Refer A Diagnostic Code Change?

[Sgt. Wilky]

Hello All,

I frequently read the forums here, being that I have several claims in the VA for, and am currently waiting over two years for a resolution. That being said, I wanted to get your opinions about a subject that I was just reading.

I just read in an opinion rendered by the BVA, that, "The veteran and his representative have not suggested that another diagnostic code would be more appropriate."

I read this several times, and was astonished that this would be acceptable. Unfortunately, I have a condition that was denied by the VA, because they said they had no rating schedule for the paticular diagnosis. But when I saw that a veteran or his representation could 'suggest' a more appropriate diagnositc code, my hopes were somewhat revived.

Has anyone ever 'suggested' a more appropriate diagnostic code and won? I found a glaring error by the VA when they 'mistakenly' assumed two different problems were one problem, and subsequently denied the claim because of this. I wrote to them explaining the two conditions were separate conditions, and very simply divided the issue using medical evidence. They still assert that the one condition is non-compensable because no rating schedule exists for the condition. My hopes are to take this condition, and ask them to assign a closely related diagnostic code so that I can receive compensation. I hope that perhaps somebody has some experience with this issue and can give me some insight!

Thanks and Semper Fi!

Matt

[Sgt. Wilky]

Oh, and Yes, I do have a Representative, a local VSO.

Berta,

Thank you, Thank you, Thank you!! Your contribution is very much appreciated!! I hope that someday soon I will be able to report back favorable findings!! In the mean time, I continue to look forward to reading and perhaps contributing to the success of other disabled veterans!!

Semper Fi!!

Matt

[john999]

I got a BVA decision where the VA had rated me on "latent Schizophrenia" and my doctor had said "chronic, undifferenitaled, schizophrenia". These are two different DX'es. The BVA accepted my doctor's dx code. The BVA said the basic diagnositic criteri were the same and that the vet and his attorney did not contest the BVA's finding that the vet's condition would be better described as "Chronic, undifferentiated schizophrenia". This is from a 40 year old rating that I CUE'ed. Latent schizophrenia means you don't have the condition yet. Chronic schizophrenia means you have it and are unlikely to get rid of it. My CUE was denied at the BVA. Does this make sense? The VA had up until this point excluded my doctor's DX and his report, so I got 10% rating.

[Berta]

If the diagnostic code was wrong and because it was wrong,it caused the lower rating-then in my opinion that was a CUE.

For example part of my CUE is similar and regards this:

(This is from a 1998 award for DIC under Sec 1151 for myocardial arrthymia due to myocardial ischemia as consequence of coronary atherosclerosis with multiple cerebral infarcts contributing-causing death due to negligent VA medical care.)

The veteran had 100% SC P & T for PTSD.

His major cerebral vascular accident was posthumomsly rated thus:

8009-8520 40% residuals CVA with lower right extremity weakness)

9305 30 % cognitive impairment residual CVA

8514 20 % Upper right extremity weakness , residual of CVA.

They added 6510 at 10% for sinitis which I roved t OGC that he never even had and totalled these as 80% NSC.

SSA however ( the veteran had 2 separate SSA award letters which I explained before-one solely for PTSD and one solely for CVA)which VA had as well-

had awarded solely for CVA total and permanent in 1993.

Also at the C & P exam I attended with my husband for his CVA C & P, the VA Neuroogist declared him 100% P & T due to the CVA.Her records were never considered by the VA in the 1998 decision.

The VA Rating schedule the rater used says this:

“8007  Brain, vessels, embolism of.8008  Brain, vessels, thrombosis of.8009  Brain, vessels, hemorrhage from:

Rate the vascular conditions under Codes 8007 through 8009, for 6 months100 Rate residuals, thereafter, minimum10 “

100% for 6 months and then residuals (in my husband's case, the medical evidence clearly warranted 100% P & T for the additional 1 and 1/2 years prior to his death for residuals of this 1151 CVA, which became 100% CVA due to DMII last year by BVA award.I also believe he qualified for 3 separate K awards.

The VARO SC death AO award letter of 2010 was so ridiculous I Nodded their errors. They failed to provide any new posthumous rating whatsoever .

My point here is these diagnostic codes are wrong.

The error caused the rating to be lower than 100% .

The VA also failed to consider SMC as the veteran had also 100% P & T for SC PTSD.

The major cause of his death- myocardial infarction and the 6 years of evidence that VA had malpracticed on both these conditions and awarded both FTCA and 1151 benefits was never even rated at all and completely disregarded in this award for both IHD and CVA causing the veteran's death.

When the VA admits to malpractcing on CVA and IHD then they both have to be rated . DUH!

Another CUE.

(The IHD aspect is now pending under Nehmer.)

These errors allowed the VA to not consider me for Accrued SMC award. Another CUE as they failed to consider SMC as a mandated inferred benefit.

A diagnostic code that is incorrect and causes improper rating criteria to be applied means the VA has cost you money and that is a CUE.

(9305  is Vascular dementia ) It is important to know that VA can assess and separate PTSD from other forms of brain trauma.

One can readily see that the VA in this 1998 decision made sure I would not receive a proper SMC accrued award.

My POA rep at the time seemed to strongly indicate to me (he had never seen a 1151 death award before and had just received my POA) that 1151 made the SMC a moot issue.But it took me years to find out he was wrong.In my case I was ignorant of the diagnostic codes, schedule of ratings and other regs I needed to figure this award out in 1998 and NOD it. My POA didnt think I should NOD it.The ignorance I had then is what VA depends on to save cash.

[Sgt. Wilky]

Thank you everyone for your answers and your support! I did write a letter to the VA, and faxed it to my VSO who will then forward it on the VA. IRIS told me my claims are still with the DRO and are in the decision phase. There should still be time to get this to the VA's hands. Hopefully, I will have a competent rating specialist who can see through the FUBAR mistake that was made. I wrote both letters in Barney-style, so that's my hope. I wish all of you well and thank you for taking the time to help me out!!

Semper Fi,

Matt