hypertension Finally Got My Rating....

[Nathan104]

Well after 11 months total and 6 months of sitting at the rating board, I called today and they told me my rating. This was my first claim after leaving the service for disability on my knee in dec 05. I had knee surgery on my knee in service and surgery on my lower back a few months after leaving service. I had good documentation in my SMR's for all my claims. I am very disapointed and simply in disbelief at my rating. I havent gotten my paper yet but this is what I was told over the phone.

Hypertension (20%) (This is actually what it should be based off what Ive read)

Gastro problems- (10%)

IBS- (10%)

tele right knee (10%) This just pisses me off

Degenerative disc Disease (10%) If the kne pissed me off, this makes me insane)

hemmoriods (0%)

scar-face (0%)

scar- knee (0%)

flat feet plantar- (0%)

Seasonal Rhinitus (0%)

Bilateral Tinitus DENIED

painful right hip DENIED

tendonitis right DENIED

pinched nerve back DENIED

TOTAL RATING 50%

I just cant believe they gave me 10% for my back and 10% for my knee. I had sent in all the info from my civilian dr on my back including MRI reports showing how bad it was and my surgucal reports, letters from me and my wife saying how bad it was and that I had to drop out of school and could no longer drive. The only thing I can evem imagine happen is that I didnt send in anything after my surgical reports so maybe they were thinking, "well he had surgery, he's all better." Im actually worse after surgery. But only 10% for my knee also. During my c&p, the VA Dr made me scream because he grabbed my leg and just bent it out straight. I was actually in tears.

And out of the denied stuff, the hip, tendonitis havent bothered me in a while. But, they were chronic in service and documented. I wanted at least a 0% and service connection just in case. The bilateral tenitis is a big problem. It drives me insane at times.

I know I already said it, but im just so let down. I know lots of people have trouble but most Ive seen have been out a long time and have trouble connecting things to service. I filed right after getting out and it was all in my SMR's, with lots of civilian dr stuff and mri's. Hell, I was put out of service after 8 years because of my knee and they only give me 10%.

I know I can appeal, which I will. I guess I will go with one of the VSO's (Im guessing there is a VFW around here). Have them help me with the appeal. Ill be putting in for TDIU and adding a few more things to my claim that I didnt find out about until it was at the rating board so I didnt want to hold it up. Stuff showed up in my lung Xray with my lungs and another problem with my intestines found during a colonoscopy.

I guess this will take another year? Out of my 50%, Ill only get paid 40% because the army gave me a lump sum for my knee when I got out. From what Ive heard, the money (10%) for my knee goes back to the army until it is repaid the whole lump sum. So, just another long wait. I havnt been able to work since getting out of the army last december. Cant do much at all, and when I try, I pay for it for days. I just feel like they slapped me.

Ill appeal but, I dont know what else I could submit, ITS ALL THERE! There should be enough proof in front of them. I do have my after surgery MRI for my back which shows lots of scar tissue wrapped around nerves and the disc they operated on has rebulged and two new herniation have shown up. Ill submit that. But, I dont have anything else. I only had insurance for 6 months after getting out so I havent been to the Dr anymore. I had one follow up with my surgeon before my insurance ran out. Im just at a loss right now.

Im sorry this turned out so long, I just needed to get all this out. Thanks.

[john999]

I would ask for a DRO Hearing and perhaps get another IMO on your most serious conditions. You can submit that evidence at the Hearing or before. You need to get at least on condition bumped up to 40 % if possible for the TDIU and then you need only 60% overall. I would file the TDIU papers and don't let the SO tell you that you can't do it. The claim is in your hands so don't let the VSO tell you not to appeal or to just be satified with what you got. Get more evidence of disability. It may cost you but it will be worth it if you get TDIU and P&T. Keep it local and produce more evidence. Evidence is just more medical opinions or an opinion from a Voc Rehab specialist. You don't have to use the VA for this. Consider it an investment in the future.

[Pete53]

I agree with John and if you don't agree you should appeal. Did they give you a C&P for all the denied claims?

Hang in there and don't give up.

[JR Reihs]

Nathan,

John is correct in what he said, heed the advice as you have some backpay coming.

Also you need to file for arthritis for knee, hip and back.......hit them hard with everything you can think of and you will get to the IU, with your claims you are well on your way.

[Former Member]

Nathan- I would ask them to reconsider their decision- if you dont get anywhere on that -you should still file the NOD in time. They probably did not use much of your evidence and a Reconsideration request would bring that to their attention.

This is only my opinion and I would ask your vet rep to support this type of request.

