Copies Of Past Denied Claims

[ROMAD]

How do I go about getting copies of claims that were denied from 1993 - 1995. Does anyone know if there is a record of these that I can get. I can not find my copies and denials. And I am sure i will need them for my CUE.

My second question has to do with combined diagnosis type ratings. How do i receive a rating for both conditions. I just recently had my rating increased to 50% SC "Cluster Headaches with Horners Syndrome" 8100. I see that Horners Syndrome has seperate rating criteria but there is no rating for it that I can tell. My service medical records refered to my condition with the entire phrase as well "Cluster headaches with Horner's syndrome" So in addition to the CUE for not being rated for my 8100 claim should this be brought up at the same time or would this be two seperate issues. The rating for horners would be an additional 10 -20% 6019 or 6030 from the guide. So what do you all think??

ROMAD

[Objee]

How do I go about getting copies of claims that were denied from 1993 - 1995. Does anyone know if there is a record of these that I can get. I can not find my copies and denials. And I am sure i will need them for my CUE.

My second question has to do with combined diagnosis type ratings. How do i receive a rating for both conditions. I just recently had my rating increased to 50% SC "Cluster Headaches with Horners Syndrome" 8100. I see that Horners Syndrome has seperate rating criteria but there is no rating for it that I can tell. My service medical records refered to my condition with the entire phrase as well "Cluster headaches with Horner's syndrome" So in addition to the CUE for not being rated for my 8100 claim should this be brought up at the same time or would this be two seperate issues. The rating for horners would be an additional 10 -20% 6019 or 6030 from the guide. So what do you all think??

ROMAD

Man o' man, that question stops me cold. Sure would think that prior denials would be in your C-file (mine were) but I'm not sure. I'd either get a file review or order out a copy of my C-file to see. Are "cluster headaches" separately ratable? If so, they should not have been rated with Horner's UNLESS it would cause pyramiding. I defer to the true experts on this board.

Ralph

[Vike17]

Romad,

Prior rating decisions and so forth are in your C-file at your regional office. You can request a copy of your C-file by writing the VA a short letter asking them for a complete copy of it and referencing the 1974 Privacy Act. the VA is suppose to respond with 20 days accoding to Federal law. This rarely happens due to the enormous backlog, but they will send it to you.

As far as your contentions that you have a CUE with regard to being seperately rated for Horner's syndrome aside from your cluster headaches, I'm afraid that isn't the case. From the looks of things your medical records indicate that Horner's syndrome is a symptom or residual of your cluster headaches and, therefore, are taken into condieration with the rating of your headaches. In this case VA cannot assign a seperate rating due to pyriamiding. Cluster headaches are known to cause Horner's syndrome.

Furthermore, §4.124a states;

"Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc., referring to the appropriate bodily system of the schedule"

So, if you had any actual impairment of vision due to your Horner's syndrome or any type of facial paralysis then, yes, it would warrant a seperate rating. However, symptoms such as sinking of the eyeball into the face or small (constricted) pupil would not be able to be rated seperately.

I hope this helps.

Vike 17

Edited March 9, 2007 by Vike17

[Berta]

I cant believe this dog isnt dead yet-GGGGGEEEEEEEZZZZZZZ

a veteran does NOT need to file FOIA or even Privacy Act request !

I put in these requests for vets- the info is req

[Berta]

I cant believe this dog isnt dead yet- GGGGGEEEEEEEZZZZZZZ

a veteran does NOT need to file FOIA or even Privacy Act request for copy of their VA med recs!

I sometimes put in these requests for vets- 'the info is requested under 5 USC 552, the Privacy Act'-

just a habit- most of the time I dont and the VA doesnt care-

unless these regs have sudden changed----PLEASE SHOW ME THE NEW REGS THAT SAYS it has to be a FORMAL FOIA REQUEST!

ALSO the feds will usually RESPOND in 20 days but that does NOT mean the copies come with the response- it just means they will RESPONSE (as an acknowledgement) to the REQUEST!!!!

And again- Just send a letter to the VAMC that treats you- send to the Records Access Officer-

and ask them for a complete copy of your med recs!

By stating here this has to be done under FOIA only causes confusion to vets out there who feel they have to use legalize to get their med recs.

The vet who keeps stating this incorrect FOIA advise could have and should have gotten their med recs months and months ago-

It should be the first thing a vet does when they file a claim and certainly not request them when the claim is at a rating board.

This veteran is argumentive about just about every thing under the sun re: claims.

I am taking a big break from all this- what good is our advice when it keeps getting compromised by an "expert" who has not even obtained his own VA med recs yet .

PS - My vet rep saw a FOIA in my file- regarding a legal matter I had with VA-

FOIA has nothing to do with copies of med recs-

It was the first FOIA he ever saw.

Lots of luck getting some vet rep to help with a FOIA REQUEST THAT THE VET DOESNT NEED FOR THEIR MED RECS.

Let our FOIA expert start answering your claims question.

[Vike17]

Berta,

Was your post directed at me???

Romad was referring to his C-file at his regional office in obtaining previous rating decisions and so forth. He didn't make any references to any medical records at his VAMC. If a veteran wants a copy of the C-file that is held at their RO, they must do so in writing. Granted, you specifically do not need to put "Freedom of Information Act request" or "Privact Act request" on the written letter, but if one does it substantially reduces the chances of the VA missing it. I even think VA has an actual form to request one records too if the veteran doesn't want to sit down and write a letter.

Also, as you did indicate, if a veteran wants a copy of his medical treatment records from their VAMC, they must also do so in writting, or they can go to the VAMC in person and request them.

I have never used the FOIA, just referenced the 1974 Privacy Act with absolutely no problems. We all know that the 20 days set forth by the Privacy Act is largely unrealistic when dealing with the VA. I also meant that the VA didn't need to actually have one's records to them within 20 days, I was also meant they would ojly need to acknolwedge the receipt of the request as a "response."

I certainly hope your remarks weren't shot across my bow!

Vike 17

[Vike17]

For some reason I double posted, sorry. I deleted it!

Vike 17

Edited March 9, 2007 by Vike17