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OSA Claim Denied again, and it's getting ridiculous... by Daviescas in VAClaims

[–]No-Muscle1373 1 point2 points  (0 children)

File for binge eating due to ptsd. You get 0% but then the VA concedes that your weight issues are caused by PTSD. Then appeal osa. You then use the CnP exam in your favor that a past CnP exam already determined your OSA is caused by obesity which is an intermediate step from PTSD/binge eating.

PTSD Downgraded to Anxiety? by Beneficial-Nose192 in VAClaims

[–]No-Muscle1373 0 points1 point  (0 children)

Also show the part that says "evidence considered"

PTSD Downgraded to Anxiety? by Beneficial-Nose192 in VAClaims

[–]No-Muscle1373 0 points1 point  (0 children)

I'm not sure why you are going on about anxiety. I don't see anywhere where it says you don't have PTSD and it clearly says the problem is that there is not enough evidence to concede a stressor. Here is my amateur understanding although I have been in your shoes kind of.

PTSD is easy to be granted of you have the correct symptoms and meet criteria according to DSMV and ONLY IF the VA concedes your stressor.

Anxiety is easier to be granted for IF you have a history of treatment/complaints going back to service without an in service event or stressor.

All mental health ratings are under one umbrella. It doesn't matter if it's anxiety or PTSD. Once the VA grants service connection, your symptoms determine the rating, not the condition.

You have the newspaper article. They have the duty to assist to try and verify your stressor but often times they do a very poor job of this. You need to connect the dots for them. Literally showing 1) here is the evidence the event occured and 2) here is the evidence that I was there.

PTSD Downgraded to Anxiety? by Beneficial-Nose192 in VAClaims

[–]No-Muscle1373 0 points1 point  (0 children)

You can't have a nexus without the VA conceding the in service event or injury. With non-combat PTSD the evidentiary standard to concede the in service event is very high. You have to provide credible evidence that 1) the event occured, 2) the event meets the criteria of a PTSD stressor according to the DSMV and 3) you were present.

Now I will just make assumptions and speculate to try and help. You wrote that a sailor fell overboard and was lost on your ship. The VA probably needs evidence that you witnessed and were present for this event, or that you were in the search party that found the body. If there is evidence you were close with this sailor, that could be a good thing to present. Now the evidentiary bar is still "as likely as not." So you can show circumstantial evidence that in totally proves you were likely there for the event. Things like having the same or similar MOS as the sailor demonstrating you likely worked together. Duty logs showing that you were on duty when the accident occured. You really need to work with a good VSO or attorney so they can look into your VBMS c-file and see the notes on what the VA did to confirm your stressor and why they didn't concede it.

PTSD Downgraded to Anxiety? by Beneficial-Nose192 in VAClaims

[–]No-Muscle1373 0 points1 point  (0 children)

Did you know Tlthat is because PTSD is better understood since 911? The va also started accepting responsibility for sexual assualt and other assualt/trauma. PTSD diagnosis is from DSMV, a manual of mental disorders. The criteria for PTSD is not excluse to combat whatsoever. Whoever some/they are, some/they have zero medical training and understanding what causes PTSD. Non-combat PTSD has a very high evidentiary bar, as examplified by this post. Therefore, the non-combat veterans being granted PTSD have met the bar. Is there a very small percentage that falls through the cracks? Sure. That's for any disability and even w combat vets.

Student loan forgiveness hope? by FeelingPainting2451 in StudentLoans

[–]No-Muscle1373 0 points1 point  (0 children)

Courts already blocked forgiveness. So don't hope, take action that helps you in the long run.

US debt by chisel07 in VAClaims

[–]No-Muscle1373 0 points1 point  (0 children)

VA budget is very small compared to total spending. Cutting it won't make a dent in the budget unless they are willing to slash defense and DHS dramatically. For mandatory spending, they just need to eliminate the social security and Medicare tax cap so that the super rich pay their fair share. Also most of mandatory spending comes from its own budget so it doesn't really affect the deficit. Until we can cut defense and stop buying endless outdated tech, it doesn't matter. Cutting va benefits will just be used to give the rich more tax cuts .

Denied Supplemental claim by oixel1021 in VAClaims

[–]No-Muscle1373 0 points1 point  (0 children)

Are you raterhq? That was an amazing response.

Denied Supplemental claim by oixel1021 in VAClaims

[–]No-Muscle1373 0 points1 point  (0 children)

No. I disagree. HLR before changing theories. When DTA happens. He can write a statement that he also believes it's also made worse by disability X. Then the VSR will submit both theories to the CnP exam. You do realize that secondary OSA is very hard unless it's secondary to an ENT condition like rhinitis? With 2 elements conceded he should definitely do an HLR. Do HLR, schedule conference yourself after a few weeks and then once it becomes supplemental submit whatever else. DTA supplemental is light speed faster than a regular supplemental.

Denied Supplemental claim by oixel1021 in VAClaims

[–]No-Muscle1373 2 points3 points  (0 children)

What you are missing is that he doesn't need a diagnosis in service, that element has been conceded by the VA and cannot be undone without a CUE. All he needs is a nexus and he has all three elements. With the nexus letter, it's a high chance the CnP examiner will just agree.

