A Stab In The Dark Here....va Claims And Overall Care

[cskeeter]

I'm completely lost and I'm sure this will get a little long....

My husband has a 10% rating for an ankle injury while on active duty. I've been doing ok with the VA up to this point....at least I thought so! I didn't think it would be nearly this hard actually. I'm currently trying to get a higher rating and gerd added to his service connected illnesses but to be honest I think my 6 year old will be eating veggies with no complaints before this is over. My husband is young (31) and had surgery in 2001 on his ankle. He broke all his tendons and ligaments in his ankle and had to have it all reconstructed. The injury could have been avoided (I think anyway) had the Army done the surgery sooner b/c he kept spraining it over and over and then finally in March of 2001 he fell 15 feet out of a tree and broke everything in there but the bone. They finally got him into surgery in Sept of that year. Anyway, in all those months he was taking naproxen/alleve for the pain apparently taking this medication daily like he did can cause constant heartburn/gerd. He's been taking some RX medication for this (the VA doctor he saw wrote it for him) but the VA doesn't want to add the illness because there is no record of it. It actually took us years to figure out it was the meds causing the heartburn. The VA doctor he saw was the first to suggest it. Oh and another issue on this claim is the idiot doctor that did the exam for the claim somehow brought his left ankle into the claim and they are saying that since we are linking it to the left thats another reason nothing is covered along with saying that my husband said he'd had heartburn long before this ankle injury. He never had heartburn like this before his ankle injury.

He has been seeing our ortho surgeon b/c in August I believe it was the surgeon he saw at the VA said surgery won't fix his problem and that he was going to have to live with the pain. The overall care he gets is just horrible. I can't imagine a doctor telling a patient that he has no options and will have to live in pain. I made him an appointment with our doctor and apparently he has a bone spur on the front of his ankle that is causing the pain. We already knew the bone spur was there from an xray this same doctor did in 2005 but at that time it was a small spur that wasn't needing any treatment at the time. He went back recently because the pain is just too much at times and this small spur that the VA led us to believe was there is actually covering the entire front of this bone. Our surgeons opinion in 2005 was that it might need surgery b/c it is possible it will get bigger but there was a chance it wouldn't get any bigger. Well, he now says the only option is surgery.

I know the VA won't cover our out of pocket cost for a surgery as I am fairly certain our insurance won't cover it 100%. My husband has no faith in the VA hospital and its staff at all. What choice am I left with but to figure out how to pay for it on our own? Obviously I wouldn't want someone doing surgery on me if I had no trust and faith in them and I don't expect him to just suck this up and use the VA. Is there some complaint process here?

If we could get a higher rating it would cover the out of pocket expenses we have using our own doctors. At this point the only thing the VA is good for is getting him his pain medication at no cost and the heartburn medication at a reduced price. I'm thankful for the prescription coverage he is getting because that would cost me an arm and a leg. One of the doctors there asked him if he could find a new job to stay off his feet. This injury has limited his activities greatly. I'll also add that the VA also added that his range of motion is fine in his ankle and until it gets worse they won't raise his rating.

Any thoughts, insight, help would be greatly appreciated!

Thank you

[cskeeter]

cskeeter:

Welcome to Hadit and thank your husband for his service. It is a great thing you are doing in assisting him with his claim and you are commended for your actions.

All injuries of this type are rated on range of motion. The only way around this at this point is to get an independant medical opinion from a civilian doctor. Once this is done and the doctor agrees that his range of motion is limited to some degree then you can carry on with the claim.

As for the Gerd: the same applies here. We all know that some meds cause gerd but you will have to get a doc to provide that it is at least as likely that his meds caused his current gerd. If the VA is saying that the Gerd was present prior to his requirement to take the meds then ask the doc if the meds have aggravated that condition. Without that I am afraid that you are stuck here also.

