TKR & 100% temp disability

[mtmorical]

We are new to the site and hoping for some help.

My husband left service in 2002 honorably and medically. After he got home and received treatment they determined him at 0%. We went about life although his R knee has always been an issue. In 2013 it finally became to much for him so in the spring he started going back to the VA, they tried to clean it out with a scope, then they tried cortisone injections, but the doc said that his knee was too far gone and that he needed a TKR so at 38 years old he put as long as he could and it was scheduled for Dec 2015.

Unknown to us the VA was doing something with his discharge and one day we got a check in the mail for over $8k, and two days later a letter explaining that his R knee has now been rated at 10% do to degenerative joint disease, arthritis and would be receiving compensation at the 10% rate. Great!

Now my questions:

Will the approve the temp disability for his TKR since he has been determined 10% for arthritis?

Is there anything that they could deny it for? Like not getting medical care (we couldnt afford it and didnt know he was VA covered)

We filed a FDC only to get paper in the mail that he needed to sign saying his had no additional information, so we signed it and sent it back, then we got flag on ebenefits stating requested information past due. So we contact a VSO, he called us back and told us that they never should of sent that letter since we submitted a FDC, that he was working with a manager and was going to request an informal expedite since its caused his claim to be suspended due to the paper that should never of been sent, the flag about requested information past due has since been removed.

Has anyone had experience with this? Will they now drop us to a standard claim because we submitted those additional documents? Has anyone had luck with an financial hardship expedite request?

 

Thank you in advance for your help!

mtmorical

Edited March 28, 2016 by mtmorical
more info

[Rx7mike]

9 minutes ago, mtmorical said:

 

Now my questions:

Will the approve the temp disability for his TKR since he has been determined 10% for arthritis?

Is there anything that they could deny it for? Like not getting medical care (we couldnt afford it and didnt know he was VA covered)

We filed a FDC only to get paper in the mail that he needed to sign saying his had no additional information, so we signed it and sent it back, then we got flag on ebenefits stating requested information past due. So we contact a VSO, he called us back and told us that they never should of sent that letter since we submitted a FDC, that he was working with a manager and was going to request an informal expedite since its caused his claim to be suspended due to the paper that should never of been sent, the flag about requested information past due has since been removed.

Has anyone had experience with this? Will they now drop us to a standard claim because we submitted those additional documents? Has anyone had luck with an financial hardship expedite request?

 

Eben is usually behind the mainstream. You Need a good VSO preferably one who is in the Regional office. Most have one DAV American leion ect. Get their number and it will most likely help get answers faster. (It helped in my case)

The Flag happened to me a few times also get the VSO on it if it comes back. Stay on your VSO not alot but to stay rellevant they work with alot of Vets.

The total Knee replacement is it elective or i am guessing not by the VA?

Financial Harship sometimes works sometimes does not. Ihave submitted 3 and 1 was approved. But every situation is different. The VA is logged still so it get a red tab added to the file to be looked at to see if it warrents a expidited claim. Thats how it was explained to me.

Please wait for some more seasoned Vets here for input as i just posted my experiences that i had. Its a cat and mouse game just keep your ducks in the row and wish you the best..

 

[mtmorical]

No it wasnt elective. His knee was totally shot at 38, the doc said in 20 years he's never seen a knee that bad on someone his age, it took 5 hours and he had to have bone transplanted to complete it. We just found out who the DAV through the American Legion is since the person who filed for us forgot to mention she isnt a VSO, and we found her unhelpful so I started searching the information about the claim and found this person.

I'm mostly concerned they will move it to a standard claim since we submitted the form the requested back, how much longer is that going to take if it happens?

I'm alittle concerned they will deny his claim, but only because I dont know about this stuff. He was SC 10% for his knee.

Thanks

Edited March 28, 2016 by mtmorical
Info

[broncovet]

Since you are apparently SC for your knee issue, then, yes you "should" get 100% temporary for your knee replacement.  Vets compensation is full of glitches, tho,  and these glitches often lead to homelessness.   

If you have little/no income, and served in wartime, and are not working, then you should likely apply for NSC pension.  Its easier to get than compensation and sometimes happens fairly quickly.   You can be on pension while applying for compensation.  

Ten percent sounds low to me if you need new knees.  It should be 20 or 30, as TKR is not for a mild knee problem..its for very serious knee problems.   You can/should file a NOD disputing the 10 % and allege that your TKR shows the condition is more severe than "just" 10%.  

Edited March 29, 2016 by broncovet

[broncovet]

5055Knee replacement (prosthesis).
Prosthetic replacement of knee joint:
For 1 year following implantation of prosthesis		100
With chronic residuals consisting of severe painful motion or weakness in the affected extremity		60
With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5256, 5261, or 5262.
Minimum rating		30

[Rx7mike]

55 minutes ago, broncovet said:

Since you are apparently SC for your knee issue, then, yes you "should" get 100% temporary for your knee replacement.  Vets compensation is full of glitches, tho,  and these glitches often lead to homelessness.   

If you have little/no income, and served in wartime, and are not working, then you should likely apply for NSC pension.  Its easier to get than compensation and sometimes happens fairly quickly.   You can be on pension while applying for compensation.  

Ten percent sounds low to me if you need new knees.  It should be 20 or 30, as TKR is not for a mild knee problem..its for very serious knee problems.   You can/should file a NOD disputing the 10 % and allege that your TKR shows the condition is more severe than "just" 10%.  

Broncovet has given some very good info. I forgot my neighbor had TKR and recieved 100% while in recovery in mean time he applied for a increase and was awarded a p&T 6 months after a C&P he had a year after surgury. was given 60% 

not elective is in your favor. I have to get left shoulder replaced just had the right done 4 yrs ago i had recieved 100& temp till i was rehabilitated lasted 9 months. The VA is trying so hard to update their systems and it changes alot. Stay positive and Supportive as you have its alot of red tape but you have a great group of info here at HADit. Stick to it and dont fall victim to them making it so frustraiting you just give up and get everything you are owed. Hope he feels better and with the replacement 800mg Motrin helps alo espescially when cold or wet weather is comming in and the aches set it.

[mtmorical]

I dont know how to quote previous replies, sorry!

He served from 1998 to 2002, he was a part of Stop Loss after 9/11, I dont know that he would qualify for that program?

We are very concerned to start anything else until the temp 100% is determined, we have heard that they will lump everything together and it will take a lot longer. I am hoping that they resolve this soon, it's been open since Jan (yes I know alot of other vets have waiting longer) He should of been higher rated, but once he got out and they declared him 0% we went on with life, the VA then went and upgraded him to 10% all on their own with no prodding from us, like I said we just got a big check in the mail one day and a letter a few days after. He was seperated with degenerative arthritis of the R knee. 

Once this is resolved, we are seriously going to have to try to get his L knee considered since he's walked with a limp and off gait for the last 14 years.

This was an original FDC claim, then they sent that letter we thought we had to response too, concerned that they will now drop this to a standard claim and it will take even longer???

I am hoping that the person we spoke with on Friday at the MN DVA (American Legion) is going to be able to help with that. But we have read on hadit that if you respond it drops you.