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crabbyone

Appeal Filed-what To Expect

Question

I filed my appeal and the VA has it. What should I expect? Below is the info about my case...

14 yrs active duty-Airborne-diagnosed while on AD with Tibofibular subluxation of the left knee, and put on a permanent profile against running, marching over 5 miles and some other activities. I spent 10 more years in the Reserves and retired May 08. Filed original claim June 08. Awarded 10% for left knee strain. Award letter indicated additional compensation for instability may be considered. Recieved award Apr 09. Also recieve 10% for tinnitus and 0% for hearing loss. I had ACL replacement in July 09 due to constant problems. Filed for temp 100% in July 09 and awarded 100% temp in Sept for 1 month. I requested my file and finally got it in Mar 10. Upon review, I found the C&P Exam Dr indicated I had no limp or instability and used ibuprofin and knee brace for pain. This was wrong-I useb ibuprofin for pain, but knee brace for stability and had a pronounced limp. I also found out he indicated I had no stability problems. Where this came from, I dont know as I remember telling him I did have instability. I have also been receiving treatment for kidney stones since 2001 and my Urologist finally agreed and put in writing that he was convinced they developed while on AD. I also submitted 3 letters from my wife and 2 co-workers that attest to my limp and knee problems in a work and home environment. Below is my appeal letter.

16 April 2010

Department of Veterans Affairs

251 N Main Street

Winston Salem NC, 27155

Attention: VA File Number xxxxxxxxx

Notice of Appeal and Adjustment to Original Claim

Dear Sir/Madam,

I am appealing the decision on my claim filed 3 June 2008 for the following reasons.

1) VA Claim filed 3 June 2008 indicated that I had left knee pain and instability and that I wore a brace that helped with the instability and used Ibuprofen to treat for the pain. An evaluation and rating of 10% was given for the pain in the left knee and no rating or evaluation was given to the instability. I also demonstrated during the exam and have attached statements confirming the fact that I did have a pronounced limp due to the pain and instability of this knee.

2) VA Claim filed 9 July 2009 was approved for a temporary rating of 100% for surgery on the left knee to replace a ripped Anterior Crucial Ligament.

The Code of Federal Regulations Title 38, Section 4.71a, 5257 indicates that instability warrants a rating between 10% for slight instability and a maximum of 30% for severe instability. Considering the fact that I had to have ACL replacement due to the pain and instability of the knee, I feel that I am entitled to a rating for instability of my left knee from the date of the original claim of 3 June 2008. Even after the surgery, I still have to use a knee brace for some activities to ensure the stability of the knee. I also continue to have some pain in the knee even after the surgery.

In reference to the modification of the original claim, I want to add a claim for recurring kidney stones. Attached please find medical documents from my Urologist concerning my kidney stones and the resulting treatments.

I will be awaiting your reply.

Sincerely,

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I filed my appeal and the VA has it. What should I expect? Below is the info about my case...

14 yrs active duty-Airborne-diagnosed while on AD with Tibofibular subluxation of the left knee, and put on a permanent profile against running, marching over 5 miles and some other activities. I spent 10 more years in the Reserves and retired May 08. Filed original claim June 08. Awarded 10% for left knee strain. Award letter indicated additional compensation for instability may be considered. Recieved award Apr 09. Also recieve 10% for tinnitus and 0% for hearing loss. I had ACL replacement in July 09 due to constant problems. Filed for temp 100% in July 09 and awarded 100% temp in Sept for 1 month. I requested my file and finally got it in Mar 10. Upon review, I found the C&P Exam Dr indicated I had no limp or instability and used ibuprofin and knee brace for pain. This was wrong-I useb ibuprofin for pain, but knee brace for stability and had a pronounced limp. I also found out he indicated I had no stability problems. Where this came from, I dont know as I remember telling him I did have instability. I have also been receiving treatment for kidney stones since 2001 and my Urologist finally agreed and put in writing that he was convinced they developed while on AD. I also submitted 3 letters from my wife and 2 co-workers that attest to my limp and knee problems in a work and home environment. Below is my appeal letter.

16 April 2010

Department of Veterans Affairs

251 N Main Street

Winston Salem NC, 27155

Attention: VA File Number xxxxxxxxx

Notice of Appeal and Adjustment to Original Claim

Dear Sir/Madam,

I am appealing the decision on my claim filed 3 June 2008 for the following reasons.

1) VA Claim filed 3 June 2008 indicated that I had left knee pain and instability and that I wore a brace that helped with the instability and used Ibuprofen to treat for the pain. An evaluation and rating of 10% was given for the pain in the left knee and no rating or evaluation was given to the instability. I also demonstrated during the exam and have attached statements confirming the fact that I did have a pronounced limp due to the pain and instability of this knee.

