Long Wait For Compensation Increase - Someone Will Call Us In 5-7 Days?

[xray328]

My 34 yo wife had a total knee replacement on 9/11/09. She got 100% temporary for 1 year. This was reduced to 30% which is the minimal amount for a total knee prosthesis. This can be increased to 60% for residual weakness or pain. She can now barely walk up the stairs due to some kind of nerve damage during the surgery.

The 100% expired 10/10 and was reduced to the minimal 30%. We expected VA to schedule a routine follow up since the 100% expired. But as of 11/10 they hadn't.

So in 11/10 we filed an increase in compensation request. She was seen by VA in 1/11 for an exam where the doctor agreed she should be more than 30%.

We've checked with VA in both 7/10 and on Friday and they said the claim is still in the development stage ( I think that was the term they used) they said claims can only be there for 130 or so days and hers was over 180 at this point. Si when we called Friday we expected fir things to have moved along, but they hadn't,

They told her someone from VA would be contacting her regarding the claim in 5-7 days.

Anyone know what the call is for? We've never heard of them doing that.

We didn't expect an increase in benefit to take this long.

Thanks in advance!

[USNDW]

My inital claim awarded me 30% for the right knee, even though 2 1/2 years of medical records showed I was on pain management medications and have to walk with a cane, and then not very far. I filed a NOD and it took about 9 months to be completed. The claims process is so backed up right now there is no way to even guess how long it will take. I have a NOD with the Seattle RO, has been there since 4/2010 and has not been touched.

Did your wife use a Cold Therapy Unit on her knee after surgery? I too have severe nerve damage and the worst of it is in the knee where I used the Cold Therapy Unit. There has been some discussion about these units and some have actually been recalled. If she did let me know and I can share with you the information I found about these.

Tell her good luck with the knee, I know exactly what she is going through.

[cooter]

USNDW

I'm curious to know what reason they gave your 60% for. Was it the same reason they gave me?

[Interested]

I wouldn't necessarily view this as pyramiding.

Like John said, I would at least get in contact for legal advise from a malpractice attorney. Since she had her surgery outside the VA is probably the reason the va never contacted her for the 1 year postop exam. I'm assuming that was a C&P exam she had on 1/11, and if it was, it sounds like the ball is rolling towards your favor. The PN can be SC by secondary to the surgery, but if she get's the max rating of 60% for the TKR it might be considered as pyramiding. That would have to be an opinion from other members here that know the rules of pyramiding, as I don't have that knowledge. As far as the phone call, I wouldn't even venture to go there since I have no idea what it would be about. I prefer not to give you any false hope or sad news, since I would only be guessing. Did your wife happen to get a copy of the 1/11 exam? Also, is that yours or wifes profile showing 40% disabled?

[cooter]

I wouldn't necessarily view this as pyramiding.

Can you elaborate more on this, as I and others need the education on pyramiding.

[USNDW]

The reason for the 60% rating was because of "Chronic residuals of the right knee following a TKR, of weakness, and pain. The medical records show that you have to use a cane or a walker to ambulate showing the weakness described and are also on pain management medications because of the residual chronic pain. A rating of 60% is awarded."

What was crazy was that the medical records showed the exact same thing when they initially rated me at 30%. So I had to file a NOD. I think the VA does cause some of their own pain as I clearly described that my condition warranted a 60% rating to begin with.

X-ray, I forgot if I mentioned before, but if she has to take pain medication make sure and bet a copy of the pharmacy records, highlight every month and type of meds and write a little note. Hvae you written a letter to the VA as a witness to the pain and weakness that exists in her knee? Lay evidence is being accepted much more than it used to, I think. You have a first hand knowledge of the condition and daily struggles she has, and writing a letter will definitely help her case to the 60%.