denial letter HLR Denial. Need guidance for Low back and Radiculopathy for Legs

[Blaze99]

Hello,

Last year I filed two supplemental claims for GERD, tinnitus, and bilateral radiculopathy for legs, and later filed an increase for low back strain and a new claim for neck condition. For some reason, all claims were combined in one decision letter, and they were all denied. I immediately filed a HLR and requested an informal conference. I never received a call, but a decision was made denying all claims again in August 2022. There were so many discrepancies with the letter. I was overwhelmed and put off addressing the decision due to other life matters. 

Between moving overseas and traveling for work, I finally caught a break to focus on gathering what I need to file supplemental claims. I'm a bit confused and need some guidance on how to proceed for low back strain and radiculopathy for the legs. I have a redacted decision letter for reference. Also, I am SC for Lumbosacral strain (20%), Migraines (50%), and PTSD (70%).

For low back strain, I'm not sure if I read the letter about the evaluation correctly. My condition has worsened over time, which was the reason for an increase. I could barely move during the exam and was in tremendous pain. I would like to note that CT, MRI, X-rays, and chiropractor treatment records were provided as evidence, which showed my condition was worse due to degenerative arthritis. How would I go about addressing this? Do I filed for DDD or get a nexus letter? 

2. Bilateral Radiculopathy for Legs: I filed a supplemental claims secondary to my low back with new evidence mentioned above. Would I need a nexus letter for these claims as well?

Any insight, feedback, and/or guidance is greatly appreciated! TIA

[broncovet]

Welcome to hadit.  Your senario is exactly why I dont use the HLR, tho some have had success with it.  I appeal to the BVA, by filing a NOD, instead.  My opinion is HLR rarely has a good result, and mostly wastes time getting to the BVA, where your chances are better.  

If your newest HLR is within one year of the decision, or less, my advice is to file a NOD, disputing the decision at the BVA. 

Hadit members can help you with the NOD, as your VSO can.  

When I file a NOD, I have the decision in hand, and refute their findings.  As a hypothetical example:

Quote

I disagree with the Regional office decision dated (dd/mm/yy).  

Of course, you need to decide which issues to appeal..all of them, some of them, etc.  You can appeal a hearing loss decision, for example, and not dispute your PTSD rating,.  

    After this, I would explain why the rating decision is incorrect.  Again, an example may be:

"According to the rating decision, there was no evidence of an inservice event.  However, I am resubmitting a doctor report, where I injured the knee/back  while in military service, which is dated 11/14/2004, during my military service".  This exam should suffice to acknowledge an in service event, the decision does not dispute this medical report.  

     Then, enclose a copy (keep the original) medical report, and send the copy to VA, with your NOD.  

Edited June 17, 2023 by broncovet

[Blaze99]

Hi Broncovet,

Thank you so much for your feedback! That makes a lot of sense so I'll move forward with disputing the decision with BVA. 

[broncovet]

Great.  When you do the NOD, best is to have the decision and your medical records available.  Evidence wins claims, while BS does not.  And, especially medical evidence, wins claims.  

If you "did not" go to the doctor in military service, "But", you had a buddy who can testify you (injured your back, neck,knee etc) then that evidence may suffice.  

Of course, your buddy is unlikely qualified to diagnose or treat your maladies, "But", he can testify, as an example:

"Yes, I was with (your name) during the military. We served (at so and so military base from date to date), and we worked together on a regular basis.   He "jumped out of airplanes" like I do, and at least once, in our 3o jumps together, he complained of knee pain, and treated it by taking tylenol.  If I recall, that jump was in the summer, just after 4th of July, 2008.   I saw him limp for several days after the event".  

Signed

(Your military service buddy) date.

This is a sample buddy letter.  Do not use this one, instead, contact your buddy who served with you, that knew you and ask him to tell the story.  Its good to include dates, where you served, and as many details as you can recall.  

 

The courts have ruled that "lay people" (that is, people who are not doctors or other medical professionals), can testify on simple things (but not medical diagnosis).  So, your buddy can testify he saw you fall off a building, but he probably isnt competent to testify you had a fracture of your c3c4 spine with a slipped disc.  Your buddy can communicate, for example, if you had seen a medic, and the medic told you its likely a c3 slipped disc, but you were too busy to get further medical treatment, and no medic report is available.  

Always be honest, dont try to BS the VA, you wont get a good result.

 

[Rattler]

broncovet and I disagree on HLR's. I used an HLR to file a CUE claim that came back in 3 weeks and gave me 6 figures in back pay. But you have to know how to file and What to say in one. Without seeing the denial letter both of us a shooting in the dark. If you would like to upload it for us to review you will need to take a sharpie and block out all your information, like name address, claim number social security etc. There are things in your denial letter that we will pick up on that you may not know how to read it. (I didn't at first until someone show me how. There are two boxes to check on a NOD one is fore a record review. (One is a records review only this means you cannot add ANY evidence) I request a direct review with a hearing. You can add evidence when you file and for I think 90 days after you file. 

In you case you will need to follow his instructions above and get the denial letter(s) and your medical records together and file them with your application. I usually put a sheet of paper and put Exhibit 1, 2, etc on the front info that I am submitting and refer to them in the NOD.