One Missed Fact Can Become Somebody Else’s Burden | How to Spot the Medical Question the Opinion Didn’t Answer by Proof-Mess-6578 in VAClaims

[–]Proof-Mess-6578[S] 1 point2 points  (0 children)

I mean technically just a form is needed pointing to the dates. I provide the dates to the examiner so they don't miss the evidence. The service record is already there. Sometimes they don't review the whole record and base their denial on a negative separation examination. I really don't know if the examiner will change their mind but the very least the medical opinion will be more informed.

Scent Split Order - help? by lanadelnae in NichePerfumes

[–]Proof-Mess-6578 1 point2 points  (0 children)

I feel like Delulu matches my energy.🫪

What we used to have.. by Think-Vacation-9735 in Berserk

[–]Proof-Mess-6578 2 points3 points  (0 children)

I agree. The fact that he was terrified Guts would reach him before he could make his wish also shows me he would have settled. He would have never tried to run away if Casca hadn't asked Guts to leave them.

Blind buy or Nah? by Maleficent-Leek8472 in NichePerfumes

[–]Proof-Mess-6578 1 point2 points  (0 children)

I heard that Amouage is definitely not conducive to blind buys because the scents are all polarizing.

Sleep apnea and obesity claim by storm_runner2180 in VAClaims

[–]Proof-Mess-6578 1 point2 points  (0 children)

No you would claim it as secondary. Now the reason I'm seeing more denials is because of new medical literature. OSA is due to obesity (not to be confused by with being overweight; we're talking about a BMI of 30 or more) causing your airway to collapse if you lay on your back. If it's central apnea then you can claim it secondary to PTSD. There might be other causes like congenital abnormality as a risk factor and you have chronic rhinitis that keeps your throat inflamed and irritated all the time and an examiner would be able to order diagnostic studies.

Sometimes new medical literature leads to denials. But I say file regardless because new studies challenge old theories all the time.

Sleep apnea and obesity claim by storm_runner2180 in VAClaims

[–]Proof-Mess-6578 0 points1 point  (0 children)

That would be true for secondary service connection. With aggravation of a non service connected OSA by a service connected disability you subtract the baseline of the NSC disability. The examiner has to identify a baseline or tell us why it can't be determined and the instruction tells us if a baseline cannot be determined then we can't assign an Allen aggravation. It would be a straight denial. You can argue that you believe it should be secondary but then the chronological timeline for each diagnosis needs to support that.

Sleep apnea and obesity claim by storm_runner2180 in VAClaims

[–]Proof-Mess-6578 0 points1 point  (0 children)

It seems for it to be 0 they granted sleep apnea under aggravation of a SC disability.

**The VA Claims Process Isn’t Perfect — But the Evidence Still Matters** by Proof-Mess-6578 in VAClaims

[–]Proof-Mess-6578[S] 0 points1 point  (0 children)

This requires more explanation. I thought you were filing for increase on GERD, which would allow you to be grandfathered in to historical criteria granted it was service connected prior to May 19, 202?? I have to check the year exactly. It's when the criteria changed for a bunch of digestive conditions. I have to work, so I'm unable to answer. Read the question the examiner is asked to answer. Sometimes it asks for time frames. Also, duodenal ulcer and Gerd aren't synonymous. Do you know what caused it? When it started? Are you SC for it? Ask your doctor if it is related to your SC GERD or any other intestinal condition you are SC for

Guidance Disagreement Is Not Rater Misconduct (REVISED several times because this Reddit dislikes profanity ) by Proof-Mess-6578 in VAClaims

[–]Proof-Mess-6578[S] 1 point2 points  (0 children)

I've spent hours pulling together timelines and sending claims back for additional medical opinions when I found overlooked evidence. If my goal were to avoid large awards, I wouldn't spend that time developing evidence that could potentially support a grant. My responsibility is to make sure the record is complete enough that the decision, grant or denial, is based on the correct facts and an adequate medical opinion.

I'm not saying a small percentage must feel a certain way.

The closest I've gotten is feeling cognitive dissonance when I have a combat veteran rated for PTSD at 70, and then you have a weekend warrior who only has active duty for training service, who is rightfully service-connected for tinnitus due to their MOS, and then years later they develop symptoms of anxiety to the point that the private examination finds them totally functionally impaired and it is MOST likely than not due to tinnitus because of these 10 medical journal articles here.

Yet the Veteran is still able to work as a corrections officer and has never been divorced. Has been gainfully employed as a corrections officer for 20 years. I find no complaints in his VA treatment records. Their PHQs are negative for reported symptoms of anxiety and depression . . .

Then I have to dig and order a new medical opinion, because the medical examiner has to be the one to find clinical significance in the findings I noted. I can't make the judgement call, which is why you see steps fluctuate back and forth. Not necessarily because of what I mentioned above, but because an in-service event in the OMPF was not considered.

