hypertension Recieved Tdiu Decision, Need Adice On Appealing

[dav_marine72]

Hi Everyone,

Finally received my award letter yesterday. Here is what they decided:

A temporary evaluation of 100% was assigned effective month day, 2009 based on surgical or other treatment necessitating convalescence. A 40% evaluation is assigned from 3 months after surgery.

Entitlement to special monthly compensation based on housebound criteria being met is granted during the 3-month convalescent leave period.

Entitlement to individual unemployability is granted effective month date, 2009. This was the date I received the letter from the company I worked at stating since I could not return to work I was fired.

There were some other increases that they denied for but I want to focus on the back and TDIU. I know what I need to do with those.

Now mind the decision summary given to my SO was a little different. He had stated it said I was entitled to continue receiving SMC and my total monthly payout would be $3700 a month for the convalescent leave based on housebound and regular aid and attendance and then $3400 a month moving forward with some sort of SMC.

He also said I was awarded P&T. He said there was a statement to the accord that my wife couldn't work based on the fact that she had to stay home and take care of our children who aren't in school yet and myself. Now they did include language under the TDIU award reasons that says "You experience episodes of your back locking up which requires your wife to stay home from work in order to care for you."

Now let's go back to the temp 100% with SMC. They based this on my back being 100% and having mental (50%) and asthma (30%). They also state my surgeon ordered a 3 month convalescent leave period. This was flat out lie. My surgeon from the get go gave me a form that stated I was to be on no duty for six months after the surgery. This would only be important if I can't get SMC moving forward. If that's the case the VA should have put me on 100% back and SMC for six months and not three. It may seem trivial based on TDIU but it's about $900 to me. Right now waiting to go to the SS judge in 11 months, $900 is $900.

Now on to TDIU. No verbiage on P&T. The award was based on my back (50%) and mental (50%) combined mostly it sounds. Although I have sc asthma (30%), sc lower extremity weakness (10%), sc right foot injury (10%), sc left foot injury (0%), sc chronic right testicle pain (0%), hypertension (0%), and eczema (0%).

Mind you above my back (20%), chronic testicle pain (0%), left (0%) and right feet (10%) conditions were at the BVA in which they were all denied higher ratings and they awarded lower extremity weakness (10%) based on the neurological aspect of my back. The BVA's decision was just thrown out at the U.S. court and we will be going back to the BVA on remands.

My asthma, hypertension, eczema, entitlement to service connection of GERD 2nd to all the pills I take for sc aliments and entitlement to service connection for erectile dysfunction 2nd to my spine condition are all on appeal at the RO.

I'm 80% by the schedule and will likely get 100% on the schedule with 1-2 years. So that will be my 2nd 100% counting TDIU. I need P&T because I need to carry insurance for my family. I can't watch the kids and my wife going to work doesn't make sense because the daycare would cost more. I am paying for cobra now and since the economy took a dive my monthly payment is only $350. However, come February it will jump to $1100 a month. My wife and kids also deserve the education benefits based on having to deal with the VA and me.

Game plan:

I know I need to ask for P&T from the RO. What can I do increase the likelihood I get it? I am 37 and my back condition has been severe since 1997 so we are going on 13 years. I have had two failed surgeries including (L3-L4, L4-L5 discectomies and laminectomies, 2000) the latest (L3-S1 fusion with cages, rods, and screws, 2009). The surgeon thinks I will not get any pain relief from the surgery or I would have felt it already now that I am six months + post-op. He is recommending a spinal stimulator that I am not too keen on, giving my history with back surgeries. I have failed water PT, failed a spinal stimulator trail, failed nerve blocks, failed facet joint injections, had an exam done that showed unsymmetrical muscle groups in my lower extremities to include atrophy and muscle wasting from my sc L3-S1 condition, I have been prescribed a cane, I can’t sit for more than 5-10 minutes without getting nauseous and wanting to throw up, I can’t stand for more than 15 minutes, I can only walk so far, I can’t help out around the house at all, I can’t hold my kids or help with them, I can’t get dressed by myself most of the time, I’m on 3 Oxycontin 40mg and 3 roxicodone 30mg per day for my pain and they don’t work well.

