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Appeals And Rating - I'm Confused


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5 replies to this topic

#1 Objee

 
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Posted 05 January 2007 - 04:30 PM

I submitted a NOD and 2 new claims in May '06.
My VSO says they are all at Appeals.

Claims: Sleep Apnea and TDIU
NOD: Hypothyroidism

Will my claims go from Appeals to Rating or will
Appeals handle the whole situation? (The TDIU
needs the NOD and possibly the apnea claim to
hit the 60% or 40/70% for TDIU rating at VARO.)

The only rating I have now is 10% for hypothyroidism.
Hypo symptomatology rates 100% - I expect 60%.
Use a BiPap so apnea should be 50%.

The VARO is Oakland.

Ralph

#2 john999

 
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Posted 05 January 2007 - 07:03 PM

Have the 2 new claims been denied or approved yet? If they have not been adjudicated how can they be at the appeals level yet? The claim you sent in the NOD on should trigger an SOC and you should have either gone to the BVA or the DRO route. The claim you sent in the NOD on should split off from the other two and go to some sort of appeals process. The new claims need to be denied or approve first.

#3 olenavygoat

 
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Posted 05 January 2007 - 07:43 PM

I don't understand this either. If you submitted a nod, claims and a TDIU form I was under the impression that all of the files would go together to work on the TDIU request. Then, if in the process they actually look at your evidence and see if you could be rated 100% P & T without going the TDIU route they would work the new claims then appeals in order to send you a response. Their first duty is to look at your unemployability and keep you from living in the streets, then after the TDIU is awarded you can go and fight for 100% P & T so your spouse and children can benefit and spouse also receive Dependant Indemnity Compensation if and when you pass.

#4 Objee

 
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Posted 05 January 2007 - 08:10 PM

It's a "VA cute" situation. I NODded my July '05 DL
for all 3 items - hypo, apnea and TDIU based on the
reopening medical opinion cited in the DL as evidence but not
addressed at all in the decision. (I reopened the claim from
'92 in 2003.) The claim opinion doc said I was 100%
permanently disabled due to thyoidectomy, due to ionizing
radiation, resultant hypothyroidism and sleep apnea
secondary to the hypo. VA granted 10% for hypo. Service
medical records aren't important since thyroid cancer shows
up years after exposure. My hypothyroid mental problems
appeared but were not diagnosed as such on active duty.

The Oakland VARO carved the apnea and TDIU out of
the NOD, saying they were new claims. This would eliminate
3 years of retro, so their motivation is clear.

OK, so the NOD goes to Appeals and the claims to Rating,
right? Not in this case and that's what has me confused.

Ralph

#5 Vike17

 
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Posted 06 January 2007 - 12:38 AM

Objee,

First of all, before I can even begin to speculate on what is happening, you need to get your story straight. I don't mean this in a negative way, jsut trying to sort things out, as you said in your first post;

"I submitted a NOD and 2 new claims in May '06. My VSO says they are all at Appeals. Claims: Sleep Apnea and TDIU. NOD: Hypothyroidism"

Then said in your most recent post;

"It's a "VA cute" situation. I NODded my July '05 DL
for all 3 items - hypo, apnea and TDIU based on the
reopening medical opinion cited in the DL as evidence but not
addressed at all in the decision. (I reopened the claim from
'92 in 2003.)
"

Apparently you were denied back in 1992 for some condition. Was it for Sleep apnea, hypothyyroidism and IU, or just one of them?? Then you submitted "new and material evidence to try and re-open those denied claims in 2003 and were subsequently denied in July, 2005. When was Hypothyroidism granted, in July, 2005?

You also stated;

"The claim opinion doc said I was 100% permanently disabled due to thyoidectomy, due to ionizing radiation, resultant hypothyroidism and sleep apnea secondary to the hypo"

If I'm not mistaken, isn't thyoidectomy the removal of the tyroid gland? Do you have your thyroid gland? Also, it doesn't matter whatthe doctor said as far as his opinion on what the rating pecentage is. that's up to the RVSR. For what it's worth, according to the VA Physician's guide to C&P exams, it specifically states that an examining doctor should not opine as to the percentage of disability he/she thinks should be awarded. Did the examining doctor make an official nexus statement for the sleep apnea? I'm not sure how a non-functioning thyroid gland can cause sleep apnea, but I'm not a doctor. Having said that, being tired is a symptom of a thyroid gland that isn't working correctly. Maybe the two got mixed up ??

"My hypothyroid mental problems appeared but were not diagnosed as such on active duty"

Are you contending that you should be awarded an earlier effective date??? When did you ETS from the service? Was it in 1992 when you filed your original claim??

"The Oakland VARO carved the apnea and TDIU out of the NOD, saying they were new claims. This would eliminate 3 years of retro, so their motivation is clear"

You need to answer all of the questions I've asked before I can even begin to sort things out and give an educated guess/answer to your questions.

Vike 17

#6 Objee

 
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Posted 06 January 2007 - 01:01 AM

Objee,

First of all, before I can even begin to speculate on what is happening, you need to get your story straight. I don't mean this in a negative way, jsut trying to sort things out, as you said in your first post;
Sorry about the confused posting.


"I submitted a NOD and 2 new claims in May '06. My VSO says they are all at Appeals. Claims: Sleep Apnea and TDIU. NOD: Hypothyroidism"

Then said in your most recent post;

"It's a "VA cute" situation. I NODded my July '05 DL
for all 3 items - hypo, apnea and TDIU based on the
reopening medical opinion cited in the DL as evidence but not
addressed at all in the decision. (I reopened the claim from
'92 in 2003.)
"

Apparently you were denied back in 1992 for some condition. Was it for Sleep apnea, hypothyyroidism and IU, or just one of them?? Hypothyroidism and all other diseases secondary to thyroidectomy. Then you submitted "new and material evidence to try and re-open those denied claims in 2003 and were subsequently denied granted 10% in July, 2005. When was Hypothyroidism granted, in July, 2005? Correct

You also stated;

"The claim opinion doc said I was 100% permanently disabled due to thyoidectomy, due to ionizing radiation, resultant hypothyroidism and sleep apnea secondary to the hypo"

If I'm not mistaken, isn't thyoidectomy the removal of the tyroid gland? Do you have your thyroid gland? No Also, it doesn't matter whatthe doctor said as far as his opinion on what the rating pecentage is. that's up to the RVSR. For what it's worth, according to the VA Physician's guide to C&P exams, it specifically states that an examining doctor should not opine as to the percentage of disability he/she thinks should be awarded. Did the examining doctor make an official nexus statement for the sleep apnea? Yes I'm not sure how a non-functioning thyroid gland can cause sleep apnea, but I'm not a doctor. Thyroidectomy caused hypothyroidism & obesity. Both are causative of sleep apnea. Having said that, being tired is a symptom of a thyroid gland that isn't working correctly. Maybe the two got mixed up ?? The 10% was granted in 2005 for fatigue and medication.

"My hypothyroid mental problems appeared but were not diagnosed as such on active duty"

Are you contending that you should be awarded an earlier effective date??? No When did you ETS from the service? In 1964. Thyroidectomy was in 1981. Was it in 1992 when you filed your original claim??

"The Oakland VARO carved the apnea and TDIU out of the NOD, saying they were new claims. This would eliminate 3 years of retro, so their motivation is clear"

You need to answer all of the questions I've asked before I can even begin to sort things out and give an educated guess/answer to your questions.

Vike 17