tdiu Problem With Unemployability

[medic455capt]

Hello to all, this is my first post, I am sorry that it is long, but I need any help I can get.

I am service connected for my bilateral shoulders 30%, 0% for my right ankle, 0% for my left hand. Following my service I became a Critical Care Paramedic and an instructor. My right shoulder has been surgically repaired 3 times now, after the last one in June of 2011. The surgeon stated that I can not lift anything over 30lbs, and that if I did my shoulder would then be non repairable this has ended my career of 13 years. He also stated that my shoulder needs to be replaced but my private insurance and the VA would not approve it until I am closer to 50 years of age. I have lost over 50% range of motion in the shoulder and am in extreme pain that increases significantly with movement making the are virtually useless. I take a high dose of vicodin for this pain however it does not do much good and the DR at the va clinic is talking about placing me on Methadone for this pain. I need help getting dressed and performing basic functions from my wife and teenage children. I have seen the surgeon at the va hospital for the left shoulder as well as my right one, and he has stated that there is nothing they can do for the left shoulder (no diagnotic tests were performed to see if another surgery would help) and the right one needs surgical intervention but since it did not work on the left there is no sense in performing surgery on the right one.

I have not been able to work in my chosen field since the surgery due to the limitations of the arms and the weight restriction, and am now looking at forclosure of my home, I have no other skills for gainful employment besides who would want to hire someone that is high on medication all the time I know I certainly would not want to hire someone like that due to liability concerns. I had a C&P exam last month and the examiner wanted to know why I am not filing for my right hip and for Unemployability. I informed her that I did she stated that known of that was listed for her to examine. She felt that I qualified for unemployability and should receive it.

I had submitted for an upgrade for my left and right shoulders to include unemployability. A congressional inquire was recently done and we received a response that stated I can get gainful employment in an other area and should attend vocational rehab. Again who would hire me while I am on pain medications, and what type of job can I get that would not require the use of my arms. My right hand was operated on while on active duty. The surgery required a bone graft from my right hip to the hand to my left hand. I filed a claim on the right hip in 2006 that was denied. I recently discovered that an abdominal cat scan performed a few year ago showed that the bone graft site in the hip had not grown back. I have file a new claim on this and submitted the new evidence (Radiology report and the CT images) but it is being denied stating that the 2006 decision was final unless new evidence exists. I have submitted this new evidence twice with the same results what else do they need. All I want is for them to aknowledge the hip even if it is at 0%.

I do not know what to do at this point, my conditions are getting worse I am severly depressed all the time and feel that the VA system does not care about the veterans. I am concidering returning to my profession at another service that does not know about the shoulder. I know that the first time I lift someone the shoulder would be destroyed. Maybe that would get me the what I need. If anyone can give me any ideas of what I should do at this point, It would be greatly appreciated. Thanks to everyone for your service.

[medic455capt]

I should of also mentioned that I have been diagnosed with severe degenerative arthritis in my left shoulder that is eating into the bones. Sorry for the omission..

[cooter]

I should of also mentioned that I have been diagnosed with severe degenerative arthritis in my left shoulder that is eating into the bones. Sorry for the omission..

Welcome Aboard medic..You need to file a claim for the arthritis and if you were dx with arthritis when you where granted the 30%, you could file for retro from that date on the same claim. I've read some BVA cases where some was granted retro for 10 years or more.

Coot

[71M10]

You need to submit the paperwork for the Vocational Rehab, they will give you an assesment to determine if they think you can be rehabed. When they determine you cannot be rehabed due to the high levels of opiates (pain killers), lifting restrictions and requiring help with the basic functions. That will help your claim for TDIU or extraschedular rating. I am assuming it was a rater that indicated you could work in another field after vocational rehab.

Best regards,

[medic455capt]

I am going to answer both replies in the same post. The arthritis was included in the claim, however the VA did not do any specific exams for it during the C&P. A rating determination has not been concludedd, that is just what the director of my regional office stated in reply to a congressional inquest.

[JR Reihs]

You need to submit the paperwork for the Vocational Rehab, they will give you an assesment to determine if they think you can be rehabed. When they determine you cannot be rehabed due to the high levels of opiates (pain killers), lifting restrictions and requiring help with the basic functions. That will help your claim for TDIU or extraschedular rating. I am assuming it was a rater that indicated you could work in another field after vocational rehab.

Best regards,

With the rating you now have......this is your best bet at the moment. I would also get an IMO on the shoulder, and concentrate on getting any and all 0% ratings raised if possible......also on top of the arthritis claim , you need to file for Scars.

[sixthscents]

They are denying the hip because of the ankle I'd guess. Ankle, knee, hip, lower back... if you have a pre-rated injury to the ankle, then proving a subsequent injury up the chain to the lower back becomes easier... still not easy but easier.

Further I would look at loss of use for the arm/hand

§ 4.63 Loss of use of hand or foot.

Go there and read that.

Now unemployability is helped by what 71M stated, if the Voc Rehab section denies you because you are in fact unemployable due to injuries etc.that will enhance your claim.

Also letters from your past supervisors, or employers as well as people you worked with attesting to the fact that you physically could not do your previous job (and why) can be of real help. It helps to nail that coffin shut before you go on to proving unemployability ok? I would certainly revisit claims for the ankle and hand as well if they have worsened over time. Plus remember, foot, ankle, knee, hip then lower back. It's a chain and if you now have subsequent knee problems they might be linked to the previous ankle, it would be worth examining. Aslo look at:

§ 4.59 Painful motion

(though this can be a bear, if you can include it with another claim for increase on sholder for you hand etc. or the unemployability. You might think of filing for an increase in hand based upon this as well as other factors.

Personally I think you will have to include the hand, and other factors to get this thru (IMHO as Carlie says)