2) VA Claim filed 9 July 2009 was approved for a temporary rating of 100% for surgery on the left knee to replace a ripped Anterior Crucial Ligament.

The Code of Federal Regulations Title 38, Section 4.71a, 5257 indicates that instability warrants a rating between 10% for slight instability and a maximum of 30% for severe instability. Considering the fact that I had to have ACL replacement due to the pain and instability of the knee, I feel that I am entitled to a rating for instability of my left knee from the date of the original claim of 3 June 2008. Even after the surgery, I still have to use a knee brace for some activities to ensure the stability of the knee. I also continue to have some pain in the knee even after the surgery.

In reference to the modification of the original claim, I want to add a claim for recurring kidney stones. Attached please find medical documents from my Urologist concerning my kidney stones and the resulting treatments.

I will be awaiting your reply.

Sincerely,

Have you submitted any medical documents to support what you are saying in regard to your limp etc. If not you really need to provide this supporting medical documentation. Letters from family and friends will not win you an increase without supporting medical documentation such as reports from the ortho surgeon, or any other doctors that have treated you for this condition. You cannot assume they will get this info for you, it is in your best interest to provide this yourself and get "time stamped copies" of each document you submit. This is a start you need to get this info ASAP, becuase everything you say sounds good but without a paper trail to support what you say the VARO won't take yours or anyone elses word of what you are saying to be true. Regarding your bad C&P exam your supporting medical documents will discredit the lies reported by the

A-hole doctor in your exam.

Hope this helps,

Bergie

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Ad

Below is my appeal letter.

16 April 2010

Department of Veterans Affairs

251 N Main Street

Winston Salem NC, 27155

Attention: VA File Number xxxxxxxxx

Notice of Appeal and Adjustment to Original Claim

Dear Sir/Madam,

I am appealing the decision on my claim filed 3 June 2008 for the following reasons.

I will be awaiting your reply.

Sincerely,

crabbyone,

You are past your time limits to appeal (NOD) a 3 June 2008 Rating Decision.

carlie

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How can I be past my deadline when their decision was not given until April 2009. I have 1 year from the date of the decision, not when it was filed, right? Furthermore, the request for the records took almost 8 months, so I had no idea that the Dr gave wrong info to the person making the decision.

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How can I be past my deadline when their decision was not given until April 2009. I have 1 year from the date of the decision, not when it was filed, right? Furthermore, the request for the records took almost 8 months, so I had no idea that the Dr gave wrong info to the person making the decision.

crabbyone,

My bad, my mistake.

When I read, "I am appealing the decision on my claim filed 3 June 2008 for the following reasons."

I took 3 June 2008 as the date of your rating decision.

I feel it should be stated as, I am filing a Notice of Disagreement with the Rating Decision dated XX/XX/XXXX.

As you state, "How can I be past my deadline when their decision was not given until April 2009."

So you have until April ___, 2010 to submit your NOD, we are at that timeframe right now.

You may have already missed it or have only a few days left to submit your NOD.

The VA will not give any merit to the contention that,

" Furthermore, the request for the records took almost 8 months, in extending your time

to file the NOD.

Also on this part

"I had no idea that the Dr gave wrong info to the person making the decision."

The decision maker is to adjudicate with consideration of the medical evidence of record,

it will be another hurdle for you to prove "that the Dr gave wrong info".

From what you have posted, I believe the VA granted 10 percent for the left knee

due to both issues of pain and slight instability.

Without knowing exactly what the VA stated in the Reasons and Bases Section

any other conclusion would just be speculation.

jmho,

carlie

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My original claim was filed on 3 June 2008 and rating decision was made on 22 April 2009. I have filed my NOD and it was received on 20 April 2010. I finally received my file on March 10 2010 and it took a few weeks to go through it and get my statements from co-workers and my wife. Yes it was close, but it was filed in time!

The rating award letter said "A 10% evaluation is assigned for painful or limited motion of a major join (your knee)." Later it states "The next higher evaluation of 20% is warranted when there is dislocation of the semilunar cartilage with locking, pain, and effusion, or flexion limited to 30 degrees, or extension limited to 15 degrees. A seperate evaluation may be assigned for instability of the knee." From that I gather that they didn't grant anything for the instability that I am requesting. After discussing my situation with an Orthopedic Dr last May and an exam, xrays and an MRI by him (paid for by my personal health insurance), he determined that the instability was due to an ACL/LCL deficiency and scheduled a scope/surgery for repair. The biggest symptom he had was the instability I was experiencing. I could walk 5 miles 1 day before my knee would give way and 5 ft the next before my it would give way. Playing sports was very risky as it would give without notice and the pain was excruciating. Since the surgery, the better part of the constant pain I had is gone and most of the stability is back. I still wear a brace for certain activities and have to watch myself on some things that put a huge strain on my knee (climbing ladders, lifting heavy objects, sports activities, etc).

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