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What should I do now?

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 I just received a denial for my claim for GERD secondary to Obstructive Sleep Apnea.  I cannot seem to find a way to scan it or attach to this post. 

It appears that the VA considered it a stand alone claim, and only did a records review and a DBQ filled out by the PA that did the records review. I sent in a Nexus Letter and DBQ that I had done with VBE and it's not listed as evidence considered. I don't even think they got the records from my Primary Care Physician to look at.

What should my next move be?

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  • Moderator

Most likely, you will need to appeal the denial, probably by filing a NOD appealing to the BVA.  Also, a HLR appeal "may" work, but many of us go direct to the BVA, and not HLR.  If you think there is already evidence supporting your GERD or sleep apnea in your file, then you may need to resubmit evidence which VA may not have had, under 38 cfr 3.156.  

Also possible is that there was "clear error" in your decision and you may be able to file CUE>. 

If you tell us the reasons VA says you were denied, we can help better.  

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5 minutes ago, broncovet said:

Most likely, you will need to appeal the denial, probably by filing a NOD appealing to the BVA.  Also, a HLR appeal "may" work, but many of us go direct to the BVA, and not HLR.  If you think there is already evidence supporting your GERD or sleep apnea in your file, then you may need to resubmit evidence which VA may not have had, under 38 cfr 3.156.  

Also possible is that there was "clear error" in your decision and you may be able to file CUE>. 

If you tell us the reasons VA says you were denied, we can help better.  

The following is Copied from the denial: 

EVIDENCE

VA Form 21-0966, Intent To File A Claim For Compensation and/or Pension, or Survivors Pension and/or DIC, conducted March 31, 2024

Lay Statement (or) Statement Received in Support of Claim, received April 4, 2024

VA Form 21-526 EZ: Application for Disability Compensation and Related Compensation Benefits, received April 4, 2024

Lay Statement (or) Statement Received in Support of Claim, received April 19, 2024

VAMC (Veterans Affairs Medical Center) treatment records, Wilmington, for the period May 1, 2024 to May 1, 2024

TERA Memorandum conducted May 6, 2024

Section (§) 5103 Notice, received May 18, 2024

VAMC (Veterans Affairs Medical Center) treatment records, Wilmington,

VAMC, for the period March 5, 2024 to May 20, 2024

VAMC (Veterans Affairs Medical Center) treatment records, Charelston, 

VAMC, for the period December 15, 2023 to May 2, 2024

Disability Benefit Questionnaire, GI Esophageal Disorders, received May 25, 2024, conducted May 13, 2024

 

REASONS FOR DECISION

Service connection for GERD (gastroesophageal reflux disease). Service connection may be granted for a disability which began in military service or was caused by some event or experience in service. (38 CFR 3.303)

Service connection for GERD (gastroesophageal reflux disease) is denied since this condition neither occurred in nor was caused by service. (38 CFR 3.303, 38 CFR 3.304)

A direct grant of service connection requires: 1) medical evidence of a current disability, 2) evidence of the incurrence or aggravation of a disease in active military service, and 3) medical evidence of a nexus (link) between the current disability and the in-service disease or injury. The evidence does not show an event, disease or injury in service. Your service treatment records do not contain complaints, treatment, or diagnosis for this condition. We did not find a link between your medical condition and military service. The evidence does not show a current diagnosed disability. (38 CFR 3.303, 38 CFR 3.304, 38 CFR 3.159) A VA exam was conducted on May 13, 2024, the VA examiner stated the e claimed condition was less likely than not caused by the indicated toxic exposure risk activities, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities. Review of literature is silent for the claim exposures of MOS of Navy Submarine Repair leading to or causing GERD. A nexus cannot be established Therefore, service connection for GERD (gastroesophageal reflux disease) is denied. We considered whether your condition resulted from a toxic exposure risk activity (TERA) in service. (38 U.S.C. 1168, 38 U.S.C. 1710(e)(4) The evidence of record shows participation in a TERA

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My current disabilities status:

Your individual ratings

Service-connected ratings

10% rating for left lower extremity radiculopathy, sciatic nerve

Effective date: September 11, 2023

10% rating for right lower extremity radiculopathy, sciatic nerve

Effective date: September 11, 2023

10% rating for right knee strain

Effective date: September 11, 2023

40% rating for lumbosacral strain (claimed as back condition)

Effective date: September 11, 2023

10% rating for tinnitus

Effective date: September 11, 2023

50% rating for obstructive sleep apnea

Effective date: September 11, 2023

10% rating for left knee strain

Effective date: September 11, 2023

20% rating for lateral collateral ligament sprain, right ankle

Effective date: September 11, 2023

0% rating for hearing loss, left ear

Effective date: September 11, 2023

20% rating for lateral collateral ligament sprain, left ankle

Effective date: September 11, 2023

Conditions VA determined aren’t service-connected

hearing loss, right ear

gerd (gastroesophageal reflux disease)

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The following is listed in the files submitted.  The file marked with *** *** was not listed in the Evidence submitted. :

 

Your compensation claim

Received on April 4, 2024

What you’ve claimed

gerd (gastroesophageal reflux disease) (New)

StatusFilesOverview

Claim files

You can see the files associated with this claim.

 

Additional evidence

The claim is closed so you can no longer submit any additional evidence.

