Weight-Related Claims Denied ???

[harry59]

I submitted claims at the end of Sept of 2021. I just received, and read, the VA decision letter that I received today. The claims I submitted that were related to my already service-connected back conditions were approved. I am now at 80%. However, even though the VA confirms the diagnosis of all my secondary conditions that I submitted, all of my secondary claims (Obstructive Sleep Apnea (OSA), Hypertension, and Abdominal Hernia) that I submitted and associated to my weight gain, due to my SC back condition, were denied. I specifically stated in my veteran statements that I was connecting these secondary conditions to my SC back conditions, since I am effectively unable to exercise, using my weight gain as the "intermediate step," per the Walsh v Wilkie Decision. In my veteran statements I also referenced other VA Decisions where others have been granted service connection for the exact same medical conditions (using weight as their intermediate step) that I submitted?

 

In their reasoning for the denials (file attached), the VA mentions nothing at all about me using my weight as the "intermediate step" for my secondary claims. After reading this I wondered if they even looked at my veteran statements, or even took the Walsh v Wilkie Decision into consideration. I emailed my VSO about this and he said that the VA raters do not use court decisions when determining ratings because they are specific to that veteran. That just doesn't sound right to me. 

 

The letter also states that my claims for Insomnia, Depression, PTSD, and TDIU have been deferred for "Additional Development." What does that mean? 

 

So I guess my main questions are:  

1. Is my VSO correct, or did the VA totally ignore my veteran statements? 

2. Do I have a good chance at a Higher Level Review (HLR)?

3. What would be my best way to proceed? Attorney?

Thank you for your time. Any advice, replies, and opinions are greatly appreciated!

 

OSA Denial.pdf

[Mr cue]

I would appeal higher level if you don't have any more evidence.

 

It sound like you are on the right track to fight with the law from the Case you used.

I don't think you need a lawyer to do the higher level review.

the vso could help and should put the paper in for the review.

If not make sure you do it you have a year from the date on the decision.

To appeal the decision or request a higher level review.

I think it a Year on the higher level don't hold me to that one.

Now the good and bad.

The regional office doesn't like to address law.

The board might address the law the way they see it.

The us court of veterans appeal will address the law.

So the vso is partly right. My opinion

45 minutes ago, harry59 said:

using my weight gain as the "intermediate step," per the Walsh v Wilkie Decision

This let me no you are on top of your case good luck.

An keep up the fight

 

[pacmanx1]

 

1 hour ago, harry59 said:

In their reasoning for the denials (file attached), the VA mentions nothing at all about me using my weight as the "intermediate step" for my secondary claims. After reading this I wondered if they even looked at my veteran statements, or even took the Walsh v Wilkie Decision into consideration. I emailed my VSO about this, and he said that the VA raters do not use court decisions when determining ratings because they are specific to that veteran. That just doesn't sound right to me. 

What some veterans do not understand that even though you submitted a copy of BVA decision(s) that was similar to yours, DID you have an IMO stating that your service-connected disability caused your OSA or that your OSA is as least likely as not the result of your service-connected disability? The VA is looking for a medical opinion and a medical rationale about your condition and do not have to accept BVA decisions because they are not precedent. Now you may win on appeal, but you still need an IMO with a good medical rationale of how your conditions are related. In some cases, the VA can accept lay statements but in this particular case the VA will want a medical opinion from a medical specialist/doctor with a good medical rationale.

[harry59]

My Sleep Specialist doctor wrote me a Nexus Letter stating that it was more than likely that my OSA was caused by my weight gain due to my inability to exercise caused by my service-connected back condition. I also submitted her notes from my medical record. I would've thought that would be enough for the VA. 

[pacmanx1]

4 minutes ago, harry59 said:

My Sleep Specialist doctor wrote me a Nexus Letter stating that it was more than likely that my OSA was caused by my weight gain due to my inability to exercise caused by my service-connected back condition. I also submitted her notes from my medical record. I would've thought that would be enough for the VA. 

There are no guarantees with the VA, and you are going to have to file a disagreement.  

[Mr cue]

7 minutes ago, harry59 said:

My Sleep Specialist doctor wrote me a Nexus Letter stating that it was more than likely that my OSA was caused by my weight gain

I take you when to exam to.

So just do the higher level review and if they denied appeal to the board.

Don't worry about why they didn't look at your evidence.

You have evidence an some one will address it.

I would just write a statement addressing your evidence.