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All Kinds Of Messed Up; Wrong Rating, Increased, Decreased, Ignored


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6 replies to this topic

#1 wutzthedeal

 
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Posted 12 March 2012 - 07:04 PM

Hey guys; I would have posted in a more specific forum but my question covers a rather wide range of topics (from TDIU to ratings time limitations to legal reps).

Long story very short; served USAF 1990-94. Blew knee out in basic. Had 2 surgeries:
1st: partial crushed medial meniscus removal and notation of acl deficient (snapped) knee Langley, 1992
2nd: full bone-tendon-bone graft acl reconstruction, Ft. Wainright, 1993.

Although I was on a 6 year enlistment, my surgeon wrote up the paperwork that made me 4t (not worldwide deployable) and offered me an out with a small severance pay and a "20% less 10% EPTS" rating, because they say I injured it before enlisting, which is true. And there is the first problem; a private doctor, orthopedic, paid by the VA, checked me out at MEPS and called the knee 100% healthy, and that's in my records. Doesn't that make any new injury a NEW injury? So why the 10% subtraction? Been fighting that on and off since 1999.

Around 2002, with help from this forum and a close friend, I get my C&P and jumped to 50% with the VA doctor claiming that I had major arthritis in the knee and the condition was degenerative (which I always took to mean "doesn't get better; might stay the same if you're lucky"). I was happy.

2006 or so, the pain got a lot worse and the bone grinding started. I went for an increase, thinking I could at least get 60 or 70 and maybe take a shot at TDIU. I got reduced to 20%, and if that isn't bad enough, here's the fun part...

I have a scar over my eye from a hasty cyst removal; that got me 10% in both cases. The other scar is sensitive and painful (on my knee) yet I didn't get anything the last time as the rating suggests. The doctor for that C&P seemed like a bitter guy. I'm honest, and I had recently been given some pretty good pain medication for my back which helped with my knee. I told him that; I told him that that day was a good day. I had letters of support from people that had witnessed how my leg had affected my life. Even while on the pain medication, when he went to bend my knee by pushing my heel toward my butt, I let out the predictable yell almost the second he started, but he kept pushing until I tried to jump off of the table using my left leg; he then used that as the ROM (range of motion).

My degenerative condition had somehow been healed by the angels. The other tests involving flexibility and laxity and that type of thing were apparently all normal, according to him. All any human needs is one look at an MRI of mine to know that's all wrong. The first sign is the bones making contact in the knee joint.

So I appealed, but couldn't get to the hearing (had no money, no car). Over the past few years I've written a few letters and otherwise grown very tired with the fight. Finally, most recently, I got in touch with Alpha Veteran's Disability but had a bad experience with an employee there who blamed me for not getting in contact with him when I had received no calls or letters after 6 months and finally complained; least professional person I have ever dealt with in the business world. Now, I've filed with Rep4Vets and I don't know how that's going to go.

So that's about it: 20%-10% (10%) raised to 50 for degenerative conditions that magically turned regenerative and dropped me to 20. I hope I haven't put too much out at once. I read other posts and believed that getting the whole story out, in as few words as possible, was the best way to go. Please let me know what you would do next or what I've done wrong so far.

#2 71M10

 
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Posted 12 March 2012 - 07:56 PM

Wutzthedeal,

It sounds like you need to get represented. Either by misinformation from VA, or organizational limitations that you have, your story sounds mixed up.

Who told you a VA contracted physician ok'd you for service? I highly doubt it was VA connected, However, I am sure you saw a physician contracted by the government but I have never heard of VA being involved in pre enlistment exams or clearence.

Currently, while appealing a VA decision about the only way you are getting a hearing is if you specifically ask for one.

I mention these two previous examples not to challenge your credibility but to point out you need to get a clear grasp on what VA has given/done to you in writing. What they have told you verbally unless documented in thier system is going to have no value. You need to make sure that every statement/written request you send to the VA is clear, concise and complete. Try to avoid making any statements or allegations that are not supported by fact. I have no doubt you were given a C&P that was incorrectly completed. I also think you need to have someone sit down with you and organize your records. If you don't have a copy of your C-file get one!

Any attorney that takes your case or is considering taking your case will have a lot of questions.

Be sure to keep an eye on your deadlines. You may have to appeal/ formalize your appeal before getting a copy of your c-file.

Best regards,






#3 71M10

 
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Posted 12 March 2012 - 08:06 PM

You also need to get your current doctor to write a nexus statment on how your knee problem has caused or worsened your back condition. If the knee is altering your balance or gait it probably is screwing up your back.

