I Need An Opinion

[JHawks]

I haven't had much to do with the VA for 30 years. I never thought I would need to be looking at a rating increase. Here goes:

I was sent to a medical board in 1978 after 6 years of service in the Air Force. I had crushed my ankle and had 3 surgeries while on active duty to repair it. Left the AF with 20% rating at the VA and went on with my life.

Today, I am much much older (59) and the old bones have decided it was time for them to give me grief.

My ankle is full of arthritis and I also have a mal-union of the tibia and fibia as a result of the original facture. Hard to believe I have had this all these years and only now is it keeping me from walking too far. I have been wearing a brace since 2005 per my podiatrist. Recently I purchased a custom made brace (Arizona Brace) to stabalize my ankle.

My wfe talked me into putting in a claim to increase my disability rating. I am glad she did. I am rated as follows but have a review in process which I will explain.

30% for: status post trimalleolar franture, left ankle, with post traumatic arthritis with distal tibular deformity

10% for: scar #1

10% for: scar #2

The scars are on my ankle and are exremely painful to the touch so each is rating individually.

I am now rated (combined) 40% SC.

When got this rating there was no mention of the fact I was required to wear a brace which according to the schedule would qualify me to 40% instead of the 30% for my ankle.

Now, here is my question...

I asked for reconsideration of my rating decision based on the brace. I was told by another poster that all I could get for my ankle was 40% and I was at the max already and my request for reconsideration would not change a thing.

I am new to this so I have no idea. My scars are rated seperately. The rating decision is quoted exactly as I received it below:

"We have changed the status post trimalleolar fracture, left ankle, with tarsal syndrome, mild degenerative changes, to status post trimalleolar franture, left ankle, with post traumatic arthritis with distal tibular deformity, and increased your evaluation to 30% disabling, effective March 10, 2009, the date we received your claim for increase. An evaluation of 30% is granted for malunion of the tibia and fibula with marked ankle disability. A higher evaluation of 40% is not warranted unless a brace is required because of nonunion and loose motion."

Am I waisting my time with this or was the other poster wrong?

[12R3G]

Bump....

JHawk

The RO was very clear (and quoting the specific diagnostic code in the VA ratings schedule) about what is required for a 40% rating: wearing a brace.

The question is, why wasn't this documented, or if it was, why did the RO ignore the record and lowball the claim.

Did the VA obtain medical records from your doctor (look at your latest rating decision under the heading "Evidence"). If yes, was the brace documented in the medical records? If the VA didn't review your treatment records, or if the records don't document the brace, then fix that and obtain a copy for your records and send a copy to the VA.

I'm not sure what the other poster was trying to tell you. However, if you plug the numbers in the ratings calculator, your current combine rating is 43% which rounds down to 40. If you rating for the ankle is increased to 40%, then your combined rating will jump to 51% which rounds to 50.

So..."yes, it's worth it."