Should I get evidence from outside doctor to push for a claim that was denied by the VA?

Cpl Jose Zavalapina — Sat, 13 Apr 2019 17:24:26 -0400

Hello, I submitted a claim that the VA specifically posted on their website and they denied me. One of them states that they do not need medical evidence for support, but yet I am assuming that they still need some sort of evidence. I know that I have a year to re-open the claim but should I go to an outside doctor and get treated/evidence from an outside source? I already spoke to my VA doctor and she said that I already have back pain(documented) but she believes that there is no need for me to see a specialists for the reason why my fingers and feet start getting numb when I walk for a bit. Should I go back to the Veteran Service Office and re-open the case or should I go to an outside doctor and get that evidence stacked up first? I have attached the links that I was looking at and was going to give to my doctor. Any thoughts.....

https://www.publichealth.va.gov/exposures/gulfwar/medically-unexplained-illness.asp
https://www.publichealth.va.gov/exposures/vibration/index.asp
https://www.publichealth.va.gov/exposures/wars-operations/iraq-war.asp

medically-unexplained-illness.asp

Response by 1SG Private RallyPoint Member made Apr 13 at 2019 5:40 PM

1SG Private RallyPoint Member — Sat, 13 Apr 2019 17:40:22 -0400

What was the reason for denial in the rating decision?
That will guide my answer to your question.

Response by SSgt Jim Gilmore made Apr 13 at 2019 5:51 PM

SSgt Jim Gilmore — Sat, 13 Apr 2019 17:51:41 -0400

You need to contact your representative before the VA. THAT IS THE PERSON WHO HELPED YOU FILE YOUR CLAIM. If you did this on your own, you need to find a county service officer, VSO (like VFW, etc.), accredited claim agent or an accredited attorney to assist with your appeal. Those are your best avenues to help.

Response by SFC George Smith made Apr 13 at 2019 7:44 PM

SFC George Smith — Sat, 13 Apr 2019 19:44:41 -0400

Did You Not Have Documentation in Your Health Records … And Did You Not Keep A Certified Copy Of Your Records... ... Thanks for the share

Response by SSgt Robert Matlock made Apr 13 at 2019 7:57 PM

SSgt Robert Matlock — Sat, 13 Apr 2019 19:57:22 -0400

After the VA initially rejected my claim (as they do 31% of the time), I read what the examiner found to be deficient, went online to find the exact wording the VA looks for, there are VA checklist and copies of the VA templates used to make the diagnosis online, rewrote the wording into a paragraph that sounds like it came from my Dr, then I went to my Dr and explained how the wording of my diagnosis must parallel the VA verbiage exactly, he looked it over to make sure we weren't lying, and he signed it. That helped out a lot. I included my military medical records that highlighted my issues, and treatment by current providers that shows it's an ongoing problem. I used my local VSO, but I have already filled in the paperwork when I bring it in. Make sure you have got copies of your records from the Marines and the VA. I ended up with 4 copies of my military medical records, and each one had pages not contained in the others, it took 3 days, but I finally consolidated into a single complete (I think) record. Good Luck!

Response by MAJ Raúl Rovira made Apr 13 at 2019 9:15 PM

MAJ Raúl Rovira — Sat, 13 Apr 2019 21:15:07 -0400

Cpl Jose Zavalapina, the VA has to determine that there is a (1) service connection (2) severity and (3) impact in your quality of life (work, live).

The VA doctor only treats you. When it comes to condition evaluation for a rating (%), apply and see your VSO as the best avenue.

It helps if you can write your own statement on your condition, what you feel, and how it impacts you. Hint, read CFR 38 on the conditions that apply to you.

Best of luck.

Response by SGT Osmundo Thompson made Apr 13 at 2019 10:55 PM

SGT Osmundo Thompson — Sat, 13 Apr 2019 22:55:03 -0400

Yes, it would be in your best interest to get a complete write-up from an outside doctor, be it MD or Chiropractor, their medical observations and diagnosis weighs the same. Get as much medical evidence as possible, as well as lay statements from family and friends who are aware of and witnesses your condition.