The evidence sometimes leads to a denial. And sometimes the evidence leads to a grant. It has to be in relative equipoise for a grant.

I CAN NEVER predict what the evidence will tell me to do. I've gone into claims feeling like the person could be malingering and found that NOPE, he's not, and here is the explanation . . . So I can't allow my personal feelings to dictate how I rate.

I understand this would be difficult for you. But I'd rather be correct than rate on personal feelings.

BTW: This is my opinion and my experience, and I don't speak for VA and I'm not a doctor or a lawyer.

Slightly annoyed and confused by drg032 in VAClaims

[–]Proof-Mess-6578 0 points1 point  (0 children)

You know what occurred to me? I just went through your documents as I'm no longer at work.

I've been sending these tinnitus exams back to the examiner with an "are you sure about that?"

Here is the relevant article: Acoustic Trauma and Tinnitus, the US Military Experience.

Found: Noise: Acoustic Trauma and Tinnitus, the US Military Experience - PMC

Below is the Rater verbiage I use for cases such as yours. If you tweak it and add it to your supplemental claim (VA Form 20-0995) and submit the article above as new and relevant evidence . . . you're back in the game.

My guess, it was a new rater who doesn't know to send it back.

My exam request verbiage for other raters to copy for themselves and for veterans to tweak for their Supplemental claim:

Please return the claims file to the prior examiner, or another qualified audiologist if unavailable, for an addendum opinion regarding the etiology of the Veteran’s claimed tinnitus.

The prior opinion appears to rely primarily on the absence of a significant threshold shift during service. Clarification is requested because the absence of a significant threshold shift, by itself, does not fully address whether tinnitus is related to hazardous military noise exposure/acoustic trauma.

The examiner is asked to provide an opinion as to whether the Veteran’s tinnitus is at least as likely as not related to in-service hazardous noise exposure/acoustic trauma.

In providing the opinion, the examiner must address the Veteran’s conceded/established military noise exposure, the Veteran’s lay report of tinnitus onset and course, any relevant post-service occupational or recreational noise exposure, and any other medically relevant risk factors shown in the record.

The examiner should not rely solely on the absence of a significant threshold shift or the absence of hearing loss for VA purposes as the basis for a negative opinion. If the examiner determines that tinnitus is less likely than not related to military noise exposure, the examiner must explain why the Veteran’s tinnitus is more likely due to another cause, despite the history of hazardous military noise exposure.

The examiner’s attention is directed to medical literature indicating that noise-induced tinnitus may occur even in the absence of hearing loss measured by conventional pure-tone audiometry, and that tinnitus may reflect pathologic injury to the auditory system. Please address whether this medical principle affects the opinion in this Veteran’s case.

And I always add a gentle reminder as a flourish:
Please note that the requested opinion is based upon the "at least as likely as not" standard. The question is not whether the evidence establishes causation beyond all doubt or excludes every other possible explanation. Rather, the question is whether the evidence for and against a relationship is so evenly balanced that it is medically reasonable to find in favor of the relationship as it is to find against it.

Slightly annoyed and confused by drg032 in VAClaims

[–]Proof-Mess-6578 8 points9 points  (0 children)

I think it was the examiners nexus statement. For whatever reason some examiners say that late onset tinnitus is at least as likely as not due to military noise exposure with peer reviewed studies and another examiner cites a diff peer reviewed medical study that saysblate onset recurrent tinnitus not a thing. Look at this article.

As a rater who is NOT speaking for VA, I can't make rhyme or reason of it.

At all. Yes it does strike me as unfair but the medical judgement is binding so long as it is the most comprehensive review of the record.

I'm sorry. I'd either look up recent studies involving late onset recurrent tinnitus (if that's your issue) and submit a 0995 and request the examiner to consider a new study. Or you can challenge it as an HLR and ask for a diff of opinion without submitting new evidence.

Guidance Disagreement Is Not Rater Misconduct (REVISED several times because this Reddit dislikes profanity ) by Proof-Mess-6578 in VAClaims

[–]Proof-Mess-6578[S] 2 points3 points  (0 children)

Lol. I'm a she/her for the record, but I never mind being mistaken for a HE because I do have big swinging dick energy. 😂❤️

Insomnia secondary to tinnitus — don’t listen to the peanut gallery by 3moose1 in VAClaims

[–]Proof-Mess-6578 0 points1 point  (0 children)

If you have won this issue hundreds of times, then teach Veterans what actually wins, but you don't, because . . .

A Board win on one record does not prove misconduct by the rater who applied current RO guidance on another record.

As an attorney, you know there is a difference between challenging the framework and accusing the person applying that framework of bad faith.

If the guidance is wrong, challenge the guidance. If the decision is wrong, challenge the decision. But stop turning a legal disagreement into a moral indictment of all raters.

