ptsd I Won! Woo Hoo! But I Still Have Questions.

[Quint7]

I won!!!!!!!!!!!!

Got my brown envelope today!

My appeal from a DRO hearing to raise my SC knee from 10% to 20% was approved and so was

SC for my IVDS/DDD w stenosis. The IVDS/DDD was rated at 40%.

That takes me up to 90%!!!!!!!

BUT, I still have a few questions.

I was SC @ 0% for the knee since my service. VA put me at 0% because I "failed to show" for an exam in 1994. Long story short, they screwed up, I would have shown up back then, but I won't get into that.

I was also denied for "lumbar strain" in 1994 immediately post service for the same reason, "failure to show" for a C&P.

So here are my issues:

Both ratings have re-exams listed. The back is shown as having a re-exam in April 2011 because "it is expected to improve" (I had a fusion, don't know how it will improve) and the knee says 'a exam will be shceduled to see if the knee rates a higher rating".

I had a knee C&P last friday which I'm assuming was this 'exam for a higher rating", so I think that the 20% is a lock. Since the 20% is retro'ed back to Dec. 2006 is that when the 10 year rule starts or whatever that is?

The back is dated from Feb. 2007. It approves me for IVDS/DDD with stenosis. It lists that I had a fusion but doesn't rate me for that. 2011 is a long way off but not that long.

I guess I'm wondering if I can request that these ratings be made P&T since they originated (though honestly not as severely, I would say at a max 10% for the knee and back each back then) during my one year post-service time period? Like I said, the knee looks like it might be P&T since they only wanted to increase above the 20%, but the back still has IVDS/DDD at the next level below my fusion and a spinal fusion is a separate listing under the DX codes. I know that Rentalguy and I have chatted on here that for a fusion DX rating it "looks" like you need an entire segment of the back fused (not just 2 or 3 vertebre), but we weren't sure.

My final issue is the temp. convalesant rating. They approved me for 3 months at 100%. I have been out of work post-fusion surgery for 4 months and will be out until June 22nd which would put me at 5 months and 15 days post-op. Should I fight this and request the 100% for the entire time?

Also, without pushing it too much, after my DRO hearing the service rep I had suggested that if I get the 20% for the knee that I should then fight to get the 0% from 1994-2006 changed to a 10% from 1994-2006 as the VA used the supposed "failure to appear" as the only reason for rating me 0% even though my SMR's showed that I had long term knee problems for 5 of the 6 years I was in the Marines and if it is currently 20% , it HAD to have been 10% before.

I meet with my service rep tomorrow.

So, I'm happy. I have no clue how to figure my retro out since I got the 10% for the knee, then 70% for PTSD 14 months later and the knee increase and back both fall inbetween the two claims.

For what it's worth, I have been down on Dr. Bash before for the service I got from him. The claim does list him, along with all of the other back docs but doesn't specifically list his opinions as the one that made the claim stick. As for my knee, it doesn't even mention that Dr. Bash was involved in that claim. So, was he worth it? I don't know and I will leave it at that.

I can say, without a doubt, that HadIt helped me. Period. Without this site I would be another 'casualty" in the VA's war against Vets. I wish I had known about this site when my step-dad was still alive and fighting the VA for Agent Orange issues. He might have at least been able to die in his own house instead of losing everything.

Thank you, thank you all for everything. I'm actually getting choked up as I type this because I was going down a path of destruction before I found this site.

Jason

[Quint7]

Thanks everyone!

I assumed I was qualified for 100% for as long as it takes too. I'll ask my rep tomorrow.

As for the EED, the issue I have would be a CUE. VA claimed to have had the letter sent to me in Los Angeles in Aug. 1994 returned, which I believe the envelope is in my cfile (even though they didnt include a copy of it in my free copy). I have submitted proof that I was using the VAMC in Los Angeles and collecting the GI Bill at that time. I also have my DD214 in the original envelope along with a transcript in it's original envelope that were each mailed to me within 2 weeks of either side of the leter VA had returned. I can't understand why it was returned, but it doesn't matter. Even without an exam there is enough evidence in my SMR's to rate 10% for the knee and since I was a month out of service the regs (I believe say) that if no other record exists, to use the SMR. I think they committed a CUE by stating that the only reason to assign a 0% was the returned letter that brought on the missed C&P. They made no atempt to contact me other than the letter even though the USMC, VAMC and VA Education let along my unit knew where I was. Therefore the no show is a wash, we both blame the post office and neither wins. But if you read my SMR's there is ample evidence that rated a 10% even without an exam. They took the easy way out of "you didnt show, you get a zero".

As for why I never followed up? I never heard from VA again about the claims and moved back to NY in Dec. of 94. Still never heard from them but collected GI Bill for 3 years in NY. Berta said (I'm not quoting her) that if I was never contacted then I cant have "abandoned my claim" and they didn't try too hard to find me. My excuse? I was just trying to adapt to civilian life, go to school, make enough for rent, etc. I forgot about the claims until I needed knee surgery.

So, I'll run it by my SO but who knows.

Thanks again everyone!

[Ricky]

Quint - just a couple of notes on you questions

-there is no such thing as 90 percent P&T. In reality, there is no true 100 percent P&T as you know the VA can call for an updated C&P at anytime. The only thing that will insure a P status for individual ratings is the 20 year rule.