It was a reconsideration request I made that got them immediately working on my denied SMC CUE claim again.

Because they failed to address the VA case law and regs that warranted this claim and its retro.

Again one has to watch for the NOD date - when they file for a Reconsideration-The NOD limiting date is still within one year after the denial date. A Reconsideration request does NOT extend that date.

A vet almost lost their appeal rights by filing for a reconsideration that was denied.

The only thing that saved this claim at the BVA was that the vet rep sent a 4138 supporting the Recon Request and asking the VA to accept the request as a formal NOD if the request still roduced a denial.

Reconsiderations of a decision in some cases save a lot of time- but the evidence you have MUST be solid.

Edited October 4, 2006 by Berta (see edit history)

[Vike17]

Nathan,

The rating percentages for your back and knee are derived from your range of motion during your C&P exam. Your MRI's and the other documents that you mentioned do not have anything to do with the rating. Those documents only help establish service-connection, which the VA has already conceeded.

The range of motion is suppose to be measured with a Gionometer during your C&P exam. The degree of movement is suppose to be measured when the joint starts to becomes painful, not how far you can possibly move. Then the examiner is suppose to take a second measurement after repeated movement to see if you have any further reduced mobilitydue to fatigue ect.... The second measurement is then taken at the point when pain starts due to fatigue and/or pain (this is called the DeLuca criteria). Then the rating the VA assigns comes from the second measurement. So, if you bent over (forward Flexion) from anywhere between 65 degrees and 80 degrees, then the 10% rating for your back is correct. As far as the knee is concerned, it depends on what Diagnostic Code was assigned.

As far as IBS and gastro problems, the ratings are assigned according to how often you have problems. For example, IBS is rated at 10% if the veteran has "Moderate; frequent episodes of bowel disturbance with abdominal distress." The criteria for Gastro problems depend on which Disagnostic Code was assigned because there are numerous possiblities. Having said that, a 10% rating for the most part, is assigned under most of the relavent Diagnostic Codes for moderate symptoms.

Hemorrhoids are assigned a 0% rating when mild or moderate symptoms are present and a 10% rating is assigned when "Large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences." A 20% rating is given when "With persistent bleeding and with secondary anemia, or with fissures."

Scars are given a 0% rating when they are non tender. A 10% evaluation is given if the scar is superficial and/or tender. However, the scar on your face is rated at 10% if there is "... one characteristic of disfigurement," a 30% evaluation is assigned if "With visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, lips), or; with two or three characteristics of disfigurement forehead, eyes (including eyelids), ears (auricles), cheeks,."

You stated that you were going to probably file additional claims, such as;

"Stuff showed up in my lung Xray with my lungs and another problem with my intestines found during a colonoscopy"

You are already receiving compensation for this from the IBS and gastro rating. Actually I'm surprised they gave you two rating for this anyways. Normally, this is pyrmiading because they assigned a rating for two disabilities that cover one bodily etoliogy.

If you do decide to appeal, I stongly suggest you do so through the DRO process.

Vike 17

Edited October 4, 2006 by Vike17 (see edit history)

[huskerfanfl]

Vike17,

I, for one, appreciate the information on the measurement of the joints. Of course, it means I got hosed on my rating, since my back hurts as soon as I bend even a little, but I can still bend. Same with my knees. Back and right knee ended up being rated at 10%, 0% for my left knee. I have appealed and have also requested an increase. Since my orignal rating I have been diagnosed with anxiety/depression (with nexus to service), my back has gotten even worse, and have had to have arthroscopic surgery on my right knee. My left knee has also gotten worse.

Tim

[Nathan104]

Wow, thanks for all the information so far. It is very helpful. I wasnt aware that Range of Motion is the only thing considered when assigning the rating. I figured the type of narcotic meds they have me on for it, the fact that I have 4 herniations with two being severe and the horrible sciatic pain that does not allow me to drive would be considered in a rating decision as well. Had no idea is was all ROM. My ROM for my back at my C&P would be completely different than it is now though. My back got much worse after the C&P and now after surgery is much worse. Not sure what I should do on that one. Just get a ROM measurement from another doctor? Instead of filing an appeal, file for an increase and get a new C&P? Or is there a way to get a new C&P with an appeal? Hopefully a ROM test by another Dr sent in with a request for reconsideration will be enough?

Based offf of what you stated for the hemoroids, my rating is probably correct as they are probably moderate although they make life horrible a lot of the time. I agree with the ratings for the scars,hypertension,insomnia,IBS, gastro and rhinitus. The 10% rating for gastro is due to acid reflux disease and the IBS 10% is due to severe stomach problems.

