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Just Curious If Anyone Knows What The Thinking Is Regarding Claim

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7 replies to this topic

#1 ruby


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Posted 21 December 2007 - 04:27 PM

In Nov of 06 applied for increase.

CE done late Jan 06

Filed for secondary early Feb 07

Submitted all evidence in support of claim Mid April 07

Notified in July 07 of increase in award for primary increase

Recieved back pay retro from July of 05 (first seen by doc after 25 yrs)

Secondary was remanded for further medical exam.

Recieved CE Nov 28, 07.

CE at Regional Office Dec 18, 2007.

Does anyone know what the VA is doing such as agreeing that secondary is service connected? related to arthritis in all other joints

How long it will take on the raters desk based on the above.

What is the likely hood I will get an increase?

Would they retro from the 05 date or the date I filed for secondary claim.

I understand that your treating VA physician, stating that he feels you are P&TD isn't sufficient to the VA, is this in fact true.

I know its a waiting game but I have limited funds and I am getting scared that I will be forced to sell my house if I have to wait.

Any comments good or bad is welcome, I would rather know its really a game they play then false hope.

On my last comp exam for the secondary conditions they used 2 yr old xrays, if my rating is denied or less than what I think the minimum should be, would I dispute this based on them using 2 yr old xrays.

Thanks for any insight.



#2 Berta


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Posted 22 December 2007 - 08:23 AM

They will most likely use the date of the secondary claim for any retro on the secondary condition-

I would think a C & P exam would involve more recent X rays being taken-

If a VA doctor agrees with medical rationale that the secondary condition is due to the SC one- that should be good enough for the VA to award it as secondary-

"On my last comp exam for the secondary conditions they used 2 yr old xrays, if my rating is denied or less than what I think the minimum should be, would I dispute this based on them using 2 yr old xrays"

Yes you could argue on that basis but there would be nothing better than to have more recent Xrays done if the disability has gotten worse since then.

On that last exam- did they deny the secondary at that point? Not only the older XRays but anything at all they said in the C & P report that is incorrect and does not reflect the extent of this condition should be rebutted.

I am a little confused here-
have they formally denied the secondary but you are appealing the denial of that and did you appeal this with more medical evidence?

they will probly combone the rating with what you have now and do funny VA math- hard to say-

and even harder to know just when the VA will get a claim done-

We have to be PROACTIVE all the time-
and send to the VA- by Certified mail or priority with a tracking slip ANY and ALL evidence they need in order to award a claim.

I have continually sent VA evidence for almost 5 years now for my AO death claim.

If you have had any recent private Xrays or treatments done make sure they know this- and that they get this or you send it to them yourself.

#3 ruby


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Posted 22 December 2007 - 11:50 AM

No, they haven't denied the secondary, I am trying to get my ducks in a row should they, incase I have to appeal I want the info mailed to them the day I recieve the denial.

They can only deny half, as I am service connected for half of my body, primarily the left side, so its the right side that is in question.

This all goes back to whether they give me the arthritis as auto immune or degenerative.

That's why my question about if they remanded my SI's 20 yrs ago and no decision was made and I didn't do anything else about it, did I lose on the SI as service connected as that clearly shows 2 yrs after I was active I had minimal changes noted in my SI joints and it clearly states its is probably auto immune. From all my research minimal changes can show as early as 6mos to a year but there would be changes for sure at the 2 yr mark.

Here's part of what was written:

The Board notes that the vet is currently reported to have ankylosing spondylitis and there was x ray evidence of si joint involvement in 1977 during service. There was also xray evidence during service, however of a prior myelogram and it was subsequently reported on VA hospitalization that the veteran had fallen into a ditch a number of years earlier and had been treated with traction. The Board believes medical records of all such treatment should be obtained before a final appellate decision is reached on this issue form the veteran's appeal.

Accordingly, the claims folder is REMANDED to the originating agency for the following action:

The vet should be asked to specify the dates and sources of any back treatment she received prior to service. Whith her permission, the medicl records of such treatment should be obtained and associated with the claims folder.

When this development has been completed, the veteran and her representative should be provided with a supplemental statement of the case, if in order. The case should then be returned to the Board in accordance with the usual appellate procedures for futher review. The purpose of this REMAN is to obtain additional evidence. No action is required by the veteran until she receives further notice.

I had no evidence to give them that many years later, the myelogram was done in the late 60's to early 70's. I didn't remember the doctor I saw for the headaches 15-18 yrs after the fact. I didn't know to get my SMR records, I just got those in the last 6 months it clearly states who I saw then, they had that info and could have obtained those records which would have prove my side(there was no such thing as HIPPA in those days). There is no supporting evidence I can obtain, except letters from my family.

If they deny the degenerative and I lost my rights to file for the SI's/auto immune then I am screwed. I need to put my house on the market now, so I don't lose it by repossession. I have 6 months reserve, if I apply for SSDI and get it, it will only pay my mortgage nothing else.

I didn't quit my job because I wanted to, I had no choice, I can't do it anymore period, especially when they hired someone that another person refuses to work with and I am told I have to work with this person now who requires twice the amount of physical excertion then others---I can't do it.

