JaxVet

Well, in that case, kudos to you for coming to that conclusion before it was too late. I think that's how we'll end up, but we'd rather it be our decision, not forced upon us by the powers that be at the VA.

Thanks Pete. That's actually what we're going for. I currently handle the finances (but only since just recently). If it comes to the point that a payee/fiduciary has to be appointed, we would hope that would be me. I already have a limited POA as well as medical POA. The last thing we want is someone appointed from a VA list or what have you.

I do not believe his issues rise to the point of incompetency, especially considering the ramifications of such a ruling. As of right now, he is fighting the ruling. That decision has changed a couple of times since we received the rating, but after learning what effects the incompetency ruling would have outside the VA, he has determined to fight the incompetency as long as possible. I am however, very glad the payee program has helped you. It sounds like it was a blessing in disguise for you.

Unfortunately, I've not had good experiences with the service reps. One put a "Request for Reconsideration Based on New Evidence" into the system as an "Appeal" causing a loss of nearly 9 months of compensation for my husband. Granted, we could have left it as an appeal and waited several years, but we opted to refile. On the refile, I did the paperwork, sent in the necessary evidence and followed up until my husband's back was added as a secondary condition and his TDIU was granted. I would say most service reps are great, but they are limited in what they can do since they are helping so many veterans.

Thanks! I will be filing the paperwork and what not. The IMO is to cut down the paperwork on the VA's end since they are supposed to give the benefit of the doubt to the veteran when two opinions differ on competency.

My private doctor has agreed to see my husband and write the IMO to contest the incompetency proposal from the VA. Before we head in there, I'm just wondering if there is a format or special wording the letter needs to have? I thought I had seen a sample letter before, but I can't seem to find it now. Thanks in advance for any help/advice!!

We had the same issue with my husband. The VA continued to deny due to "lack of evidence proving service connection." We finally got a good VA doctor who wrote one sentence in his file that completely changed everything. He wrote: Back pain secondary to service connected knee condition. My husband's doctor actually laughed and said, "They're all connected of course it's causing it." Once that was put into his VA medical record, the claim for degenerative joint disease in lower back secondary to degenerative joint disease in knees was approved - after we requested a reconsideration. Turns out the rater didn't actually read all of the medical records submitted. So, the second time around I sent a copy of that page of his medical record with that sentence highlighted for them to see. So, if you have a VA doctor who agrees that your back is secondary to your knees and is willing to make that statement in your VA medical records, that will help too.

If TDIU is granted based on two injuries (knees and back) and the veteran has additional ratings of 50% and 10%, does this meat the requirements set forth in Bradley v Peak?

Forgot to add, I'm not sure if he would qualify for a SMC K award since he can still use his legs, just not much. He can't stand for more than a few minutes, can't walk more than a few feet, etc.

Thank you all for your responses. I'm putting together letters now to be sent out Friday (via signature confirmation of course) when hubby gets paid again. I think this is where we stand now. First, I'm working on a Request for Reconsideration Based On New Evidence with the following requests: With the neurologist now saying the cognitive issues are due to his depression, we will be requested that the Adjustment Disorder be evaluated at 70% rather than 50%.That the Lower Back rating of 20% be increased to at least 40% (but preferably 60%) based on the fact that he spends a minimum of 4-5 days per month (48-60 days or 7-8.5 weeks per year) in bed due to debilitating pain in his back.That a new C&P exam be ordered since the doctor did NOT perform measurements using a goniometer. He apparently guessed at the range of motion degrees for my husband and funny thing is he guessed all normal. A reevaluation on the A&A based on his current rating of 100% TDIU for his knee and back disabilities with the additional SC disabilities of his adjustment disorder and ankle. In separate letters, we will also be contesting the VA proposal to find my husband incompetent and we will be submitting information to respond to the VCAA request regarding the radiating pain from his lower back into both legs - for some reason the VA appears to have separated this from his prior knee conditions.

TDIU was approved effective April 28, 2008. We have (thankfully) ChampVA insurance and a multitude of other benefits thanks to the P&T rating.

