Covealescent Ratings From A Civilan Hosp?

[dav_marine72]

Do you need permission from the VA to have surgery in a civilian hospital on a service connected issue to get convalescent leave?

Anyone have this situation before?

This sounds like you don't

§ 4.30 Convalescent ratings.

top A total disability rating (100 percent) will be assigned without regard to other provisions of the rating schedule when it is established by report at hospital discharge (regular discharge or release to non-bed care) or outpatient release that entitlement is warranted under paragraph (a) (1), (2) or (3) of this section effective the date of hospital admission or outpatient treatment and continuing for a period of 1, 2, or 3 months from the first day of the month following such hospital discharge or outpatient release. The termination of these total ratings will not be subject to §3.105(e) of this chapter. Such total rating will be followed by appropriate schedular evaluations. When the evidence is inadequate to assign a schedular evaluation, a physical examination will be scheduled and considered prior to the termination of a total rating under this section.

(a) Total ratings will be assigned under this section if treatment of a service-connected disability resulted in:

(1) Surgery necessitating at least one month of convalescence (Effective as to outpatient surgery March 1, 1989.)

(2) Surgery with severe postoperative residuals such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches (regular weight-bearing prohibited). (Effective as to outpatient surgery March 1, 1989.)

(3) Immobilization by cast, without surgery, of one major joint or more. (Effective as to outpatient treatment March 10, 1976.)

A reduction in the total rating will not be subject to §3.105(e) of this chapter. The total rating will be followed by an open rating reflecting the appropriate schedular evaluation; where the evidence is inadequate to assign the schedular evaluation, a physcial examination will be scheduled prior to the end of the total rating period.

(:D A total rating under this section will require full justification on the rating sheet and may be extended as follows:

(1) Extensions of 1, 2 or 3 months beyond the initial 3 months may be made under paragraph (a) (1), (2) or (3) of this section.

(2) Extensions of 1 or more months up to 6 months beyond the initial 6 months period may be made under paragraph (a) (2) or (3) of this section upon approval of the Veterans Service Center Manager.

[41 FR 34256, Aug. 13, 1976, as amended at 54 FR 4281, Jan. 30, 1989; 71 FR 28586, May 17, 2006]

Being in the hospital for a prolonged treatment sounds like it does.

§ 4.29 Ratings for service-connected disabilities requiring hospital treatment or observation.

top A total disability rating (100 percent) will be assigned without regard to other provisions of the rating schedule when it is established that a service-connected disability has required hospital treatment in a Department of Veterans Affairs or an approved hospital for a period in excess of 21 days or hospital observation at Department of Veterans Affairs expense for a service-connected disability for a period in excess of 21 days.

[Eric_M]

I haven't had that circumstance, but I think you are on the right track.

As long as it's a service-connected condition, it shouldn't matter where you got worked on.

I would just get the documentation, and send it to them.

Just my 2 cents.....Eric

[dav_marine72]

Yeah I'm 99% I am right. I had some congressional aides step up the pressure since they have had the documentation since March and one told me today I didn't rate it. I was like what? He said the VA owned my back from a medical stand point and I needed their permission to get surgery done on it outside the VA. I was like are you on crack? You need that for fee basis or getting civilian scripts filled at the VA but clearly the law states nothing about needing to have surgery at the VA or letting them know. I kept asking the guy to show me some proof. He said he had been doing this for 20 years. I said I'm 80% right now with 11 service connections, 4 at the U.S. court, and 7 on appeal at the regional. I worked all my regional stuff and the BVA myself. That's probably why I got shafted. My lawyer at the U.S. court said she has never seen so much evidence ignored by the BVA and so much incompetence at the regional level.

As I stated before I just had 3 level fusion with interbody cages and cleared scar tissue at two levels. I had been on 80 mg oxy 3 times a day, 30mg roxy 3 times a day, 20mg Valium 3 times a day, 1 mg ativan 3 times a day, 20mg buspar 4 times a day, 200mg of Zoloft a day for the last three years. This included when I was at the BVA. I had surgery number 1 in 2000. I had scar tissue at two levels. I was getting nerve blocks every month. I did a spinal stimulator trial. I have 3-4 panic / anxiety / hyperventilation attacks because the pain is so severe. I got fired after my surgery in March of this year because I couldn't go back to work and sit.

The best part of all? My back is 20% LOL. The BVA left it 20% and gave me 10% for my lower extremities based on straight leg raises. They said I had no neurological effects from my back because a nurse practitioner at the VA clinic said the weakness, numbness, and tingling in my legs was not from my back. I also submitted two separate independent medical evaluations from an MD who specializes in VA disability, is a DAV, is a board certified diagnostic radiologists, a senior member of the American Society of neuroradiology, is licensed by the Maryland Board of Medical Examiners, certified by the National Board of Medical Examiners, an Associate Professor at a medical Military college, and has an MBA. His evaluations stated I should be rated 60% for my back and be considered for unemployability. The BVA ignored his letters totally and the regional with no MD to challenge him just said we read his letter but with taking everything into consideration we feel 20% represents my symptoms. That’s what I get for trying to work the whole time. I won’t even get into my 30% Asthma, 10% for busted feet, and all my 0’s for GERD, eczema, high blood pressure, right testicle pain, and erectile dysfunction LOL.

LOL the forces are not with me! Oh by the way my back is 20% as I said, well my mental is secondary to the back and severe pain and it's rated 50%. Go figure. Sorry for the vent but I needed it.

Thanks for your post!

[Eric_M]

Hey no problem. I try not to get frustrated by my claims & conditions.

I try, and sometimes suceed, at keeping a good attitude. It's not easy.

I'm a firm believer in letting the law work for me, not against me.

Good luck with your claim(s).....Eric

[Ricky]

Now you know why the country is in such a mess! Stupid congress critters comes to mind.

Nope you do not need permission from the VA as no one owns your body!!!!!

Now as we all know how the VA is, they may require a C&P prior to paying the temp 100 percent comp. They should not as a doc is a doc - but like I stated we all know the VA.