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  • 14 Questions about VA Disability Compensation Benefits Claims

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    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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big jim

Help Denied Twice

Question

was geting 100% from july 2009 to jan 2010 for ankle fusion. ortho doc gave me off tell july 2010 in dec 2009 this was denied. after the visit with ortho doc in dec my surical wounds started to drain real bad. whent to er was sent to opd clinec. refieled for temp 100% for wounds not heald, denied. doc set in dec wounds were healing, i told him about the dranage he just shafed it off. my wife was there to back me up . now the va keeps denieing me because what the dock said in dec. i have been going to the opd clinec twice a mouth sence dec to get my wounds heald. also i had a little infection sent in that had to be treded. acording to title 38 4.30 i stell am intield to the 100% tell my wounds are heald is this not right. i did a regular requst then a reconsederation, what next, and earer on there part our what. if iam not intieled fine put i dont see how. pleas help me i am at a lose on how to proced.

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Can you scan and post the decision here? (Cover personal stuff) or tell us their exact wording of the reasons for denial?

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va rating dated april 8 2010 we denied entitlement to and additional period of convalescence because treatment of the service-connected disability did not meet any of these conditions. you were advised of this decision by va letter dated april 13 2010. we received a reconsideration of your entitlement to and additional period of convalescence.

A review of your records showes that you underwent surgery on this ankle in Julu of 2009, and authorized a temporary evaluation until January 1, 2010. We have reviewed the statement from Dr. McHugh concering convalescent leave and although this statement showes you well be on convalescent leave untel July 21, 2010, there is not basis presented for this convalescent period. A review of your treatment records showes that in early December physical examination o0fm your ankle showed medical surgical wound healing well with no evidence of infection. he bone fusion appared to be consolidating and you were iaaued a rocker bottom sole shoe to begin to increase your weight bearing over the followinf 2 weeks. Treatment notes from March 2010 showed that you had a slighty painfull gait but were walking on this ankle ans x-rays showed a solidly heald ankle arthrodesis. the additional evidence does show ongoing treatment for right ankle however it does not show a severity in your condition to warrant a continued entitlement to convalesence.

A temporary 100 Percent evaluation may be assigned when it is established that a disability, subject to VS compensation, required surgery necessitating at least one mouth of convalescence, surger with severe postoperative residuals, or treatment with immobilization by cast of one major joint or more. Entitlement to and additional period of convalescence has been reconsidered anf remains denied because treatment of the service-connected disability did not meet any of these conditions

An evaluation of 20 percent is assigned from January1.2010. An evaluation of 20 percent is assigned for malunion of the tibia and fibula with moderate knee or ankle disability. A higher evaluation of 30 percent is not warranted unless there ia malunion with marked knee or ankle disability.

This disability is not specifically listed in the rating schedule; therfore, it is rated analogous to a disability in which not only the fuctions affected, but anatomical localization and symptoms, are closely related.

Now this is what they told me. But my wounds are not heald all the way and no comment about the infection i had treatede for a mouth. About this earl dec comment about my wounds healing. I told the doc that my wounds are draing bad, he said dont weary about it that they ar ok . So in late Dec i had to go to the opd clinec because they were not healing been going ever since.

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"although this statement showes you well be on convalescent leave untel July 21, 2010, there is not basis presented for this convalescent period." Is Dr. McHugh a private doctor and not a VA doctor?

He needs to give more medical rationale for the reason you should have longer convalescence.

"But my wounds are not heald all the way and no comment about the infection i had treatede for a mouth. About this earl dec comment about my wounds healing. I told the doc that my wounds are draing bad, he said dont weary about it that they ar ok . So in late Dec i had to go to the opd clinec because they were not healing been going ever since."

Is the doctor who knew of the infection and healing problems the same doctor?

If so he should incorporate this information into his opinion as to the need for further convalescence.

As I understand this-the surgery you had was in July 2009 but it is now almost a year later and the wounds are not healed?????

I would get a more detailed rationale from the doctor- that considers the long healing process you are having and I would also file a Section 1151 claim against them.

Section 1151 can be found under FTCA forum and the search feature.

It seems to me that this is an extraordinary long time for the wound to heal.The longer healing takes-m0re time for infection to set in.

Was the surgery and follow up all done by the VA?

WHo is Dr. Mc Hugh and what type of doctor is he?

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"A review of your treatment records showes that in early December physical examination o0fm your ankle showed medical surgical wound healing well with no evidence of infection. he bone fusion appared to be consolidating and you were iaaued a rocker bottom sole shoe to begin to increase your weight bearing over the followinf 2 weeks. Treatment notes from March 2010 showed that you had a slighty painfull gait but were walking on this ankle ans x-rays showed a solidly heald ankle arthrodesis. the additional evidence does show ongoing treatment for right ankle however it does not show a severity in your condition to warrant a continued entitlement to convalesence."

Did they have evidence of the infection before they made the decision?

How did they list it as evidence- I don"t seem to see how they even mentioned it at all.

Do you have copies of all of your med recs that are up to date copies top prove the infection and that the wound is still not healed?

Do you have copy of the med profile that shows they had to give you antibiotic for the infection?

Do they give yo any pain meds at all for this?

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Can you tell me the medical term they used for the type of infection you had?

This is why I mentioned 1151 claim:

THE ISSUES

1. Entitlement to an evaluation in excess of 10 percent for

status post staphylococcus (staph) infection of left shoulder

surgery from January 26, 2004 to March 1, 2004.

2. Entitlement to temporary total rating beyond August 31,

2004 based on the need for convalescence (38 C.F.R. § 4.30

(2009) following status post staph infection of left shoulder

surgery.

3. Entitlement to an evaluation in excess of 40 percent for

status post staph infection of left shoulder surgery from

September 1, 2004.

from: http://www4.va.gov/vetapp10/files1/1007575.txt

(on remand)The important point to note is that the 1151 disabilities due to the staph infection had already been granted and established.The remand was to address higher ratings and longer convalescence.

http://www4.va.gov/vetapp10/files1/1007813.txt- this case has the criteria for Section 1151 claims.

Edited by Berta

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