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Insomnia - Combined Rating


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#1 Detonator

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Posted 18 July 2008 - 08:11 PM

I left the Army in 1995 with 20% lower back, 10% left knee meniscus, and 20% right knee PCL deficiency following surgery (50% total). Last year, I asked for an increase on my left knee, right knee and requested a secondary service connection for insomnia due to chronic pain.

Today, I received a letter stating that they denied any increase for my knees but did grant service connection for my insomnia (it dates back to 1998) and awarded 10%. However, the letter states the VA does a combined rating and will not increase past my 50%.

So what does the 10% service connection for my insomnia mean? I was hoping to get at least a 12 month back dated check for the 10% but it doesn't sound like I will get anything.

If someone could explain how this service connection for insomnia will help me....please let me know.

Also, the way they worded the decision, it makes it sound like I'm lucky they didn't decide to reduce my 50%. Amazing!

Any insight would be helpful!

#2 Detonator

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Posted 18 July 2008 - 08:14 PM

The letter states we do no add the individual percentages of each condition to determine your combined rating. Also under the insomnia decision, because apparently my doctor didn't put in there that insomnia effects my employment, it has some significance. Even though I only work one day a week (Part time job) and just recently began seeing a therapist for depression side effects.

#3 Detonator

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Posted 18 July 2008 - 08:17 PM

Also, if my insomnia condition continues to worsen....since it is service connected now....could I get that temporary total disability? Could my VA Sleep Doctor request that?

Sorry to keep adding questions...I'm just a bit frustrated with that letter. It didn't come at a good time! :rolleyes:

#4 vaf

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Posted 19 July 2008 - 07:51 AM

Detonator, ratings are awarded in increments of 10% (10%, 20%, 30%, etc.). They are also combined with your other ratings, not parsed out and rated separately, or retroactively. What the VA appears to be stating is that even though they've added 10% for the insominia rating, when combined with your other ratings and compared to the Combined Ratings Table in 38 CFR Part 4, it wasn't enough to increase your ratings or payments. A higher rating might have done so, but again, everything is combined and measured through that Combined Ratings Table. There's a calculator on the home page of hadit. Plug in your ratings for your separate conditions and see what you get.

http://www.hadit.com...ting_Calculator

You can file a Notice of Disagreement, get the doctor to clarify his staement saying that you can't work, and while you're at it, file for TDIU (unemployability). Again, there's a lot of information mentioned on the home page here that should help direct you.

#5 john999

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Posted 19 July 2008 - 04:33 PM

I would try and work the insomnia and chronic pain into a depression claim. You can get a greater percentage rating for depression than insomnia alone. Are you seeing a psychiatrist about your chronic pain and insomnia. If you can't work file for TDIU. Just about eveyone who has chronic pain does suffer from some depression.

#6 trailblazer

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Posted 19 July 2008 - 09:49 PM

Detonator, I received the same answer on 7-14-08. MY initial rating for DMI II was 40% and hypertinsion was defered on the initial rating pending an additional C&P exam. I was awarded 10% sc for the hypertinsion but my combined rating remained at 40% ( Quote from th rater. We do not add the indiviual percentages of each condition to determin your combined rating. We use a combined rating table that considers the effect from the most serious to the least serious conditions) The way I understand the rating calculator 50% plus 10% gives you a total rating of 55%. If it had been 55.5% it would have been rounded up to 60% total rating. In my case 40% plus 10% equals 46% rounded up to 50%. I am with you, I don't understand this and I am still looking for an explanation. I am sure someone on HADIT can handle that.

#7 Ricky

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Posted 19 July 2008 - 11:34 PM

55 will round up to 60 percent. VA math is hard to understand. It is based upon the fact that if you have a 40 percent rating then you are still 60 percent good/well/capable. If you then apply for another disability and they give you a 10 percent rating for that disability, it is matched against you good/well percentage which would be 10 percent of 60 percent which equals 6 percent. It is then added to you bad side of 40 percent which equals 46 percent. Meaning you are actually 46 percent disabled and now only have 54 percent of good left in you. However, for pay purposes the 46 is rounded to 50 percent and they pay you at the 50 percent level.