-as far as changing the 0 percent to a 10 percent rating: you will have to prove CUE since the rating is final. From what you have posted I do not see a CUE. Now if the rep who had access to your file saw one then I would go for it.

Congratulations on your success.

[ruby]

Congratulations, I hope I can say the same thing soon.

[allan]

Congratulations Jason & Judy!!!!!!!!!!!!

[halos2]

Rah Rah sis coum baa you did it and we are soo proud!!!!

I won!!!!!!!!!!!!

Got my brown envelope today!

My appeal from a DRO hearing to raise my SC knee from 10% to 20% was approved and so was

SC for my IVDS/DDD w stenosis. The IVDS/DDD was rated at 40%.

That takes me up to 90%!!!!!!!

BUT, I still have a few questions.

I was SC @ 0% for the knee since my service. VA put me at 0% because I "failed to show" for an exam in 1994. Long story short, they screwed up, I would have shown up back then, but I won't get into that.

I was also denied for "lumbar strain" in 1994 immediately post service for the same reason, "failure to show" for a C&P.

So here are my issues:

Both ratings have re-exams listed. The back is shown as having a re-exam in April 2011 because "it is expected to improve" (I had a fusion, don't know how it will improve) and the knee says 'a exam will be shceduled to see if the knee rates a higher rating".

I had a knee C&P last friday which I'm assuming was this 'exam for a higher rating", so I think that the 20% is a lock. Since the 20% is retro'ed back to Dec. 2006 is that when the 10 year rule starts or whatever that is?

The back is dated from Feb. 2007. It approves me for IVDS/DDD with stenosis. It lists that I had a fusion but doesn't rate me for that. 2011 is a long way off but not that long.

I guess I'm wondering if I can request that these ratings be made P&T since they originated (though honestly not as severely, I would say at a max 10% for the knee and back each back then) during my one year post-service time period? Like I said, the knee looks like it might be P&T since they only wanted to increase above the 20%, but the back still has IVDS/DDD at the next level below my fusion and a spinal fusion is a separate listing under the DX codes. I know that Rentalguy and I have chatted on here that for a fusion DX rating it "looks" like you need an entire segment of the back fused (not just 2 or 3 vertebre), but we weren't sure.

My final issue is the temp. convalesant rating. They approved me for 3 months at 100%. I have been out of work post-fusion surgery for 4 months and will be out until June 22nd which would put me at 5 months and 15 days post-op. Should I fight this and request the 100% for the entire time?

Also, without pushing it too much, after my DRO hearing the service rep I had suggested that if I get the 20% for the knee that I should then fight to get the 0% from 1994-2006 changed to a 10% from 1994-2006 as the VA used the supposed "failure to appear" as the only reason for rating me 0% even though my SMR's showed that I had long term knee problems for 5 of the 6 years I was in the Marines and if it is currently 20% , it HAD to have been 10% before.

I meet with my service rep tomorrow.

So, I'm happy. I have no clue how to figure my retro out since I got the 10% for the knee, then 70% for PTSD 14 months later and the knee increase and back both fall inbetween the two claims.

For what it's worth, I have been down on Dr. Bash before for the service I got from him. The claim does list him, along with all of the other back docs but doesn't specifically list his opinions as the one that made the claim stick. As for my knee, it doesn't even mention that Dr. Bash was involved in that claim. So, was he worth it? I don't know and I will leave it at that.

I can say, without a doubt, that HadIt helped me. Period. Without this site I would be another 'casualty" in the VA's war against Vets. I wish I had known about this site when my step-dad was still alive and fighting the VA for Agent Orange issues. He might have at least been able to die in his own house instead of losing everything.

Thank you, thank you all for everything. I'm actually getting choked up as I type this because I was going down a path of destruction before I found this site.

Jason

[Quint7]

Again thanks everyone!

I think that the thing that put me over the top in my back claim was that VA Training Letter on IVDS/DDD. There really is no way for VA to refute that. I even included pictures of the "Amtrac" Amphibious Assault Vehicle that I worked on and drove for 6 years to back up the issues I claimed I dealt with every day that also matched the "causes" listed under that training letter. I highly recomend that spine claim vets use that in their claims!

Clown- Yep, I do know that about P&T as you said. I guess I meant more of getting my claims to fall under the "no further exams are scheduled at this time" listing that some of us have on our approved claims. As for the CUE, when I have talked about it on here it was brought up to me that it was a CUE because VA failed to follow it's own regs and use the medical info it had on hand to rate me, whether I showed for an exam or not. They agreed (in the rating info I got 12 years later) that "there is a long history of treatment for the knee, but because the veteran failed to show up for an exam we must rate the knee at 0%". Taking the "why I didn't show up" out of it, there was ample evidence in my SMR for them to rate the knee at 10%, not 0%, but they overlooked that and only took the lack of a C&P into account when assigning a %. That is whereit is a CUE. That is what I have got from talking on here about it. Like I said, I'm not going to go nuts about it, i'll run it by my rep.

As for the 100% convelesent, I am definately bringing that up! I even told the C&P exmainer 2 weeks ago that I hadn't worked since late Dec. and wouldn't be working until late June. My surgery was Jan. 7th and I return to work on June 21st. In VA math I would assume I get 100% for all of Feb, Mar, Apr, and May (if not Jan and June but those are partial so I assume VA wont pay on them). That is 4 months at 100% temp. My decision gave me one month at 100%. I'll post later today what my rep says.