Reading Through The Decision, Etc

[hedgey]

Okay. So my DH got his big white envelope. Here's the background of his disability: He was in an jeep accident back in the military, severely burned, especially his arms, shoulder, and head (both his ears were burned off and most of the back of his scalp - they did reconstructive surgery and did a decent job, but the scars are still very noticible. His shoulder joint was partially burned away, and he very narrowly missed having both hands amputated. He spent a year in the Burn Center at BAMC. He recovered (miraculously) and stayed in to eventually just get out a few years later with a regular honorable discharge in 1985.

His friend said go to the VA, and to the VA he went. He got rated at 50%: 10% + 10% for 2nd degree burn scars, and 30% for left shoulder condition. He was young and happy to have 50%, so he didn't question anything about it. He didn't even know he had access to VA healthcare, he just went on his way.

25 years later, he filed for an increase, only because a buddy asked him how long it had been since he'd been evaluated. "25 years!! Get ye to the VSO!!". That's what he did, but in addition to the scars he filed for loss of motion in both his hands.

So here we are with the decision today.

They ADDED 30% for 3rd degree burn scars on his head.

They ADDED 30% for 3rd degree burn scars back, neck and chest.

They Increased from 10% for 2nd degree burn scars to 30% 3rd degree burn scars on his left arm.

They Increased from 10% for 2nd degree burn scars to 20% 3rd degree burn scars on his right arm.

They said that his Left Shoulder Condition had not worsened, that it was DJD and is not changed, and remains at 30%.

They denied both of his claims for his hands (even though they admit in the narrative that both hands suffered 3rd degree burns). They state that there was no evidence in the record of any injury to the hands. (uhhhh....)

In addition, we saw that they did not receive or consider an IMO from a board certified doctor

and they did not receive or consider evidence that his hands had been un-usable for a period of time.

So here are my questions:

First of all, can he file something about the VA missing that his burns were 3rd degree back in 1985? He had no instructions that he could appeal. There's surely no way that his burn scars changed from 2nd degree to 3rd degree over the 25 years.... If they're 3rd degree now, they were that back then. Plus, how the heck did they miss the scars on his head??? If they had just appeared magically, they wouldn't be SC now, would they?

Second, how does he disagree with the examiner's findings on his shoulder? When the examiner (NP) told him to reach up with his left arm, he said it hurt. He said do it anyway. DH had tears rolling down his cheeks. It's even stated in the decision that he was in pain throughout the examination, but that he had little loss of ROM due to pain. They also state that he was guarded in his movements.

The same thing happened with his hands - the examiner made him squeeze a grippy thing and told him to squeeze as hard as he could, regardless of the pain. DH squeezed until there were tears in his eyes. Ergo, no loss of grip, no range of motion.

I feel like we're looking a gift horse in the mouth, but at the same time, it feels like he's been cheated.

Any thoughts or advice? Thanks! And if you think I'm being greedy, say that too, okay?

Edited March 23, 2010 by hedgey

[Philip Rogers]

Hedgey - so what is he now rated now for a total?? I'd request a copy of his complete c-file. I'd file a CUE on the original rating 25 yrs ago. jmo

pr

[akwidow]

I am so glad your DH is still with you -

Now is the time, if you have not already done so, to dig in deep and ask all the questions you never asked before.

If you have not got the treatment records from "VA Central", you could try to get those old treatment records from the location he was actually treated at - the hospital. Sometimes this will get you more.

Were there providers outside of the VA that can verify the breadth of any of his injuries?

Are there any old letters (which he couldn't write...) photographs of his injuries, or any other documented data that would prove the hand or other injuries?

Start thinking sideways. I won my case with the help of two letters my late husband wrote home from RVN in 1968, which I did not have in my possession nor even know about for 40 years! (I changed my opinion about old girlfriends...)

AkWidow

Edited March 23, 2010 by akwidow

[cowgirl]

Yes, get this claim together and go for it. No one should be made to present a medical condition to the point of tears. My c&p tears were for mental health, not for physical symptoms. Can't imagine the depressive thoughts going through your dear husbands mind for all this.

Bless you.

Cg

[pacmanx1]

Yes, get this claim together and go for it. No one should be made to present a medical condition to the point of tears. My c&p tears were for mental health, not for physical symptoms. Can't imagine the depressive thoughts going through your dear husbands mind for all this.

Bless you.

Cg

CG, I agree that he should be treated for some type of depression and a depression claim should be filed.

Hedgey, What is your Hubby service connected for?

[acesup]

You didn't mention TDIU. Have you applied for it? Your DH sounds like a good candidate for TDIU P&T, just my humble opinion.

You aren't being greedy. You're just trying to get the benefits your DH and you deserve, and there are a lot of folks rooting for you. FWIW I am one of those folks.

Best of luck, and don't be discouraged by denials or being shortchanged. Just appeal.

[broncovet]

Hedgey

I havent put those percentages in a benefit calculator to know what the combined rating is, but it sounds like it at least 90% combined. May I ask as to what is a "DH"?

It sounds like his injuries are definately in the severe category, and there is a "SMC" ratings for loss of use of a hand or a foot, which would add to the benefits. Also, I dont know if he is working or not, but if he is not, then you should ask for, and probably eventually get TDIU.

It is a "no brainer" that you need to file a Notice of Disagreement. ...if he is at 100% combined, then NOD based on that he deserves SMC and an Earlier effective date. I think that when he went to the VA to get treatment for 3rd degree burns from Service connected conditions, that would be an informal claim for increase, effective the date of the examination.

The potential Retro for that many years is enormous, probably in 6 figures, so proceed carefully and methodically so this Vet can get what he deserves.