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

[Vync]

Hedgey,

If any of DH's SC conditions are listed as bilateral, please let us know that too.

Also, on his 30% SC 3rd degree burn ratings for his arms, I noticed that you listed him as 30% for the left arm and 20% for the right arm. Just curious if the right arm % was a typo and supposed to be 30% instead of 20%.

[cowgirl]

Do you have a copy of your husbands Cfile? there should be a complete history of claims and decisions in there to help you revalidate any inquiry. Dates and diagnosis's, as well as diagnostic codes. Go ahead and post here, we'll at least give a go!

The evidence should have been listed on the VCAA letter. Was it? Was there a unit report or citation of sort for the vehicle accident? Was he reassigned to another unit or MOS afterwards because of the long recovery time? Did he attend physical and/or mental therapy during the time he was hospitalized?

Do you have his Service Medical Records? Many answers and probably a few more questions will be in there. Like his discharge physical and the recognized medical conditions in effect at that time.

Did you husband see any civilian providers after service for continued medical care? or has his care only been through the VA? Does he take medications for any SC condition?

Its possible he had a VSO help him file a report after service and either he/or the VSO may have records to then.

Did you husband ever process vocational rehabilitation for help? Or maybe a veterans center, from what i understand they keep records totally seperate from the VAMC (Medical Center) records and release them only if the vet requests.

For now, best relax for a few days and appreciate the increases. I'm sorry this occured, but suspect these service connected medical conditions have impacted his(your) life and possibly employment issues since discharge.

Have a box'o'chocolates and in a few days try meditating for what is 'next to accomplish' on your/his VA list.

Best to ya,

CG

p.d. pardon me if the questions are repeats ~ !

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 24, 2010 by cowgirl

[hedgey]

Thank you, everyone, for your responses and support!

DH = Dear Husband

They don't refer to his arms as bilateral, and no, no typo. They gave him 30 on his left arm and 20 on his right. He had a 'release' on his left side, the burn scars tore open one day when he was badgered into doing the monkey bars during PT. So the scars on his left arm are a bit more impressive. (Hell, they're all impressive. But beautiful in a way. Miracles of the human body, of healing...)

He works and loves his job so he doesn't want to retire yet (he's getting close, though), so IU isn't something he wants to go for just now. Besides, right now none of his conditions are greater than 30% so he'd have a fight for that.

He's definitely had a time with the mental aspect of the impact on him but he's resisted mental health treatment. The good news is that he's been by my side while I've gone through my own MH travels, and he's opening up to the idea.

We don't have his C-file or his SMRs. The SMR's have been requested, and we are planning a trip to the VARO to look at both his and my C-file. It's a 6 hour drive one way, so it's a small road trip for us.

He didn't have a VSO handle his initial claim, he just went to the VARO and put the claim in. He said his original C & P took less than a half hour - he remembers because he was amazed at how short it was. He had a VSO this time, and neither his IMO nor his documents he had written for him while his hands were out of commission made it into his file.

Right now he's rated at 80% combined. Fuzzy VA math, I guess: 30% + 30% + 30% + 30% + 20% = 80%. The rating calculator that I downloaded from here comes up with 81%, if I entered everything right.

It's funny that they don't consider his arms Bilateral. Is that because they're uneven ratings?

Anyway, I'm going to bed. It's been a very VA kind of day, and we've been searching through records all evening.

We're still very happy that he got as much as he did. And really amazed at how fast... Just over 9 months!

Thanks again, everyone, thanks so much!!

[Berta]

"It's funny that they don't consider his arms Bilateral. Is that because they're uneven ratings?"

I think so or because they are 2 separate SC disabilities that are not related for a bilateral award. I am not sure on that though-

Do you feel it would be better to request a copy of the C file by mail?

You would need an appointment at the VARO to see it in person and I know that -if I had done this- I would have been too distraught or stressed up to know what I wanted to have copied from the file.

When I requested it by mail- (it was only the C file and only a few med recs that might have been sent to support the claim-the actual medical records are kept separate from the C file)it didn't take too long (this was years ago) 3 weeks I think to get here and the C file contained some startling information.

It had info I might have breezed over or completely missed the significance of-if I had accessed the file at the VARO.

[stillhere]

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?

You can file and ask to have the claim reopened and point out the mistake that was made in 85. Might work and you are correct if they are 30% now they should have been 30% then.

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.

You can also file and NOD or reconsideration and point out that he was in severe pain when using his shoulder.

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.

When you file the other NOD add this too and make sure you make your point about the PAIN.

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

DH should be compensated for the injures at the rate he deserves!

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

Edited March 24, 2010 by stillhere

[hedgey]

Thanks for all your help, everyone. My husband made an appointment with his Vet Rep for tomorrow. In the meantime, I'm going to try writing out a narrative and work on getting all the little duckies we have in our mitts to line up.

Berta, thanks for the tip about getting the C-file. That's a good point about being flustered at the appointment. Couldn't we just go there and tell them we want complete copies made... thanks, we'll wait...?

I'm so paranoid about dealing with the VA. I can't help thinking that we need to get his C-file in our hands BEFORE he files any NOD or CUE. I'm fretting that key bits might accidentally fall out of the folder, if you know what I mean.

Right now, the only thing we have in our hands from his original 1985 C&P rating decision is just one piece of paper that states that his claim has been approved, and what the separate ratings are. There is no mention of the disability codes, or in the case of his scars, which scars they're talking about. All it says is

"Left shoulder condition: 30%"

"2nd degree burn scars: 10%"

"2nd degree burn scars: 10%"

The only way we know now which scars they're talking about is from the new decision letter that tells him that one of his 10% was raised to 30%, (upper left extremity) and the other 10% was raised to 20% (upper right extremity). Plus the two new ratings for his head (scalp & ears) and his back. Again, all of his burn scars are now called "3rd degree burn scars".

Sorry, starting to babble and get on a soapbox. I guess I'm just restating things to hear them again and reassure myself (and him) that the VA really did do him wrong back in 1985. He says that in '85, most of his scars were much more noticible than they are now, especially on his head. His ears had been completely burned off, and they'd made new ones for him with skin & cartilage grafts. They look okay from a distance, but close up you can easily see that they aren't right.

My sweetie. He's the most handsome guy I ever met. I looked in his eyes and fell right into them, never even noticed his scars for quite a while... we made a good fit because we both pushed everyone away... and wound up sitting side by side, alone together.