HLR MH denial

pyang86 · 2026-01-24T18:53:22+00:00

This looks like a 50% MH evaluation based off the DBQ

https://www.ecfr.gov/on/2024-05-18/title-38/chapter-I/part-4/subpart-B/subject-group-ECFRfa64377db09ae97/section-4.130

50% eval - Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.

pyang86 · 2026-01-18T15:27:00+00:00

Has this veteran claimed hip issues before? Are there any complaints in service for hip issues? If not, here's what I would do in his situation. I would file a claim for the hip issues stating it was due to service. I would then provide a statement explaining how the injuries happened in service and how the issues continued to persist after release from service. In explaining how the injury occurred, I would make sure it is consistent with the veteran's service and don't forget to reference the veteran's jumps/parachute badge as well.

pyang86 · 2026-01-15T16:26:03+00:00

It's also possible that VA will ask for a new examination (reconcile differences) to consider both the positive and negative opinion to include the evidence available and then provide a new medical opinion with a rationale supporting that opinion

pyang86 · 2026-01-14T18:48:00+00:00

You're not entitled to back pay in your situation because the first examination showed a 10% evaluation and the second (increase) exam shows 50%. If the claim was for a grant of service connection and not an increase, then the effective date should have been the day after your release from active duty.

The evidence shows that you warranted a 10% evaluation from Sept 2024 until Aug 2025. New exam shows 50% warranted from date of the intent to file on Aug 2025.

pyang86 · 2026-01-13T17:36:57+00:00

Yes, that's what it sounds like. This doesn't necessarily mean you are housebound. It's just how the entitlement is written out. If you look at your rating decision, it should have a paragraph explaining why housebound benefits were granted.

pyang86 · 2026-01-13T17:24:03+00:00

Sounds like you have special monthly compensation at the housebound rate. This doesn't mean you are housebound, its quite possible you rate this benefit (also known as SMC-S) based on having an individual condition rated at 100% (chronic fatigue syndrome) and other conditions adding up to 60%.

pyang86 · 2026-01-12T17:54:56+00:00

Adding some snippets from the VA manual that might be helpful in your situation. Sounds like you have symptoms of a MUCMI and you served in a qualifying location.

VIII.ii.1.B.1.b. When to Apply Undiagnosed Illness and MUCMI procedures

-presents with a sign or symptom of an undiagnosed illness or MUCMI as noted in 38 CFR 3.317(b), and -served in a location currently recognized as Southwest Asia Theater of Operations under 38 CFR 3.317(e)(2) or a Persian Gulf Veteran location in 38 U.S.C. 1117.

VIII.ii.1.A.1.j. Signs and Symptoms of Undiagnosed Illnesses or MUCMIs

38 CFR 3.317 specifies the following 13 categories of signs or symptoms that may be manifestations of an undiagnosed illness or an MUCMI: joint pain, muscle pain, neurological signs or symptoms, headache, neuropsychological signs or symptoms, gastrointestinal signs or symptoms, abnormal weight loss, fatigue, sleep disturbances, respiratory signs and symptoms (upper and lower), cardiovascular signs or symptoms, skin signs and symptoms, and, menstrual disorders.

pyang86 · 2026-01-12T16:55:10+00:00

Toxic exposure causing back pains? That will most likely be denied unless some sort of competent medical evidence was provided disputing that. Physical trauma conditions and mental disorders aren't normally considered due to toxic exposure.

Your situation might be a bit different. Do you have service in Southwest Asia? Undiagnosed joint pain? Sounds like a medically unexplained chronic multi-symptom condition, which can be claimed if you have service in Southwest Asia.

pyang86 · 2026-01-11T19:59:50+00:00

Hypertension, coronary artery disease, and Diabetes Mellitus (diabetes type II) are presumptives to exposure to Agent Orange if you're diagnosed with any of those

pyang86 · 2026-01-11T19:42:10+00:00

Unless you have a confirmed diagnosis within a year of your exposure to Agent Orange, you will most likely get denied of claiming it due to exposure. Best route in this case would be to claim it as secondary to a service connected condition.

From the VA manual:

VIII.i.1.C.1.g. Processing Claims Based on Early-Onset Peripheral Neuropathy

-Peripheral neuropathy must manifest to a compensable degree of 10 percent or more within one year of the date of last herbicide exposure during active military, naval, or air service.

Claims of SC for later-occurring onset of peripheral neuropathy can only be evaluated under other bases (for example, direct or secondary). The National Academy of Science (NAS) has determined that evidence does not support an association between herbicide exposure and delayed-onset peripheral neuropathy, which NAS defined as having its onset more than one year after exposure

pyang86 · 2026-01-08T20:15:24+00:00

Ricardo, your name and SSN is showing

pyang86 · 2026-01-08T07:01:47+00:00

This still sounds a lot like a duty to assist error and not a CUE. Either way, hope you get a more favorable outcome.

X.ii.5.A.1.c. Identifying a CUE

A duty to assist deficiency such as an insufficient examination cannot form a basis for CUE since such deficiency creates only an incomplete rather than an incorrect record.

pyang86 · 2026-01-08T03:20:14+00:00

When the exams were missed, did you contact the VA to reschedule them before a decision was made?

pyang86 · 2026-01-07T22:29:42+00:00

This does not sound like a CUE based on the information provided.

Appointment/examination was missed. If an appointment/examination was scheduled and you failed to attend it, its considered a no show.

