VA Support letter for service connection

[usmcwife27116]

Hello,

New member here. I am assisting my father with his supplemental claim after initial denial for service connection for colorectal cancer from Agent Orange exposure in Vietnam (Has already had confirmed TERA).

For a Statement in Support of Claim (form 21-4138) we are at a bit of an impasse as to what should be included.  I have drafted a letter detailing current medical literature, prior VA determinations and rulings that all support strongly in total a service connection. My parents have read that this letter however should only include a personal statement as to how the cancer has affected his life (which has led to total disability and soon hospice).  I do not understand how such a letter would support establishing the service connection, as this to me seems that it would only support the percent disability. Most examples I have found of this Statement in Support of Claim discuss the ways the condition has affected the veteran's disability, but not to establish the service connection.   

Does anyone have any guidance or experience with how to convey the actual scientific literature and legal precedents to include in justifying the claim? 

Thank you in advance for any guidance you may have. 

[brokensoldier244th]

The establishment of SC should be taken care of by the TERA and if he's confirmed RVN, or blue/brown water Navy. The support letter is more were you get to do just what you described to help humanize the medical records and explain what issues he's having with his ADL (activities of daily living). Its not 'just' that, though- if you have medical or other things in the records that you know of then use some of the letter to explicitly point that out, at least with approximate dates. Re-read the denial and frame your letter around the reasons for the denial as they are put in the letter. 

[usmcwife27116]

Thank you for taking the time to respond. This is new navigation for me.   

The TERA is confirmed and is not disputed from the VA (and he has established service connection for HTN, DM based on his RVN TERA exposure) but these are relatively low disability ratings since it is his cancer that is the driver of his actual disability. The issue is that colorectal cancer is not yet one of the presumptive conditions related to AO exposure (most other cancers are, and colorectal is a presumptive for burn pits, but not yet for AO).  The reason for denial is simply stated as "toxic exposure was 50 years ago, not a presumptive condition". His documentation is clear on the disability caused by his colorectal cancer (all medical records and spousal support letter submitted detailing his ADLs that he is unable to perform, which is unfortunately at this time almost all of them). The dispute from the VA therefore appears to not be with whether or not he is disabled, but with whether or not his AO exposure is likely to have caused his cancer. We have a letter from an oncologist supporting this but I was able to find additional medical journals, prior VA case determinations granting this service connection for other RVN AO exposures, etc supporting the link.  I'm just not quite sure how/where to submit this info.

Thank you again.

[brokensoldier244th]

You can do it one of 2 ways- you can scan it (unless you have downloads that are already scanned as PDFs) and fill out the claim form on VA.gov, then upload the documents with the claim. Alternatively, you can put it together on paper and mail it to Janesville WI. Dept of Veterans Affairs Evidence Intake Center, PO Box 4444, Janesville WI 53547-4444

[pacmanx1]

Most veterans that suffer from chronic illness and or pain should also file a claim for depression. His RVN TERA exposure could also be considered as some form of depression. Has mental health treated him, or you can request from his PCP (primary Care Provider) that he be seen and evaluated? Going to mental health does not mean he is crazy; it simply means that he has been through and seen things that could cause him depression. 

[broncovet]

It sounds like you have your bases covered, USMCwife.  Generally, I cant recommend too many letters and long winded explanations when you apply for benefits.  EVIDENCE wins claims.  And, especially MEDICAL evidence.  VA wont award benefits without applicable medical evidence.  

The reason I suggest exercising caution in the letters you send to VA is because the VA is looking for anything to discredit your statements.  Please allow an example:

    You write in a letter to VA, that 2 or 3 years ago, in the military, you had (xxyy happen) which you allege caused your claimed disability.  

Some time later, you fill out a form for VA.  They want to know "when" then event in service happened.  Well, this time, you remember meeting your husband and he was in training on xy date, so you know his injury was before that date.  So, you fill out a date that indicates it was 4.3 years ago.  Uh-oh.  You made conflicting statements.  Since Im bad about remembering dates, I try to make sure I dont "guess" one time, then look up the date on different forms to VA, because you will look like a liar, even tho its probably just forgetfullness.  

Generally, VA does not want the VEterans opinion , and generally wont rely upon it anyway, "unless" its consistent with all the other known facts.  Since it sometimes takes decades in order to apply for, and win benefits, I often forget what I told VA six months ago, let alone 10 years ago.  Yes, it took me from 2002 to 2020 to get all my benefits..over 17 years.  It involved multiple multiple claims and multiple multiple appeals at different levels.  (BVA/CAVC etc.). 

All this said, keep to the basics:

CALUZA elements:

1.  Current diagnosis.  

2. In service event or aggravation.  T

3.  Nexus or doc opinion that the current diagnosis is at least as likely as not due to an event in service.  

NOTE:  Presumptive SC is sometimes easier, "provided that" you meet all the applicable criteria such as the country of service, the period of service, and/or the illness or condition claimed is on the presumptive list.  

Finally, secondary conditions can happen when you are service connected for "x" condition and it causes "y" condition.  For example, if you are SC for high blood pressure, that may cause kidney problems secondary to high blood pressure.  