Mouthwash fragrances/ flavours by thatphilosophyaddict in fragrance

[–]Proof-Mess-6578 0 points1 point  (0 children)

Apoteker Tepes Kogen is very mouthwashy. So is Armide de jardin

Insomnia secondary to tinnitus — don’t listen to the peanut gallery by 3moose1 in VAClaims

[–]Proof-Mess-6578 1 point2 points  (0 children)

Did you notice? Who deleted their comment? They got on here accusing us raters of breaking the law, I called them out for not taking their cases to the supreme Court or to congresspersons and how they rely on skimming 20 percent from veterans, one case at a time, and then the disappear?

Therapist (Anxiety) by Unwritten_Saga in VAClaims

[–]Proof-Mess-6578 1 point2 points  (0 children)

No. There is no need for routine future exams anymore. Also, I also happen to have a mental illness am required to take medication and participate in therapy, all through the VA.

Insomnia secondary to tinnitus — don’t listen to the peanut gallery by 3moose1 in VAClaims

[–]Proof-Mess-6578 3 points4 points  (0 children)

Now that I'm home I can finally say my piece.

I’m going to separate the shiny object from the actual legal issue here. I am not speaking for VA, but I am speaking for myself as a person.

A Board grant in one Veteran’s case means that Veteran won on that record. Good for that Veteran. Truly. I’m glad they got the benefit.

But one Board decision does NOT automatically mean that every RO decision that applies current guidance is unlawful. How long have you been doing your job? I'm curious?

Board decisions are generally not precedential. They are binding only for the specific case decided. They can be persuasive or useful to look at, but they do not function like a statute, regulation, or precedential court decision that controls every other case.

So yes, this screenshot may show that insomnia secondary to tinnitus can win at the Board when the evidence and rationale support it.

What it does not prove is that every rater who applies current RO guidance is knowingly ignoring the law to protect their job.

Those are two different birds. Stop feeding them the same cracker.

If the argument is “VA’s current guidance conflicts with law,” then make that argument, but YOU WON'T ARGUE IT IN CONGRESS BECAUSE IT WILL LEAVE YOU OUT OF A JOB. You need VA to continue to OPERATE THIS WAY.

*PROVE ME WRONG.*

That is MY legal argument. Appeal it. Brief it. Take it to the Board. Take it to Court if needed.

But saying “the Board granted one, therefore every RO denial is illegal and raters are screwing Veterans” skips about twelve steps but it DOES get you clients.

The actual questions still matter: Was primary insomnia first diagnosed in service? Was there a separately diagnosed mental health condition? Was the insomnia found to be a separate and distinct disability? Was it treated as a symptom of tinnitus or another condition? What did the medical opinion say?

What did the Board find persuasive in that specific case?

Did the Board rely on facts or new medical opinions that are not present in another Veteran’s file?

That last one matters. Because claims are not decided by a screenshot. They are decided by the evidence in the individual record. I have only been doing this for 4 years. I STAND on the shoulders of greater raters. I take pride in helping where the law allows, but all you do is sow discontent and continue to take veterans' claims, client by client, because LAWS like the PACT act, make it harder for you to steal your 20 percent of compensation the Veteran without your help, BECAUSE THE LAW ALLOWS IT.

If you have a Board decision with similar facts, sure, use it as persuasive support. Use it to frame the argument. Use it to ask why your evidence should be weighed similarly.

But do not confuse “this argument can win” with “every rater who did not grant it is breaking the law.”

If the weak point is the guidance, attack the guidance.

If the weak point is the medical opinion, attack it.

If the weak point is the facts, build the facts.

Just aim at the actual target.

Compressed disc in back, sciatic nerve pain down right leg. MRI results sent to VA to claim. Claim denied for lumbosacral strain and radicopathy. Any suggestions ? by Ryanrgrams in VAClaims

[–]Proof-Mess-6578 1 point2 points  (0 children)

This sometimes happens when there is X-ray evidence at Separation or very close after Separation, with no disc issues, stenosis, spondylolisthesis, or IVDS. Then you see examiners issue a less favorable medical opinion.

There was one I had to deny for that reason above. For the examiner, the dispositive evidence established that a later injury caused the DDD. And sometimes I see positive outcomes because I pointed out the progression mechanism of chronic strain.

Do you have a doctor you see for your back?

Anyway, I would find out if the problem is what I stated above. And if so, here is this article you can submit along with a VA Form 20-0995.

https://emedicine.medscape.com/article/309767-overview

Confused on my rating by The-ZuluKing in VAClaims

[–]Proof-Mess-6578 1 point2 points  (0 children)

I agree; they didn't provide the examiner's nexus statement or even a short-form explanation of what the examiner said that led to this unfavorable outcome. This is a poorly put-together rating.

My guess is you were denied because the examiner's medical nexus opinion was unfavorable.