ptsd Question About Ratings

[recon13]

In 1998 I was awarded 100% IU P&T, my wife and five children received their chapter 35 and Champva paperwork. At that time I was rated,

30% depression

20% rt ankle

20% rt femur, hip, knee w/leg length discrepancy

20% DDD Lumbar

10% left knee

In the rating decision it stated that I was determined to be disabled not by my MH condition or physical conditions on their own, but when looked at together the record showed that I was disabled due to my service connected conditions, which were caused by a single event in service. (Parachute accident)

In 2002 the depression was raised to

50% for PTSD/depression

and also I received two different ratings for painful scars

10% Painful scar

10% painful scar

IU was continued.

Do the conditions that were initially used to grant IU count for 100% towards the 100% + 60%?

My question is how do the ratings in 2002 count for a SMC rate?

Is Radiculopathy a separate claim of DDD, can it be?

Can cervical spine bulging discs be secondary to DDD Lumbar. I don't think it should be a secondary, I actually injured my neck when I hit the ground wearing a Kevlar helmet, but at Womack Army Hospital the records only state that I complained of back pain.

I recently had a back surgery that did not go as planned and although its been 20 years since I've filed for anything to do with the back, I think I'm going to file for an increase.

I realize there are several questions here that don't really pertain to the thread, I hope it's OK.

[jbasser]

Iu has to be based on a total condition plus an additional 60 percent rating for S.

If you were IU for depression and had another 60, then yes.

J

[FormerMember]

Dear Mr. R13.

Read http://asknod.wordpress.com/2011/09/27/cavc-buie-5-v-shinseki-0-2011/ to understand Mr. Buie's predicament. It is similar to yours but varies in some respects. Consider this. Your initial rating lacked one 40% rating which is integral to getting IU. I see they took the totality of all your knee, ankle and hip maladies and used it to fashion the 40% as they are all interconnected as a single interrelated injury. Correct me if I am mistaken.

Now you have received increases for items that were originally used in 1998 to grant that IU. In order to qualify for SMC S, you would have to be granted a new rating on another claim that did not involve any of the items that provided the basis for your TDIU. TDIU is a stand alone rating which, although rated at 100% for compensation purposes, is technically not a 100% schedular rating. It does, however represent one part of the criteria for an SMC S rating- to wit: the needed 100% rating. The second facet required is either being substantially housebound or having an additional rating(s) adding up to 60% or more above and beyond the TDIU.

Increases in ratings that comprise the original TDIU simply improve the underlying reason for the TDIU. In order to "pull a Buie", you would have to rearrange your ratings such that one (say the 50% depression) was upped to 70% and rated as TDIU in its own right. VA is not going to do this no matter how nonadversarial you think they are.

VA will view all your back injuries as one condition and thus dodge the bullet of them being separate issues with separate etiologies and different, unrelated diagnostic codes. Read SMC S carefully and you will see that the additional 60% in ratings (above the 100% rating) have to be different issues involving different anatomical parts and not a compendium of other related ones to things you are already rated for.

VA historically will deny SMC S based on being "substantially housebound". They did it to me even though I just got out of the VAMC after a six month stay and had a shiny new colostomy bag and confined to a bed with 150%-10% shy of the extra 60% needed. They did it to another Vet I helped even though he is photosensitive and has thyroid cancer. Their rationale? "Well, bubba. You can attend doctor appointments and go shopping even if your sister drives you. That ain't housebound in our book." They denied me on similar logic as well. I don't drive and have the same photosensitive issues (AO PCT disease) as well as cryoglobulinemia which prevents me from going out in weather below 40 degrees. Of course, if you asked the VA to send your PCP over for a house call, you can figure that would go over like screen doors in submarines.

You can win the SMC S "substantially housebound" argument if you are truly housebound- but not at the RO. They have a one-size-fits-all denial for this and you'll have to fight that one at the Complaint window at 810 Vermin Ave. NW Washington DC 20420. Best not to mention my name. Allison Hickey and I are not on good terms this year .

Edited June 20, 2013 by asknod

[sambo808]

In 1998 I was awarded 100% IU P&T, my wife and five children received their chapter 35 and Champva paperwork. At that time I was rated,

30% depression

20% rt ankle

20% rt femur, hip, knee w/leg length discrepancy

20% DDD Lumbar

10% left knee

In the rating decision it stated that I was determined to be disabled not by my MH condition or physical conditions on their own, but when looked at together the record showed that I was disabled due to my service connected conditions, which were caused by a single event in service. (Parachute accident)

In 2002 the depression was raised to

50% for PTSD/depression

and also I received two different ratings for painful scars

10% Painful scar

10% painful scar

IU was continued.