Then you go to your VSO to help you reopen the claim. If you get denied again, contact your local Congressman’s office to look into your claim as to why it keeps getting denied.

Response by SFC Cynthia Eyer made Apr 14 at 2019 12:35 AM

SFC Cynthia Eyer — Sun, 14 Apr 2019 00:35:03 -0400

CPL Zavalapina, going numb in your extremities is a spinal and/or nerve issue. See a different doctor at the VA and take copies of all records of any and all falls and/or injuries to torso, neck, and upper/lower extremities, nerve agent exposures from deployments, and any exposure to weapons that affect the neurological system over time. Seeing a neurologist outside of the VA is also a safety precaution for YOU. Regardless of VA’s current status and recognition of your symptoms, you are in charge of your health, not the docs. So take charge CPL. Your Soldiers are counting on you to be their shining example, mentor, and rally point.

Response by CSM Darieus ZaGara made Apr 14 at 2019 8:00 AM

CSM Darieus ZaGara — Sun, 14 Apr 2019 08:00:37 -0400

Contact the BFW or DAV, they have people that can assist. If your claim is valid they can help. Thank you for your service.

Response by CPT Private RallyPoint Member made Apr 14 at 2019 8:48 AM

CPT Private RallyPoint Member — Sun, 14 Apr 2019 08:48:20 -0400

It is very difficult to observe where your claim falls in the process for medical benefits from my position. And I do not decide claims.

I found Disabled American Veterans more inclined to process initial claims efficiently and effectively than VFW or AL. The initial claim was accepted within one year.

Veteran Service Officers work outside of the VA usually for county or state government. VSOs efficiently and effectively submitted paperwork to increase the disability rating.

Keep all medical records safe and documented.

Response by SPC William Simmonds, Esq. made Apr 14 at 2019 8:51 AM

SPC William Simmonds, Esq. — Sun, 14 Apr 2019 08:51:55 -0400

1. Why were you denied? This is stated under the section “Why you were denied” in your rating decision.
2. Get new evidence that SPECIFICALLY AND LEGALLY NEGATES the reason for denying your claim (a new doctor’s appointment will do).
3. File your claim appropriately in the new AMA system (it’s getting too difficult for you to do this alone already...)
4. Wait your turn in line.
5. Successfully lay out your argument to give the VA no legal option but to grant your case.

If you don’t know what you’re doing, your chance of success is greatly reduced. If you start getting denials, your chance of eventual success is further greatly reduced.

Hire a claims agent or attorney. Most, like me, will do your claim on a contingency basis—so you wouldn’t pay me anything unless I get you your grant.

How do you know I know what I’m doing? I was rated at 10% initially when I got out of the Army. Now I’m 100%. And I used to rate other Veterans injuries for the VA as a rater. And my team members—they’re all former VA employees. The best of the best that I’ve encountered over the years. We’ve rated hundreds of thousands of claims. We’ve essentially seen everything. We know the system. We know the rules. We know the people making the decisions. And we know the processes and paperwork you need to file.

Or you could guess how to do it or hope you get assigned a VSO who has received training.

I know what I’d do.

Www.vahelp.claims

Veterans Law Attorney | Veterans Legal Advocates | United States

We're passionate about helping America's Veterans securethe disability benefits they deserve. Founded by a Veteran, former VA employee, and attorney, Veterans Legal Advocates provides real disability benefit advocacyservices to deserving Veterans across the United States.

Response by MAJ Private RallyPoint Member made Apr 14 at 2019 10:20 AM

MAJ Private RallyPoint Member — Sun, 14 Apr 2019 10:20:37 -0400

It doesn’t hurt to try, but the VA and military are under no obligation to take the advice or opinions of private sector physicians. It’s why they have their own doctors. The issue is that most private sector physicians will try and “help” their patients with the thought that they are getting you the compensation you deserve. I had seen this in Recruiting as well, but the Military and VA will always go with the opinion of the physicians who work for them before they accept the opinion of a private sector physician.

