- April 27, 2024
- Posted by: legaleseblogger
- Category: Related News
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## Seeking Assistance with Claim Denial
### Overview of Situation
I recently received a claim denial letter and I am in need of advice on what steps to take next before proceeding with a judge appeal.
### Concerns with Denial
One of my main concerns is whether they are able to deny a claim simply because it wasn’t an in-person visit with my doctor. I am aware of numerous individuals who have had their telehealth claims approved, so I find it perplexing that mine was denied.
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****** just grabbed a
The Dr needed to check the box saying they reviewed your medical records. Without that and it showing you didn’t see the provider in person it likely raised a red flag…
Pretty much, there have been so many fraudulent DBQ’s and Nexus letters the VBA is generally ignoring them at this point.
Looks like they denied based off of your Dr not reviewing your records. I doubt they actually denied you because of not seeing the Dr in person. I know multiple vets that had their mental health C&P exam appointment via video conference. The VA definitely allows it.
Did you use a pay for play company? A company that you pay x amount of money and they do your dbq/nexus/imo. Or was this your personal, longtime doctor? This info can help a lot of vets who are contemplating doing the same.
Why did they not have your records? My C&P for MH was virtual as well, but she did have my records at least…
Did you pay for some service to do the claim?
the bottom line is that they know you have the disability, you need to establish connection to service… they said you never went to sick call while in the service… you need to establish proof that you seen Drs for this condition in service… do you have that?
Why not just apply for a acquired mental health disorder and let them figure it out?
Seems like they are really cracking down on people who use those companies.
Was this diagnosed from a Dr. you only visited once and by telehealth? That’s not going to be accepted as credible (for VA purposes).
They completely make shit up along the way as they go. The standards the VA has vs the standards the VA is actually performing are completely elective depending upon who applies what. There is no standard. Keep fighting. I have an anxiety diagnosis from the VA. I’ve never asked them for counseling or sought any sort of treatment. The only thing I’ve ever sought treatment through the VA for, are service connected physical injuries. Somehow, somewhere along the way I was diagnosed with anxiety. The notes even say the anxiety is about my service injuries and their worsening state. I’m certainly not compensated for that. Fuck the VA. Get yours. (Unless of course you’re one of those people who didn’t make it through bootcamp because of a previously held condition and the yelling made you sad.)
Yes, they can do that.
Tele-health examinations are accepted. I think your biggest issue is that there allegedly are no in-service signs/symptoms/diagnoses.
You need to establish service-connection. What caused the depression and anxiety? You’re best bet is to claim PTSD and then secondary anxiety. There are requirements for the mental health claims to qualify. How I proved mine was service-connected was that I was deployed and I have a combat action badge. I think there is four requirements on the list and I had two.
Be warned. The first question asked in my MH exam was if I paid for any of my diagnoses. Luckily it was all through my primary care physician.
I am guessing you paid an IMO to do a DBQ or Nexus letter for you. Probably from one of the more well known companies or a doctor that is already flagged. They know that doctor did not review your records because they couldn’t have. No matter what flowery words the IMO used they cannot prove service connection if they don’t have your medical records from in service (or a well documented event) to link it to.
In short. Yea they can do this. In fact they have even been warning vets for a few months now that they were going to start doing this.
You need to read the whole paragraph. The last sentence says “in your case your service treatment records do not show complaints or treatment in service for the claimed condition”.
Is this depression and anxiety secondary to ptsd or just depression and anxiety?
Was your IMO completed by a private doctor or a VA/VA contractor?
Really should have deferred or just put it back into evidence gathering and had a VA / VA contract examiner look at it.
your private doc has to say they reviewed for c-file and medical records in their opinion .Or the va will deny your claim.
I say jus hit the revaluat button
Let me guess, you ignored the Va exam scheduling
Hell NO!! My CMP for this exact issue was via tele-health and I was granted however; I’ve been to PTSD Treatment programs before and it’s well documented. However, I don’t understand why it’s says that you were denied, yet at the bottom it states that you were diagnosed with a ‘disability Independent…”. So I’m confused.
Did you actually have a CMP done specifically for depression and anxiety by like LHI or the VA or some of the other civi groups out there. If not, I’d request a CMP and def have a civi contractor do it, the VA CMP’s are a lot more how do I say this by the book I guess.
I will say if you don’t have extensive written hx by the VA or a civilian psyc doc of dep and anx it will most likely be denied. My first claim they group it all together with PTSD which I was pussed about. It was basically like 5 mental health issues all just rated 80% PTSD. My second they finally broke it down for my 100% TDIU
Edit: I didn’t read through all the comments just the topic subject.
get the record from hr army …. Send it to va
Seems to me the more important issue you need to address is that you don’t have a history of your illness in your military medical records and therefore it can’t be service linked.
Besides everything else, OP you said that you submitted a DBQ. Have you read the DBQ and gone through it? There are sections of the DBQ that explicitly asks what records are reviewed. So if the doc didn’t properly list what they reviewed, the VA can’t assume they reviewed the relevant documents (this is assuming you sent the IMO doc all your medical records).
Additionally, in the DBQ the doc may not have linked your MH issues to what happened in service. Did you have a nexus letter to take your diagnosis (DBQ) and link that to service? The doc saying you have depression is not the same as saying service caused it.
Did they request a C&P or just deny you?
Submit personal statement with in service stressors. Try to give them as much detail as possible even if you have to include emails, magazines, news articles
It has to be some u said. They don’t just flag Deni bc it’s a telephone interview.
Question does long term grief count as depression? Or is that not something claimable