hypertension Increase Claim Denied

[Charleese]

Hi Everyone,

Posted here the other day about Hartford Regional Office. Well Berta gave us a number and person to call and my husband did. Even though that person didn't call him back he received and e-mail from IRIS stating that Notification was mailed on yesterday. Today we received his decision and everything has been denied. Needless to say my husband is livid over this. They kept this claim for 22 months to deny everything. He has a brace that the VA has given him for his left knee servicer connected condition, which would give him and increase of another 10%. Decision is states "A higher evaluation is not warranted because these findings are not currently shown." As stated above he has a brace that the VA gave him, also at last C&P exam, Doctor changed the originally brace, to the brace that he has now, which is a better brace. Also, my husband gets a clothing allowance because of the wearing of this brace. This was documented in his application for an increase. No where in this Decision does it state that the C&P Doctor states that his condition has gotten worse and he needs a knee replacement and that he is unemployable. Everything he applied for: Right Knee, Left & Right Shoulder, Diabbetes, Hypertension, Bilateral carpal tunnel syndrome, cholsesterol, Gout, and ED were all denied. He gave them ample amount of evidence to prove these conditions, which are conditions that the VA treats him for, as well as private doctors, but they still denied him stating that they didn't occur in the service. My husband stated in his application for increase that his right knee has deteroriated as a result of him compensating for his left knee. Even C&P Doctor agreed with him on this. He has Osteoarthritis/Arthritis/Degenerative Joint Disese in his left & right knee, left & right shoulder. Also, the fact that he stated and attached an Article which states: "In fact, most studies now strongly suggest that carpal tunnel syndrome is primarily associated with medical or physical conditions, such as diabetes, osteoarthritis, etc. My husband has diabetes and is obese. Conditions that can lead to secondary osteoarthritis include obese, repeated trauma or surgery to joint structures,(husband was always falling because knee would lock up on him), gout, diabetes, and other harmone disorders. He let them know that because he was obese, and have stress and pain from left knee injury,high cholestero, hypertension he associated all with his diabetes. They denied all because they say he didn't have when he was in the service. For them to deny him ED because they said it did not happen when he was in the service, is a little bit too much, when they are the ones supplying him with medication for it. Decision goes on to state: You walk with a walker and cane for better weight balance." If they had read his c-file then they would of known that my husband fell last July and injured his whole right side, and because of that fall doctors discovered his spinal chord was damaged and he had a herinated disc wrap around his spinal chord. He had major surgery and had to be operated on immediately. He stayed in the hospital for 40 days. He gave VA a copy of his medical records pertaining to this fall. The surgeon doctor that attended him has writtern a letter stating that he is Permanent and Totally disable and cannot work at that job anymore.

I intend to help him NOD this decision. We are going Monday, to get a copy of his last C&P exam to see exactly what Doctor put in that report. If she didn't put in report about knee replacement and unemployable, then we will write her and ask her why. We also intend to use surgeon's letter as well.

What I need to know is how do we get them to look at all info in his c-file, and all evidence we send them. They overlooked about him having a Brace etc. and didn't report about what C&P Doctor said.

The person who did this claim is the one we made a complaint about through IRIS and I guess this is her way of retailiating by denying everything. How do we prove that all disabilities does not originate in the service, but can happen over periods of times from service connected injuries.

Please help us. Sorry for long Po0st.

Thanks

[Philip Rogers]

Charleese, file the TDIU form now and request an extra-schedular rating. As for the increase, in his SC knee condition, did the VA do a comp exam after the request for increase or did they rate on the existing evidence of record? Anytime a claimant files for an increase, in an already SC condition, the VA is required to do an exam. Something to bear in mind is when the VA does a reconsideration, the examiner rarely looks beyond the current decision and generally affirms the current decision. A DRO hearing would be a better way to go. Bear in mind raters are paid based on work product, not work product done correctly. Therefore it's easier to affirm the current decision. jmo

pr

Edited March 28, 2009 by Philip Rogers

[Charleese]

Hi everyone,

My husband and I would like to thank all who replied to this topic. We greatly appreciate it, and intend to use your suggestions as suggested.

