Full Knee Replacement

Rhodesia · May 6, 2016

I just came back from the Ortho doctor in town he said I need a full knee replacement for my service connected injury after looking at past 11 years of x-rays from the VA and what he just took today. The Marine Corps. somehow don't keep x-rays after a certain period of time. The VA says they will not do one until I'm 60 years old, all they wanted to do was give me injections for the pain. What I have now is a Torn ACL and I'm running bone on bone, and my knee cap is just about gone so here is the question. I already receive 20% for my left knee, due to the past 3 surgery's. So after having the knee replacement what will I be looking at? for an increase? Does the VA have to pay for this since I live 178 miles from the Nearest VA hospital? because they are still telling me if you were injured on active duty you must go to the VA hospital even through the VA says They will not do a knee replacement until I'm 60? I already talked to two Veterans in town at the Vet center and they had the same problem but they paid for it out of their own pocket for the surgery then filed for an increase award. So far they are still waiting for the VA to answer them back. any ideals on the best route to take? I hate to get this done out in a local hospital then fine out the VA will not pay and give me an increase for the full knee replacement. Thank for any information on this subject.

Chuck75 · May 6, 2016

First, if you have newer x-rays from outside the VA, get them and the reports into your VA med file. The distance from the VA hospital initially is not as important as the distance to a local VA outpatient clinic.

But, once you convince the clinic PCP then outside care (consult in VA speak) can be authorized, since the VAMC is farther away than 40 miles.

mdrn · May 6, 2016

Been there with bilateral TKR's. My first was service connected, I was young at 53. I was a nurse. My civilian ortho Doc stated its all about quality of life, so he did mine, 2 yrs later i had the second done. I was awarded SC for the 2nd thru CAVC remand. If you get your care all thru VA then, then yes they are going to deny it. I went the civilian route and had no issues with my pay or increase in ratings. Reality, if you have civilian insurance as the local vets told you have it done then file for your permanent increase to 30%. Don't live in pain and loss of quality of life. As far as VA paying for it, i think they gave you your answer whether locally or 200 miles away they're not going to do it till 60. They will also pay you 1 year at 100% for convalescent pay. If you have chronic residuals of moderate to severe pain , loss of range of motion after the 1 year per as they will do a follow up c&p you could go to 60%... Others may chime in on eligibility on your circumstances. The moral of this is do what you need to do to work around the VA bureaucracy to take care of yourself and collect the benefits due you. The convalescent pay isn't immediate if civilian and prepare yourself for 4-6 months till your paid once you file. When your surgery is completed get your surgical report of operation and file for your pay.

PS: Having a bad knee, if you have or develop problems with your back / hips / opposite knee, depression due to chronic pain etc , be meticuous in documentation and getting treatment to establish history / paper trail for possible SC down the road ;)

Edited May 6, 2016 by mdrn

Rhodesia · May 6, 2016

4 hours ago, mdrn said:

Been there with bilateral TKR's. My first was service connected, I was young at 53. I was a nurse. My civilian ortho Doc stated its all about quality of life, so he did mine, 2 yrs later i had the second done. I was awarded SC for the 2nd thru CAVC remand. If you get your care all thru VA then, then yes they are going to deny it. I went the civilian route and had no issues with my pay or increase in ratings. Reality, if you have civilian insurance as the local vets told you have it done then file for your permanent increase to 30%. Don't live in pain and loss of quality of life. As far as VA paying for it, i think they gave you your answer whether locally or 200 miles away they're not going to do it till 60. They will also pay you 1 year at 100% for convalescent pay. If you have chronic residuals of moderate to severe pain , loss of range of motion after the 1 year per as they will do a follow up c&p you could go to 60%... Others may chime in on eligibility on your circumstances. The moral of this is do what you need to do to work around the VA bureaucracy to take care of yourself and collect the benefits due you. The convalescent pay isn't immediate if civilian and prepare yourself for 4-6 months till your paid once you file. When your surgery is completed get your surgical report of operation and file for your pay.

PS: Having a bad knee, if you have or develop problems with your back / hips / opposite knee, depression due to chronic pain etc , be meticuous in documentation and getting treatment to establish history / paper trail for possible SC down the road ;)

Is that 1 year convalescent pay the same pay they would pay a veteran that has 100% service connected disability?

mdrn · May 6, 2016

Yes full month pay 2906 i think;)

Rhodesia · May 7, 2016

19 hours ago, mdrn said:

Yes full month pay 2906 i think;)

Ok now I get 20% for my knee so after having the knee replacement they will increase it to 30% in another words the VA will just add 10% to my 20% claim to make it 30% am I right on this? or is the 30$ separate from my 20% I currently have for the Knee. Thank you