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Got The Envelope But I Have A Serious Question


JHawks
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Question

I don't want to come across like some greedy pain in the ass here. I got my rating decision and am happy overall. However, there appears to be a mysterious deletion of an already established claim.

On May 24th, 2006 I was granted the following: Effective August 4, 2005 (5 Years Ago)

Left Ankle Scar Status Post Surgery @ 10%

Left Ankle Medial Scar Post Surgery @ 10%

Status Post Trimalleolar Fracture, Left Ankle

with Tarsal Syndrome, Mild Degenerative Changes @ 20%

Overall Rating 40%

Today I got the envelope with an increase in rating to 70% rated as follows:

Chondromalacia Patella, Left Knee @ 20%

Chondromalacia Patella, Right Knee @ 20%

Achilles Tendonitis, Right Ankle @ 10%

Planter fasciitis @ 0%

Status post trimalleolar Fracture, Etc (same as 2005) @ 30%

Combined Rating 70%

HERE IS THE QUESTION.........

I have been SC for extremely painful scars for the last 5 years. Why would the VA discontinue my SC for these scars without any explanation? Could it be just a simple oversight? The scars would have made me be 80%.

I don't want to complain, but if they were SC for the last 5 years what could cause the change. My C&P even talks about the painful scars?

Anyone have any insight or suggestions?

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  • HadIt.com Elder

Obviously because the VA likes to "lowball" when they think that they can get away with it.

While the compensation for scars is not protected, you can certainly file a query, NOD, or even "CUE" concerning the failure to continue the scar compensation or explain why it was dropped.

On the surface, it appears that the VA did not follow law or regulation in this matter.

It might be really interesting to see what the VA's reply to an "IRIS" query would be. (They are supposedly required to reply in a short period of time. (for the VA anyway)

I don't want to come across like some greedy pain in the ass here. I got my rating decision and am happy overall. However, there appears to be a mysterious deletion of an already established claim.

On May 24th, 2006 I was granted the following: Effective August 4, 2005 (5 Years Ago)

Left Ankle Scar Status Post Surgery @ 10%

Left Ankle Medial Scar Post Surgery @ 10%

Status Post Trimalleolar Fracture, Left Ankle

with Tarsal Syndrome, Mild Degenerative Changes @ 20%

Overall Rating 40%

Today I got the envelope with an increase in rating to 70% rated as follows:

Chondromalacia Patella, Left Knee @ 20%

Chondromalacia Patella, Right Knee @ 20%

Achilles Tendonitis, Right Ankle @ 10%

Obviously because the VA likes to lowball any way they can.

Planter fasciitis @ 0%

Status post trimalleolar Fracture, Etc (same as 2005) @ 30%

Combined Rating 70%

HERE IS THE QUESTION.........

I have been SC for extremely painful scars for the last 5 years. Why would the VA discontinue my SC for these scars without any explanation? Could it be just a simple oversight? The scars would have made me be 80%.

I don't want to complain, but if they were SC for the last 5 years what could cause the change. My C&P even talks about the painful scars?

Anyone have any insight or suggestions?

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  • HadIt.com Elder

There should have been an explanation.

Something to be aware of is the "amputation rule." A below-the-knee amputation is worth 40 percent; even if you have a bunch of conditions that add up to 60 percent, the most you can get for everything below the knee is 40 percent. So, if your ankle is increased to 30 percent, the most you're going to be able to get for any number of scars is going to be 10 percent (even if you had been getting 20 percent for them previously).

38 CFR 4.68 Amputation rule.

The combined rating for disabilitiesof an extremity shall not exceed the rating for the amputation at the electivelevel, were amputation to be performed. For example, the combined evaluationsfor disabilities below the knee shall not exceed the 40 percent evaluation,diagnostic code 5165. This 40 percent rating may be further combined withevaluation for disabilities above the knee but not to exceed the above the kneeamputation elective level. Painful neuroma of a stump after amputation shall beassigned the evaluation for the elective site of reamputation.

So, that's possibly why, but it still should have been brought up in the narrative of the rating. While we can make changes to the corporate database that holds everyone's rating information in them, we're not supposed to make those changes without an explanation on the narrative of the rating. Are you sure it was this particular rating where it was changed, and not one previously?

Edited by JamesBreckenridge
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Congratulations on your award. It looks like the VA did include the percentages for your scars. Your new decision is of 30% 20% 20% 10% by VA Math is only 60%. The pre-existing scar awards of 10% 10% will only bring your total to 67%. The total is rounded off to 70%. Your award letter probably did not mention your scars but it was included.

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What Brother Gate said is totally correct. The VA does not address conditions that are not in the current claim. The reason being, if they do, it opens up your appeal period for that condition.

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