Response by LCDR Rabbah Rona Matlow made Apr 14 at 2019 12:00 PM

LCDR Rabbah Rona Matlow — Sun, 14 Apr 2019 12:00:13 -0400

More evidence can't hurt. But a few things to consider. There must be a service connection.
1) Did this occur in Gulf Service? Have you been getting treatment for it?
2) If not, is there evidence of it occurring in your service or within the first year after you left, and with continuous treatment afterwards?

I would urge you to go to a VSO such as the DAV rather than dealing with the VA directly, they can help you go through this and get you the benefits you have earned.

Response by MSG Donald Onley made Apr 14 at 2019 6:50 PM

MSG Donald Onley — Sun, 14 Apr 2019 18:50:01 -0400

You must fight don't give up I had to fight for almost 6 years before I started getting my claims the only way, I received any was I went to a specialist in the field like a psychologist for PTSD.

Response by SSgt Alan Lopez made Apr 15 at 2019 2:14 AM

SSgt Alan Lopez — Mon, 15 Apr 2019 02:14:19 -0400

Yes,if you are being treated by an outside doctor you can submit that treatment as part of your claim. Before you re-open your case, why not appeal the VA's decision? I submit you speak with a veteran's service officer at your local VA or one of the service agencies, DAV,American Legion, VFW and the like.

Response by MSG Robert Conrad made Apr 15 at 2019 5:45 PM

MSG Robert Conrad — Mon, 15 Apr 2019 17:45:41 -0400

Absolutely, the VA considers evidence from any provider. Just stay away from the online psychiatrists, telemental health exams are limited to VA providers.

Response by SPC Linda Dockery made Apr 30 at 2019 7:42 PM

SPC Linda Dockery — Tue, 30 Apr 2019 19:42:46 -0400

An outside opinion can prove the more likely than not rule. Also get letters from everyone that say your injuries happened while on active duty. It can't hurt your case.

Response by SN Donald Hoffman made May 3 at 2019 12:20 AM

SN Donald Hoffman — Fri, 03 May 2019 00:20:38 -0400

Go to the VFW at your federal building to help with your claim

Response by 1LT Daniel Burdekin made May 8 at 2019 10:28 PM

1LT Daniel Burdekin — Wed, 08 May 2019 22:28:55 -0400

Contact Rep for Vets
5325 Primrose Lake Circle
Unit B
Tampa, FL 33647
[login to see]
They will diligently represent your claim directly with the VA.
As an alternative, contact the VFW and ask for help with a claim. You can get help from individual representatives who have been trained to represent Veterans with claim issues.

Response by SPC Arthur Lowder made May 8 at 2019 10:29 PM

SPC Arthur Lowder — Wed, 08 May 2019 22:29:14 -0400

yes

Response by SSgt Private RallyPoint Member made May 8 at 2019 10:40 PM

SSgt Private RallyPoint Member — Wed, 08 May 2019 22:40:24 -0400

Todavia yo estoy esperando que contacto me cite para un hearing en Puerto Rico.

Response by CPO Private RallyPoint Member made May 9 at 2019 12:13 AM

CPO Private RallyPoint Member — Thu, 09 May 2019 00:13:27 -0400

I complained of back pain as well at the VA, but they couldn't find a physical reason for it. A chiropractor noticed my back was curved but not enough to be considered scoliosis. You may want to consider a chiropractor adjustment(s) for your back pain and include that as well as a civilian Dr. Include any pertinent x-rays also. The chiropractor adjusted me 3 times a week for a couple weeks, then 2 times a week for a couple weeks, then once a week, etc until I felt better but still needed pain meds that the VA wouldn't prescribe. Thats why I now have a civilian Dr for my physical needs but get the yearly physical at the VA also. Did you know you can also file for Social Security Disability (SSDI) and receive it concurrently with VA disability? Yes you can.

