Insomnia - Combined Rating

[Detonator]

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!

[Ricky]

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 July 20, 2008 by Ricky

[Detonator]

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.

[Detonator]

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?

[Detonator]

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.

[john999]

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.

[trailblazer]

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.