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60+20=60?new Exam By Original C&p Examiner

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cannoncocker

Question

Below is the redacted version of the letter I received as a result of a very recent Decision Review Officer action, which leads me to 2 questions:

These are my questions

1. “Your overall or combined rating remains 60% effective April 22, 2008. We do not add the individual percentages of each condition to determine your combined rating. We use a combined rating table that considers the effect from the most serious to the least serious conditions.” In English and standardized math how in the world did they come up with the 60 plus 20 equals 60 since they didn’t seem to pull the pyramid card out?

2. If 60 plus 20 equals 60 what would be the point of another exam, utilizing the same examiner by the way, that denied me in the first place due in no small part because of the numerous discrepancies in his original C&P Exam and the MRI/Consult/Physical Therapy/IME exam findings, which pretty much agreed? It would be relatively difficult to ignore or disagree with an MRI image it would seem to me. So why another exam for severity since 60 plus whatever equals 60?

DEPARTMENT OF VETERANS AFFAIRS

We made a decision on your appeal.

This letter tells you about your entitlement amount and payment start date and what we decided. It includes a copy of our Rating Decision that gives the evidence used and reasons for our decision, We have also included information about additional benefits, what to do if you disagree with our decision, and who to contact if you have questions or need assistance.

What We Decided

Service connection for XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXis granted with an evaluation of 20 percent effective April 22, 2008.

The above action is considered a full grant of this benefit sought on appeal.

An examination will be scheduled at once to evaluate the severity of your service connected XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. You will receive notification regarding the date and time of your exam in a separate letter.

Your overall or combined rating remains 60% effective April 22, 2008. We do not add the individual percentages of each condition to determine your combined rating. We use a combined rating table that considers the effect from the most serious to the least serious conditions.

Your compensation payment of XXXXXXXX will continue unchanged.

Any hunches would be greatly appreciated. Actually I have spoken to an Attorney and I seem to be out of my depth here.

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OK I've been trying to wrap my head around this till tomorrow so I have this:

1. 30 sinus tachycardia

2. 20 lumbar (First claim submitted April 2008/denied June 2008/Denied August 2009-New DRO Grant 17 March 2010)

3. 10 tinitus (bilateral) X 1.1 = 11

4. 10 L foot

5. 10 R Foot

4&5 Pyramid = 10% total

6. 10 Hypertension

7. 0% R high frequency hearing

= 90%

or

with pyramid factoring

X 1.1 = 81%

Obviously I am doing something wrong. I have the L and R Feet pyramided to 10% instead of 20%. Still the VA has me rated at 60%. I can call 1-800-827-1000 Tuesday or IRIS the quetion but if anybody can tell me where my thinking has gone wrong that would be quite helpful.

The only new items are:

2. 20 lumbar (First claim submitted April 2008/denied June 2008/Denied August 2009-New DRO Grant 17 March 2010)

3. 10 tinitus (bilateral) X 1.1 = 11 granted June 2010

I have found no spreadsheets that are relevant to this and clueless for the rest of this.

It comes out to 64 for me, rounding to 60

Your bilateral for tinitis = 10+10 = 19 + 10% or 1.9 = 20.9 rounded to 21.

If 4&5 are pyramid, I believe they ignore one of them so you get 10 on that.

So you end up with 30+21=45 + 20=56 + 10=60 + 10=64 using VA fussy math, which rounds down to 60%.

At least that looks like what they are doing to you.

Edited by chr49
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I believe I agree with you and the VA (how strange is that as bizzare as their computational rules are?} 4 and 5 for sure fall into the pyramid rules so one of the 20 are kicked to the side of the road. So we can put this one to rest as far as I can tell.

Thank you guys for your generous help. 64 has to be right, given my luck and all.

