Good News I Think!

[Charleese]

Hi everyone,

My husband called the Doctor at the VA Satellite OFfice who gave him the prescription to get his knee brace and told him that because he didn't say knee brace was required that he got denied for an increase for knee brace.

Doctor said if I send him to get a knee brace then it is required. We had a hard time explaining to him thaat it doesn't go that way. We even gave him a copy of decision which states: " To assign a greater evaluation of 40% there must be evidence that a brace is required because of nonunion and loose motion; or evidence of extension of the leg limited to 30 degrees; or, evidence of ankylosis of the knee with flexion between 10 and 20 degrees. A higher evaluation is not warranted because these findidngs are not currently shown."

He finally agreed to put something in writing. What he did was to amend the last page of his Progress Notes of ll/19/2008 with todays date 4/2/09 to say: " patient requires left knee brace for his history of left knee problem", and signed.

I hope this statement is enought to get him an additional 10% increase for his left knee condition, which will make his rate at 70% instead of the 60% that he now has, when we file for Reconsideration.

? What Do You Think will he get approved for increase or not with using this statement? Mind you he is not using the words nonunion and loose motion, but using the word required. Let us know what you think.

Thanks!

[purple]

I hope it helps....I think it would have been better if the Doc would have been a tad more technical with his wording than using the word "problem" though. I hope that doesn't create a problem (no pun intended)...as you know by now how picky the VA can be.

[luvHIM]

It is so hard to tell with the RO's these days. You just can't be sure how the dice are going to fall with them.

But I sincerely hope that it is indeed good news for you and your husband. "Left knee problem" sounds understated but I think the word "required" is the operative word here...so keep us posted.

[Charleese]

Hi everyone,

This VA Doctor has been treating my husband for over 4 years and this is the first time he has used the word problem. My husband has been SC for his left knee since 1985. Therefore, we don't think the word problem will be a problem. Furthermore, his 11/13/09 C&P exam which was done by another VA Doctor details everything that wrong with his left knee.

[john999]

I also wish your doctor had been more specific. You are counting on the VA connecting the dots and often they won't do that. Things for the VBA need to be broken down like you would explain to a six year old. " Vet needs a knee brace becasue of nonunion or loose union.....etc". If you want more money for a disability it should be specific and detailed as to why, how, when etc. That is my nonmedical opinion.

[Charleese]

Hey everybody,

I found a case dated 1/2/09 where the veteran was granted increase for knee brace was denied because evidence did not state knee brace was required because of nonunion and loose motion. Veteran appealed and won. Court states: The requirement of the long-leg brace and the limitation of weight bearing are analogous to impairment of the tibia and fibula. Such impairment is evaluated under DC 5262, which provides a 10 percent evaluation for slight knee disability with a loose motion, requiring a bracer, or for malunion. The veterans meets the criteria for a compensable , 10 percent evaluation under DC 5262 beginning on August 1, 2002, etc.etc.

My husband DC's are 5262 & 5257 or 6257. We intend to attach this case to Reconsideration. It's under USCAVC and the Citation Number is 0900132 for anyone who wants to look it up. We believe this should do the trick, along with Doctors statement.

What do you think?

[mags1023]

What do you think?