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

[raytaylor]

goodmorning, iam not too good at this typing stuff i read all these post all the time l and learn alotmy i say DIDO<DIDO mysc is for back , me and your hubby sound like twins but ihave documents stating i was obese in the army,344pd know 2yrs after 14meds and40%later and too get turndown it is a crying shame that a vet has too be treated like this,my wife dont understand this could happen tous vets, god bless america;and our wifes also.

[Berta]

"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"

Does he have a vet rep or service officer?

I feel he should file for a reconsideration - however this does NOT stop the NOD clock.

With the support of a good rep (one who as an office in or near the VARO) the reconsideration request might draw out the evidence better.

TDIU-VA will NOT consider TDIU until the vet's SC is 70%-that is why we MUST apply for TDIU ourselves.

There is a lot there you can attack in the NOD or Reconsideration Request.

Some of this -however- I do not understand-

"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. "

Are they in his SMRS? and/or listed on his discharge physical?

Are any of them presumptive? such as the diabetes- was he an incountry veteran?

"How do we prove that all disabilities does not originate in the service, but can happen over periods of times from service connected injuries."

That will take a strong independent medical opinion by a real doctor who can access every SMR and medical record available and rovide a complete medical rationale for the inservice nexus to disabilities your husband has now.

[Charleese]

Hi everyone,

Berta to answer your questions:

1. No he does not have a vet rep or service officer. I have been doing the NODs, etc. for him and because I got him the 60% rating he does not want no one else to work his case.

2. Decisions states: "You have one year from the date of this letter to appeal the decision." If I was to do the Reconsideration for him and they don't act upon it within a certain time period can a NOD be done also?

3. I am confused when you say: "TDIU-VA will NOT consider TDIU until the vet's SC is 70%-that is why we MUST apply for TDIU ourselves." Our you saying that because he is 60% now that I should apply for TDIU now or should I wait till he becomes 70%? I don't understand. I believe he can get the 70% once we file for Reconsideration or NOD because the person who did his claim refuse to look at Application for Annual Clothing Allowance that was attached to Application for increase dated 5/28/07 which stated that he had a knee brace from VA that was given to him on 1/17/07. Since applying he gets a clothing allowance each year. Clothing allowances are for veterans who use or wear a prosthetic or orthopedic appliance (artificial limb, braces, or wheelchair) or use prescribed medications for skin condition, which tend to wear, tear or soil clothing. Its all in his file and the attachment that was submitted to increase application. Their bases for denying the brace is: "A higher evaluation of 40 percent is not warranted for the left knee osteoarthritic changes and chronic chondromalacia because evidence fails to show that a brace is required because of nonunion and loose motion of the left knee. If its not required then why did fit him for one, plus at last C&P exam they change brace and gave him a better one. Once again do I have to wait for him to get 70% or can I file now at 60%. Especially if we find that C&P states that he needs a knee replacement and is unemployable.

4. His SMRs were burned up in the fire in St. Louis. We had to send directly to Lackland AF base to get his medical records about his knee injury because VA would not do it. In 1983 when he got it and submitted it they still denied him and had to NOD to get them to accept these records. Once they accepted it they gave him a 0% rating. It was only until 2000 when we filed for an increase did they give him 10%, then NODed and they gave him 20%. In 2003 they called CUE on themselves and gave him the 60% (30% recurrent subluxation, left knee and 30% status post fracture left tibial tubercle with osteoarthritic changes and chronic chondromalacia. In this decision they have now added after chronic chondromalacia and left thigh atrophy stating: "A separate evaluation is not warraanted for the left thigh atrophy because this condition is considered part of the left knee disorder. There is no evidence of a disability associated with the left thigh atrophy."

5. By in country if you mean was he in Viet Nam, no. He was in the Korean War from 1954-1958.

6. The problem is he doesn't have many medical service records because of his SMRs being burnt. The only records we have is his treatment records from VA and private doctors and to get a good IMO would be costly and that's something we can't afford at this time.