So what can I do to help get P&T? Am I missing anything here I should be getting, SMC, etc.? I would think I would meet the need for regular aid and attendance based on the fact that my wife has to take care of me. Some of the tasks they describe I can do myself sometimes but the reg states that to get it you don’t have to need someone to do all the daily tasks for you.

[dav_marine72]

One more thing. Under the reasons and basis for TDIU it does not say we consider this to be temporary based on the likelihood of improvement in the future. Nothing like that is said. Nothing is said either about this being permanent or the likelihood of my disability picture not changing in the future.

[Berta]

I feel you might want to consider investing some of the retro in getting an IMO that shows you are P & T.

Take the time to study some P & T awards at BVA site or here if you can to find the exact criteria you need to meet and then have a IMO doc write it up.

Still- IMO or not definitely appeal this-

The SMC concerns me-you have valid point here too-

Has your SO suggested supporting a Reconsideration Request?It doesn't stop the appeal clock but I feel this is appropriate way to go here-

He might be very willing to help you with that since it appears he gave you incorrect info on the P & T.

"They also state my surgeon ordered a 3 month convalescent leave period. This was flat out lie. My surgeon from the get go gave me a form that stated I was to be on no duty for six months after the surgery."

Use this against them in the Recon Request.Tell them they provided no medical rationale whatsoever that your surgeon was wrong.

You did good veteran-This award should help your SSA claim if you have one pending.

[dav_marine72]

Thanks Berta,

Good points. I do have a SSA claim pending and my lawyer wants a copy of this decision to use with the Judge. I actually had my surgeon schedule me for an occupational therapist to evaluate me. She said they didn't usually send people for these except for workers comp. I told her I wanted it for SSA. She said she didn't have a problem scheduling me. Will this work in place of an IMO as long as the report is favorable to me?

[Testvet]

Hi Everyone,

Finally received my award letter yesterday. Here is what they decided:

A temporary evaluation of 100% was assigned effective month day, 2009 based on surgical or other treatment necessitating convalescence. A 40% evaluation is assigned from 3 months after surgery.

Entitlement to special monthly compensation based on housebound criteria being met is granted during the 3-month convalescent leave period.

Entitlement to individual unemployability is granted effective month date, 2009. This was the date I received the letter from the company I worked at stating since I could not return to work I was fired.

There were some other increases that they denied for but I want to focus on the back and TDIU. I know what I need to do with those.

Now mind the decision summary given to my SO was a little different. He had stated it said I was entitled to continue receiving SMC and my total monthly payout would be $3700 a month for the convalescent leave based on housebound and regular aid and attendance and then $3400 a month moving forward with some sort of SMC.

He also said I was awarded P&T. He said there was a statement to the accord that my wife couldn't work based on the fact that she had to stay home and take care of our children who aren't in school yet and myself. Now they did include language under the TDIU award reasons that says "You experience episodes of your back locking up which requires your wife to stay home from work in order to care for you."

Now let's go back to the temp 100% with SMC. They based this on my back being 100% and having mental (50%) and asthma (30%). They also state my surgeon ordered a 3 month convalescent leave period. This was flat out lie. My surgeon from the get go gave me a form that stated I was to be on no duty for six months after the surgery. This would only be important if I can't get SMC moving forward. If that's the case the VA should have put me on 100% back and SMC for six months and not three. It may seem trivial based on TDIU but it's about $900 to me. Right now waiting to go to the SS judge in 11 months, $900 is $900.

Now on to TDIU. No verbiage on P&T. The award was based on my back (50%) and mental (50%) combined mostly it sounds. Although I have sc asthma (30%), sc lower extremity weakness (10%), sc right foot injury (10%), sc left foot injury (0%), sc chronic right testicle pain (0%), hypertension (0%), and eczema (0%).

Mind you above my back (20%), chronic testicle pain (0%), left (0%) and right feet (10%) conditions were at the BVA in which they were all denied higher ratings and they awarded lower extremity weakness (10%) based on the neurological aspect of my back. The BVA's decision was just thrown out at the U.S. court and we will be going back to the BVA on remands.

My asthma, hypertension, eczema, entitlement to service connection of GERD 2nd to all the pills I take for sc aliments and entitlement to service connection for erectile dysfunction 2nd to my spine condition are all on appeal at the RO.