Response by SPC Arthur Lowder made May 9 at 2019 12:37 AM

SPC Arthur Lowder — Thu, 09 May 2019 00:37:08 -0400

yes.

Response by Marlene Stahl made May 9 at 2019 1:00 PM

Marlene Stahl — Thu, 09 May 2019 13:00:19 -0400

You definitely should pursue this. I went through the process with my Papa who is a WW11 vet and a friend who survived Vietnam. It takes persistence. I have great contacts, so feel free to reach out to me.

Response by TSgt William Danic made May 9 at 2019 1:19 PM

TSgt William Danic — Thu, 09 May 2019 13:19:02 -0400

Have you tried using a veterans va officer such as American legion, vow, dav. I had to get a lawyer to win my agent orange case. Expect a long wait they can tell you what you need. Good luck Vietnam vet

Response by SPC Traci Wall made May 9 at 2019 1:38 PM

SPC Traci Wall — Thu, 09 May 2019 13:38:37 -0400

I went to outside Dr. and specialists, when va started running me in circles. same issues as you. but DO NOT tell them you are going for comp. it seems to change their opinion. Not kidding on that. It took me 10 yrs to finally get my disability and my back recognized. I played nice at first thinking they were there to "help" me... pffft... I hurt my back in Korea, in 87. I got out in 91. I had civilian Dr. tests that I had in the va, civy said yes you r really messed up va, nothing wrong. so I took the records with me to a va appt and asked why this said and showed my back was toast.. lol... the look on their face "priceless". Hope this helps... CYA all the way

Response by MSG Private RallyPoint Member made May 9 at 2019 3:53 PM

MSG Private RallyPoint Member — Thu, 09 May 2019 15:53:15 -0400

I could be wrong here but I don't believe outside records will do you any better than the records you have. Once you have documentation of the injury or ailment and your claim is submitted you still will have to be examined by a third party contracted doctor who will make the recommendation to the VA.

If you had a VSO help you with your packet and it was denied they should have explained why that specific issue was denied. Every specific thing that the VA denied me was explained as to why. If you didn't have a VSO you should get one, I recommend the DAV, they were very helpful.

Response by SP5 Dennis Ryan made May 9 at 2019 7:05 PM

SP5 Dennis Ryan — Thu, 09 May 2019 19:05:12 -0400

Pinched nerve , what are they doing for it ?? go see a DR. outside of the VA ..

Response by SPC Clayton Sizer made May 9 at 2019 8:56 PM

SPC Clayton Sizer — Thu, 09 May 2019 20:56:53 -0400

don't forget to file a Intent to file a claim for Compensation Form 21-0966 This form once on file makes the VA pay you all the way back up until the time you filed the claim (File for each claim)

Response by PFC Sylvio Ramsey made May 10 at 2019 5:01 PM

PFC Sylvio Ramsey — Fri, 10 May 2019 17:01:38 -0400

Most definitely, most of my substantiated evidences was through private physicians, good luck!!

Response by SN Donald Hoffman made May 10 at 2019 5:18 PM

SN Donald Hoffman — Fri, 10 May 2019 17:18:02 -0400

Are you on active duty? If so, then I would suggest getting a medical work up from an outside specialist. If you are no longer active, talk to the VFW or American Legion. It would not hurt having them fight for you, if your still active duty.

Response by SPC Arthur Lowder made May 10 at 2019 11:11 PM

SPC Arthur Lowder — Fri, 10 May 2019 23:11:37 -0400

yes.!!!