You need to decide if you want to file any additional claims now or after the appeal has run its course

#4 donna68

 
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Posted 12 March 2012 - 08:09 PM

wutxthedeal,
Sorry to inform you, but it looks like the 50% was a CUE or ERROR. I didnt read the threads so I may be repeating stuff. The first thing is see is it looks like you were rated for ONE knee at 50%. The knee condition maxes out at 40% since an amputation at the knee is 40% when fitable with a prosthetic. So they arent supposed to give someone who still has their knee more than someone with an actual amputation of the knee.
A 10% can be granted for limited flexion, extension, sbuluxation and instability (range of motion) and a 10% for the paiful scar, so if you have limitation of motion, subluxation, instability and a painful scar, that would be 10% for each. Its rare but happens!
The reason why it seems like they arent reading your letters is because in this case, the VA ey give rates joints based on the VA exam based on the above limitations.
Degenerative joint disease or arthritis without any of the above limitations is 0% unless there are two knees with degenerative arthritis and normal range of motion, then they can give 10% for both.
Sorry that you are in so much pain, but no matter how much your knee hurts, no matter how many surgeries you have endured and no matter how arthritic your knee is, if it isnt limited in the above it rates at a 0%.
The grant should have been a grant based on aggravation or an aggravated injury because there was an injury prior to service.
The 10% subtraction may be VA math unless your entry exam shows decreased range of motion which would have been a baseline at 10% on entry.
You are right degenerative means gets worse, but VA doesnt grant based on MRI results. There could be pins, bone to bone, arthritis, cartilage damage.....They grant based on the above..
VA sees things differently. You could have arthritis in every joint in your body with normal range of motion and only get 10%.
If you got 20% they are definitely not saying you are healed, they are saying you are limited. It means that you only met the 10% criteria for 2 of the above or 20% for 1, probably flexion and extension. Most veterans get 10% and at times 20% for one knee unless its been amputated.
Unfortunately, your mistake like many other veterans was asking for an increase, when there is no increase possble.
If you get a replacement, you will rate higher, like 30% for replacement. I suggest that you look at the rating schedule for knees DC 5260, 5261.....so that you have a better understanding about what you may be entitled to. There is a link on this site. 38 USC..
Good luck with your case. Consider one kneecould have aggravated the other knee or your back, so you can submit a claim for asecondary condition.
Donna

#5 Berta

 
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Posted 13 March 2012 - 07:08 AM

“I got reduced to 20%”

“So I appealed, but couldn't get to the hearing (had no money, no car). “

“So that's about it: 20%-10% (10%) raised to 50 for degenerative conditions that magically turned regenerative and dropped me to 20 “

I might be reading this wrong but as I see it, you might have to file a new claim for a higher rating on this with new and material medical evidence.

It might take an independent medical opinion.

"My degenerative condition had somehow been healed by the angels"

Can you scan and attach here (cover personal name and C file # stuff)

the SOC or C & P result that determied this condition had "healed"?

Wat medical rationale (MRI or X ray etc( did the examiner use to say that it had decreasedin disabling affect?

#6 wutzthedeal

 
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Posted 13 March 2012 - 09:57 AM

Sorry folks; in my attempt to keep it short, I left out some of the connecting items. I'll start from the bottom.

1. 71M10: The orthopedic doctor probably was paid by the government, and not the VA. My point was that the knee was called 100% healthy at a private ortho doctor that MEPS sent me to while I was up there to clear the knee. There were no limits, no ROM issues, no swelling. So when I snapped my ACL in basic and crushed my medial meniscus, that was new. So how is that aggravating an old injury, just because (me, being stupidly honest again) admitted that I had hurt my right knee over the summer? And I did ask for a hearing; it was the last straw effort, hoping I could get a ride or get to the hearing which was ~200 miles away. Anyway, I'll take your advice and push forward with Rep4vets unless someone suggests otherwise.

2. donna68: I guess I should have included that he did max the knee out at 40%. The 10% was for the scar over my eye. He noted all limitations in ROM, laxity, and stability as well as what caused those limitations (arthritis). He even put the x-ray up on the wall light to show me all the arthritis (and that was in 2002... 10 years ago... you can imagine what was in 2006ish... and now...). Nobody yet has considered that 8-inch long scar over my knee. It's like a burn or a cut; as soon as you stretch it or put weight on it (like kneeling) you are shocked with pain that's just miserable. I guess I haven't been tough enough or maybe frank enough to just say, "Hey, this scar is a major source of pain, above and beyond the inner knee pain." It's like a super duper thin sheet of skin... they really opened me up; I had the record that year at the Army base (I was AF but we had no surgical facilities at Eielson in AK for big jobs so we went to Ft. Wainright). 23 staples. They even let me take some out when it was time for that.

