Confused 30% Rating Decision

[rese]

Hello All,

Well, I WON !

A 30% rating (and I am grateful) in Febuary 2006 but there are too many things wrong with this and my DAV SO is uncertain as to how to proceed with the NOD. Not only is my SO confused, but every Vet Rep I have confided in thus far... so I bring my case back to HADIT for procedural guidance on the following questions.

1. this rating is for pain and 2 scars. can anyone tell me what is the code for cavernous hemangioma active disease of the left forearm, wrist and hand? In other words, why didnt they rate the underlying diease in addition to the pain and scars? the pain was rated under limitation of motion, yet I didnt qualify for the minimum (wrist) rating there. I tried to find a code but the closest I could come was similar diseases on the tumor rating chart A because chart B is for Brain tumors and chart C is for minor tumors. This condition (according to C&P exam) is active, progressive and debilitating blood vessel tumors. I know many here dont have a medical background but I just want to know where the code is. Is it possible VA dont know either? is it possible they need to make one up? let me say also that I have a medical background (clinical lab) but I cant find the code! any help would be appreciated!

2. What do you think about an EED? this was a won repoened claim. I was initially denied in 1980 for exactly the same condition! I have an appeal on file and there is no response from them in my C-file! how common is this? I must have just forgot about it after a couple of appeal statements and the condition got worse (it reoccured).

3. I had surgery in-service that resulted in radial nerve damage. This is documented in the hospital records which strangely enough, was not mentioned in any way in the evidence considered to grant the claim. How reasonable is that, no mention of hospital records?--in their possesion as evidence to grant the claim! in any event, can this be part of a NOD or a whole new claim? I dont know how to handle this.

How should I go about this NOD? what should it look like? it there a certain form? I think I need the best minds here but please whatever you can add likely can help since too many already dont have a clue.

[Berta]

http://www.va.gov/vetapp05/files4/0526922.txt

The above vet, although this is a TDIU decision, has a 20% rating for this condition-

I dont know if scars are within that rating-cant find the code there-but it should be right in your rating decision- if they didnt attach a rating decision with the code (probably didnt-since it was an award letter) ask your SO if he has the blue rating decision as-somewhere-the VA had to determine what code they decided this under.

"I was initially denied in 1980 for exactly the same condition! I have an appeal on file and there"

the appeal-since 1980- it has never been decided? What is last info in your c file on that?

"This is documented in the hospital records which strangely enough, was not mentioned in any way in the evidence considered to grant the claim. How reasonable is that, no mention of hospital records?--in their possesion as evidence to grant the claim! in any event, can this be part of a NOD or a whole new claim? I dont know how to handle this. "

VA does this all the time- do you have copies of those records?

Send them copies with your NOD and state that this is evidence,as attached,which they have not considered properly.

The NOD-a regular letter- just type in Caps Notice Of Disagreement on a regular letter under their address etc on the left and put your c file number on it.

Just state:

I completely disagree with your decision of (date) as you have failed to consider and address all medical records pertinent to my claim. My inservice surgery resulted in radical nerve damage that has not been considered and properly rated.

I have attached copies of ( anything you have)

and then add the side affects if any, of any meds you take for this.Also add that 'I fully intend to continue to appeal until the benefits I seek have been granted.'

(I would hold off until on the NOD until you get their letter and the DC code-and also check the rating schedule someone gave you to see what rating is appropriate. You might have the correct rating-then again-the medical evidence might reflect a higher one.

Was a goinometer used on your wrist to determine range of motion?

Have you lost complete use of the hand affected?Is it your dominant hand?

Do you have all of your SMRs- and also do you have a copy of the actual C & P results?

If not send the VAMC where the C & P was done a letter to the Records Access Officer with your c file number on it requesting a copy of the C & P results and give them the date of it.

Do you have copy of your complete c file?

The VA-with appointment -will show it to you but better yet ask them (send this to the VARO) for a copy of it.

Edited April 17, 2006 by Berta

[Guest fla_viking]

Dear Veteran

One of the biggest complaints by everyone who pratices VA law is the VA low ball claims. You cant trust the VA decission on the rating.