Berta, to make sure I correctly understand you: (1) If I do a Reconsideration I am suppose to attach TDIU Form to it, or should I do TDIU Form first and send, then Reconsideration later; (2) If TDIU or Reconsideration is not resolved before his NOD expiration date, then I am suppose to send NOD with TDIU attach to it before its expiration date. Berta also, if you can remember when you helped me with his 2005 CUE Claim you stated: "The reasons and bases that 3 rating specialists signed and agreed to in the 1985 Decision in no way legally comlies with the proper rating codes nor do these reasons and bases take into consideration the secondary osteoarthritic changes as noted within 2 separate documents in the medical records." As you know as of yet they have not acted on his CUE Claim. In his increase claim that they denied I had put Osteoarthritic Changes as secondary to his left knee injury. They totally ignored this item in their decision.

Sharon: Yes, his increase claim does list secondary conditions such as: (1) Osteoarthritic Changes-secondary to left knee injury. Also stated that obesity(my husband is obese) causes osteoarthritis by increasing the mechanical stress on the cartilage; (2) Atrophy of Left Thigh-secondary to left knee injury and secondary to osteoarthritic changes; (3) Gout-secondary to left knee injury and secondary to Osteoarthritic changes; (4) Right Knee - secondary to osteoarthritic changes and stated: "My right knee has deteriorated as a result of my having to compensate for my left knee disability; (5) Left & Right Shoulder-secondary to osteoarthritic changes; (6) Diabetes-secondary to osteoarthritic changes. Stated also that conditions that can lead to secondary osteoarthritis include obesity, repeated trauma or surgery to the joint structures, gout, diabetes and other hormone disorders; (7) Bilateral Carpal Tunnel Syndrome-secondary to osteoarthritic changes, oas well as diabetes; (8) Hypertension-secondary to osteoarthritic changes, diabetes, left knee injury, as well as medications; (9) Diabetic Eye-secondary to Diabetes; (10) Hypertensive Heart Disease-secondary to Hypertension, Diabetes; All items were submitted with evidence from VA medical records, private doctors, and articles, attached;

(11) Knee Brace-secondary to left knee injury, osteoarthritic changes . Va stated that there isn't any evidence to say that he requires a knee brace, even though twice VA has given him braces plus he gets a clothing allowance since he's been wearing brace. The fact that evidence shows my husband has arthritic changes of the left knee with constant pain, locking, and instability which produces severe impairment requires him to have a knee brace. They denied him the 10% increase that is called for by VA regs if you have a knee brace.

This is why my husband is so livid with VA. As stated before we will get a copy of his last C&P exam and answer Reconsideration or NOD or both.

Once again thanks to all.

[Charleese]

Hi Philip Rogers,

What is an extra scheduler rating and how do you request i t? Also, yes he did have his C&P after he filed increase. C&P was done for knee only, none of the other items listed on increase such as Atrophy of Left Thigh, Right Knee, Left & Right Shoulder, Bilateral Carpal Tunnel Syndrome, Hypertensive Heart Disease, Diabetes, Diabetic Eye or Mumps, C&P were given.

[Philip Rogers]

An extra-schedular rating must be requested when applying for TDIU, when not meeting the required minimum percentages of 38 CFR 4.16(a). The request can be attached to the TDIU form. I usually use the "Statement In Support Form," VA form 21-4138, for most requests. I believe requesting a reconsideration is a complete waste of time. jmo

pr

Hi Philip Rogers,

What is an extra scheduler rating and how do you request i t? Also, yes he did have his C&P after he filed increase. C&P was done for knee only, none of the other items listed on increase such as Atrophy of Left Thigh, Right Knee, Left & Right Shoulder, Bilateral Carpal Tunnel Syndrome, Hypertensive Heart Disease, Diabetes, Diabetic Eye or Mumps, C&P were given.