VA compensation claim

[JeffreyAlleman]

I filed a claim for PTSD and it came back denied. Insufficient evidence. I never received a C&P exam. I was stationed out in Japan during this time. My deployments were from 2010-2012, out in the Asian western pacific. How can I get this over turned or appealed properly? 

[MarineLCpl]

9 hours ago, JeffreyAlleman said:

I filed a claim for PTSD and it came back denied. Insufficient evidence. I never received a C&P exam. I was stationed out in Japan during this time. My deployments were from 2010-2012, out in the Asian western pacific. How can I get this over turned or appealed properly? 

I would start by trying to get ahold of your C-File and finding all evidence within it relating to your claim. Beyond that, it wouldn’t be a bad idea to start collecting new evidence before you decide to appeal. Consult with a private practitioner, have an exam done yourself. If the exam results in significant signs pointing to PTSD, you include this in your “additional evidence” submission upon appeal. Letters from friends and family could also help if they have beared witness to behavior that aligns with PTSD or diminished mental health. 
 

As far as official procedures to appeal, I can’t really help you there. But rest assured, there are plenty of people here who can. Hang in there! 

Edited January 26 by MarineLCpl
Typo

[broncovet]

Welcome to hadit: 

    I agree with Marine.Cpl.  

  However, since VA LOOOOOOOOOOVVVVVVVVVES to delay, if you see that when you request your cfile, file the nod anyway, in any case before your year after the decision is up.  They could take over a year to get your cfile!  

Shortcut:  

    You could/should be able to get your cfile as soon as "now" by going to a VSO "who has VBMS access" in real time.  Ask them before granting your POA.  

    Then, compare your records, to make certain the following  3 things are in place.   Unless your VSO is clueless he should be able to help.  If he does not know what "Caluza elements are", well, he needs more training.  This is VSO 101 training.  

1.  Current diagnosis

2.  In service "event" (if applying for ptsd this is referred to as a stressor event) which you allege caused your condition you applied for.  

3.  Nexus, or doc statement that your current diagnosis is "at least as likely as not" due to your in service event.  

The 3 above are called the Caluza elements:  Get them and get service connected, miss one or more and get repeatedly denied.  

    Sometimes, to get your nexus, the va doc wont provide it.  This means you need to go to a private doc that you pay for to provide the nexus, called an IMO, or IME.  

    The va wont call for a c and p exam if:

a.  You have no inservice event or stressor.  

b.  You have "bad paper", that is, such as a dishonorable discharge.  Or you dont meet "qualifying military service" serving the applicable time period.  

c.  A c and p exam "wont change the outcome" such as if your military records are missing.  

     A review of your records is necessary to find out if:

a.  You were missing one or more caluza elements.  OR'

b.  Its a bogus denial, you had all the caluza elements and va denied you anyway.  (This is what va did to me, and others, too). 

     "IF" your military service records were missing, but then VA and/or you find them, then you can/should resubmit this claim under 38 cfr 3.156 C, and you should get benefits back dated to when you first applied.  

[namvet6567]

Great post, Bronco!  I recommend all claimants file appeals, not refile, as many VSO's suggest.  You can also refile the claim at any time.  During my 10yr claim I appealed all decisions and refiled 3-4 times, just in case, I was doing something wrong, that I was unaware of.  That way I was at least assuring myself of some kind of retro award date.  I also made sure that I noted in my claims/appeals that I was seeking all benefits, both "known/sought and unknown", by me, to protect any appeals I may have. 

When I started my claim, I had to move to the VAMC area, to live, so I could have the manuals available to me, to work my claim.  The RO in 1990, had to set me up in a room, where they rolled out the M-21 rules, in an 8'-10' cart, for me to use and then provide me w/printed copies of anything I wanted.  They hated that!!  In fact, when the gentleman who had to do it retired, he made sure all his 100% rated friends received an SMC "s" award.  I knew 2 of them.  I had to appeal mine for 31yrs but won in the end.

Claimants should watch for lines similar to this:  "this decision is considered a full award of all claims/benefits being sought" or a VSO having the claimant sign anything that states that the claimant agrees with the decision. (a technique used in the late '90's), when the VSO's got a win.  I had 2 vets I know do that and lost their appeal period over that. just sayin' . . .

[Dustoff1970]

It is possible the VA raters saw no evidence of a stressor event/s in your SMRs or 201 file or DD214 and therefore did not order a C&P exam and simply denied your claim.  It is also possible you have or can get evidence of a stressor event/s while you were in service.  Maybe you saw a private doctor after the event for treatment, therapy, medications ????., etc.  The above comments are most helpful to your claim situation.

My comment is not legal advice as I am not a lawyer, paralegal or VSO.

Edited January 26 by Dustoff1970