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Claims denied

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OIFVETMC

Question

Background:

OIF1 veteran with 60% or more in combined service connected injuries  


filed a multi symptom claim consisting of :

chronic fatigue, chronic rhinitis/nasal breathing, Gastrointestinal , TBI/migraines, sleep disturbance. 

went through the 6 month process of c&p exam by VES (sub contractor) who performed incorrect tests and or no tests , diagnosed issues as CPTSD

result :denial of claimed injuries except TBI at 0% linked with existing CPTSD  

currently waiting on higher level review , submitted with a vso  

 

primary care and referral doctors will not diagnose IBS, cf/me, want to link it to CPTSD  

Ideas for getting these issues diagnosed and thus properly claimed? 
if the higher level review doesn’t work then what?

TY

 

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Welcome to Hadit.com

The bottom line is that your HLR may or may not work and if they deny your claim you are going to have to appeal to a higher level to the BVA and or even up to the CAVC. Many of us had to go down this road. The VA denied my original claim back in 1998 and I finally got the CAVC to award my claim back to the original effective date. Most claims/appeals should not take that/this long but you have to be prepared to fight and never give up.

If you have to file a claim/appeal to the CAVC, there are attorneys that will take your case free of charge under the EAJA (EQUAL ACCESS TO JUSTICE ACT).  

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Ok I can help here I think.  So for the VA doctors, you need to tell them what your issues are and GET SEEN FOR THEM.

You say hey I have IBS, then you need to go to the specialist and get all the test to see.  Then they have no choice but to say you have it or not

Same with CFS, they have many tests for this you will need to go through to get a diagnosis.  

The sleep disturbances you should get a Sleeping test done.  This can lead you down that path.

This is the same for any issue you are having, go see them until they can tell you what is wrong.  

As said above apeal the decisions.  Just because they did not give you a diagnosis yet does not mean they won't.

They VA goes off of when you had the symptoms, so as I said above go get checked for everything!  See the needed specialist.  It took me 6 years to get it right and I am still fighting the VA after 10 years.

But I am at 100% P&T and those benefits are great for you and your family!  Keep fighting and never give up!

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@OIFVETMC When you described your IBS symptoms, did they do any imaging or studies (i.e. x-ray, CT scan, upper/lower GI/colonoscopy)? If they did, obtain and read the findings. I have seen some examiners who skim the results and do not thoroughly report the findings back to the VARO. If you have alternating constipation and the runs, be sure to let them know. That is a subjective complaint (lay statement) and although they don't have to observe the results of you actively taking a dump, they are supposed to consider what you tell them.

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Thank you for the replies. 
 

is there a consensus on submitting a supplemental appeal vs BVA on a claim such as mine?

I’ve been to several other docs besides primary, done the burn pit registry, lots of tests etc. one issue I neglected was lay letters from my Marines, which I do now have. 
I’m hesitant to use an atty, already had a bad experience just getting my case reviewed. 
That said I’m not totally opposed to them. 
 

-Stockdale Paradox": you must maintain unwavering faith that you can and will prevail in the end, regardless of the difficulties, and at the same time, have the discipline to confront the most brutal facts of your current reality, whatever they might be.

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Personally I would file the supplemental appeal, While this is going on I would go see more doctors at the VA.  The BVA is also a good choice, jsut don't not file the appeal.  Also if your primary is not helping you, you can ask for another.

I know the doctors take a lot out of you, but that is how I got what I needed from them.  

I have used an attorney twice and only at the CAVC.  This is past the BVA.  At the CAVC they pay for the attorney as long as you have a case they will take.  Most of the time there is one who will as they will not take them if they don't think they will win.  

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Several years ago, I filed a claim for an EED (Earlier Effective Date) of one of my already service-connected disabilities and the VARO denied my claim. I was told since my disability was already service connected and I was only trying to get a corrected effective date that if I filed a Supplemental Claim that the VARO would catch it and correctly rate my claim. This was after the VARO sent me to an updated medical opinion and the VARO ignored my request for an EED and they also ignored their own medical examiner's opinion and denied my claim. I had to file an appeal to the BVA, and my appeal has been pending waiting to be assigned to a VLJ (Veteran Law Judge) for over two (2) years.  

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