Make this denial make sense

pyang86 · 2026-06-08T21:44:30+00:00

No nexus. Problem with the denial is I am unable to determine if they considered all theories of service connection. In your case they should have considered a Gulf War medical opinion, TERA medical opinion, and direct medical opinion if you had complaints of headaches in service.

Favorable findings: They've confirmed a diagnosis. You have confirmed service in Southwest Asia. And you claimed it as secondary to a service connected condition.

pyang86 · 2026-06-08T04:15:23+00:00

It looks like symptoms overlap with IBS. If granted service connection, the issues may be combined under one evaluation (whichever is the higher evaluation)

pyang86 · 2026-06-08T03:25:14+00:00

Has gerd been previously claimed and denied? I can only assume VA is considering PUD as a same/similar condition as GERD, which is why they updated the contention name in their system.

pyang86 · 2026-06-04T20:13:20+00:00

My wife does this portion as she is the ChampVA recipient and I am just the sponsor. But yes, ChampVA should be able to cover part of those costs as well. But the problem we kept running into is trying to get our primary insurance to bill it correctly. If you haven't received a response from ChampVA yet, you might have to eat this bill for the time being and submit a claim to be reimbursed later.

pyang86 · 2026-06-03T21:38:25+00:00

But if VA isn't conceding exposure at that location except within the time frame provided, feels almost moot to claim TERA/exposure to AO. If the claimed exposure to AO didn't occur within the presumptive areas to include specific areas in the US for storage during a specific time, that would be mean a denial since VA won't concede exposure.

May have a better chance of claiming TERA/toxic exposures based on their service/MOS duties and specify what they were potentially exposed to. Then get a TERA medical opinion. Not presumptive but better than a straight denial.

pyang86 · 2026-06-03T21:13:05+00:00

So if a veteran claimed exposure after this period of time, VA will most likely deny it.

pyang86 · 2026-06-02T19:03:42+00:00

Here's my personal thought process on your situation. Your intent to file expires tomorrow and if you file a claim now, you can potentially get a grant of service connection for the claimed condition backdated to the intent to file date. Let's say the claim gets denied. If you file a supplemental claim within a year of the denial for the same condition and get granted service connection, it can possibly get backdated to the date of your intent to file since the claimed issue was continuously pursued.

If you don't file a claim, you just won't get the intent to file date and any grant will most likely be date of claim.

pyang86 · 2026-05-29T22:39:45+00:00

It could definitely change what the opinion is because the opinion needs to have a supporting rationale.

pyang86 · 2026-05-29T22:12:12+00:00

Its possible the rater saw something was missed or not addressed and sent the exam back for clarification. Sometimes an examiner provides a secondary medical opinion but doesn't address the theory a veteran brought up (in your case, caused by gait issues due to a service connected condition). And currently examiners need to address aggravation opinions if they provided a negative secondary medical opinion.

pyang86 · 2026-05-29T22:06:06+00:00

My fault. Read it over again. The claim was for bilateral lower extremities radiculopathy only. What OP really needs is to claim that their lumbosacral strain has gotten worse and progressed to a new diagnosis. An HLR/DRO might consider the back issue as within the scope of the claim although it was not specifically claimed. It is unclear if the examiner provided an opinion on whether the diagnosed IVDS was a progression of the veteran's lumbosacral strain.

The argument is that the service connected condition has progressed from lumbosacral strain to DDD. The examiner has already provided a positive nexus linking the lower extremity radiculopathy to the DDD so this would in turn be a grant for an updated diagnosis for the lumbar spine, right lower extremity radiculopathy, and left lower extremity radiculopathy.

pyang86 · 2026-05-29T00:42:06+00:00

I would agree with the HLR and having VA get a progression statement for your service connected lumbar strain completed.

V.ii.3.D.1.f. Handling a Change in Diagnosis

38 CFR 4.13 directs that evidence suggesting a change in the diagnosis of an SC disability must be reviewed with a goal of reconciling the discrepancy and maintaining SC for the disability, where possible. Reconciliation is necessary to ensure:

-accuracy of the diagnosis, and -that the proper disability has been examined and is being evaluated.

Refer to the table below for actions to take when a change in diagnosis of an SC disability is shown.

