Deferred and Denied claims

kano1620

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I was able to see on VA.gov that one of my claims was approved with two secondary percentages awarded (40% + 10% right + 10% left). Two of my claims (tinnitus and right side carpal tunnel) were denied. My PTSD/Depression/Anxiety shows deferred. About a week or two ago I dropped off more paperwork for my VA claims since I had received a notice that they couldn't find my Service Treatment Records (STR). It also included some updated information on the mental health claims. What does the deferred status mean? Do I need to do anything? VA.gov still states my claim is in the evidence gathering phase with an expected completion date of April 2020. Also for the tinnitus and the right carpal tunnel what should I include in my appeal? I'm in the signal field and I have a diagnosis of carpal tunnel on my right side. Thank you for any advice!
 

oddpedestrian

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You have to wait on the letter to see why they denied the two before you can amount a successful appeal diagnosis is only part of a claim you might need an in service event nexus or chronicity. The deferred claim just means its still in progress.
 

kano1620

PEB Forum Regular Member
Registered Member
I received the letter and here is what it stated:

Carpal Tunnel:

Service connection may be granted for a disability which began in military service or was caused by some event or experience in service. (38 CFR 3.303)

Service connection for right-sided carpal tunnel syndrome is denied since this condition neither occurred in nor was caused by service. (38 CFR 3.303, 38 CFR 3.304)

Your service treatment records don't show you were seen for complaints of right-sided carpal tunnel syndrome.

Kaiser records show a current diagnosis of carpal tunnel syndrome, but there is no comment linking the condition to military service.

Favorable findings identified in this decision:

An after visit summary from Kaiser Permanente shows you underwent an injection for right carpal tunnel syndrome.

Tinnitus:

Your occupation of Signal Systems Support Technician had a low probability for noise exposure.

There were no complaints of tinnitus in your service treatment records.

At your VA exam, you reported the tinnitus has been present for the last two years with no inciting incident. In the examiner's opinion, the tinnitus was less likely than not caused by or a result of military noise exposure with the rationale you have only noticed it for the past few years, far later than would be expected if it were the result of noise exposure in the military.

Favorable findings in this decision:

You reported at your VA exam that you have had bilateral constant tinnitus for the last two years.

Depression and Anxiety:

The issue of compensation for depression and anxiety is deferred for the following information: clarification from the VA examiner.
 

oddpedestrian

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It looks like they have your service records but that did not help your claim as the decision states no complaints in service which is required for service connection. Getting a Nexus letter would be the next step from a provider, the tinnitus one is risky since they already claim you had a low noise job meaning a Nexus may still be not be convincing without proof a major incident. Deferred claim means the provider gave ambiguous language on your MH claim and they need an addendum for clarification can be good or bad. Are you working with a VSO? I would recommend one with appeals.
 

kano1620

PEB Forum Regular Member
Registered Member
Thanks for your reply! I am trying to switch VSOs for the appeals because my first VSO didn't really do much and lost a bunch of paperwork. Luckily I had all the originals. I definitely intend to consult with the VSO before trying any appeals though. I didn't get a great vibe from the MH provider. If it comes back bad, then that can be part of the appeal also correct? She only asked about one specific incident and did not ask about any of the other MH issues. I turned in a lot of paperwork from civilian providers showing diagnosis and prognosis for the MH issues.
 

kano1620

PEB Forum Regular Member
Registered Member
I met with a new VSO and she has been very helpful. After meeting with her I got called to schedule two more VA exams, one for mental health and one for hearing. I completed both of those exams on Dec. 27th, so hopefully in a month or so I will get the rating from the VA. I also had a nerve conduction test for the carpal tunnel done in December and my VSO said that will help in the appeal.
 

gsfowler

Super Moderator
Staff Member
PEB Forum Veteran
I received the letter and here is what it stated:

Carpal Tunnel:

Service connection may be granted for a disability which began in military service or was caused by some event or experience in service. (38 CFR 3.303)

Service connection for right-sided carpal tunnel syndrome is denied since this condition neither occurred in nor was caused by service. (38 CFR 3.303, 38 CFR 3.304)

Your service treatment records don't show you were seen for complaints of right-sided carpal tunnel syndrome.

Kaiser records show a current diagnosis of carpal tunnel syndrome, but there is no comment linking the condition to military service.

Favorable findings identified in this decision:

An after visit summary from Kaiser Permanente shows you underwent an injection for right carpal tunnel syndrome.

Tinnitus:

Your occupation of Signal Systems Support Technician had a low probability for noise exposure.

There were no complaints of tinnitus in your service treatment records.

At your VA exam, you reported the tinnitus has been present for the last two years with no inciting incident. In the examiner's opinion, the tinnitus was less likely than not caused by or a result of military noise exposure with the rationale you have only noticed it for the past few years, far later than would be expected if it were the result of noise exposure in the military.

Favorable findings in this decision:

You reported at your VA exam that you have had bilateral constant tinnitus for the last two years.

Depression and Anxiety:

The issue of compensation for depression and anxiety is deferred for the following information: clarification from the VA examiner.

The deferral for the claim of depression and anxiety is almost certain to be for a medical opinion regarding the diagnosis. You were probably given one diagnosis in service (they typically diagnose adjustment disorder) and the VA examiner gave you a new diagnosis. The VA rater probably asked if this was a progression of the in service diagnosis or a new and distinct diagnosis.

The tinnitus is going to be difficult to get service connected unless you file a supplemental claim with new and relevant evidence. You will do this with form 20-0995.

An example of new and relevant evidence would be some for of evidence of a hazardous noise exposure (maybe you spent quite a bit of time on the weapons range, or perhaps your job as a 25U kept you in close proximity to a generator, or a lay statement from a family member that you have been complaining about ringing in your ears since you left service).

You may want to submit a statement in support of claim describing your hazardous noise exposure, there's ALWAYS noise exposure outside of the scope of your MOS.. You can use this form for a lay statement as well.

If you get a lay statement, make sure they state you have had complaints of tinnitus within one year of separation if that is the case.

Take a look at your C&P examination, see if the provider diagnosed you with "recurrent tinnitus". That should have been listed on your favorable finding rather than what the rater wrote.

To service connect tinnitus you must have a diagnosis of "recurrent tinnitus" from an Audiologist, a nexus to military service (typically they take it from the military occupational specialty in absence of any other evidence such as complaints or a diagnosis of tinnitus in your service treatment records) and of course the claim in which you state you have the disability.
 
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