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crabbyone

Va Claim For Knee

6 posts in this topic

I have a few questions...

I have an award (10%) for SC knee pain that also says further evaluation for instability is warranted. When I filed my claim, I listed the fact that my knee gives out frequently. I was diagnosed while on active duty in 96 with a tibo-fibular subluxation of this knee. I retired from the Reserves last May and filed my claim then and received my award this June along with 10% for tinnitus and 0% for hearing loss (free hearing aids that work wonderfully BTW.

My questions are:

1-I went to my civilian orthopedic Dr and he said my ACL was torn and had been for some time (hard to tell how long). I got home today after having ACL replacement. He informed me that it WAS an old injury and the ACL was torn from the bone, not in the middle as are most. Should I file a disagreement and request compensation for the instability and ACL replacement since the records show this was diagnosed in 96?

2-I have also been treated and continue to be treated for kidney stones. I was diagnosed with them in 01 while in the Reserves and the Urologist said that based on the number and size, I had them for a quite a while. I left active duty Oct 98. Can I claim this?

Thanks!!!

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The knee I can comment on as I am in the same boat. Torn cartilage(UNLESS DISLOCATED,ETC.)or ACL is not actually what they rate you on. What I mean is they (VA) rate the instability, locking clicking, subluxation, osteoarthritis--limited motion and pain. If you are already rated for slight "instability" of the knee (Diagnostic code 5257) is 10%, and 20% for moderate, or 30% for severe instability. *You can receive multiple ratings for a knee injury. Example: if you find on Xray that you now have arthritis in the knee you can receive a second rating in addition to instability. Suggestion: review the following diagnostic codes: (5256 Knee, ankylosis of), (5260 Leg, limitation of flexion of), (5261 Leg, limitation of extension of), and (Tibia and fibula, impairment of). In closing, if/when you have or had any knee surgery---remember to reopen your claim for a higher compensable rating.

Edited by vmo

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Here is the NOD I plan on filing. Any comments or suggestions?

Notice of Disagreement

17 July 2009

Department of Veterans Affairs

[ Address of Regional Office ]

Attention: [ Your Claim Number ] – [ In Reply to: (right hand corner of rating decision) ]

Dear Sir,

I received a rating decision dated [ Date ]. Consider this letter to be an official "Notice of

Disagreement" (NOD) regarding the following disability:

1) Left knee problems

I am requesting a "De Novo Review" by a new Decision Review Officer. I submitted a permanent profile along with the numerous medical documents that all documented a tibofibular-subluxation of the left knee. During the exams I went through and the 3 physicals I submitted as evidence, I indicated that I wore a knee brace most of the time that helped. I further indicated that I experienced frequent locking of the knee and instability in the same knee due to the looseness of the knee. I also explained to the examiner that when I walked extensively, that the pain and instability increased, and the locking became more frequent. I have since consulted with an orthopedic doctor who sent me for x-rays and an MRI followed by a knee scope. The scope revealed the upper portion of the ACL was torn from the bone and a complete ACL replacement was performed. The doctor further explained that up to 80% of the pain should be gone after recovery and I should have 80% of the stability restored after completion of physical therapy.

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Your NOD confuses me only because it sounds as if your knee problem is much better! For your sake, I hope it is. Not really going to help your claim at all.

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Here is the NOD I plan on filing. Any comments or suggestions?

Notice of Disagreement

17 July 2009

Department of Veterans Affairs

[ Address of Regional Office ]

Attention: [ Your Claim Number ] – [ In Reply to: (right hand corner of rating decision) ]

Dear Sir,

I received a rating decision dated [ Date ]. Consider this letter to be an official "Notice of

Disagreement" (NOD) regarding the following disability:

1) Left knee problems

I am requesting a "De Novo Review" by a new Decision Review Officer. I submitted a permanent profile along with the numerous medical documents that all documented a tibofibular-subluxation of the left knee. During the exams I went through and the 3 physicals I submitted as evidence, I indicated that I wore a knee brace most of the time that helped. I further indicated that I experienced frequent locking of the knee and instability in the same knee due to the looseness of the knee. I also explained to the examiner that when I walked extensively, that the pain and instability increased, and the locking became more frequent. I have since consulted with an orthopedic doctor who sent me for x-rays and an MRI followed by a knee scope. The scope revealed the upper portion of the ACL was torn from the bone and a complete ACL replacement was performed. The doctor further explained that up to 80% of the pain should be gone after recovery and I should have 80% of the stability restored after completion of physical therapy.

Take out anything that is subjective (what you told an examiner).

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I'm currently receiving compensation for knee instability (30%). Recently my knee has been "giving out" almost daily and knee pain is horrendous. The VA MRI'ed the knee and found that my meniscus and graft from a previous surgery is torn. I am to have surgery on the knee again. I want to submit a letter saying my condition has worsened. Should I do this with the current Dr's report/MRI or wait until after surgery?

thx

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