Response by CDR Anthony Miller made May 11 at 2019 5:54 PM

CDR Anthony Miller — Sat, 11 May 2019 17:54:11 -0400

I am both a Veteran and a VA physician. You should definitely appeal if you believe that your condition is service connected. It is an easier process if you believe that this is a worsening of a condition for which you are already service connected. The other posters are correct that you need to start with a VSO (DAV, VFW, etc.) first. They navigate the process for you, and they are experienced. If you have an outside physician, there are VA forms (specific to each condition for which you are applying) that the civilian physician can fill out for you. Get the forms from the VSO. That way you do not have to go through a C&P exam at the VA. Good luck.

Response by LTC John Shaw made May 14 at 2019 5:00 PM

LTC John Shaw — Tue, 14 May 2019 17:00:54 -0400

Find a VSO that is responsive, I have numbers for the Wounded Warrior Project if you need it.
Typically you need to show the origin of the medical issue while in the service, the problem you are experiencing how and the nexus between the original medical issue and the current medical issue being experienced. If you can't do this with VA medical evidence alone, I encourage you to get it from an external doctor. You can also have buddy statements from family or most importantly someone from when you were in service and they observed the issue and the pain from the issue.

Response by Sgt Private RallyPoint Member made May 14 at 2019 5:24 PM

Sgt Private RallyPoint Member — Tue, 14 May 2019 17:24:04 -0400

Thank you for posting this question Cpl Jose Zavalapina Let me first explain that I am a Disabled Veteran myself and I am a Massachusetts DAV Chapter Commander... I know more than the average veteran in this kind of situation... because I work with veterans and the VA...

The first thing we do as disabled veterans is try to go it alone with a claim... Hopefully you had someone act as your agent or Power of attorney. If not you should have because a veteran should never try to do it alone, primarily because the claim will not get the proper attention it deserves simply due to volume of claims received and without support... Also, in some ways working with the VA administrators for claims is somewhat like working with an Insurance company in that their first inclination is to deny the claim as some just go away... A VSO, or local city or town Veteran's Agent can be of help... So can a DAV National Service Officer (a Veteran and a trained/paid professional) who works on behalf of Veterans as their agent and Power of Attorney... They know the ins and outs of VA Claims Processing and can guide you through the intricate and bureaucratic process. One could hire an attorney, but it is going to cost you a few shekels along the way and they do not work that closely with the VA on average...

I do recommend you see an outside specialist Dr. if you can and get a diagnostic report. Then my recommendation is to contact your DAV Department of California office or one of their local offices in your area, explain the situation and ask to have them assign a DAV National Service Officer to your claim... (if you wish to message me with where you live, I will see if I can come up with contact information for you... If you can't message me yet from RallyPoint, then email me at [login to see] and I will respond within a few days...

Good luck,
Kerry F. Harkins,
Commander, DAV Chapter #90
Norwood, Massachusetts

Response by PFC Sylvio Ramsey made May 14 at 2019 5:34 PM

PFC Sylvio Ramsey — Tue, 14 May 2019 17:34:32 -0400

You should reopen your claim as well as getting outside evidence to further substantiate your claim, best of luck !!

Response by CAPT John Kittler made May 15 at 2019 1:13 PM

CAPT John Kittler — Wed, 15 May 2019 13:13:02 -0400

Get the medical evidence, then re-open the case. It really bothers me that you have a condition and the VA rep said not to see a doctor. SSgt Gilmore is correct about contacting your representative before the VA, but what he is talking about, I believe is the person who was chosen to represent you when you originally filed that claim. They have a Power of Attorney to act on your behalf and generally sit just down the hall from the VA examiner. It may be the VFW, AMVETS, American Legion, etc. Your county service officer can tell you who this is. I most strongly disagree with using an attorney, as I have seen them sit on cases to collect more fees. They are REALLY a last resort for when there is an actual legal issue involved. Find a good service officer who really looks at your case and can explain it back to you, not just one who puts it together and sends it in. Have the county service officer give you the name of the POA rep at the VA and call them. Disability plus service connection = benefit. Wish I could see what you turned in and got back from the VA.