Therefore, I will just have to do the best that I can for him and with God's help and the help with people like you and other hadit people I believe we will prevail. Thanks!

[Berta]

If they dont act upon the Reconsideration Request the NOD should be filed within that year.

I fiked recon request but marked my calendar and was able to file th NOD in time as they never acted on the Recon request.

Records destroyed in the St Louis Fire-

I have a vet's file here that contains records (SMRS) destroyed in the St Louis Fire.

His Rep asked me to help with the claim.

VA had sent only 2 SMR sheets and said the rest had been destroyed in the fire.

I looked at the SMrs and asked the rep where the watermarks and charring was on them????? DUH-firemen dont save 2 documents at a time.

I had the vet send the SF 180 in himself.

I still have his complete unburned SMRS here.

You should double check on his SMRs yourself- a SF 180 can be filled out and sent at the NARA web site.

Without inservice proof suvch as SMRs or buddy statements -the VA will not grant these claims that reply on the SMRs after Lackland.

How has he done as far as attempting to reach any corpmen or buddies in service, or even his CO-to get an eye witness account of whatever caused his disability or that he was symptomatic of the disability in service?

Lackland is where my daughter graduated. (USAF)I would imagine he was not there that long to have too many SMRS from Basic training-

but why would these be available at Lackland AFB and not at NARA? it is worth a shot to try to get the SMRS directly from NARA.

Everytime the VA sees USAF they figure we can deny and say the records were lost in the fire. It is BS.

I know a local vet who -I just screamed when I read his decision-

VA said his USAF SMRS were burned in the St Louis Fire.

He had enlisted YEARS after the St Louis FIre. I was delighted to prepare a sarcastic NOD to the VA for him-suggesting how illiterate they truly can be.

He won his claim based on the SMRs which he got from NARA himself.

[Charleese]

Hi,

Can someone or anyone answered these questions for me:

1. I am confused when you say: "TDIU-VA will NOT consider TDIU until the vet's SC is 70%-that is why we MUST apply for TDIU ourselves." Our you saying that because he is 60% now that I should apply for TDIU now or should I wait till he becomes 70%? I don't understand. I believe he can get the 70% once we file for Reconsideration or NOD because the person who did his claim refuse to look at Application for Annual Clothing Allowance that was attached to Application for increase dated 5/28/07 which stated that he had a knee brace from VA that was given to him on 1/17/07. Since applying he gets a clothing allowance each year. Clothing allowances are for veterans who use or wear a prosthetic or orthopedic appliance (artificial limb, braces, or wheelchair) or use prescribed medications for skin condition, which tend to wear, tear or soil clothing. Its all in his file and the attachment that was submitted to increase application. Their bases for denying the brace is: "A higher evaluation of 40 percent is not warranted for the left knee osteoarthritic changes and chronic chondromalacia because evidence fails to show that a brace is required because of nonunion and loose motion of the left knee. If its not required then why did fit him for one, plus at last C&P exam they change brace and gave him a better one. Once again do I have to wait for him to get 70% or can I file now at 60%. Especially if we find that C&P states that he needs a knee replacement and is unemployable.

2. Is veterans who served in Viet Nam and the ones who had diabetes in service, are they the only ones who can claim Diabetes.

[Berta]

If you feel a NOD or reconsideration request will get him to 70% then just wait for that decision and they will send him the TDIU form.

My point here is that once TDIU form is filed by the vet or sent and then rated by the VA-it is the date of the TDIU form that becomes the usual award date.

A vet could be medically TDIU in 2003 by medical evidence and by 2006 the VARO still has not raised him or her to 70%- they then might do that and send the TDIU form out-

If medical evidence warrants the vet as being TDIU as of 2003- in this case- the vet has lost years of TDIU compensation, waiting for the VA to take them up to 70% when their evidence could warrant a TDIU form they file themselves much sooner than that.

Maybe my post was too strong- not MUST-

SHOULD

If a vet doesnt want to file the TDIU form themselves and wants to wait for the VA to send them one -so be it.