"How and When to File" Questions

[harry59]

Morning All,

My Questions in this post are somewhat tied to my post of Feb 8th. I really appreciate all the input I received on that post. I've been really struggling on how I should proceed with two of my secondary claims (OSA and Hypertension) that were denied by the VA. Especially the OSA claim. And here's why... For my C&P exams for my Hypertension, Back Issues, Bilateral Radiculopathy, Abdominal Hernia, and OSA, the VA sent me to a Physicians Assistant (PA). The PA checked all of these claims in one appointment and hardly asked me anything about my OSA and Hypertension. My claim for Radiculopathy ended up being granted and I received an increased rating for my already service-connected (SC) back. However, the other claims were denied. Just to be clear, as I believe I noted in my Feb 8th post, I submitted the denied claims as secondary claims to my SC lower back using my obesity (caused by my SC back issues) as the "intermediate step" to these secondary claims. On a side note - I was given a C&P exam by a different PA, on a different day, on my knee. This was also a weight-related secondary claim that was denied. So, so far, the VA has denied all of my secondary weight-related claims. In any case, I have been seeing a Sleep Specialist for my OSA, who wrote a Nexus for me that I submitted with my claim. In fact, every claim I submitted I had a Nexus for (from Doctors - not a PA), as well as sufficient medical records. And yet, the VA chose to take the word of a PA over a Specialist. On a good note (at least I think) the VA did acknowledge in their decision letter that I did in fact have OSA and Hypertension. Is that a good thing for me?

Even though I have four claims that have not been rated as of yet, that I sent in at the same time as the ones mentioned above, the VA sent me a decision letter for the ones that have been decided. The claims I'm still waiting on three claims that fall under the mental health category, and my TDIU claim. So I'm not sure if the VA already knows they will deny them, or if they realize it will take a long time to decide, so they went ahead and sent a decision letter. Doesn't make sense to me that they would send a decision letter when I still have undecided claims out. Thoughts on this??

Anyway, my main questions are:

1. For my OSA claim: should I get a DBQ from my Sleep Specialist and file for a Supplemental Claim, or no DBQ and just do a Higher Level Review (HLR)? This is the question that's had me tossing and turning the most.      

2. Should I wait for all my claims to be decided before I file for a Supplemental or a HLR on my denied claims? 

3. Should I file all denied claims at the same time, or stagger them? 

I'm mostly concerned about my OSA and Hypertension claims getting approved. If any of my conditions kill me, it will likely be one of those two - and I want to make sure my wife has a good chance at DIC if it does. 

 

Thanks again for any inputs and advice. It's much appreciated!

[Vync]

17 minutes ago, harry59 said:

1. For my OSA claim: should I get a DBQ from my Sleep Specialist and file for a Supplemental Claim, or no DBQ and just do a Higher Level Review (HLR)? This is the question that's had me tossing and turning the most.      

A medical nexus is usually a plus if you are able to get one. The C&P examiners are supposed to review all evidence (including your nexus) and offer an opinion as to how they agree or disagree with it. However, that doesn't mean that the C&P examiners actually do that. I included one with one of my claims and the NP simply noted that it was reviewed, but completely failed to opine about it. 

Supplemental might be faster, but HLR might be more thorough and take much longer. 

 

22 minutes ago, harry59 said:

. Should I wait for all my claims to be decided before I file for a Supplemental or a HLR on my denied claims?

If the VA takes too long to decide all of your claims, you could risk losing the effective date of those. I'd recommend sending them on in. 

 

23 minutes ago, harry59 said:

3. Should I file all denied claims at the same time, or stagger them? 

See previous answer. The effective date of a rating is very important.

 

Keep in mind that the VA often will decide what they can while leaving others as pending. That's helpful to us veterans because if you win, then you might be retro much sooner. If you get a denial, then you can carefully pick apart the decision letter's reasons and bases to figure out what the VA might have missed.

[broncovet]

1.  Dont go the HLR route "unless" you are certain you have no new evidence.  (HLR excludes new evidence).  Frankly it sounds like you will need new evidence, so that excludes the HLR option.  My advice is to stick with the basics:  Do you have the caluza elements documented?  You would have to review your file to answer that question..."guessing" does not count.  I have found HLR to be "almost" useless and pointless.  HLR reminds me of asking your girl friend:  Gee, my last girlfriend refused to marry me, so are you gonna refuse also?  (likely).  If the last RO decision maker denied you, do you really expect the next one to render a different result, with nothing else changed?  Someone said the defination of insanity is to do every thing you did the last time you failed, the same, and expect a different result this time. My advice, therefore, is to review your file, see if caluzas are documented, and, if they are, proceed to the Board.  If you are missing a nexus, you need to fix that problem, probably with an IMO, before you will get SC for it. 

2.  It depends on how much you need money as to how long you should wait to file any claim.  If you just won 200 million in the lottery, heck wait until..forever.  However, for the rest of us non lottery winners, the earlier you file, the bigger the retro, and the sooner you can hope to begin receiving your desired compensation.  The formula is simple: File early..get approved early.  File later..get approved later.  Ditto with appeals.  

3.  See the answer to number 2, above.  Sure, you could "stagger" filing your claims based on the cycles of the moon, when your favorite team wins the super bowl, or some other system you think up.  But, for me, I need the money sooner rather than later, and the only way to do that is to file each claim (or appeal) at the earliest possible time.  We cant control "how long" it takes VA to process our claim, but we can control when we file it.  

4.  As far as DIC for your wife, there are 2 ways to qualify:  

a). die of a SC condition.  (filing sooner is better than later..you dont know how long it will take to get approved or to file the appeals.  Again, the only thing you control is when you file, so dont be the "weakest link" in your own claim.

b) Die of any condition, but only after you have been p and T 10 years.  File sooner:  The 10 years comes sooner.  

     Im pleased you are considering your spouse here, and your delays (for any reason), will not help her.