crabbyone

Got the usual letter today acknowledging my claim. I am guessing they are going to consider it an ammendment since they didn't specify otherwise in this or the NOD acknowledgement. Will they send me for a C & P if I submit my IME that has a statement that says "I suspect it is exceedingly likely that he had substantial stone burdon prior to leaving the military given the situation at hand." There are other pages to the IME that date back over 10 years and document my history of stones. I suspect I may have passed some while in the military, but I drank beer daily and never had any difficulty urinating. As I got older and quit drinking, this issue came to light and has progressed to the point of needing lithotripsy 1 time and a probable need for lithotripsy again to blast more large stones. Since I had not had the lithotripsy prior to filing my original claim, I did not include it then. After having the lithotripsy and discussing the situation with my urologist, he easily gave me the statement and discussed having the VA pay for it. Thanks for the help!!

Got my letter today acknowledging my Notice of disagreement and explaining the process. Nothing in it about ammending my original claim though. Does this mean it is going to be ammended and I will have another C & P for the additional claim or what? Do I need to send an IRIS and ask about the ammendment now that my NOD is in? Thanks!

My original claim was filed on 3 June 2008 and rating decision was made on 22 April 2009. I have filed my NOD and it was received on 20 April 2010. I finally received my file on March 10 2010 and it took a few weeks to go through it and get my statements from co-workers and my wife. Yes it was close, but it was filed in time! The rating award letter said "A 10% evaluation is assigned for painful or limited motion of a major join (your knee)." Later it states "The next higher evaluation of 20% is warranted when there is dislocation of the semilunar cartilage with locking, pain, and effusion, or flexion limited to 30 degrees, or extension limited to 15 degrees. A seperate evaluation may be assigned for instability of the knee." From that I gather that they didn't grant anything for the instability that I am requesting. After discussing my situation with an Orthopedic Dr last May and an exam, xrays and an MRI by him (paid for by my personal health insurance), he determined that the instability was due to an ACL/LCL deficiency and scheduled a scope/surgery for repair. The biggest symptom he had was the instability I was experiencing. I could walk 5 miles 1 day before my knee would give way and 5 ft the next before my it would give way. Playing sports was very risky as it would give without notice and the pain was excruciating. Since the surgery, the better part of the constant pain I had is gone and most of the stability is back. I still wear a brace for certain activities and have to watch myself on some things that put a huge strain on my knee (climbing ladders, lifting heavy objects, sports activities, etc).

How can I be past my deadline when their decision was not given until April 2009. I have 1 year from the date of the decision, not when it was filed, right? Furthermore, the request for the records took almost 8 months, so I had no idea that the Dr gave wrong info to the person making the decision.

I filed my appeal and the VA has it. What should I expect? Below is the info about my case... 14 yrs active duty-Airborne-diagnosed while on AD with Tibofibular subluxation of the left knee, and put on a permanent profile against running, marching over 5 miles and some other activities. I spent 10 more years in the Reserves and retired May 08. Filed original claim June 08. Awarded 10% for left knee strain. Award letter indicated additional compensation for instability may be considered. Recieved award Apr 09. Also recieve 10% for tinnitus and 0% for hearing loss. I had ACL replacement in July 09 due to constant problems. Filed for temp 100% in July 09 and awarded 100% temp in Sept for 1 month. I requested my file and finally got it in Mar 10. Upon review, I found the C&P Exam Dr indicated I had no limp or instability and used ibuprofin and knee brace for pain. This was wrong-I useb ibuprofin for pain, but knee brace for stability and had a pronounced limp. I also found out he indicated I had no stability problems. Where this came from, I dont know as I remember telling him I did have instability. I have also been receiving treatment for kidney stones since 2001 and my Urologist finally agreed and put in writing that he was convinced they developed while on AD. I also submitted 3 letters from my wife and 2 co-workers that attest to my limp and knee problems in a work and home environment. Below is my appeal letter. 16 April 2010 Department of Veterans Affairs 251 N Main Street Winston Salem NC, 27155 Attention: VA File Number xxxxxxxxx Notice of Appeal and Adjustment to Original Claim Dear Sir/Madam, I am appealing the decision on my claim filed 3 June 2008 for the following reasons. 1) VA Claim filed 3 June 2008 indicated that I had left knee pain and instability and that I wore a brace that helped with the instability and used Ibuprofen to treat for the pain. An evaluation and rating of 10% was given for the pain in the left knee and no rating or evaluation was given to the instability. I also demonstrated during the exam and have attached statements confirming the fact that I did have a pronounced limp due to the pain and instability of this knee. 2) VA Claim filed 9 July 2009 was approved for a temporary rating of 100% for surgery on the left knee to replace a ripped Anterior Crucial Ligament. The Code of Federal Regulations Title 38, Section 4.71a, 5257 indicates that instability warrants a rating between 10% for slight instability and a maximum of 30% for severe instability. Considering the fact that I had to have ACL replacement due to the pain and instability of the knee, I feel that I am entitled to a rating for instability of my left knee from the date of the original claim of 3 June 2008. Even after the surgery, I still have to use a knee brace for some activities to ensure the stability of the knee. I also continue to have some pain in the knee even after the surgery. In reference to the modification of the original claim, I want to add a claim for recurring kidney stones. Attached please find medical documents from my Urologist concerning my kidney stones and the resulting treatments. I will be awaiting your reply. Sincerely,

