I was in a jeep accident in Vietnam in 1968 which resulted in the transverse fracture through the anatomical neck of the humerous of my left shoulder. I underwent surgery in a field hospital in Vietnam which left a large ugly ragged deep tissue scar on my left shoulder. Shortly after my discharge from the Marine Corps in 1970, I filed a claim for disability with the VA. The VA service connected my shoulder injury at 0% and I appealed their decision and provided the VA with a photograph of the scar on my shoulder. After I appealed, the VA awarded me 10% disability for residuals of fracture of left shoulder. I appealed the 10% award and underwent an exam by the VA in 1971. During the 1971 VA exam, the examining doctor stated the following in his report:
"On examination, there was a 10 and 3/4 inch slighly ragged nonlineal scar running down the anterior left shoulder and into the anterior axilla. The scar was old and well healed and not symptomatic. The veteran could go through all motions with the left shoulder, but it seemed to be somewhat stiff. He complained of pain and tenderness just posterior to the acromioclavicular joint on the left shoulder. X-ray films showed possible minimal cortical irregularity involving the metaphysial region of the left humerus, more apparent in external rotation, compatible with old, healed, remote fracture. The final diagnosis was old fracture, left upper humerus, moderate."
My scar runs from under my arm pit and goes completely over the top of my shoulder. Looking at my shoulder from the front it appears that my arm had been ripped off at the shoulder and sewed back on. The scar's width varies in width from about 3/4 inch to over an inch. Because of my scar's ugly appearance I do not go out in public without a shirt on. Even when I go swimming I always wear a t-shirt to cover the scar. I would estimate my scar covers between eight to ten square inches.
In the Statement of the Case I received from the VA in 1971, it made the following reference concerning their denial of a rating for my scar: "For a compensable rating to he assigned for scars of the shoulder, there must be poor nourishment with repeated ulceration, tenderness and pain on objective demonstration, or limitation of function of the part affected. (Codes 7803, 7804, 7805)." NOTE: Based on this statement by the VA I felt further appeal for a rating for the scar would be futile.
In the Decision paragraph of my final letter from the VA it states the following: "Entitlement to an increased rating for left shoulder disability or to an earlier effective date of the compensable rating for left shoulder disability is not established. Accordingly, thte appeal is denied."
In doing some recent research about the scars rating criteria used by the VA, I discovered the VA has changed their scars rating criteria one or more times since my claim in 1970. The most recent rating criteria I could find (Diagnostic code 7801) Burn scar(s) or scar(s) due to other causes, not of the head, face or neck, that are deep and nonlinear and cover at least 6 square inches but less than 12 square inches is entitled to a 10% rating for the scar. Based on this recent criteria, it appears that I would be rated at 10% if rated by the VA under the current criteria. NOTE: Nothing in the VA decision letter from 1971 referenced Diagnostic Code 7801. It appears the VA indicated in their decision letter that my shoulder scar did not meet any VA criteria for them to even consider a compensable rating for my shoulder.
QUESTION: Does anyone know if Diagnostic Code 7801 contained the same criteria in 1970 as it does today?
QUESTION: If Diagnostic Code 7801 did contain the same criteria in 1970, would I have a basis for a CUE since it appears Diagnostic Code 7801 was not considered in my decision?
QUESTION: If the VA used the correct Diagnostic codes and rated my scar appropriately in 1971, would I be successful in asking the VA for a review and reconsideration to now allow a compensable rating for my scar under the current Diagnostic Code 7801 criteria?
QUESTION: Should the VA have service connected my shoulder scar and at least awarded a 0% rating so the rating could be increased if the criteria changed in the future?
I really feel like I was low balled by the VA when they made the decision about my shoulder but that is water over the dam. I have had other problems with my left shoulder over the years (bursitis, arthritis, torn rotator cuff, etc.) and if I am entitled to any additional compensation for my shoulder I defintely want to file a claim for the additional compensation. Any input or suggestions hadit members can provide would be appreciated.
