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Va Claim Reevaluation Help Wanted


nates0812

Question

I was hoping someone that works at the VA could provide me some insight. I was in the Marines from 2001-2005 with two combat tours. I went through the initial process in 2006 and was awarded:

PTSD 10%, degenerative joint disease of the right knee 10% and degenerative joint disease of the left knee 10% for a total of 30%. After speaking with friends I decided to have my claim reevaluated. I opened my claim with the VFW January of this year for: PTSD (Increase), degenerative joint disease of the right knee (Increase), degenerative joint disease of the left knee (Increase), residual injury lower back (New), Hypertension, arterial (New), Rhinitis, allergic (New), tinnitus (New), eczema (New), hiatal hernia (New), elbow pain (New).

All of the issues marked as “new” are being reviewed as administrative error. They were evaluated by the VA Dr’s and approved as being service connected but were never given a rating, not even 0%. I was only called in to meet with a physician for PTSD (Increase), degenerative joint disease of the right knee (Increase), degenerative joint disease of the left knee (Increase). During my knee exam I had limited range of motion as well as chronic pain that affects my job and personal life. Also, no x-rays were needed because they had x-rays from 8 years ago proving my condition. During my evaluation for PTSD the Dr said my issues have gotten worse and it affects my work/personal life as well.

Long story short my question is about increase and my current process. My status in eBenefits is "Preparation for Decision" but I was never seen by a physician for: residual injury lower back (New), Hypertension, arterial (New), Rhinitis, allergic (New), tinnitus (New), eczema (New), hiatal hernia (New), elbow pain (New). Is it a good or bad that I wasn’t seen by a physician for the 7 new issues that were filled as administrative error? They are in my file as being service connected but again never given a rating, not even 0%. I know it’s a tough call without seeing all my documentation but what do you think my outcome will be? I am open to insight.

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This seems very unusual.

I feel they could definitely raise your rating for one or more of the SC conditions, depending on your evidence, but then might defer the "new" conditions to obtain C & Ps.......and I am just taking a guess here.

I assume the 'new' conditions were not formally claimed and somehow VA picked up on them???

It seems they found an error they made in the original decision and might have cued themselves to correct it.

Maybe even your VCAA letter was not proper.

Still , this is unusual because even when a vet files for an obvious secondary, it isn't obvious to VA until they get a medical nexus statement from a C & P doctor. And the raters have no real medical training at all..

Did you have an IMO or even C & P results for the 2006 claim ,that could have revealed these other issues?

VA is sure under the gun these days and it sounds like some vets might be farmed out to private doctors in the future, to prevent long wait times for appointments.

That situation might definitely cause the VA to become more willing and more adept at recognizing potential SC disabilities, even if not formally claimed, but more importantly, it might mean the VA doctors have to be more careful in their documentation, diagnosis and treatment, because private doctors who vets get farmed out to by VA will probably be more thorough in reviewing the VA med recs, and probably ,in many cases, have more expertise than some VA doctors.

The House Vets Affairs committee ordered the new Secretary of VA to review 250 million veterans medical files to see how long it took VA to give them timely appointments.

VA only reviewed a few thousand veterans records and gave the H VAC some bogus statistics that Chairman Miller was livid about.

Is it possible ( I am just guessing) that your initial claim did mention these other conditions,and you never got any appointments for treatment or C & P exams and your medical records were in the limited review the Secretary did????

You did say no physician saw you for these conditions. Somehow the VA found them

Do you have a vet rep?

Has VA advised you in writing of this?

Can you expand on what you mean here?

"They are in my file as being service connected but again never given a rating, not even 0%."

Edited by Berta (see edit history)
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OH PS, I read your post again.....I dont work for the VA, but used to as a volunteer in a VA Vet Center.....the PTSD combat vets voted me into their PTSD group sessions....and ...we do have some VA claims people here at hadit, perhaps you could contact Veldrina via email through her profile page.

That 10% for PTSD is probably way too low!

Edited by Berta (see edit history)
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Thanks for the info and I might have explained the 7 marked as new wrong. They were on my initial claim in 2006 and the VA said yes they are legit conditions and service connected but I was never given a rating when I should have because they were service connected. My VFW rep said because they were medically documented and approved as service connect they should have given me at least a 0% rating. I did see outsourced physicians for my 3 increases but never for the 7 that were marketed as new. My question is did the VA not decided to have me see a physician for them because I did in 2006 and saw they made a error?

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"My VFW rep said because they were medically documented and approved as service connect they should have given me at least a 0% rating."

Your rep is correct .

"I did see outsourced physicians for my 3 increases but never for the 7 that were marketed as new. My question is did the VA not decided to have me see a physician for them because I did in 2006 and saw they made a error?"

They did call a CUE on themselves.

In my opinion ,whatever the ratings should have been in 2006,based on medical evidence they had then, those ratings might warrant a higher level by now and I would think they would want to order C & Ps for the disabilities that were not rated in 2006.

VA might even have to do a Fenderson rating....meaning ,lets say one of those disabilities warranted a 10% SC rating in 2006 ,but by 2010, increased to 30% per the VA schedule of ratings, and then maybe by 2014 it is now ratable at 50%.

It is hard to predict what the VA will do, but we have the complete VA Schedule of Ratings link for every diagnostic code here, above the main claims forum.

On the past DJD ratings did they employ the DeLuca factor?

It is explained within Fast Letter ( FL 06-25) which is available here under a search.

The DeLuca FL was dated in June , 2006 and might have applied to the 2006 DJD claim.( or they should have applied it)

Your vet rep sounds very good!

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