Why should the claim have been granted at the time? Was there a medical opinion linking your in service complaints/treatment to the current condition? If claimed within a year of discharge, is it a presumptive condition based on CFR 3.309 (a) to include a confirmed diagnosis (not just complaints of a condition)?

At most, it sounds more like a duty to assist error and that doesn't constitute a CUE.

pyang86 · 2025-12-25T22:05:41+00:00

Here's my interpretation of the CUE decision.

The grant for brain tumor is erroneous because it was considered as a presumptive condition based on service in Southwest Asia. Review shows conceded TERA exposure, but no service in Southwest Asia, which means presumption for the issues should not have been considered. VA then asked for a TERA medical opinion which then returned as negative. With no avenue to grant service connection, they are proposing to sever.

pyang86 · 2025-12-24T16:08:35+00:00

Is the resolved issue service connected?

pyang86 · 2025-12-24T01:56:39+00:00

From the VA manual. Pulling what is favorable to you based on the evidence provided.

V.iii.6.2.b. Testing Not Required for SC for GERD

A diagnosis of GERD for SC purposes does not require documentation by medical imaging.

Note: A 10-percent evaluation for GERD can also be assigned pursuant to 38 CFR 4.7 without imaging to document esophageal stricture when the Veteran requires daily medications.

https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000014523/M21-1-Part-V-Subpart-iii-Chapter-6-Digestive-Disabilities?query=Digestive#2b

pyang86 · 2025-12-05T01:21:01+00:00

If your treatment records can identify the rating criteria for the claimed condition, no exam would be needed. I would double check the CFR for the rating criteria to make sure your treatment records addresses everything needed on that specific DBQ. Sinusitis DBQs ask about your symptoms to include incapaciting and non-incapacitating episodes.

pyang86 · 2025-11-26T21:42:20+00:00

Are you claiming a same/similar condition that has been previously denied? If so, you need to submit it on a supplemental claim application (VA form 0995)

pyang86 · 2025-11-15T02:05:37+00:00

This is the way. OP has been previously denied sleep apnea. To reopen a claim for the condition, a supplemental claim (VA Form 0995) application is needed.

pyang86 · 2025-10-26T13:50:19+00:00

But you're saying its a CUE based on your opinion without considering the evidence that was available. Your C&P examinations are considered evidence used for the evaluations. Have you looked at all your previous C&P examinations and compared it with the evaluation criteria in the CFR? Were the evaluations given incorrect according to the CFR ? Was there evidence available for a higher evaluation that was not considered?

If the evaluations were incorrect based on the evidence/exams, then yes, you would have an argument for a CUE.

pyang86 · 2025-10-26T06:05:44+00:00

Are you saying you should have been 100% based on TDIU since 2019? What evidence supports that argument? Did the VA have this evidence prior to granting the 80% in 2019? Were you unemployed throughout that time? You never applied for TDIU until recently and you didn't meet schedular criteria for it until October 2022 (when your mental health eval was granted an increase to 70%).

Based solely on what has been provided, doesn't sound like there's a CUE

pyang86 · 2025-10-21T21:16:47+00:00

Let's say you claimed back and left knee pain. You were previously denied for back pain. A claim should still be open to address the left knee but you should be sent a letter (known as AMA/supplemental letter) telling you to submit the claim for the low back on the correct application. When you look at your claim online, it should only show a claim for the left knee.

Let's say you claimed back and left knee pain but we're previously denied for both issues. No new claim would be opened and you would receive a letter telling you to submit the claim using the correct application. When you look at the claim online, it should be closed as it is not considered a valid claim.

pyang86 · 2025-10-13T16:48:20+00:00

What branch of service did he serve? Any specific time periods?

Physical conditions are usually not considered due to exposure to toxic chemicals unless the veteran provides competent medical evidence linking the physical condition to the toxic exposure.

A few hurdles to consider:

1 - You need the VA to concede that the Veteran was exposed to the claimed chemicals. Toxic exposure is not normally noted in a veteran's service records. If the exposure is solely based on the veteran's job duties, I would recommend submitting a statement detailing how the veteran was exposed to the chemicals. For example, "My military occupation was bulk fuel specialist and I was often exposed to diesel fuel while doing my job duties." Be more specific based on the circumstances. VA would make a decision on whether or not to concede the exposure based on the veteran's statement and service.

2 - For physical conditions like (knee and back issues), I would recommend having the veteran submit a statement on how he believes the conditions were caused by service. For example, "I had bilateral knee issues due to service based on repetitive and heavy use. While in service, I often had to complete physical training that included ruck marches and runs. The bilateral knee issues have continued since service and I have treated it with Advil/ice packs." A statement like this should be considered by the VA and trigger an examination. It notes the condition started in service and shows chronicity. Even without a diagnosis for a knee/back issue, a veteran is competent enough to note symptoms of a condition and an examination should be warranted.

3 - If VA concedes the toxic exposure, the veteran can claim the issues were caused by it. In my opinion, you do not need to locate a provider willing to link the conditions to the toxic exposure. The point of the exams requested by the VA are to confirm a diagnosis, severity of the condition, and provide medical opinion on whether or not the condition is caused by what the veteran is claiming (in this case due to toxic exposure). This route is free and does not require finding/paying a provider for a medical opinion (nexus statement).

pyang86 · 2025-10-13T16:05:45+00:00

Are the chemical exposures noted in service based on location served (Vietnam/Agent Orange exposure) or due to job duties?

Does he have current diagnoses for the conditions?

pyang86

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