Response by SP6 Sunniko Sommervold made May 15 at 2019 1:27 PM

SP6 Sunniko Sommervold — Wed, 15 May 2019 13:27:08 -0400

When I applied for my disability claim I went through the state VA rep. (That’s was about ten years ago so I don’t remember what they are actually called.). All VA clinics have someone to help with claims. But she had indicated to never use an attorney to help with a claim. Initially I was given 20%, which is no monthly money. But she said, and that is what she did, to continually submit a claim to receive a true review. I then received notification that my claim request was approved and a percentage was quoted. Anything after 20% is a monthly disability check. So Good Luck!

Response by PFC Meg Meyer made May 15 at 2019 11:18 PM

PFC Meg Meyer — Wed, 15 May 2019 23:18:12 -0400

Yes!

Response by SGT Chad Hale made May 21 at 2019 9:12 PM

SGT Chad Hale — Tue, 21 May 2019 21:12:48 -0400

THE VA WILL ALWAYS LIE TO YOU.
They tried to lie to me too!
I had to bring in lab results and medical records from a civilian doctor before i would be seen at ALL...
I had to have my entire medical record printed out to point out the very damn day I was given a shot on DUTY, that has crippled me with a half dozen "Autoimmune diseases" all swept under the nice neat title of "Multiple endocrine failure". I don't have any missing limbs, I have never been wounded in combat, but thanks to a vaccine I WAS FORCED TO TAKE UNDER ORDERS FROM A ONE STAR GENERAL...
I have a 40% disability rating, I can't have children, and I can't work. I am a fucking zombie. They only way I can get out of bed is to take a fist load of pills and a handful of shots.
I am still appealing the decision, as 40% of E-5 SGT, Minus medicine...
Doesn't pay any bills.
My family is struggling to make ends meet and there is NOTHING I can do about it.

DO THEY NEED TO PAY FOR WHAT THEY'VE DONE?
oh hell yes.

Response by TSgt William Danic made May 24 at 2019 9:20 PM

TSgt William Danic — Fri, 24 May 2019 21:20:15 -0400

If you have been disapproved on your disability you can send an attorney that's familiar with military and VA protocols they will let you know if they will take your case. My attorneys got me approved for agent orange. Dont expect results right away mine took over 2 years. Decision are being made a lot faster now. Good luck.

Response by Lt Col Bill Fletcher made May 26 at 2019 9:47 AM

Lt Col Bill Fletcher — Sun, 26 May 2019 09:47:31 -0400

If you can get a real doctor to review your situation, make a diagnosis send for MRIs or xrays and then make a recommendation of disability ( if one exists) then you should do it. Waiting for the VA to get it right is a waste of your time. If you have friends who served with you when the injury or cause occurred get them to write you a letter detailing the injury cause including the type of service activity that was the root of your problem. Be ready to submit them as well. Go fully loaded to save time and expedite the process. Then wait because they are neither quick nor efficient.

Response by PO1 Matt Maness made Jun 21 at 2019 6:50 AM

PO1 Matt Maness — Fri, 21 Jun 2019 06:50:27 -0400

Get with the D.A.V. They don't mess around and will help you. Just follow their instructions.

Response by SSG Gordon Holmes made Sep 28 at 2019 9:32 AM

SSG Gordon Holmes — Sat, 28 Sep 2019 09:32:40 -0400

I used several outside doctors to document my injuries. As for the VA doctor, I would go over their head and complain that you are not receiving the treatment you need. Also unless you have experience with the VA, go back to your VSO, or whomever helped you filed the first claim and appeal immediately. The VA should at a minimum send you to a doctor for an evaluation before they deny you claim. My experience is that the deny all claims expecting you will go away. I had to take my case all the way to the Veterans Appeals Court where the judge ruled in my favor. By then I had over 1,000 pages of medical documents, medical research on my injuries, diagnostic tests. etc.