Appeal Gone Wrong

[JayBrown1]

I receive a letter from the VA which was a Supplemental Statement Of Case dated 12-15-09 which I received 12-24-09 and it states that I had 30 days from the date on the letter to respond. However, upon reading the letter I found that they had changed the original issue which was "Evaluation of aggravation of osteochondral defect, right medial femoral condyle evaluated at 20 percent disabling." to my current rating after I had a right knee replacement which is now rated a 30 percent.

My original claim was filed 9-28-05, where I requested an increase in my rating due to right knee instability, bone lost, increase in pain and swelling, and the fact that my doctor documented that I needed a knee replacent which I had in Jan. 2008. I received their decision on 5-22-06, denied and I sent in a Notice of Disagreement which they received 5-30-06. On 1-24-08 they sent me an Appeal Election letter and I selected a traditional review. Now I received this SSOC on 12-24-09 which states that I am Appealing my 30 percent rating that I received after having my knee replacement in 2008. In the Adjudicative Actions it states nothing before 4-2008 and under the evidence section it only shows evidence from April 2008.

At this point, what do I need to do to correct this?

[jbasser]

Jay, you need to go to the RO and sit down with a REP and the VA to straighten the record out.

Take your copies with you.

From my dealings with claims, Montgomery RO is pretty much unorganized chaos.

J

[myround0]

I say, hold someone accountable, and fire the incompetent worker. I understand a lot of work goes into preparing a Veteran's file for compensation, however, a history of it reveals a systemic problem that needs to be fixed, and taking someone jobs, take some money, would all send a clear message, to the employees in Alabama...Playtime is over

[JamesBreckenridge]

I receive a letter from the VA which was a Supplemental Statement Of Case dated 12-15-09 which I received 12-24-09 and it states that I had 30 days from the date on the letter to respond. However, upon reading the letter I found that they had changed the original issue which was "Evaluation of aggravation of osteochondral defect, right medial femoral condyle evaluated at 20 percent disabling." to my current rating after I had a right knee replacement which is now rated a 30 percent.

My original claim was filed 9-28-05, where I requested an increase in my rating due to right knee instability, bone lost, increase in pain and swelling, and the fact that my doctor documented that I needed a knee replacent which I had in Jan. 2008. I received their decision on 5-22-06, denied and I sent in a Notice of Disagreement which they received 5-30-06. On 1-24-08 they sent me an Appeal Election letter and I selected a traditional review. Now I received this SSOC on 12-24-09 which states that I am Appealing my 30 percent rating that I received after having my knee replacement in 2008. In the Adjudicative Actions it states nothing before 4-2008 and under the evidence section it only shows evidence from April 2008.

At this point, what do I need to do to correct this?

I hate not being able to flip through a file and look at the code sheets and previous ratings. Your knee can be rated with three different diagnostic codes without running afoul of pyramiding. There's limitation of flexion, limitation of extension, and instability. It sounds like you filed a claim for increase in your knee instability in Septebmer 2005. Knee instability is rated on mild/moderate/severe. Why did they deny you in May 2006? In any case, it appears that you turned right around and send them an NOD a week later. Now somewhere in there you must have filed for an increase, after your knee replacement, which is worth a flat rate 30 percent.

It looks like you need to explain to the VARO that you were disagreeing with the evaluation of the knee for the time period between September 2005 and whenever you got your 30 percent for the knee replacement. Of course, now that decision will have to be done using only the evidence of record, since it's not like they can evaluate your knee now that it's been replaced.

I suspect that what happened is that they used the old diagnostic code and bumped it to 30 percent for the knee replacement... so that it looks like you're disagreeing with the 30 percent current rating, when it was really the old evaluation (whatever it was) that you were disagreeing with.

Need More Facts. But I'm sure that once they see what's going on that they will fix it.