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georgiapapa
I was in a jeep accident in Vietnam in 1968 which resulted in the transverse fracture through the anatomical neck of the humerous of my left shoulder. I underwent surgery in a field hospital in Vietnam which left a large ugly ragged deep tissue scar on my left shoulder. Shortly after my discharge from the Marine Corps in 1970, I filed a claim for disability with the VA. The VA service connected my shoulder injury at 0% and I appealed their decision and provided the VA with a photograph of the scar on my shoulder. After I appealed, the VA awarded me 10% disability for residuals of fracture of left shoulder. I appealed the 10% award and underwent an exam by the VA in 1971. During the 1971 VA exam, the examining doctor stated the following in his report:
"On examination, there was a 10 and 3/4 inch slighly ragged nonlineal scar running down the anterior left shoulder and into the anterior axilla. The scar was old and well healed and not symptomatic. The veteran could go through all motions with the left shoulder, but it seemed to be somewhat stiff. He complained of pain and tenderness just posterior to the acromioclavicular joint on the left shoulder. X-ray films showed possible minimal cortical irregularity involving the metaphysial region of the left humerus, more apparent in external rotation, compatible with old, healed, remote fracture. The final diagnosis was old fracture, left upper humerus, moderate."
My scar runs from under my arm pit and goes completely over the top of my shoulder. Looking at my shoulder from the front it appears that my arm had been ripped off at the shoulder and sewed back on. The scar's width varies in width from about 3/4 inch to over an inch. Because of my scar's ugly appearance I do not go out in public without a shirt on. Even when I go swimming I always wear a t-shirt to cover the scar. I would estimate my scar covers between eight to ten square inches.
In the Statement of the Case I received from the VA in 1971, it made the following reference concerning their denial of a rating for my scar: "For a compensable rating to he assigned for scars of the shoulder, there must be poor nourishment with repeated ulceration, tenderness and pain on objective demonstration, or limitation of function of the part affected. (Codes 7803, 7804, 7805)." NOTE: Based on this statement by the VA I felt further appeal for a rating for the scar would be futile.
In the Decision paragraph of my final letter from the VA it states the following: "Entitlement to an increased rating for left shoulder disability or to an earlier effective date of the compensable rating for left shoulder disability is not established. Accordingly, thte appeal is denied."
In doing some recent research about the scars rating criteria used by the VA, I discovered the VA has changed their scars rating criteria one or more times since my claim in 1970. The most recent rating criteria I could find (Diagnostic code 7801) Burn scar(s) or scar(s) due to other causes, not of the head, face or neck, that are deep and nonlinear and cover at least 6 square inches but less than 12 square inches is entitled to a 10% rating for the scar. Based on this recent criteria, it appears that I would be rated at 10% if rated by the VA under the current criteria. NOTE: Nothing in the VA decision letter from 1971 referenced Diagnostic Code 7801. It appears the VA indicated in their decision letter that my shoulder scar did not meet any VA criteria for them to even consider a compensable rating for my shoulder.
QUESTION: Does anyone know if Diagnostic Code 7801 contained the same criteria in 1970 as it does today?
QUESTION: If Diagnostic Code 7801 did contain the same criteria in 1970, would I have a basis for a CUE since it appears Diagnostic Code 7801 was not considered in my decision?
QUESTION: If the VA used the correct Diagnostic codes and rated my scar appropriately in 1971, would I be successful in asking the VA for a review and reconsideration to now allow a compensable rating for my scar under the current Diagnostic Code 7801 criteria?
QUESTION: Should the VA have service connected my shoulder scar and at least awarded a 0% rating so the rating could be increased if the criteria changed in the future?
I really feel like I was low balled by the VA when they made the decision about my shoulder but that is water over the dam. I have had other problems with my left shoulder over the years (bursitis, arthritis, torn rotator cuff, etc.) and if I am entitled to any additional compensation for my shoulder I defintely want to file a claim for the additional compensation. Any input or suggestions hadit members can provide would be appreciated.
Georgia Papa
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