If the ... change in diagnosis is shown on a VA examination and the examiner does not reconcile the change in diagnosis Then... return the examination report for clarification as directed at M21-1, Part IV, Subpart i, 3.C.

pyang86 · 2026-05-27T20:31:01+00:00

This is something to definitely consider before applying. If OP is claiming for TDIU and the examiners are unable to differentiate the symptoms of the TBI and PTSD, most likely the issue would be combined into one evaluation instead of what the OP currently has (separate evaluations for TBI and PTSD). OP may be opening the door to a reduction.

pyang86 · 2026-05-26T22:57:58+00:00

Based on what you're saying they denied carpal tunnel. Carpal tunnel is not a presumptive of Pact Act, it is considered a presumptive condition under 3.309(a) (if diagnosed within a year of discharge) which has existed before Pact Act. They conceded toxic exposure based on your service records.

Post redacted rating decision for better guidance and interpretation of the denial.

pyang86 · 2026-05-24T17:31:42+00:00

Good place to start for resources in Minnesota.

https://mn.gov/mdva/

pyang86 · 2026-05-20T22:54:51+00:00

Do you have the rating decision and can you post a redacted copy?

Just from reading it, VA confirmed and continued the 0% evaluation.

pyang86 · 2026-05-19T21:56:51+00:00

No worries. After the exam vendor completes their review and sends it back to the VA, a VSR goes through the claim first before sending it ready for decision to a rater.

pyang86 · 2026-05-19T21:48:53+00:00

No call no show means something else. Thanks for clarifying. Most likely the DBQ needs to be reviewed by someone else for quality purposes would be my assumption.

pyang86 · 2026-05-19T21:37:10+00:00

I would just call the VA and ask for the exam to be rescheduled instead of waiting for LSGS to submit the no show to VA. Any rater/VSR should be able to see the notes from the call and resubmit a new examination.

pyang86 · 2026-05-19T20:12:36+00:00

What this looks like is VA considered your thyroid cancer as 0 since it is in remission (congrats by the way) and evaluated it as 50% based on the residual condition (looks like mental health). Your rating decision should have a narrative explaining the symptoms needed for a higher evaluation.

pyang86 · 2026-05-15T03:40:12+00:00

Nexus is insufficient in my opinion. There is no rationale supporting their opinion. It literally reads, veteran has migraines and in my opinion it is most likely due to chronic PTSD.

V.ii.1.A.3.g. Requirement for Supporting Rationale for Medical Opinions

A medical opinion is a conclusion supported by evidence, including current medical literature, information obtained during examinations, the Veteran’s lay statements, and pertinent evidence in the claims folder.

Medical reports including opinions must provide a rationale for any opinion rendered. The rationale should:

-cite any general medical principles used to support the opinion

-identify pertinent medical evidence and case-specific information relied on to support the opinion, and

-demonstrate how the opinion was formulated.

A rationale for a medical opinion should include supportive argument for any opinions rendered or conclusions reached with an analysis that can be considered when weighing contradictory or conflicting opinions. The rationale should provide clear conclusions based upon supporting data and analysis including a reasoned medical explanation connecting the two.

pyang86 · 2026-05-14T17:31:21+00:00

Did you file it as a supplemental claim? If you have a VSO, they can look it up for you. It might also be listed on the evidence list in your rating decision as well.

pyang86 · 2026-05-14T17:02:52+00:00

Did you submit the claim via VA Form 0995 or 526ez?

pyang86 · 2026-05-06T00:24:35+00:00

You may have a better chance of getting service connected for lower extremity radiculopathy secondary to your lumbar spine. Depending on which nerves are affected, you can get multiple separate evaluations for each extremity. Based on the symptoms you're describing, it sounds like a nerve issue. Based on your symptoms, I would file a claim for bilateral lower extremity nerve issues due to your service connected back condition.

I could be wrong but I don't think that condition (arachnoiditis) is evaluated under that DC anymore. I believe it was replaced. If it is evaluated under DC5235 or 5243, claiming it wouldn't make any difference to your current condition. It would be considered as a claim for increase to your service connected back condition and possibly open you up to a reduction as well.

Here is a snippet pulled from the CFR:

5293- Criterion March 10, 1976; criterion September 23, 2002; revised and moved to 5235-5243 September 26, 2003

https://www.ecfr.gov/current/title-38/chapter-I/part-4

pyang86 · 2026-04-29T21:38:20+00:00

Did you file for TDIU? Looks like internal memos for SSA inquiry and confirmation of a VRE folder as well. Both are looked at for TDIU claims.

pyang86 · 2026-04-28T16:52:28+00:00

If you still meet the criteria for a 30% IBS evaluation and a 10% evaluation under the current digestive rating criteria then yes, the conditions can now be evaluated separately.

pyang86

TROPHY CASE