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Is Medical Reimbursment Possible?

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elcamino_77us

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I had tried for years to get my Left Knee Service Connected. Note: My Right knee was previously service connected. The Fall of 2010, I was consulted to VAMC Dublin from the local outpatient clinic for MRI's of the knees due to pain. After being prescribed hinged braces bilaterally for osteoarthritis in Jan 2011, I was consulted to VAMC Atlanta. After the Doctor played games with me, he finally agreed to scope "one" knee. I chose my service connected right knee as it usually gave me more problems. Aug 2012 Knee Scope. Documented Findings: two tears of the meniscus. Undocumented Findings: A healed partial tear of my ACL. I was discharged back to my local outpatient clinic after my Post-Op Appointment.

Jun 2013, I reported into the Local VA Outpatient Clinic on Crutches as I could not walk on my Left Knee. I was sent to the local hospital for X-Rays to determine whether or not I had arthritis. I was also scheduled for a follow-up appointment 45 days later, which I kept.

Instead of waiting another two years for the possibility of a knee scope, I used a local clinic that repaired a tear to my meniscus and determined that I had scar tissue due to a previous knee injury. This resulted in my Left Knee finally being service connected with a date of Aug 2012.

What I'm wondering is there a way to get the VA to help pay for my surgery considering that I had first went through them on two different occasions only to be blown off? That I had to seek Out-Side Medical Treatment due to their inadequacies and failure to properly treat me in the first place.

Thanks

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  • Content Curator/HadIt.com Elder

Definitely worth the effort to try

"If it's stupid but works, then it isn't stupid."
- From Murphy's Laws of Combat

Disclaimer: I am not a legal expert, so use at own risk and/or consult a qualified professional representative. Please refer to existing VA laws, regulations, and policies for the most up to date information.

 

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  • Our picks

    • Caluza Triangle defines what is necessary for service connection
      Caluza Triangle – Caluza vs Brown defined what is necessary for service connection. See COVA– CALUZA V. BROWN–TOTAL RECALL

      This has to be MEDICALLY Documented in your records:

      Current Diagnosis.   (No diagnosis, no Service Connection.)

      In-Service Event or Aggravation.
      Nexus (link- cause and effect- connection) or Doctor’s Statement close to: “The Veteran’s (current diagnosis) is at least as likely due to x Event in military service”
      • 0 replies
    • Do the sct codes help or hurt my disability rating 
    • VA has gotten away with (mis) interpreting their  ambigious, , vague regulations, then enforcing them willy nilly never in Veterans favor.  

      They justify all this to congress by calling themselves a "pro claimant Veteran friendly organization" who grants the benefit of the doubt to Veterans.  

      This is not true, 

      Proof:  

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          I wish I know how VA gets away with lying to congress about how "VA is a claimant friendly system, where the Veteran is given the benefit of the doubt".   Then how come so many Veterans are homeless, and how come 22 Veterans take their life each day?  Va likes to blame the Veterans, not their system.   
    • Welcome to hadit!  

          There are certain rules about community care reimbursement, and I have no idea if you met them or not.  Try reading this:

      https://www.va.gov/resources/getting-emergency-care-at-non-va-facilities/

         However, (and I have no idea of knowing whether or not you would likely succeed) Im unsure of why you seem to be so adamant against getting an increase in disability compensation.  

         When I buy stuff, say at Kroger, or pay bills, I have never had anyone say, "Wait!  Is this money from disability compensation, or did you earn it working at a regular job?"  Not once.  Thus, if you did get an increase, likely you would have no trouble paying this with the increase compensation.  

          However, there are many false rumors out there that suggest if you apply for an increase, the VA will reduce your benefits instead.  

      That rumor is false but I do hear people tell Veterans that a lot.  There are strict rules VA has to reduce you and, NOT ONE of those rules have anything to do with applying for an increase.  

      Yes, the VA can reduce your benefits, but generally only when your condition has "actually improved" under ordinary conditions of life.  

          Unless you contacted the VA within 72 hours of your medical treatment, you may not be eligible for reimbursement, or at least that is how I read the link, I posted above. Here are SOME of the rules the VA must comply with in order to reduce your compensation benefits:

      https://www.law.cornell.edu/cfr/text/38/3.344

       
    • Good question.   

          Maybe I can clear it up.  

          The spouse is eligible for DIC if you die of a SC condition OR any condition if you are P and T for 10 years or more.  (my paraphrase).  

      More here:

      Source:

      https://www.va.gov/disability/dependency-indemnity-compensation/

      NOTE:   TO PROVE CAUSE OF DEATH WILL LIKELY REQUIRE AN AUTOPSY.  This means if you die of a SC condtion, your spouse would need to do an autopsy to prove cause of death to be from a SC condtiond.    If you were P and T for 10 full years, then the cause of death may not matter so much. 
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