All I have to do now is get through the new C&P Exam for "Lumbar Severity" knowing their is a bias for dening it since that was the result last time. He did a SLR and recorded it as negative because I didn't fall out screaming and didn't pull back due to pain till it really got bad. I am just not the histrionics type but obviously that is the wrong approach, not to mention my IME said they didn't really use that anymore, which she didn't explain beyond that but since her CV is better than anyone else's I have seen, being a certified practicing Spinal Neurologist and all, I just took her word for it. Probably has something to do with having an MRI image to actually see what nerve you are dealing with and what position it is in....

Thanks for the help with closing the book on this, since there are plenty of other aspects to this than dealing with this VA Rule thing.

Edited by cannoncocker
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  • Content Curator/HadIt.com Elder

I did some digging regarding tinnitus. See note 2, below, as tinnitus is a single rating, not bilateral.

§4.87 Schedule of ratings—ear

6260 Tinnitus, recurrent 10

Note (1): A separate evaluation for tinnitus may be combined with an evaluation under diagnostic codes 6100, 6200, 6204, or other diagnostic code, except when tinnitus supports an evaluation under one of those diagnostic codes.

Note (2): Assign only a single evaluation for recurrent tinnitus, whether the sound is perceived in one ear, both ears, or in the head.

Note (3): Do not evaluate objective tinnitus (in which the sound is audible to other people and has a definable cause that may or may not be pathologic) under this diagnostic code, but evaluate it as part of any underlying condition causing it.

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Well Vync, this is not one of those posts and you can just whip off a conclusive response. Your posts are very well thought out and require heavy research, at least to me, so I am just replying to say I thank you again and am back to the research. and not just wasting your time. I will get down to it on this one but obviously will take a few hours to fully understand how this works.

The pathology of my tinitus is as follows:

1. I have heard a ringing in my ears, both ears, not really in my head, but specifically in both ears since I was moving some equipment forward of the muzzle while in a fire mission. It is just one of thosething you just expect to go away, and as fate would have it, never does, it simply moves to the back ground. If you allowed it to move forward in your attention it would drive you absolutely insane. I didn't even file a claim for it but the Audiologist noted me a tinitus postive. Beyond that I received the brown packet that included 10% for bilateral tinitus.

How it was computed, under which code, though I guess I can go back to the SOC and track it from There. The award was June 2009 but was back dated to April 2008 so I don't know if it is too late to file a disagreement regarding this.

More researh but I would have never even considered that aspect. In the end that is probably more important than winning the Lumbar DRO.

Thank you very much!

Edited by cannoncocker
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  • Content Curator/HadIt.com Elder

Hey cannon,

I appreciate it, but I really did not spend much time at all looking up the info. I recently filed a claim for tinnitus, so I just dug into my research notes.

Tinnitus is kind of creepy condition because it can be caused by a number of factors, of course including loud noise exposure. You are not kidding abotu the sound driving you up the wall if you focus on it, but merely going to sleep is so difficult because it's always there.

I recommend you visit your audiologist again and ask if they think a treatment kit could offer you some relief. The VA audiologist issued me one, but I have not got it in the mail yet. Supposedly, the premise is that having soothing background sounds present all the time will help distract you from the constant whirring noise. The kit is one of those boxes that plays soothing sounds like ocean waves, jungle, thunderstorm, etc... They offered me a pillow with built in headphones, but the pillow really sucked compared to the one I have at home, so they are giving me small speakers to go underneath it.

Even though tinnitus is listed as bilateral, from what I hear it is still considered a single evaluation, meaning the bilateral math does not apply to it. I'm waiting to see what my claim results say, but you could call the 1-800 number and get their scoop on it.

Actually, I would say that winning every claim is equally important. For example, the military caused my TMJ problems when they did oral surgery. I am claiming tinnitus as secondary to my SC TMJ problems. If I had not filed for the TMJ and won SC, then I could not have filed for TMJ. With respect to your back, 10 or 20 years down the road, it will probably be worse and you could file for conditions which are secondary to it. It is better to have your bases covered.

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Service Connected Recurrent Subjective Tinnitus compensates

at a flat 10 percent.

Bi-lateral does not apply as the sounds are actually

perceived in the head and not the ears.

Hope this helps a vet.

jmho,

carlie

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