Do the conditions that were initially used to grant IU count for 100% towards the 100% + 60%?

My question is how do the ratings in 2002 count for a SMC rate?

Is Radiculopathy a separate claim of DDD, can it be?

Can cervical spine bulging discs be secondary to DDD Lumbar. I don't think it should be a secondary, I actually injured my neck when I hit the ground wearing a Kevlar helmet, but at Womack Army Hospital the records only state that I complained of back pain.

I recently had a back surgery that did not go as planned and although its been 20 years since I've filed for anything to do with the back, I think I'm going to file for an increase.

I realize there are several questions here that don't really pertain to the thread, I hope it's OK.

Your combined disability since 2002 is 80%. It seems that your IU is based on the combined effect of all your disabilities. But if you were granted IU based on a single disability (let say PTSD) then you would have been qualified for statutory housebound based on one single rated as if 100% (PTSD) plus 60% (combining all the rest of your disabilities). Although you have total disability based on individual unemployability your IU entitlment is never a permanent benefit because every year you have to keep re-certifying that you have not sustained or maintained gainful employment for consecutive 12 months.

Both statutory housebound and housebound in-fact are decided locally if the evidence warrants them. It is not true that the grant of housebound in fact will have to be sent to Washington DC to be granted. The only time that a claim for entitlement would have to go outside the RO is when they are considering for you extra-schedular, special opinion or review for some very unusual cases, or when you are appealing the decision of RO.

[sambo808]

Your combined disability since 2002 is 80%. It seems that your IU is based on the combined effect of all your disabilities. But if you were granted IU based on a single disability (let say PTSD) then you would have been qualified for statutory housebound based on one single rated as if 100% (PTSD) plus 60% (combining all the rest of your disabilities). Although you have total disability based on individual unemployability your IU entitlment is never a permanent benefit because every year you have to keep re-certifying that you have not sustained or maintained gainful employment for consecutive 12 months.

Both statutory housebound and housebound in-fact are decided locally if the evidence warrants them. It is not true that the grant of housebound in fact will have to be sent to Washington DC to be granted. The only time that a claim for entitlement would have to go outside the RO is when they are considering for you extra-schedular, special opinion or review for some very unusual cases, or when you are appealing the decision of RO.

You can be granted radiculopathy of the upper or lower extremities separate from your cervical spine or lumbar spine condition. If you have nerve conditions showing in your medical evidence you do not need to claim it because VA will consider it as an inferred issue. Meaning, if your cervical disability is also causing you to have radiculopathy in one or both of the upper extremity VA will automatically grant you for those without you having to claim it because radiculopathy is a well know complications of cervical or lumbar spine condition. But that is not to say you can not raise the issue yourself. If you do claim radiculopathy VA would have to set you up for medical examination for your cervical spine or lumbar spine to determine if you do have in fact radiculopathy.

[harleyman]

Is Radiculopathy a separate claim of DDD, can it be?

Yes, is can be claimed as secondary to DDD of the spine. It is separately rated as upper extremity radiculapathy ( neck, cervical soine)as one disability and lower extremity radiculapathy (thoracolumbar spine) as another disability. The thoracic spine and lumbar spine have been merged as a single condition (the thoracic and lumbar spine used to be rated separately).

Can cervical spine bulging discs be secondary to DDD Lumbar. I don't think it should be a secondary, I actually injured my neck when I hit the ground wearing a Kevlar helmet, but at Womack Army Hospital the records only state that I complained of back pain.

It is very unlikely you will get a VA doctor to state your upper cervical spine disc buldge is related to your lumbar spine. You might get a VA doctor to agree that your cervical spine condition is related to your thoracic spine condition, if you have a private IMO that states the thoracic and cervical spine are related. Doctor's generally don't like to contradict one another if they can help it, unless they are being paid to do so.

I recently had a back surgery that did not go as planned and although its been 20 years since I've filed for anything to do with the back, I think I'm going to file for an increase.

If your back is service connected and the surgery did not go well, and your back has worsened, I would diffinately file for an increase. Please remember the range or motion testing levels have changed from 20 years ago, and the requirements for percentages is much more stringent. They cannot take your percentage away from you if you have been service connected for it for the past 20 years. Because of the new criteria required for increase, it may be harder to get an increase, because of the newer examination findings needed for a higher percentage.




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Edited July 21, 2013 by harleyman