Hospital, Surgery

[Landluver]

Hello all. Question is once out of surgery and now recovering from being cut open. Does it take huge amounts of time for them to get the tempory 100% goin? I'm going to be missing about 12 weeks of work think it will start b4 I get back working or do you go to poor farm firstAl

[jvretiredvet]

I presume you have filed a claim for hospitalization or notified your friendly neighborhood VA Regional Office that you had service-connected surgery, correct? If the surgery was done in a VAMC, the VARO might have picked up that information but I can't or won't guarantee that fact. If the surgery was done at a civilian facility, even at VA expense, that information may take some time to get into your records.

You probably already know this information, but here is the regulation pertaining to convalescence after surgery: 38 CFR 4.30 http://www.benefits....PART4/S4_30.DOC .

Nonetheless, a Rating Decision is required and this does require some time. GENERALLY speaking, when a request for convalescence is received by the VARO, some screener sends it to a designated spayshul rater or section to do a somewhat more expedited rating decision. If you made your claim immediately after the surgery, and the surgical records are available, you do stand a good chance of receiving the temporary rating before you go to the poor farm.

Note: being proactive and telling your VARO of proposed or scheduled surgery really does no good. The VARO does not keep a suspense file of these kinds of proposed or scheduled events - it responds to the actual event. once it is made known.

Hello all. Question is once out of surgery and now recovering from being cut open. Does it take huge amounts of time for them to get the tempory 100% goin? I'm going to be missing about 12 weeks of work think it will start b4 I get back working or do you go to poor farm firstAl

[Quint7]

Don't expect a lot though. VA will say 'yes, you had surgery on the 3rd for your service connected xyz, you were then unable to work that month, the next and until the 13th of the next month". On their minds that equals 1-2 months of temp 100% since they go by date, meaning you lose out on that 1st month by having the operation after the 1st. They also max it out at 3 months unless the regs specifically allow for more I believe. I was off for a spinal fusion, service connected, from Jan 3rd-June 15th. I got 2 months initially, appealed and got 3. They didn't care how long I was off, they said regs give you the month of surgery as 100% then the other 1 or 2 at the discretion of the rater, didn't matter that i couldn't work, temp 100% was for post op recovery per their regs. There are certain conditions where the amount is written into the regs. Knee replacement is a full year at 100% I think I was told on here. I blew apart my knee again in late June, was off from work from June 28th to Oct. 20th. Surgery was Aug. 3rd. I'm expecting them to say I get nothing for July (didnt have surgery yet), August (didn't get the surgery til the 3rd), get Sept at 100% and don't get Oct because I returned to work that month.

I hope I'm not passing the wrong info along, but the system is brutal, set up to purposefully allow VA to not pay by institutionalized technicallity.

Anyone else that knows better than what i posted please correct me. :)

Edited January 2, 2012 by Quint7

[Landluver]

1325540650' post=267784]

Don't expect a lot though. VA will say 'yes, you had surgery on the 3rd for your service connected xyz, you were then unable to work that month, the next and until the 13th of the next month". On their minds that equals 1-2 months of temp 100% since they go by date, meaning you lose out on that 1st month by having the operation after the 1st. They also max it out at 3 months unless the regs specifically allow for more I believe. I was off for a spinal fusion, service connected, from Jan 3rd-June 15th. I got 2 months initially, appealed and got 3. They didn't care how long I was off, they said regs give you the month of surgery as 100% then the other 1 or 2 at the discretion of the rater, didn't matter that i couldn't work, temp 100% was for post op recovery per their regs. There are certain conditions where the amount is written into the regs. Knee replacement is a full year at 100% I think I was told on here. I blew apart my knee again in late June, was off from work from June 28th to Oct. 20th. Surgery was Aug. 3rd. I'm expecting them to say I get nothing for July (didnt have surgery yet), August (didn't get the surgery til the 3rd), get Sept at 100% and don't get Oct because I returned to work that month.

I hope I'm not passing the wrong info along, but the system is brutal, set up to purposefully allow VA to not pay by institutionalized technicallity.

Anyone else that knows better than what i posted please correct me. :)

Thanks guys

It is connected and the varo does know. So now I wait.

[jvretiredvet]

they said regs give you the month of surgery as 100% then the other 1 or 2 at the discretion of the rater, Well, it isn't always totally at the discretion of the rater. What period of convalescence did your surgeon recommend?