Others will come along and offer their ideals so just hang in there. As to your question about covering out of pocket expenses: the va does not do this. The only way is to get his surgery approved by the department within the hospital that handles this. I personally do not believe they will allow this if the needed care is offered by the VA hospital but you can try.

According to our civilian doctor he could have a chance at a less painful life if he had an ankle replacement but that will have to wait a while as he is so young he would outlive his ankle. He also suffers from osteoarthritis in his ankle.

The PCP at the VA was the one that told my husband he had GERD and it was caused by the meds he was taking for the ankle pain. It even says take this medication to protect stomach from naproxen on the medication the dr gave him!

Thank you for your thoughts on this.

[cskeeter]

He formally requested a higher rating and this is what they denied recently?

His medical evidence would have to reflect that he is in a higher rating criteria as within the Schedule of Ratings at:

http://www.warms.vba.va.gov/bookc.html

(actually this rating info might well be attached with the paperwork you just got)

Also- good advice here as to the GERD -it could be claimed as secondary to the SC condition due to the meds- or even he could file a Section 1151 claim- but I think the secondary claim would be the best way to go-

The TDCC award depends on many factors-if he does get surgery-

at least 21 days or more of hospitalization for a SC disability-the hospitalization benefit-and also there are other types of convalescent awards-too

all in 38 CFR 4.30.

"We just got the paperwork to appeal their decision and I started this in December of last year"-

did he get a VCAA letter that told him exactly what evidence the VA needed to award a higher rating?

Did he respond to the VCAA election notice?

have you formally sent them a Notice of Disagreement?

Are you going to elect a DRO- Decision Review officer?

I suggest that you try to find a good service officer who has offices within or near the RO you deal with as well as stay on board here to see what is best to do next and what appraoch the service officer (vet rep) will suggest.

Thank you for that link. We haven't received any of that info and I've just glanced at it and I think that will be helpful for us. We got a letter stating why he had been denied but it didn't include what we needed to show to get a higher rating. We did the notice of disagreement and just recently received and sent back the letter asking how we wanted to proceed with the appeal. My husband didn't want to use the DRO and wanted to go the traditional way.

His surgery should be pretty simple and has a three week recovery period at home. He'll be on crutches for the three weeks which will be hard because he walks a lot at work.

I'll also add that I managed to get his chronic diarrhea added with very little evidence showing that it was in fact service connected. That is a side effect from his medications as well and they'll give him a 0% rating on that but won't give him the GERD. Sometimes I wonder what these people are thinking.

[71M10]

Berta brought up a very good point on the SECONDARY connection for GERD.

If you didn't explicitly state it was secondary to the ankle due to the meds they probably have denied for direct service connection. You shouldn't assume they will consider anything that you havn't asked for.

You may want to elect a DRO review instead of going straight to the BVA. The BVA backlog is huge and getting bigger by the day.

Best regards,

Tyler

[cskeeter]

Berta brought up a very good point on the SECONDARY connection for GERD.

If you didn't explicitly state it was secondary to the ankle due to the meds they probably have denied for direct service connection. You shouldn't assume they will consider anything that you havn't asked for.

You may want to elect a DRO review instead of going straight to the BVA. The BVA backlog is huge and getting bigger by the day.

Best regards,

Tyler

Ah, I see what you mean about the GERD issue. I'll have to go back and pull the paperwork and see how we put it on there. I'm slowly learning how to navigate this whole thing!

I did talk to my husband and he is going the route of the DRO rather than the BVA.

[Pete53]

At the Dallas VA there are several organizations on the first floor near the emergency room that have Texas Veterans Service Officers, VVA, PVA and DAV Service Officers. They usually ask you to sign in an wait till a Service Officer is available.

You can call 800 849 3597 and when it answers push 0 and ask for one of them. I recommend Texas Veterans as they also have their own Service Officers in Waco which can be helpful. The VVA is good but not as well staffed.

Anyway its pretty much automatic after you have everything set up.