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Shoulder Surgery And Dc

5 posts in this topic

I have a disability compensation of 30% for my shoulder that was injured in the service. I did have a shoulder dislocation before I joined but it was on my enlistment papers and they knew about it. The DC is for the shoulder and what they originally DX as narrowing of the subcromial space in my shoulder. Along with this I also have nerve damage and am taking medication for this on a daily basis. I have been to numerous doctors and have finally found an orthopedic doctor that has said she can fix this by surgery and said it is bicep tendonesis. She will have to put a pin in my shoulder and she thinks this will fix it, but not sure if the nerve pain will go away. I have will extensive Physical Therapy. If they fix my shoulder, which is being done by the civilian doctor, can the VA come back and recoup all that money? Can they reduce my disability compensation? We'd like to get them to pay for the surgery even with it being done at a civilian hospital as an outpatient basis. Will they do that or does the surgery have to be done by the VA?

Thanks and your help is much appreciated.

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I'm not sure about getting the VA to pay for an outside surgery, but someone else probably will post on that later. The VA can decrease your SC'd compensation if your shoulder gets better. If, after you have the surgery, the VA calls you in for a C&P, and your shoulder has shown improvement, they will note it in the SOC. They will schedule you for another C&P 12 to 18 months later, and if the shoulder is still showing improvement, they will issue another SOC proposing to decrease the amount of SC comp you receive for it. You will then have 60 days to submit evidence as to why your rating should not be decreased. This is of course, if the rating has been in place for longer than 5 years. If the rating has been in place for 20 years, it cannot be reduced, unless it is found that the rating was obtained by fraud.

38 CFR 3.344 This the reg that covers stabilization of ratings.

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What if the VA doesn't know about the outside surgery? We are having it done through a civilian Orthopedic doctor. We are debating about whether to try to ask them to pay for the outside surgery or just letting it be and not asking them to pay for it. We are afraid they will decrease his compensation. He got his DC in 2003 and he has never been to the VA since due to us being in the Dallas/Ft. Worth area and they are the worst or one of the worst in the nation for VA service.

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I would schedule an appointment with the VAMC or the nearest outpatient clinic as soon as I could. I would also do this prior to any surgery. If the VARO audits his records (albeit unlikely, it does happen, and I am proof), they will take his lack of seeking medical attention/complaints to mean that his condition has improved. They will schedule another C&P based on this, and if improvement is shown they will reduce. Since he hasn't made it quite to the 5 year mark yet, it makes it much easier for the VA to reduce the amount of comp.

It is up to you whether or not to report that he is going to have the surgery, or whether he has had it. I personally would not, until it came time for a C&P. Then I would send in all records that pertained to any treatment that he has received for his shoulder.

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It could be that your shoulder will not get better, but may even be worse after the surgery. You might get increased compensation. Shoulder surgery is tricky. I had it and my shoulder is now worse than before. I doubt that the VA will take away your compensation percentage unless they see improvement via a C&P exam or by your telling them your shoulder is better. It would not hurt to get a VAMC opinion from a VA orthopod. Be sure to complain about the pain, and don't let them take you through the full ROM if it hurts. I don't think you can get too many second opinions on this stuff. They cannot uncut your shoulder after they do it. A lot of doctors will say they can fix you but it is your body. If there is not something wrong with the bones or a tear in the tendon I would be careful. I have chronic rotator cuff tendonitus and I don't know what to do about it besides PT and a shot of cortizone every 6 months. I am just advising caution. Get ready for a lot of PT to get the arm to regain ROM. I had shoulder and wrist surgery and both failed.

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