 

Documents filed

WilmGIendoscopyresults.pdf

Additional evidence

 

Document type: STR - Medical - Photocopy

 

Received on July 8, 2024

 

DBQ-{9DFDBBF3-EA0D-4F75-8318-4EC9F9E298F8}-227241042000-9025ver3.PDF

Additional evidence

 

Document type: C&P Exam

 

Received on May 25, 2024

 

DBQ-{D1FD76A5-077C-4DD5-8787-E335A1D1FFFB}-227241042000-1015ver1.PDF

Additional evidence

 

Document type: C&P Exam

 

Received on May 25, 2024

 

File name unknown

Request type: Secondary Action Required

 

Received on May 22, 2024

 

No longer needed

File name unknown

Request type: Second Signature

 

Received on May 22, 2024

 

No longer needed

ClaimDecisionRequest.pdf

Additional evidence

 

Document type: 5103 Notice Acknowledgement

 

Received on May 18, 2024

 

***Settlemeyer__Bradley_GERD.pdf

Additional evidence

 

Document type: Disability Benefits Questionnaire (DBQ) - Veteran Provided

 

Received on May 18, 2024***

 

File name unknown

Request type: Exam Request - Processing

 

Received on May 6, 2024

 

No longer needed

Exam Request - e950c0bb-6424-498f-9abf-0fae91697896.pdf

Additional evidence

 

Document type: Exam Request

 

Received on May 6, 2024

 

TERA Memo 05/06/2024 14:24.pdf

Additional evidence

 

Document type: TERA Memorandum

 

Received on May 6, 2024

Claim files

You can see the files associated with this claim.

 

Additional evidence

The claim is closed so you can no longer submit any additional evidence.

 

Documents filed

{CB1F627E-C0E8-485E-B92C-EEE947AC9A41}.pdf

Additional evidence

 

Document type: CAPRI

 

Received on May 6, 2024

 

VBA-21-10210-Megan.pdf

Additional evidence

 

Document type: Correspondence

 

Received on April 19, 2024

 

vba-21-4138-GERD (1)pdf.pdf

Additional evidence

 

Document type: Buddy / Lay Statement

 

Received on April 4, 2024

 

BRADLEY_SETTLEMEYER_106343087_526.pdf

Additional evidence

 

Document type: VA 21-526EZ, Fully Developed Claim (Compensation)

 

Received on April 4, 2024

 

e8cb450c-d476-4e2e-834c-80eb800e71c1_c1fab235-d52c-4a64-836f-4fd01b8d1231

Additional evidence

 

Document type: Certificate of Release or Discharge From Active Duty (e.g. DD 214, NOAA 56-16, PHS 1867)

 

Received on September 12, 2023

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When you appeal, you probably will need to refute VA reasons:

Quote

Your service treatment records do not contain complaints, treatment, or diagnosis for this condition. We did not find a link between your medical condition and military service. The evidence does not show a current diagnosed disability. (38 CFR 3.303, 38 CFR 3.304, 38 CFR 3.159) A VA exam was conducted on May 13, 2024, the VA examiner stated the e claimed condition was less likely than not caused by the indicated toxic exposure risk activities, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities. Review of literature is silent for the claim exposures of MOS of Navy Submarine Repair leading to or causing GERD. A nexus cannot be established Therefore, service connection for GERD (gastroesophageal reflux disease) is denied. We considered whether your condition resulted from a toxic exposure risk activity (TERA) in service. (38 U.S.C. 1168, 38 U.S.C. 1710(e)(4) The evidence of record shows participation in a TERA

The portion in BOLD is bogus.  

The portion in BOLD is NOT required for SC

Here, instead, is what IS requrired:

Quote

A direct grant of service connection requires: 1) medical evidence of a current disability, 2) evidence of the incurrence or aggravation of a disease in active military service, and 3) medical evidence of a nexus (link) between the current disability and the in-service disease or injury.

These 3, above, are called the Caluza elements.  You need those for SC, unless its presumptive, or secondary.  

In your case, the deal killer is likely:

Quote

A VA exam was conducted on May 13, 2024, the VA examiner stated the e claimed condition was less likely than not caused by the indicated toxic exposure risk activities, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities. Review of literature is silent for the claim exposures of MOS of Navy Submarine Repair leading to or causing GERD. A nexus cannot be established Therefore, service connection for GERD (gastroesophageal reflux disease) is denied

In reference to the above, many, if not most, troops "do not necessarily do work "exclusively" in their assigned MOS.  Gunners mate may work as cooks, or any thing else your commander needed and assinged to you, and he may or may not have changed your MOS to reflect this.  

    In short you need to appeal.  While I was unable to read your buddy statement, did your buddy indicate you were exposed to toxic substancess?  A buddy statement is useful in establighing 

an "in service event" or aggravation, Caluza element number 2, above.  

     The real deal killer is your c and p examiner statement that "it was less than likely due to service".  To refute this, you will likely need another medical opinion "if" indeed the examiner said that, and the only way to know that would be to check your cfile and this exam.  Another doc may have already said it was "at least as likely as not" due to an event in service, but VA does not usually read all the evidence, so denials can be just plain wrong.  

      My advice is to get your medical records, read the exam and see what they say.  Then file an appeal citing evidence.   Example:  

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