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VA denial for insomnia secondary to service connected patellofemoral pain syndrome.


Sdet74

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 Hello. 
 

      I was recently denied secondary insomnia to my service connected patellofemoral pain syndrome even though a VA sleep dr diagnosed me with insomnia and the Cp examiner linked my sleep disorder to my left knee pain.  Reading the CFR that they stated doesn’t say anything like they wrote for their explanation.  Doesn’t this write up seem to contradict itself?

Jay
 

 

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13 hours ago, Sdet74 said:

Doesn’t this write up seem to contradict itself?

Jay

You are going to have to appeal, and you may even have to appeal to the BVA. I found this granted decision, of course many are denied and remanded but you can search for yourself.

Citation Nr: A21008338

Decision Date: 04/26/21 Archive Date: 04/26/21 

DOCKET NO. 200423-81193

DATE: April 26, 2021 

ORDER 

Service connection for insomnia is granted. 

In its February 2020 decision, the AOJ found that the Veteran has been diagnosed with an insomnia disorder. Under the AMA, the Board is bound by this favorable finding. 38 C.F.R. § 3.104(c). The question before the Board is therefore whether the insomnia disorder is proximately due to or aggravated by his service-connected knee disability. 

The record contains two VA medical opinions on the etiology of the Veteran’s insomnia. In January 2020, a Compensation & Pension (C&P) examiner determined that the insomnia disorder is at least as likely as not proximately due to chronic knee pain. The January 2020 examiner reasoned that an earlier examination from 2002 noted insomnia disorder (although the 2002 examiner failed to make that diagnosis), that the Veteran’s knee pain has created sleep issues, and that medical literature is replete with connections between chronic pain and insomnia. The Board finds this opinion highly probative. 

https://www.va.gov/vetapp21/Files4/A21008338.txt

(c) Favorable findings. Any finding favorable to the claimant made by either a VA adjudicator, as described in § 3.103(f)(4), or by the Board of Veterans' Appeals, as described in § 20.801(a) of this chapter, is binding on all subsequent agency of original jurisdiction and Board of Veterans' Appeals adjudicators, unless rebutted by evidence that identifies a clear and unmistakable error in the favorable finding. For purposes of this section, a finding means a conclusion either on a question of fact or on an application of law to facts made by an adjudicator concerning the issue(s) under review.

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I "have difficulty" reading your report, in no small part because my eyes are just not that young anymore, and its somewhat blurry.  

However, this sounds like a bogus denial, and here is why.  

Rating specialists are not doctors.  They dont read xrays, they dont diagnose or treat illness.  They MUST rely on the opinions of doctors or medical professionals who do treat you, and they may "not" substitute their own unsubstantiated opinion for that of a competent medical professional.  

It sounds like the VA did precisely, the above paragraph, tho I admit its blurry and hard to read.  

Sort of like, "Sure, I know the doctor diagnosed you with insomnia, but I think that doctor is nuts.  There is nothing wrong with you.  Service connection denied."  Bogus denial.  

The VA "has" to rate you "on the criteria" in the 38 cfr.  As an example, the VA denied me hearing loss, "because it has been too long since military service".  

"Nowhere" in the criteria, is "the time since military service".  Indeed, the rating specialist substituted his own opinion for that of a competent, qualified audiologist who opined that my hearing loss "was at least as likely as not" from excessive noise during the military service.  (The military is a very noisey place.  I was stationed within about 100 yards from an airport, where jets were constantly landing and taking off, flying just overhead.  Jet engine noise, especially in older jet motors, is exceptionally loud.  So loud, in fact, many municipalities have banned the practice, forcing engine makers to design much quieter engines, or to locate airports miles away from the city.  

Dont let VA do bogus denials.  Force them to rate you on the criteria, by appealing to the Board.  The rating specialist dispute of the diagnosis, is irrelevant.  If the rating specialist did not like my blue hair, is that a good reason for him to deny?  NO> 

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Insomnia is part of my mental health condition (100%).  You may want to approach it in this manner.  It may be easier to get it approved.  I mean pain obviously causes mental health and insomnia issues after all. I also was awarded 40% for Fibromyalgia when they couldn't figure our what was causing my neck and back pain.  MRI's and Cat scans couldn't reveal what was causing my pain.  It causes mental health issues for sure.   MDD (major depression), insomnia, etc.  Of course treatment and a diagnosis from the VA would substantiate a mental health claim.  

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