I have requested copies of my C&P exams 5 times now but all they keep sending is a copy of a single exam for my feet. I have not seen the exams for the other problems. Not sure what they put down on my ROM for either my knee or back. Another thing I dont get on my back is I have severe Sciatic pain going down to my feet but I did not get any rating for radioculpathy(sp?)? Just the 10% DDD.

The other problems I recently found out about that I was going to claim is diverticulosis which is in my colon which they discovered during a colonoscopy and the other is a bunch of crystalized/calcification in my lungs they saw in my lung xrays during my surgery. There is a medical name for it but I cant find the xray report right now.

The bilateral tinitus is one I will be appealing as it is in my SMR's going back a while(of course I didnt know thats what it was, just says loud ringing) It is a constant presence and gets severe at times.

What would be the best way to proceed regarding the back issue I talked about in the first paragraph? Thanks

[Vike17]

Nathan,

In my previous post I forgot to mention that ratings for the cervical and lumbar spine are also derived from incapacitating episodes (periods of precsribed bed rest and treatment by a physician) also. The VA will assign the rating that results in the higher rating. For example, let's say you have forward flexion of the lumbar spine at 70 degrees, which would mean a 10% rating, but you have incapacitating episodes of 4-6 weeks within the last 12 months. The incapacitating episodes warrant a 40% rating and VA would assign that because, naturally, that is higher than 10%. keep in mind that the incapacitating episodes only apply to intervertebral disc syndrome, not any strains or fractures ect...

As far as what you should do about your current rating on your back, if I'm not mistaken, if you apply for an increase within the one year appeals period of your claim, you may be awarded an effective date of the increased evaluation back to the original effective date of the claim. However, do not quote me on that right this moment. I'll have to check the regulations on that one. My thinking on this is when a veteran applies for an increase, which is actually re-opening a claim, and submitts new evidence as to their disability worsening , there is a provision in the regulations that state if a claimed is re-opened with the one year appeals period and is subsequently granted the effective date is the date of the original claim. But like I said, let me ckeck into that one first!!

As far as the pain down your leg, if that pain result in "neurologic abnormalities, including, but not limited to, bowel or bladder impairment," or drop foot, you can be rated separatley for those conditions as secondary to your back.

For your lung condition, you'll more than likely need a good IMO to connect that to your military service; especially if there is little or no mention of symptoms noted your SMR's.

For the ringing in your ears, you'll need to submit a Notice of Disagreement (NOD) within one year of the rating decision to perserve the original effective date. Just explain to the VA why you think the decision is wrong and they will take care of the rest. Be sure to request a DRO review.

Hope this helps!

Vike 17

Edited October 4, 2006 by Vike17 (see edit history)

[otey2171]

none

Edited October 5, 2006 by otey2171 (see edit history)

[Nathan104]

wierd double post

Edited October 4, 2006 by Nathan104 (see edit history)

[Nathan104]

Vike- Thanks for the info, its very helpful.

Otey- I said that we had sent in statements back when my claim was put in stating how bad the condition was. We couldnt have put in statements back then stating how bad it is NOW

Unfortunately, its much worse after surgery. Instead of horrible pain down just my left leg, its now down both. The MRI showed this was because of large amounts of scar tissue that have formed around the nerves in my spine, and the rebulging of the disc they tried to fix and the two new bulging discs that werent on the first MRI.

Im pretty sure the main thing I need for my back claim is just a new C&P. With the increased problems since the surgery my ROM is laughable. Im just glad I have two small children I can annoy by calling them to pick stuff up for me B)

Edited October 4, 2006 by Nathan104 (see edit history)

[Scottyp65]

Nathan104

A very important aspect of the C&P exam is pain, and fatigue as related to ROM. So be sure to let an examiner know when your knee and or back STARTS to hurt when bending it. My ratings were more so based on pain than anything else. While I can move, it hurts to do so. Also if your knee hurts when bending over to pick up a box, and then by your claim perhaps your back does also, then tell them. They need to know how it affects your life. A key to remember is what is your PAIN FREE Range of Motion. When you bend over to pickup the box, if you can, you shouldn't feel ANY pain. Also if your leg or back gets fatigued you need to let the examiner know. What often happens in a C&P exam is the examiner watches you as you sit in the waiting area, the way you get up, your gaint, your posture in the office. and many other diagnostic clues other than what is on the C&P exam form. Now this is not the time to try and win an Oscar either. Just let them know how often it hurts, how long the pain lasts and how intense is the pain. If there are episodes daily vs weekly and or monthly.

Just my 2cents.