do was verify. I know other vets who clearly had PTSD and filed a claim, but did not have a treatment record. The DSM manual used to diagnose MH disorders has criteria which must be met to diagnose PTSD or other issues. The VA is well-known for diagnosing non-MST initial visits as an adjustment or personality disorder. However, if the VA examiner feels it was connected to service then they can definitely SC them under the MH criteria. In the end, the VA will only grant a single MH rating regardless of the number of MH disorders .

[broncovet]

Dont be confused, whodat.  Just apply, let the medical evidence speak for itself, and dont worry about primary, secondary,  presumptives...etc.  unless you want to go to work for the VA or work as a moderator at hadit. 

The pay as mod is lousy.  Since 2007, I have answered thousands of questions, gotten thousand and thousands of "likes", and finally I got my check from hadit.  $0.00.   But worth it for helping Vets. 

  The VA knows the regulations.  If they dont get it, then you appeal, or file cue.  

[blahsaysme2u]

26 minutes ago, broncovet said:

The pay as mod is lousy.  Since 2007, I have answered thousands of questions, gotten thousand and thousands of "likes", and finally I got my check from hadit.  $0.00.   But worth it for helping Vets.

at my rate i owe HADIT...im at least -50k from the help here

[Huggy]

Very good/enlightening discussion! BTW, GBArmy--I'm still chuckling over that "no tickie no laundry" crack!

[pacmanx1]

On 1/27/2022 at 12:46 PM, flow1972 said:

I want to clarify this statement.  The way it's stated is absolutely not true.  Statements like this confused and frustrated me when I first started down the VA Road.  In order to grant, yes a doctor's opinion connecting the condition to an event or already existing condition is required.  However, it is not in any way required to have this before you file.  In most cases, the C&P is where this is opinion is created.  The only time this would be needed external to a C&P is if the C&P evaluator decides the nexis doesn't exist or isn't sufficient for whatever reason; and you now need to appeal that decision with an IMO (Independent Medical Opinion) or the VA is refusing to grant an exam for some reason.  If you have one already...great; but it is NOT required prior to filing.

When I applied for my PTSD, I was told things like "Only a VA Dr's diagnosis of PTSD will be accepted" and so forth when in fact, I was granted SC for PTSD without EVER seeing a VA Mental Health Professional to this day.  My diagnosis was made by my Private Mental Health Professional who completed a DBQ for me to submit with my claim.  That diagnosis was then "validated" by the VA's chosen C&P Evaluator when they did their 3 hour C&P Exam.  I was so freaked out that I'd done it wrong because of this type if information.

In my experience, don't over-complicate things when you don't need to.

Here is where I think your opinion is off. Prior to filing a claim for disability, a veteran should first seek treatment. Just like you did, you got your diagnosis and your C & P examiners medical opinion confirmed it. C & P examiners may not be qualified to make a medical opinion about a veteran’s disability. You heard about a gynecologist giving her medical opinion about migraine headaches or a nurse practitioner giving their medical opinion about heart disease. It may not be required but it surely helps a veteran if he/she is being treated for a condition by a medical specialist working in his or her profession than a general practitioner. In fact, the VA had accepted your diagnosis, you didn’t even need a C & P exam. That right, a lot of C & P exams are not needed but veterans have to play the VA games even if the veteran already have a medical opinion.

I had my VAMC Rheumatologist write a nexus opinion that my service-connected fibromyalgia caused my sleep apnea and the VA sent me to a C & P exam and I went and asked the C & P examiner why I was there, I just got a medical opinion from my VAMC Rheumatologist and showed it to her. She said that she did not know why and wrote in my exam that she agreed with my treating rheumatologist and that was it. The C & P exam was over, and I was granted service connection within thirty (30) days of her report. I was expecting a fight, but it was all over before I knew it. Seeking treatment is the first step and should be where the diagnosis come from and not the C & P examiner. Heck what happens if the neighbor runs over the examiners dog, or the wife just leaves, or they have to fix a flat tire in the rain. My point is that a treating doctor working in their medical profession that has treated the veteran on multiple occasions, their opinion would hold more weight than a simple C & P examiner and even with the examiner having the same profession, the more weight would go to the treating doctor.

A negative medical opinion after an already positive medical opinion would immediately put the claim in relative equipoise and still no need for an outside IMO because if appealed the veteran wins.