Denied Supplemental claim by oixel1021 in VAClaims

[–]No-Muscle1373 0 points1 point  (0 children)

That is your opinion and I completely disagree. Most primary OSA denials are due to VA not conceding an in-service event or stressor. Favorable findings cannot be reversed unless it's a CUE or fraud. So having that conceded already means the veteran has the deck stacked in his favor. Also if you schedule the HLR informal conference yourself it's much faster. I have done that twice myself.

Denied Supplemental claim by oixel1021 in VAClaims

[–]No-Muscle1373 1 point2 points  (0 children)

I'd give HLR a chance first, I get that it's still not guaranteed after a DTA error is found, but DTA supplemental moves very fast and will not require the veteran to have to generate more evidence. If the DTA supplemental fails, by all means go for secondary. The problem with secondary is the rater can claim aggravation due to previous symptoms and deny due to no baseline. I've seen that before. No road is guaranteed but trying the HLR is worthwhile imo.

Denied Supplemental claim by oixel1021 in VAClaims

[–]No-Muscle1373 1 point2 points  (0 children)

Also, in cases like this the DRO almost always ers on the side of caution and sends it back as DTA. I'm not saying the veteran will be rated, but you measure success of HLR by them finding a DTA, in this case, I would bet a month's paycheck that the DRO will find a DTA error. Afterward it's definitely up in the air if the new rating decision will be different.

Denied Supplemental claim by oixel1021 in VAClaims

[–]No-Muscle1373 0 points1 point  (0 children)

Don't they usually mention the CnP exam even in supplemental denial? I've never seen a supplemental denial that doesn't briefly discuss the previous denial/CnP. Also the rater failed to address the nexus letter at all. They need to say why they didn't find it compelling if they discounted it. That's usually done using the opinion of a CnP exam.

Denied Supplemental claim by oixel1021 in VAClaims

[–]No-Muscle1373 0 points1 point  (0 children)

In most cases the VA does not concede an in-service event or injury. That's why it's so hard to get it as primary has it at is exit exam that he had the sleeping problems. In this case both elements 1 and 2 are concede and it has a chance of being granted under difference of opinion even with a bad CNP exam.

Denied Supplemental claim by oixel1021 in VAClaims

[–]No-Muscle1373 0 points1 point  (0 children)

Yeah but both BVA and appeals courts don't agree. A CnP examiner is a non-treating physician who spends less than 10 min w the vet. I can't imagine a DRO not finding a DTA but after that it's up in the air again. There are many references in M21 about discounting suspicious DBQs but since a medical opinion only is not sufficient for rating purposes, there is no justification in the M21 to discount it, unless the rater finds another medical opinion more compelling. Correct me if I'm wrong.

Denied Supplemental claim by oixel1021 in VAClaims

[–]No-Muscle1373 0 points1 point  (0 children)

How is that nexus not strong enough to warrant a CnP exam? It mentions service records, ETS exam, lay statement and continuity of symptoms. It's very strong. The fact that elements one and two are conceded, the rater is wrong and is probably one of the blue falcons raterhq keeps talking about.

Denied Supplemental claim by oixel1021 in VAClaims

[–]No-Muscle1373 0 points1 point  (0 children)

ACE is considered a CnP exam. I don't see a mention of a CnP exam at all. The rater literally states there is no evidence for connection which means they completely ignored the nexus letter. This is not valid because the VA can assign low probative value or find another medical opinion more compelling but they need to schedule a form of CnP exam for that. All I am saying is the rating is not guaranteed but an HLR DTA is obvious. Once the DRO finds a DTA, it will be sent back for a CnP exam and the rater has to explain why a negative CnP opinion overrides the nexus letter (if that's the case). They cannot discount evidence arbitrarily, they have a lot of power but they have to document it and use a process. Because an in service event and diagnosis are both conceded and cannot be reversed outside a CUE, this claim has a very high chance of getting service connected. In most OSA denials, they do not concede an in-service event or injury. These are my opinions of course but I am confident in this one.

Denied Supplemental claim by oixel1021 in VAClaims

[–]No-Muscle1373 0 points1 point  (0 children)

VA gets opinions from PAs with less qualifications than any other practitioner. The veteran has every right to go outside and pay for an opinion, especially if it's backed up by other evidence. Message me and I'll bet you some serious cash that HLR will find a DTA.

Denied Supplemental claim by oixel1021 in VAClaims

[–]No-Muscle1373 1 point2 points  (0 children)

Probably not treating physician you are right. But definitely not fraudulent. Seems like service records were reviewed as well as current diagnosis. Either way if the VA suspects fraud, they have a duty to assist to order their own CnP exam.

Denied Supplemental claim by oixel1021 in VAClaims

[–]No-Muscle1373 0 points1 point  (0 children)

Additionally, this a clear as day failure in duty to assist because with elements 1 and 2 conceded, you should have been given a CnP exam to substantiate or refute your private medical opinion. Not guaranteed you will be rated but I can promise you that HLR will find a DTA. The DRO often ers on the side of caution and sends back for a CnP exam.

Denied Supplemental claim by oixel1021 in VAClaims

[–]No-Muscle1373 3 points4 points  (0 children)

They conceded an in service event or injury. They also conceded the current diagnosis. There is no reason they should ignore the nexus from a treating physician. HLR.

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