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.

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!!!

Forgot to mention that I went to VA in Durham NC for hearing exam. Dr indicated 30% hearing loss as well as bilateral tinitus. Said that as long as I got at least a 0% rating, I would be able to get hearing aids, batteries, etc as it was service connected.

Can you explain the SSB money? do you mean Special Separation Benefit? Yes-I spent 14 yrs active, took Special Seperation Benefit (SSB) of about $55000 and left active duty-had to do 6 years in in-active or active reserve status "After my exams, this is what I have been told. I have tinnitus in both ears, a 30% hearing loss, one leg is 1/4 inch shorter than the other due to a parachute accident while on active duty (broke tibula and fibula) and a subluxation and tendonitis in the opposite knee. I frequently have to wear a brace on my knee due to the pain and problems I have. The hearing Dr said I was a good candidate for hearing aids, but nothing could be done for tinnitus. Everything documented, but nothing since I left active duty. Was told then to take ibuprofrin for knee pain as needed." Was from the C & P exam- by a VA doc? Yes-went to VA hospital in Winston-Salem NC for exam on left knee and right leg. Dr on Active Duty diagnosed it as subluxation and tendonitis and put me on a permanent profile against running. Had trouble all the time during Reserve status and supplied all documents when I filed my claim. Or was this from an inservice exam? NO Do you have copys of your SMRs and Discharge Physical? Yes-supplied all documents from SMR and ETS Physical, along with results from all physicals I took while in Reserves Are you referring to the CRDP/CRSC program? NO How long were you in the reserves? Sep 98 through May 08 I am unaware of any type of waiver you could ask for. It could be possible - Are you asking for eligibility for CRSC or CRDP info? NO

I filed my claim in June of 08. Still don't have an answer-had to go to hearing exam and leg/knee exam. I got SSB when I left active duty with 14 years active service and went in the Reserves. I took physical in Sep 07 for Reserves. Was informed by Dr. that I had hearing loss and to expect MRB, especially with my knee problem (rated a P3 for hearing and lower extremities (PULHES=113131), but no MRB. Decided to retire in May 08 and filed claim. After my exams, this is what I have been told. I have tinnitus in both ears, a 30% hearing loss, one leg is 1/4 inch shorter than the other due to a parachute accident while on active duty (broke tibula and fibula) and a subluxation and tendonitis in the opposite knee. I frequently have to wear a brace on my knee due to the pain and problems I have. The hearing Dr said I was a good candidate for hearing aids, but nothing could be done for tinnitus. Everything documented, but nothing since I left active duty. Was told then to take ibuprofrin for knee pain as needed. My 1st question is this: What rating should I expect to get? 30, 40 or 50% My 2nd question is this: Has a waiver of recoupment ever been granted for someone eligible for retirement but that had collected SSB so it did not have to be repaid out of retirement money or compensation? My 3rd question is this: If I get compensation, I was told that I only had to give up a minimum of 10% of the compensation as recoupment towards my SSB debt and I would get the rest. Is this the deal or is there something else?