3. Berta: I don't even know what a C file is although I've read enough on these forums to know I need mine. Is it just medical records? I have those. And, no, they didn't determine anything had "healed." THey just cited ROM stuff and laxity and those typical knee details, but the guy who did it was killing me. The first doctor stopped when it started hurting and called the ROM numbers there (which is what I believe the regs say you are supposed to do).

I used to ponder getting something to say the knee led to the back... I asked a VA doctor about it and he said it would be hard to say the knee most likely led to the back. I have never asked a private doctor about it because I rarely see them and had presumed they would say the same, but I'm learning now. I'll be asking them. It makes sense that if I was using my left leg more to get weight off of my right one, over the course of years, and then I suddenly have a ruptured disc from lifting a skimpy pc monitor that something had been weakened or displaced. And now, after the surgeries, the spinal arthritis has been determined by the VA, as of Feb. to be moderate-to-severe. Which means severe.

I think the knee should still be at 40. Each major scar should be 10 for 20. And maybe the back should be linked. Hope I've answered your questions and thank you all for your input so far. I appreciate what you put in to helping people on these boards.

#7 carlie

 
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Posted 13 March 2012 - 05:47 PM

Hey guys; I would have posted in a more specific forum but my question covers a rather wide range of topics (from TDIU to ratings time limitations to legal reps).

Long story very short; served USAF 1990-94. Blew knee out in basic. Had 2 surgeries:
1st: partial crushed medial meniscus removal and notation of acl deficient (snapped) knee Langley, 1992
2nd: full bone-tendon-bone graft acl reconstruction, Ft. Wainright, 1993.

Although I was on a 6 year enlistment, my surgeon wrote up the paperwork that made me 4t (not worldwide deployable) and offered me an out with a small severance pay and a "20% less 10% EPTS" rating, because they say I injured it before enlisting, which is true. And there is the first problem; a private doctor, orthopedic, paid by the VA, checked me out at MEPS and called the knee 100% healthy, and that's in my records. Doesn't that make any new injury a NEW injury? So why the 10% subtraction? Been fighting that on and off since 1999.

Around 2002, with help from this forum and a close friend, I get my C&P and jumped to 50% with the VA doctor claiming that I had major arthritis in the knee and the condition was degenerative (which I always took to mean "doesn't get better; might stay the same if you're lucky"). I was happy.

2006 or so, the pain got a lot worse and the bone grinding started. I went for an increase, thinking I could at least get 60 or 70 and maybe take a shot at TDIU. I got reduced to 20%, and if that isn't bad enough, here's the fun part...

I have a scar over my eye from a hasty cyst removal; that got me 10% in both cases. The other scar is sensitive and painful (on my knee) yet I didn't get anything the last time as the rating suggests. The doctor for that C&P seemed like a bitter guy. I'm honest, and I had recently been given some pretty good pain medication for my back which helped with my knee. I told him that; I told him that that day was a good day. I had letters of support from people that had witnessed how my leg had affected my life. Even while on the pain medication, when he went to bend my knee by pushing my heel toward my butt, I let out the predictable yell almost the second he started, but he kept pushing until I tried to jump off of the table using my left leg; he then used that as the ROM (range of motion).

My degenerative condition had somehow been healed by the angels. The other tests involving flexibility and laxity and that type of thing were apparently all normal, according to him. All any human needs is one look at an MRI of mine to know that's all wrong. The first sign is the bones making contact in the knee joint.

So I appealed, but couldn't get to the hearing (had no money, no car). Over the past few years I've written a few letters and otherwise grown very tired with the fight. Finally, most recently, I got in touch with Alpha Veteran's Disability but had a bad experience with an employee there who blamed me for not getting in contact with him when I had received no calls or letters after 6 months and finally complained; least professional person I have ever dealt with in the business world. Now, I've filed with Rep4Vets and I don't know how that's going to go.

So that's about it: 20%-10% (10%) raised to 50 for degenerative conditions that magically turned regenerative and dropped me to 20. I hope I haven't put too much out at once. I read other posts and believed that getting the whole story out, in as few words as possible, was the best way to go. Please let me know what you would do next or what I've done wrong so far.


You will need new & material medical evidence to reopen the final adjudicated issue.