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

[mtmorical]

Ebenefits shows my payment for school, but my pension payment doesn't show? Are they stopping my payment on 10% til this is decided? 133.17 isn't a lot but it's desperately needed!

what do I do?

[silverdollar22]

You will NOT loose your 10% while your claim is being processed!!! No worries there.

[broncovet]

You get the greater of...service connected compensation or pension, but not both.  You can not collect NSC pension and SC compensation at the same time. 

[broncovet]

Elective Surgery:

Definition

An elective surgery is a planned, non-emergency surgical procedure. It may be either medically required (e.g., cataract surgery), or optional (e.g., breast augmentation or implant) surgery.

Purpose

Elective surgeries may extend life or improve the quality of life physically and/or psychologically. Cosmetic and reconstructive procedures, such as a facelift (rhytidectomy), tummy tuck ( abdominoplasty ), or nose surgery ( rhinoplasty ) may not be medically indicated, but they may benefit the patient in terms of raising self-esteem. Other procedures, such as cataract surgery, improve functional quality of life even though they are technically an "optional" or elective procedure.

Some elective procedures are necessary to prolong life, such as an angioplasty . However, unlike emergency surgery (e.g., appendectomy ), which must be performed immediately, a required elective procedure can be scheduled at the patient's and surgeon's convenience.

Demographics

According to the National Center for Health Statistics of the U.S. Centers for Disease Control (CDC), in 2000 over 40 million inpatient surgical procedures were performed in the United States. Ambulatory surgery accounted for 31.5 million procedures in 1996, the most recent year for which CDC data is available. Statistically, women were more likely to have surgery, accounting for 58% of ambulatory and inpatient procedures. This data includes both emergency and elective procedures.

Description

There are literally hundreds of elective surgeries spanning all the systems of the body in modern medical practice. Several major categories of common elective procedures include:

• Plastic surgery. Cosmetic or reconstructive surgery that improves appearance and in some cases, physical function.
• Refractive surgery. Laser surgery for vision correction.
• Gynecological surgery. Either medically necessary or optional surgery (e.g., hysterectomy , tubal ligation ).
• Exploratory or diagnostic surgery. Surgery to determine the origin and extent of a medical problem, or to biopsy tissue samples.
• Cardiovascular surgery. Non-emergency procedures to improve blood flow or heart function, such as angioplasty or the implantation of a pacemaker.
• Musculoskeletal system surgery. Orthopedic surgical procedures, such as hip replacement and ACL reconstruction.

Diagnosis/Preparation

In some cases, insurance companies may require a second opinion before approving payment on elective surgical procedures. Anyone considering an elective surgery should review their coverage requirements with their health insurance carrier before scheduling the procedure.

Diagnostic and/or radiological testing may be performed to confirm the diagnosis or assist the surgeon in planning the surgical procedure. Typically, a complete medical history, physical examination , and laboratory tests (e.g., urinalysis , chest x ray , bloodwork, and electrocardiogram) are administered as part of the preoperative evaluation.

Other preoperative preparations will be dependent on the surgery itself. If a general anesthetic is to be used, dietary restrictions may be placed on the patient prior to the operation. If blood loss is expected during the procedure, advance banking of blood by the patient (known as autologous donation) may be recommended.

Aftercare

Recovery time and postoperative care will vary by the elective procedure performed. Patients should receive complete, written postoperative care instructions prior to returning home after surgery, and these instructions should be explained completely to them by the physician or nursing staff.

Risks

The risks for an elective surgery will vary by the type of procedure performed. In general, by their invasive nature most surgeries carry a risk of infection, hemorrhage, and circulatory problems such as shock or thrombosis (clotting within the circulatory system). The anesthesia used may also present certain risks for complications such as anaphylactic shock (an allergic reaction).

Read more: http://www.surgeryencyclopedia.com/Ce-Fi/Elective-Surgery.html#ixzz44Zc3GFrL

[broncovet]

Your situation demonstrates why many people have lost faith in their VSO's.  These kinds of questions should be answered by your VSO , but we understand the reality:  For most VSO's once they get your POA on file, they dont bother returning your calls.  Of course, their excuse is always, "gee I was serving other Veterans".  

     Im not buying that excuse.  If that VSO has so many Vets under POA, that he can not even return calls, then he has too many.   Its like a nurse at a hospital who "has no time to answer a light you turned on for help", or no time to bring you meds ordered by the doctor.  A nurse "accepts responsibility" for that patient, and understands that some of them may have illness or injury such that they can not get up to go to the bathroom, for example.  So, when you turn on your light, this signals the nurse help is needed, and they try to "answer the light" very promptly.  A phone call to your VSO that is not returned is the equivilant of your nurse disregarding your "help" light.   This is a big part of the purpose of hadit.  If all VSO's did their job, answered all your questions and made the necessary RO communications efficiently, AND proactively assisted Veterans in getting their maximum applicable benefits, then hadit would not be needed.  The fact is that your VSO organization is probably receiving "free rent" from VA at either the Regional Office or VAMC.  Guess what?  There is no "free rent".  These VSO's understand they get paid by/through VA and represent VA interests above yours.  

[mtmorical]

This is why we didn't care when I got out and stayed away from the VA.

My TKR was needed I was falling with my then 1yr old son.

it wasn't emergency surgery, so that means elective?

will that mean I get denied?

my 10% did show up today.