Can anyone tell me what that REMAND means.Its driving me crazy, literally not knowing what may happen.

Thanks for your help.

#4 ruby


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Posted 22 December 2007 - 12:56 PM

This is what they sent me in July 07

In all my letters from family, friends, neighbors, employers they all mentioned that I extremely depressed due to how the arthritis is effecting me and that I was terminated from a job due to a severe asthma attack.

We are working on your application for service connected compensation for IU and depression--We need evidenc showing that the following conditions existed from military service to the present time. -----I don't have any, it is due to the years of constant pain and not be able to do anything but rest on my days off.---so no I won't get it for depression.

In July 07 I also recieved this response--they granted my increase rating for the cervical arthritis and asthma

3. Eval of residual-left wrist currently rated at 0% (now claimed as arthritis is deferred for VA exam)

4. Eval of residual left ankle currently rated at 0% (now claimed as arthritis is defered for VA exam

5. comp for arthritis in right hand, knees,right foot, SI joints--the issue of comp is deferred is defered for completion of all pending development, prior to rendering a deceision.

6. The issue of whether or not the veteran is entitled to IU is deferred for notification of VCAA--whatever that means

7. The issue of com for depression is deferred for notification of VCAA-whatever that means also.

My VSO doesn't really help me.

When I went for my CE on the feet, wrist, hands and knees. They never did my SI's. My xrays alone show that I should be wheelchair bound.

I called the VA and ask why, and they haven't called me back or written me as to why?

Only my SI's amd lumbar will get me 100% P&T based on there criteria of how visibily crippled you have to be.

I don't want IU, I want to work even if its a couple of hours a week. While others may not understand this is a biggie to me. I want to be the one to say I can never work again at anything.

Can someone please give me an opinion.

#5 Pete53


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Posted 23 December 2007 - 01:32 AM


It appears that the VARO is looking for Medical Evidence to show that you Depression can be linked to your service and it is your claim that it is linked to your condition already rated by VA.

This is not as hard as you may think all you need is a Doctor to give an opinion that your depression is something linked to your arthritis and than they need to figure out the effective date.

BTW the amount of time you want to work should not jeopardize getting 100% TDIU.

Good Luck on your claim

#6 john999


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Posted 23 December 2007 - 08:11 AM

Ask you VA primary care doctor to just write a letter for you linking the secondary condition to the primary. This worked for me twice. That is why it is good to keep going to the VA for treatment and "be nice" to your doctor. I had one that would just do anything for me, well almost anything. Get a female doctor if you can. They are more sympathetic. All my male doctors got deployed and bitched about it to me. Poor things!

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Posted 23 December 2007 - 09:00 AM


#3 and #4 in your letter means that they (VA)are waiting (deferring) on making a decision on these items until they have sent you to a C & P examination at the VA or with the VA medical contractors.

Once that's done they will look at the claim and the evidence and the new evidence doctors reports and make a decision at that time. It would be wise if you can to go to your private doctor and see if he will render his medical opinion, so when they look at medical reports they will have one from the VA and one from your private doctor. (IMO)

#5 is deferred because they are not finished with either gathering evidence or they are waiting on information from the Veteran. The claims development process is not yet complete. ( make sure you have signed and returned any VCAA notices they have sent you. Also make sure all of your evidence has been sent in.
SMR's- doctors records-family statements etc.

#6 and #7- means that they have not properly notified you regarding your rights and their responsibility to help you in providing the evidence needed for the IU. They need to send you a VCAA letter telling you what you need to send them in order to be rated TDIU. Unless you are properly notified with a proper VCAA letter you have the ability to appeal decisions because the VA failed to give proper notification (due process) with a VCAA letter.

This VCAA letter is good for you...the VA has to tell you exactly what they need from you, and if you provide the needed evidence then they have to award you IU.

Hope this helps

#8 ruby


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Posted 23 December 2007 - 10:52 AM

Thank you all for your opinions.

I am probably the VA's best friend due to the fact that I am not prone to go to the doctors for anything. I know I have arthritis and going to the doctor isn't going to change that, for years I have been able to take 2400 mg of motrin a day to keep the pain at a level I could work at, now that has stopped working and the other 4 meds they have tried me on don't work either.

I am taking the max dose of sulfasalazine, methtrotrexate, leflunomide, etoladac-I occasionally throw in motrin which is a no no, but I have to take something for the pain.

I guess the depression started about 3 yrs ago when things started going down hill quick.

I don't have a private physician, didn't go to docs just grinned and beared it, said thats life get use to it.

I have an appointment on Dec 26th with the rheumatologist to get my hands injected so I can use them. I will ask him to write a note that my arthritis is interlinked. He already wrote in my records he feels I am permantely disabled but I guess that isn't worded properly.

For SSDI I was going to ask him to fill out a RFC form to save time at SSA

Does anyone know how it should be worded?

Is this good enough: It is my opinion that the patients arthritis in all joints are interelated. Due to the patients decline in her health status it is of my opinion her depression is related to this condition.

I guess when they offered me the psych consult and pain management consult I should have taken it.