Kidney Cancer

[texal1]

IS THERE ANY REGS WHICH GIVE PROTECTION TO DISABILITY RATING FOR VETS OVER 55 WITH DISABILITY RATING FOR 5 YEARS.

[kw34]

James,

I was not treated a VAMC I was diagnosed with milagnant melanoma stage 3. I filed Dec 5, 2007 which is my effective date 7 months after I completed chemo my scans still showed signs of active disease as late as April 2008 when I finally got a C&P exam. Because I had not had any treatment in the past year I was lowballed at 0% and after reconsideration lowballed a 10% despite the fact that I have a 108 sq. cm scar to remove the melanoma that went all the way to the bone and hurts like you know what.

Edema of the leg that was ignored although in my denial letter they asked if I would like to file a claim for it and when I asked for it in reconsideration they ignored it although it was diagnosed by my docs diagnosed by the C&P examiner but ignored by the rater.

James from reading your post I think you do what is right but like so many here at hadit it appears the raters we are dealing with are not as serious about there job as you are.

[JamesBreckenridge]

That scar sounds like a DC 7801 at 20 percent, if it's secondary to the service connected melanoma condition, and if it's deep.

7801 Burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear:

Area or areas of 144 square inches (929 sq. cm.) or greater 40

Area or areas of at least 72 square inches (465 sq. cm.) but less than 144 square inches (929 sq. cm.) 30

Area or areas of at least 12 square inches (77 sq. cm.) but less than 72 square inches (465 sq. cm.) 20

Area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.) 10

Note (1):A deep scar is one associated with underlying soft tissue damage.

Note (2):If multiple qualifying scars are present, or if a single qualifying scar affects more than one extremity, or a single qualifying scar affects one or more extremities and either the anterior portion or posterior portion of the trunk, or both, or a single qualifying scar affects both the anterior portion and the posterior portion of the trunk, assign a separate evaluation for each affected extremity based on the total area of the qualifying scars that affect that extremity, assign a separate evaluation based on the total area of the qualifying scars that affect the anterior portion of the trunk, and assign a separate evaluation based on the total area of the qualifying scars that affect the posterior portion of the trunk. The midaxillary line on each side separates the anterior and posterior portions of the trunk. Combine the separate evaluations under §4.25. Qualifying scars are scars that are nonlinear, deep, and are not located on the head, face, or neck.

Here is the malignant melanoma rating schedule:

7833 Malignant melanoma:

Rate as scars (DC's 7801, 7802, 7803, 7804, or 7805), disfigurement of the head, face, or neck (DC 7800), or impairment of function (under the appropriate body system)

Note:If a skin malignancy requires therapy that is comparable to that used for systemic malignancies, i.e. , systemic chemotherapy, X-ray therapy more extensive than to the skin, or surgery more extensive than wide local excision, a 100-percent evaluation will be assigned from the date of onset of treatment, and will continue, with a mandatory VA examination six months following the completion of such antineoplastic treatment, and any change in evaluation based upon that or any subsequent examination will be subject to the provisions of §3.105(e). If there has been no local recurrence or metastasis, evaluation will then be made on residuals. If treatment is confined to the skin, the provisions for a 100-percent evaluation do not apply.

Was your treatment comparable to systemic chemo, x-ray more extensinve than to the skin, or the surgery more extensive than wide local excision? It looks like it may be a bit harder to get a 100 percent for melanoma than it is for, say, lung/colon/whatever cancer, and that's even if you file a claim right away. Unfortunately, when a claim isn't filed within 6 months of the end of treatment, it becomes very difficult to grant 100 percent retroactively, although sometimes there is some sort of residual. Sometimes there's just nothing a rater can do.

Every rater at my station is very serious about their job; almost all of them are veterans themselves. The few who aren't veterans themselves have friends and family who are veterans. But there are regulations about how much we pay out, and for what conditions, and how those conditions must be proved.

Edema is not a disability in and of itself, unless I'm missing something. It's more of a symptom. Is it associated with your melanoma? If so, then the reason you probably never saw it addressed by the rater was that it was just a symptom of the residuals of melanoma, and already wrapped up with that.

I do not like being the bearer of bad news, or the bad guy, and I do not have all the facts in front of me, and this is only my own personal perspective. But this is how a typical rater may look at your claim, and if you know that, maybe it can help you in some way.

[kw34]

James,

Edema is a illness and is ratable see below i met all the qualifications 1 year of chemo as i stated surgery to remove cancer that spread beyond the local site they missed the scars the cancer and edema as you can see below but you not knowing about edema I have a lettle less confidence in those raters handling my claim

7121 Post-phlebitic syndrome of any etiology:

With the following findings attributed to venous disease:

Massive board-like edema with constant pain at rest 100

Persistent edema or subcutaneous induration, stasis pigmentation or

eczema, and persistent ulceration 60

Persistent edema and stasis pigmentation or eczema, with or without

intermittent ulceration 40

Persistent edema, incompletely relieved by elevation of extremity,

with or without beginning stasis pigmentation or eczema 20

Intermittent edema of extremity or aching and fatigue in leg after prolonged standing or walking, with symptoms relieved by

elevation of extremity or compression hosiery 10

Asymptomatic palpable or visible varicose veins 0

[kw34]

James,

Chemo is Chemo thats the problem i am having if it does not say exactly what the reg says it is denied systemic thearpy is a fancy word for chemo, stasis pigmentation and hyperpigmentation is the same thing but if it does not say stasis pigmentation it is denied or ignored.

In the case of my scar the examiner stated a deep hyperpigmented scar painful to the touch measuring 9 x 12 x 1.5 cm but because the examiner did not calculate the area for the rater they rated it under 7804 instead of 7801. I think some rater perfer the easy way out.

[JamesBreckenridge]

No, edema is a symptom of a disease condition. In this case, it's DC 7121, post phlebetic syndrome. The severity of the symptom is how we evaluate the disability. Have you been diagnosed with post phlebetic syndrome? That diagnostic code is in the Cardiovascular body system; the rating specialist isn't going to be thinking about that when he's dealing with a Skin condition.

All of that being said, it sounds like they dropped the ball on the scars if they were due to treatment for an SC condition. But if you don't have a diagnosis of "post phlebetic syndrome", it's hard to fault the rater for not service connecting "7199-7121 Persistent Edema, Residual of Melanoma treatment." The "99" code means "We're going to rate something analogous here, because it's the closest thing we can come up with that describes the type of problem the vet is having." You probably (I'm guessing) don't have a diagnosis of post phlebetic syndrome secondary to the treatment for melanoma, otherwise the rater would have probably granted it. But if you do have a diagnosis for persistent edema, rating it analogous to post phlebitic syndrome sounds like just the ticket. You may want to specifically ask for something like "please rate my persistent edema due to melanoma analogously to DC7121 post phlebetic syndrome, as the edema symptoms are similar."

Thank you for bringing that to my attention. I will add that particular route to grant some benefits to my bag of tricks.

[kw34]

James,

I was diagnosed with edema of the leg with hyperpimentation distal to the wide local resection fitted for compression stocking edema is a result of 15 lymph nodes being removed from groin by my docs and VA examiner. I not trying to confront you just trying to show how some are not doing right by us. it is a residual of my SC'ed melanoma.

Edited January 10, 2010 by kw34