I'm 80% by the schedule and will likely get 100% on the schedule with 1-2 years. So that will be my 2nd 100% counting TDIU. I need P&T because I need to carry insurance for my family. I can't watch the kids and my wife going to work doesn't make sense because the daycare would cost more. I am paying for cobra now and since the economy took a dive my monthly payment is only $350. However, come February it will jump to $1100 a month. My wife and kids also deserve the education benefits based on having to deal with the VA and me.

Game plan:

I know I need to ask for P&T from the RO. What can I do increase the likelihood I get it? I am 37 and my back condition has been severe since 1997 so we are going on 13 years. I have had two failed surgeries including (L3-L4, L4-L5 discectomies and laminectomies, 2000) the latest (L3-S1 fusion with cages, rods, and screws, 2009). The surgeon thinks I will not get any pain relief from the surgery or I would have felt it already now that I am six months + post-op. He is recommending a spinal stimulator that I am not too keen on, giving my history with back surgeries. I have failed water PT, failed a spinal stimulator trail, failed nerve blocks, failed facet joint injections, had an exam done that showed unsymmetrical muscle groups in my lower extremities to include atrophy and muscle wasting from my sc L3-S1 condition, I have been prescribed a cane, I can’t sit for more than 5-10 minutes without getting nauseous and wanting to throw up, I can’t stand for more than 15 minutes, I can only walk so far, I can’t help out around the house at all, I can’t hold my kids or help with them, I can’t get dressed by myself most of the time, I’m on 3 Oxycontin 40mg and 3 roxicodone 30mg per day for my pain and they don’t work well.

So what can I do to help get P&T? Am I missing anything here I should be getting, SMC, etc.? I would think I would meet the need for regular aid and attendance based on the fact that my wife has to take care of me. Some of the tasks they describe I can do myself sometimes but the reg states that to get it you don’t have to need someone to do all the daily tasks for you.

Maybe I am missing something here but to me this says you have a temp award based on a recovery period from surgery not TDIU rather a temp rating which will expire at the end of 90 days or 180 and I have even seen some that last a year depending on the surgery and then you will be back filing appeals to get to a permanent TDIU or 100% rating given your surgery was for your back I doubt if it gets better, most of the vets I know with back problems only get worse my brother in law had rods and screws put in it took him 3 years to go from 50% to 100% and 2 more surgeries to fix the rods me I have herniated disks from L3-S1 and they refuse to operate on me they just send me drugs but them I am 100% PTSD 60^ CAD and 10% hypertension and I know they can't fix my back anyway they have tried twice since 1992 ain't happening

On the biright side you mught get your SSD approved before the VARO gets done playing games with you

[john999]

If the VA granted IU and denied chapter 35 benefits then I would appeal the denial of Chapter 35. Get an IMO to state that your disabilites are permanent in nature with no expectation that you will get better in the future. If you win your appeal for P&T it will be effective to the date you got IU. I used this method and I got P&T within one year of being granted IU. I got an IMO to state my disabilites were permanent.

[broncovet]

Its a "no brainer" that you need to appeal. File a NOD, and be sure to list all the issues you are appealing. Do a good job on your NOD..get help if you need it, and be very clear on the issues. The NOD is your chance to tell your side of the story, including specific points as to what you disagree with. As you do your NOD give careful consideration as to whether you want a DRO (review or hearing) or go straight to the BVA.

Personally, I have had good luck with DRO reviews. DRO hearings are good also, but they take forever, and can be a waste of time. That is why I go with DRO reviews pretty much automatically every time I appeal. The DRO officer is supposed to be a very expericed Rating Specialist, and some of them can even read, contrary to popular belief.

As Berta mentioned, it may be worth it for you to pay for an IMO.

Appealing right now costs you nothing, and you have lots to gain from it. Yes, the P and T is important, as is Ch. 35. Frankly, if I understand what you said, you have had this condition for 13 years. Do they really expect something you have had for 13 years to go away or to improve? If it was going to improve, it would have done so years ago. Instead, considering your oxycodene, your condition has worsened, because Docs dont prescribe that for hang-nails. You have to be in great pain to be on that as it is considered to be a highly addictive narcotic.

Frankly I have never heard of being awarded SMC for anything less than 100% P and T. There may even be a requirement somewhere that P and T is required for SMC, others may be able to chime in on this.