Now if you apply for another disability and say they award you another 10 percent disability for it - they take this new 10 percent from the 54 percent good you have left which equals 5.4 percent. This 5.4 percent is now added to your bad side of 46 which equals 51.4 which is rounded down to 50 percent so you get paid at the 50 percent rate, therefore there is no change in your payments. The statement in the rating decision is just to remind you that, for example a person with a current 60 percent rating who just got a 10 percent rating will not get a total rating of 70 percent, the new rating will be 64 percent so there will be no change in the monthly payment cause the 64 percent rating is rounded down to 60 percent and the vet was already being paid at 60 percent. The award of the new 10 percent rating is simply a building block to a higher rating and could mean the difference of getting or not getting of DIC for the dependents if the vet happened to die of something associated with the new 10 percent rating.

See it is kinda complicated and silly but that's the way it is.



Forgot to ask - what disability code did they rate the insomina under?

Edited by Ricky, 20 July 2008 - 01:00 AM.


#8 Detonator

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Posted 20 July 2008 - 12:49 AM

John,

I did get evaluated by a VA psychologist and was referred to a therapist for relaxation techniques. I just looked back at that initial overview and in the report I did mention that I was run-down and had some depression. Their scale listed a 4/10 on the depression scale. None of that was listed in my rating report. Also, I was upset that during my C&P exam, I was never asked about the insomnia issue. The doctor said he only handled the orthopedic issues. Their insomnia decision was only based on what was in my records.

I've discovered that all the petty little B.S. that I've discussed with my sleep doctor and others seems to be what gets put in my records. Important stuff, like I only work a part time teaching job in the evening because of my insomnia doesn't get mentioned...which could probably have helped my case.

I definitely think I'm going to file a NOD. This time, I'm going to make sure my VA sleep doctor documents everything (depression, the fact that I can't work a regular day time job and my dependence on sleeping pills). I also plan on having my wife write a letter how my insomnia has affected our lives (it truly has become worse than my injuries).

I would try and work the insomnia and chronic pain into a depression claim. You can get a greater percentage rating for depression than insomnia alone. Are you seeing a psychiatrist about your chronic pain and insomnia. If you can't work file for TDIU. Just about eveyone who has chronic pain does suffer from some depression.



#9 Detonator

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Posted 20 July 2008 - 12:51 AM

Ricky, I looked over the rating report and did not see any codes listed for the Insomnia. Thanks for the explanation on the percentages.



55 will round up to 60 percent. VA math is hard to understand. It is based upon the fact that if you have a 40 percent rating then you are still 60 percent good/well/capable. If you then apply for another disability and they give you a 10 percent rating for that disability, it is matched against you good/well percentage which would be 10 percent of 60 percent which equals 6 percent. It is then added to you bad side of 40 percent which equals 46 percent. Meaning you are actually 46 percent disabled and now only have 54 percent of good left in you. However, for pay purposes the 46 is rounded to 50 percent and they pay you at the 50 percent level.

Now if you apply for another disability and say they award you another 10 percent disability for it - they take this new 10 percent from the 46 percent good you have left (not 50 percent, remember the 50 is only for pay purposes) which equals 4.6 percent. This 4.6 percent is now added to your bad side of 46 which equals 50.6 which is rounded to 50 percent so you get paid at the 50 percent rate, therefore there is no change in your payments. The statement in the rating decision is just to remind you that, for example a person with a current 60 percent rating who just got a 10 percent rating will not get a total rating of 70 percent, the new rating will be 63 percent so there will be no change in the monthly payment cause the 63 percent rating is rounded down to 60 percent and the vet was already being paid at 60 percent. The award of the new 10 percent rating is simply a building block to a higher rating and could mean the difference of getting or not getting of DIC for the dependents if the vet happened to die of something associated with the new 10 percent rating.

