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Denied claim, Diagnosis wasn’t included

ChairborneMoperator

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On August 7, 2018 my claim was denied due to lack of evidence. C&P Examiner stated I lacked any proof of evidence for condition while in the military and I am undiagnosed. Examiner stated I was referred for a medical diagnostic test but that I never made the appointment. I did make the appointment and don’t understand how the examiner came to that conclusion. August 13, 2018 diagnosis is confirmed with testing done by the VA. However, my claim was already completed. I just started looking into this again where discovered this discrepancy. My question would be do I just need to present the new evidence to that existing claim? I appreciate any advice on this matter.
 

SFC H

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SFC H

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Can I file a Supplemental Claim?
In order to file a Supplemental Claim, you must add evidence that is new (or not provided to VA previously) and relevant to your case. You can file a Supplemental Claim anytime, but we recommend you file within one year from the date on your decision letter.
Note: You can’t file a Supplemental Claim if you have a fiduciary claim or a contested claim.
 

ChairborneMoperator

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I am currently looking into getting some buddy statements VA Form 21-4138 from a few people including my company medic. Here’s the following timeline:
July 11, 2018 made initial claim
August 2, 2018 C&P examination
August 7, 2018 C&P examiner claimed I never scheduled said test. Reviewed by VA
August 13, 2018 Test done by VA diagnosed the condition.
August 25, 2018 VA came to decision not service connected.

Can I use the buddy statement as new evidence? Also this claim was started within a year of being medically retired and I received medication for the condition oct 30, 2017 just after separation. I appreciate the feedback!
 

SFC H

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As long as it’s new evidence and relevant to your case, yes.
 

Camp P Marine

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NEW AND RELEVANT EVIDENCE

"To complete your application, you must submit new and relevant evidence to VA or tell us about new and relevant evidence that VA can assist you in gathering in support of your supplemental claim. If you have records in your possession, please attach the records to this form. Please list your name and file number on each page. If you would like VA to obtain non-federal records, please review your decision notification letter for the appropriate authorization forms to complete and submit those forms to VA with this request form"
 

oddpedestrian

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Not sure why you even filed a claim without a diagnosis in the first place setting up you up for a longer and harder appeal option. Now that you have a current diagnosis you are still lacking the in-service treatment to connect the claim. You will now need a nexus connecting your current condition to your military service buddy statements won't cut it. The nexus needs to be written by a doctor.
 

oddpedestrian

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@michiganvic

Dont know what exactly? That you need a diagnosis for what you are claiming? Veterans do know they just put too much confidence in the VA doing all the leg work hoping the examiner will both diagnose and write a nexus. The examiner can do that but only for a few claims with the examiner providing extensive reasoning.
 
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mcdonaldj2323

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“Not sure why you even filed a claim without a diagnosis in the first place setting up you up for a longer and harder appeal option.”

While possibly true based on what limited details we have, not a helpful comment at this point. The nexus observations were very helpful and buddy statements won’t provide service connection, but they are new evidence if below diagnosis timing is true...

It appears a VA reconsideration may be possible based on comments made that the “condition” was medicated right after separation (which implies a diagnosis) and the VA appears to have diagnosed it themselves within a year of members separation. If true that should establish service connection


What constitutes new evidence can also include a new member signed memorandum which details the condition diagnosis timeline and quotes the VA guidance along with any attached medical evidence. I’d also get your VA case file first to see what medical evidence they had. Do NOT assume the medical side and the compensation side of the VA are in synch. For example, since retiring, the medical side does not have any of the exam info or any of my in-service medical records I submitted for my claim. If you did not provide medical records, get them and provide them if they are missing.

Get ANY treatment records which relate to the condition and go through them and point out dates and diagnosis and treatment - make sure they can’t miss it. Do exhaustive review of your records and make it as easy as possible for them to make the decision in your favor.

Good luck and if you get stuck consider legal advice if it makes sense - the appeal process is not quick or easy but others have made it through to the other side before you.
 
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oddpedestrian

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@mcdonaldj2323

I must respectfully disagree first there are no longer reconsideration claims under the new VAIMA act of 2017 he must file a supplemental claim with "new and relevant" evidence. Just because he was prescribed meds for a condition or symptoms he was having that does not constitute:

A Diagnosis
A Nexus
A Claim

The VA can prescribe meds on an "as needed" or acute basis this does not require a diagnosis from the provider a diagnosis can only happen with testing either to confirm or rule out other problems. Nonetheless, this contention is now moot because he has the diagnosis.

As for the nexus that isn't required if you file a claim within one year of your last day of service. There is no such thing as an implied claim you must file one within that timeframe or you will be required to provide a nexus like all other veterans its not the VHA's job to file claims on your behalf for everything they see you for. If he would have filed in 2017 and it was denied he could have filed an EED claim.

Bottom line he only needs a nexus from a doctor to finally win his claim this shouldn't be that hard of a burden for him to achieve.
 

chaplaincharlie

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Providers write SOAP notes for every patient encounter. SOAP is an acronym for Subjective, Objective, Assessment, and Plan. Subjective is what you tell the provider. Objective is what the provider observes. Assessment is the diagnosis. Plan is the treatment plan.

The SOAP notes would connect the Rx to the assessment (diagnosis). Obtain a copy of your medical records while on AD and COPY (never send your originals) the SOAP notes that are relevant to your claim while on AD to establish service connection. Then the COPY the test results that confirmed the diagnosis that the VA missed.
 
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