When I got 30% my lawyer had me get my VA Dr to write that I was unemploybel due to this disablity and the VA then gave me 100%.

Terry Higgins

[rese]

Hi Berta!

Let me first say thank you for your expert input and very timely response.

I will try to answer all your questions

1. scars are code 7804 (per DAV SO). this is despite C&P documentation for one scar that states "In the area of the scar, there is apparent tissue loss and depression within that area."

do you think this could get a higher rating?

2. "the appeal-since 1980- it has never been decided? What is last info in your c file on that?"

the c-file is silent (per DAV SO) on any response from VA after 2 statements in support of claim in 1981

3. "VA does this all the time- do you have copies of those records?"

Yes. I gave a copy of Hospital record to DAV SO, who submitted to VA and sent me a letter to prove it.

let me also say a statement in support of claim detailed side effects of meds that wasnt considered.

4. Question for Berta and other HADIT community in general on what this means:

"I would hold off until on the NOD until you get their letter and the DC code-and also check the rating schedule someone gave you to see what rating is appropriate. You might have the correct rating-then again-the medical evidence might reflect a higher one."

what is meant by "until you get their letter" what letter? and on the code for caverous hemangioma and pain they used code 5215 (per DAV SO)

5. "Was a goinometer used on your wrist to determine range of motion?" No

6. "Have you lost complete use of the hand affected?Is it your dominant hand?"

Yes it is my dominant hand.

I have not loss complete use, but documented subjective findings of C&P state...

"Currently, he states that the pain is 6-7/10 every day. It is a constant ache, sharp, prickling pain"

"It becomes red, hot, and stiff."

"His hand feels like it is going to swell and then bust."

"He experiences fatigue and lack of endurance."

"He states that it does flare-up a couple of days a week."

"It becomes a 10/10 and it lasts a couple of days."

"There are no alleviating factors."

"he states that he is a medical tech and he has great difficulty of the hand."

objective findings include

"Wrist flexion was from 0-25 degrees with pain."

"Dorsiflexion 0-20 degrees with pain."

"Ulnar deviation 0-10 degrees with pain."

"Radial deviation 0-5 degrees with pain and structural limitation."

"Strength was 3/5"

"There is significant swelling in this area from the thumb to the index finger."

"Regarding examination of the hand, there are multiple masses on the thumb, between the thumb and the index finger."

"(condition is) Currently active, limitation of motion at the wrist as above. Extremely painful."

This amounts to a overall 74% decrease in all flexions excluding strength and endurance.

I dont know if this amounts to loss of use, but it feels like it.

What makes it worse is that I was told if surgery was perform now, there is just too much to remove that likely would reoccur. there is no chance it will get better, only worse.

7. "Do you have all of your SMRs" No, but I have requested this

8. "do you have a copy of the actual C & P results?" Yes

9. "Do you have copy of your complete c file?"

No, but I have requested this. Is the SMRs and c-file the same?

Well, as you can see I need to work this up. Please, HADIT community, let me know your thoughts they as are appreciated, youre the only hope I have for great independent, unbiased advice to fight the common enemy!!!!

[rese]

Terry,

Thanks for your advice.

I thought you couldnt hire a lawyer to help you? is that the only route to get that letter?

I am currently unemployed

Rese

[Berta]

"the c-file is silent (per DAV SO) on any response from VA after 2 statements in support of claim in 1981"

if they did not decide this claim it is still open and that would be the actual EED-

this is odd that there is no denial in the c file at all.......

I meant by letter- I guess I meant your award letter -which you did get-sorry about that-

In the C & P results did the VA doc state their opinion as to how this disability affects your employability?

If I were you I would access the Schedule of rating disabilities which I believe someone posted- scars are ratable depending on their size, disfigurement, and pain-

Also- has the VA made any determination on SMC?-

You might fit into the criteria for SMC K award- $87.00 additional per month if you have loss of use of the hand to the degree as found withn 38 USC 1114.

Has your SO said anything about that?

[Guest fla_viking]

Dear Veteran

When my claim was in the VA system. My mother on my behalf hired a lawyer to work my claim. The VA did not like the out come lawyers were having at the VA level so they passed a rule saying vets could not have someone else hire lawyers on there behalf.

Terry Higgins