See it is kinda complicated and silly but that's the way it is.



Forgot to ask - what disability code did they rate the insomina under?



#10 Detonator

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Posted 20 July 2008 - 12:52 AM

Thanks for the info Trailblazer!

Detonator, I received the same answer on 7-14-08. MY initial rating for DMI II was 40% and hypertinsion was defered on the initial rating pending an additional C&P exam. I was awarded 10% sc for the hypertinsion but my combined rating remained at 40% ( Quote from th rater. We do not add the indiviual percentages of each condition to determin your combined rating. We use a combined rating table that considers the effect from the most serious to the least serious conditions) The way I understand the rating calculator 50% plus 10% gives you a total rating of 55%. If it had been 55.5% it would have been rounded up to 60% total rating. In my case 40% plus 10% equals 46% rounded up to 50%. I am with you, I don't understand this and I am still looking for an explanation. I am sure someone on HADIT can handle that.



#11 john999

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Posted 20 July 2008 - 12:37 PM

Unless there is some physical cause for your insomnia then it is probably due to eithier drugs you take or to anxiety or depression. People with sleep apnea have a physical cause but they suffer from many mental problems including depression. People with psychological cause of insomina are often depressed and anxious and many vet with these conditions have PTSD. I would want to look deeper and find the root cause of the insomnia.

#12 trailblazer

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Posted 20 July 2008 - 11:04 PM

I have been reading the topic on combined rating and understand how the VA math works but I don't completely understand the rating I got on July 14-08. My inital rating was for DM II at 40%. On appeal I was granted 10% sc for HBP which according to the C&P examiner was aggravated by diabetes via diabetic nephorpathy. The way I understand it my combined rating should have been increaed to 46% rounded to 50% for pay. They also said my compension at 40% would not change. Dose this fall into pyramiding? Also does the 10% affect me as far as copay for meds and the magic 50% rule. I don't want jump into this without understanding it as there are a lot of vets out there that that also need help. Thanks for your help.

#13 vaf

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Posted 21 July 2008 - 08:03 AM

If you now have two separate ratings, one at 40% and another at 10%, then according to the Combined Ratings Table in 38 CFR, you should be at 46% rounded up to 50%. You can ask the VARO for reconsideration, citing the Combined Ratings Table and make sure that the VARO understands you now have two separate ratings instead of one. It's possible someone there made an error in computing your overall rating.

I would also send them an inquiry through IRIS, the computerized system through the VA website, and make sure you keep a copy of the VA's response. If they don't agree that you're rating should be at 50%, then ask for a DRO to review the decision, keeping it local. You didn't say if you agreed with or disagreed with the total decision, but if you disagree, you can include the question about the VA math in your request for a DRO to review the entire decision.

The VA doesn't use the Ratings Table itself, but a computerized equivalent of it. If the VARO gave you a separate rating for HBP, then it is not pyramiding. You would not have received a separate rating for HBP if it had been a case of pyramiding.

At 50%, you should get your meds free of charge at the VA Medical Center or through the mail. Not sure about co-pay on doctor's visits, someone else can speak to that here, I'm sure. I don't think you pay for those, either, but someone will correct me here if I'm wrong.

#14 trailblazer

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Posted 21 July 2008 - 12:43 PM

Thanks VAF, you've been a big help. I don't have the experience you folks do and I really do appreciate having somone like you and hadit to help people like me. As my knowledge grows in the va laws and policies, I hope to be able other vets in the future. Have a nice day.

#15 Ricky

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Posted 27 July 2008 - 11:16 PM

how does a vet rating for insominia i have ratable head injuries what do i have to prove



There is no true rating for insomia as it is a symptom of some other disability and is used to justify that disability. More often than not it is worked into some type of depression issue. It can be part of PTSD, anxiety, depression etc.....