I understand that some range of motion can be determined during the regular exam, but not degrees the joint is able to move with and without pain. The problem with not using the goniometer is that the numbers then become subjective to the the examiner's guesses. This particular examiner noted full range of motion in all of my husband's joints. Two problems, first, he doesn't have full range of motion in any joint. Second, he has a fusion in his neck and is unable to bend it. The goniometer is especially important when a mere 10 degrees can change the rating level.

Pete53, No, my husband has not worked since November, 2006. He is currently disabled per the Railroad and rated at Permanent and Total via IU with the VA.

We put in a request for a rate increase for his original SC condition at the same time as the request for A&A. We also requested his Depression be added as SC secondary to his knee condition. The depression was rated at 50% for an adjustment disorder. As of his last neuro visit, all of his mental issues are a result of his (now SC) depression. So that will make one difference as at the time of the C&P (7/27/10) the depression was still non SC. Also, all of his disabilities are a result of his original service connected injury - knees. His lower back was injured due to the increased strain and altered gait. The depression is a result of the chronic pain. Currently he is rated as follows (Note - he has two ratings on each knee): Adjustment disorder - 50% Deg Arthritis Lower back - 20% Deg Arthritis Right Knee - 10% Deg Arthritis Left Knee - 10% Right ankle strain - 10% Right knee - 20% Left knee - 20%

I was in the room with him at the last C&P and the examiner used the goniometer to measure the degrees. This time around, I was told I had to wait and from what I understand, no actual measurements were taken, and there were no range of motion tests done. I wonder if this is something the individual offices are doing.

We recently filed for A&A for my husband because he needs help on a daily basis in the following areas - getting in and out of bed and chairs, getting to and from the bathroom, getting dressed, etc. He also has a lot of instability in his legs and back and has fallen on several occasions. We had the proper forms completed by his primary care doctor and the C&P examiner said he needed the A&A. We received the decision in the mail this week and here's what they said. Entitlement to special monthly compensation based on aid and attendance/housebound is denied. Your most recent rating decision dated June 24, 2009, does not show that you have one service connected condition rated at 100 percent; or, anatomical loss or loss of use of both feet; or, anatomical loss or loss of use of one hand and one foot; or, bilateral visual acuity of 5/200 or less. We received your VA Form 21-526, Application for Compensation and / or Pension, on June 16, 2010 for your claim for special monthly compensation based on Aid & Attendance. A letter dated June 21, 2010, was sent to you advising you of the Veteran's Claims Assistance Act of 2000 (VCAA), and informing you of what evidence is required to complete processing of the claim. This letter also furnished you information regarding Disability Ratings, factors affecting the evaluation, and how VA determines effective date. Treatment reports from the Gainesville VA Medical Center Healthcare System, dated from July 8, 2010, noted that you informed the VAMC that you are requesting the Aid and Attendance benefit. Examination results from the Gainesville VA Medical Center Healthcare System, dated July 27, 2010, noted that you are in need of the Aid & Attendance benefit due to your service connected and non-service connected conditions. The examiner noted that you are not permanently bed ridden, you have a poor memory (forgetting age), and you have no capacity to protect yourself from falls or harm. The examiner also noted that you need daily supervision. The VA examiner noted that you need Aid & Attendance due to your service connected bilateral condition, and your lumbar condition. However, you do not have one service connected condition rated at 100 percent; or, anatomical loss or loss of use of both feet; or, anatomical loss or loss of use of one hand and one foot; or, bilateral visual acuity of 5/200 or less. They also included the requirements from the CFR regarding A&A and housebound compensation. We are not applying for A&A for loss or loss of use of limbs. My question is this, is there a requirement in the CFR that you must have a single condition rated at 100% in order to be awarded A&A? I ask because as I read the decision, that is the only reason that the A&A was denied. Thanks for any help!

Can a vet receive a new C&P exam if he feels the first was not done correctly? On the C&P form, it clearly states that measurements are to be taken with a goniometer. What if the doctor does not use this to get the degrees for range of motion? Also, can the vet require a second person in the room with he and the examiner? My husband was required to go to the exam room alone despite the fact that he was applying for A&A. The examiner said no one was allowed in the room. Can the veteran not have someone with him to help protect him in this exam?