Knee replacement is a full year at 100% I think I was told on here. It's actually 1 month plus 12 months for a total of 13 months. See the Note 1 for DC 5055.

I'm expecting them to say I get nothing for July Well, if the surgery wasn't until August 3, not getting a 100% for convalescence is correct. However, based on the injury, you should receive a higher evaluation for the time between the injury and the surgery if there is enough evidence to do an adequate rating. Whether that results in any additional compensation or not .... quien sabe?

Don't expect a lot though. VA will say 'yes, you had surgery on the 3rd for your service connected xyz, you were then unable to work that month, the next and until the 13th of the next month". On their minds that equals 1-2 months of temp 100% since they go by date, meaning you lose out on that 1st month by having the operation after the 1st. They also max it out at 3 months unless the regs specifically allow for more I believe. I was off for a spinal fusion, service connected, from Jan 3rd-June 15th. I got 2 months initially, appealed and got 3. They didn't care how long I was off, they said regs give you the month of surgery as 100% then the other 1 or 2 at the discretion of the rater, didn't matter that i couldn't work, temp 100% was for post op recovery per their regs. There are certain conditions where the amount is written into the regs. Knee replacement is a full year at 100% I think I was told on here. I blew apart my knee again in late June, was off from work from June 28th to Oct. 20th. Surgery was Aug. 3rd. I'm expecting them to say I get nothing for July (didnt have surgery yet), August (didn't get the surgery til the 3rd), get Sept at 100% and don't get Oct because I returned to work that month.

I hope I'm not passing the wrong info along, but the system is brutal, set up to purposefully allow VA to not pay by institutionalized technicallity.

Anyone else that knows better than what i posted please correct me. :)

[halos2]

Took over 7 months for a vet I know to get 1 months worth of 100%. He was in the hosp for 24 days the first month and continued thru 22 days the second month and he got 100% for only the first month...no break in time during these 2 months and they denied the second month, and he put in a NOD and is appealing this...hope you fair better and sooner.

[Quint7]

Don't want to hijack (much) but they wanted nothing to do with any rating other than convalescence rating which they told me was only able to start on the 1st of the month after surgery even though mine was on Jan 3rd. Dr. said 6 months with no work. Like I said, they approved 2, I filed a NOD and got 3 which they said was the max.

Took this from the Cornell Law website;

A total disability rating (100 percent) will be assigned without regard to other provisions of the rating schedule when it is established by report at hospital discharge (regular discharge or release to non-bed care) or outpatient release that entitlement is warranted under paragraph (a) (1), (2) or (3) of this section effective the date of hospital admission or outpatient treatment and continuing for a period of 1, 2, or 3 months from the first day of the month following such hospital discharge or outpatient release. The termination of these total ratings will not be subject to § 3.105(e) of this chapter. Such total rating will be followed by appropriate schedular evaluations. When the evidence is inadequate to assign a schedular evaluation, a physical examination will be scheduled and considered prior to the termination of a total rating under this section.

(a) Total ratings will be assigned under this section if treatment of a service-connected disability resulted in:

(1) Surgery necessitating at least one month of convalescence (Effective as to outpatient surgery March 1, 1989.)

(2) Surgery with severe postoperative residuals such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches (regular weight-bearing prohibited). (Effective as to outpatient surgery March 1, 1989.)

(3) Immobilization by cast, without surgery, of one major joint or more. (Effective as to outpatient treatment March 10, 1976.)

A reduction in the total rating will not be subject to § 3.105(e) of this chapter. The total rating will be followed by an open rating reflecting the appropriate schedular evaluation; where the evidence is inadequate to assign the schedular evaluation, a physcial examination will be scheduled prior to the end of the total rating period.

(b) A total rating under this section will require full justification on the rating sheet and may be extended as follows:

(1) Extensions of 1, 2 or 3 months beyond the initial 3 months may be made under paragraph (a) (1), (2) or (3) of this section.

(2) Extensions of 1 or more months up to 6 months beyond the initial 6 months period may be made under paragraph (a) (2) or (3) of this section upon approval of the Veterans Service Center Manager.

[41 FR 34256, Aug. 13, 1976, as amended at 54 FR 4281, Jan. 30, 1989; 71 FR 28586, May 17, 2006]

This was the logic explained to me that it is a max of 3 months if they approve it. They didn't.

The knee thing I thought I had slightly wrong. Again, I'm no expert and was going off of a reply from one of the HadIt elders in a post I made about my temp 100%.

Edited January 3, 2012 by Quint7