[Rattler]

On 8/14/2024 at 10:55 AM, usmcwife27116 said:

Hello,

New member here. I am assisting my father with his supplemental claim after initial denial for service connection for colorectal cancer from Agent Orange exposure in Vietnam (Has already had confirmed TERA).

For a Statement in Support of Claim (form 21-4138) we are at a bit of an impasse as to what should be included.  I have drafted a letter detailing current medical literature, prior VA determinations and rulings that all support strongly in total a service connection. My parents have read that this letter however should only include a personal statement as to how the cancer has affected his life (which has led to total disability and soon hospice).  I do not understand how such a letter would support establishing the service connection, as this to me seems that it would only support the percent disability. Most examples I have found of this Statement in Support of Claim discuss the ways the condition has affected the veteran's disability, but not to establish the service connection.   

Does anyone have any guidance or experience with how to convey the actual scientific literature and legal precedents to include in justifying the claim? 

Thank you in advance for any guidance you may have. 

So the first form I wold use is: Use VA Form 20-10207 to request priority processing for your claim due to certain qualifying circumstances or status.  Because he has terminal cancer this will alow him to go to the front of the line for processing his claim. You will need a letter from his doc stating he is terminaly ill do to his colorectal cancer. You will nned to submit it with the form.

The second form I would use is: VBA-21-10210-ARE-Lay-Witness-or-Statement in support of claim- (Ex 6-30-24) You, your father and mother should all fill one out. Have your father list all the places he served. I would use Statement in Support of Claim (form 21-4138) only as a lst resort as it seems it doesn't get read in the file.

(Other than attaching evidence to VA Form 20-10207 to request priority processing for your claim)

The third form You need to use is: VBA-20-10208-ARE-DOCUMENT EVIDENCE SUBMISSION Expiration Date-08-31-2026  I submit all evidence I have with this form. The VA has a tendency to lose your evidenc. This way they cant say they didn't get it.

If you have access to s scanner I would scan them all in to your computer and submitt them vis http://access.va.gov This will alow you to upload the forms and evidence directly into the VA system. It is much quicker that mail or faxing them. You will get a confermation sheet that will be mailed to the veterans email address of record. I would print it out and save it as you may need proof.

Go to this link it will alow you to signup for AO registery and there are other links that will be helpful that will give you direct access.

VET-HOME (Veterans Exposure Team - Health Outcomes Military Exposures)

I would sign in and use the portal. I would use EVERY resouce possable as time is of the essence with his type of cancer.

On 8/14/2024 at 1:23 PM, usmcwife27116 said:

Thank you for taking the time to respond. This is new navigation for me.   

The TERA is confirmed and is not disputed from the VA (and he has established service connection for HTN, DM based on his RVN TERA exposure) but these are relatively low disability ratings since it is his cancer that is the driver of his actual disability. The issue is that colorectal cancer is not yet one of the presumptive conditions related to AO exposure (most other cancers are, and colorectal is a presumptive for burn pits, but not yet for AO).  The reason for denial is simply stated as "toxic exposure was 50 years ago, not a presumptive condition". His documentation is clear on the disability caused by his colorectal cancer (all medical records and spousal support letter submitted detailing his ADLs that he is unable to perform, which is unfortunately at this time almost all of them). The dispute from the VA therefore appears to not be with whether or not he is disabled, but with whether or not his AO exposure is likely to have caused his cancer. We have a letter from an oncologist supporting this but I was able to find additional medical journals, prior VA case determinations granting this service connection for other RVN AO exposures, etc supporting the link.  I'm just not quite sure how/where to submit this info.

Thank you again.

Did her serve in any of the Gulf War or was he exposed to the burn pits?

The 20+ new presumptive conditions for veterans:

 

1. Brain cancer, 2. Gastrointestinal cancer of any type, 3. Glioblastoma, 4. Head cancer of any type, 5. Kidney cancer, 6. Lymphoma of any type, 7. Melanoma, 8. Neck cancer of any  type, 9. Pancreatic cancer, 10. Reproductive cancer of any type, 11. Respiratory (breathing-related) cancer of any type, 12. Asthma that was diagnosed after service, 13. Chronic bronchitis, 14. Chronic obstructive pulmonary disease (COPD), 15. Chronic rhinitis, 16. Chronic sinusitis, 17. Constrictive bronchiolitis or obliterative bronchiolitis, 18. Emphysema, 19. Granulomatous disease, 20. Interstitial lung disease (ILD), 21. Pleuritis, 22. Pulmonary fibrosis, and 23. Sarcoidosis.

Note that Gastrointestinal cancer of any type is no. 2 on the list.

I would challange the desition that says, "The reason for denial is simply stated as "toxic exposure was 50 years ago, not a presumptive condition". If memory serves me right the 20 new presumptives were add this year. 

I would file a suplmental Claim and add any new evidence you have that proves his cancer.

I am more sure that I speek for all her at Hadit.com that if you need any further help please ask.

 

VBA-20-10207-ARE -PRIORITY PROCESSING REQUEST (Expiration Date-08-31-2026).pdf VBA-21-10210-ARE-Lay-Witness-or-Statement in support of claim- (Ex 6-30-24).pdf VBA-20-10208-ARE-DOCUMENT EVIDENCE SUBMISSION Expiration Date-08-31-2026.pdf