tdiu Quick Question On Dr Letter In Support Of Tdiu

[Nathan104]

"if your PCP is willing to write that your SC disabilities prevent you from being employed- that is all you need to get them to consider you for TDIU."

I read this while searching info on TDIU from old posts. I have a question about this. So far, I have not been seen by VA Dr's at all. The civilian Dr I had been seeing is willing to write a letter stating the above. What Im wondering is if there is a certain way this needs to be said or anything that needs to be included in the letter. Any examples out there?

Thanks.

Also, Is there any benefit in claiming scars? I had two cliamed on my original claim and got 0% sc for them. I have a 4 inch scar on my lower back from the surgery and Im wondering if it has any benefit at all in claiming it? Do scars cause problems as you get older? Having another 0% would not benefit my rating in any way that I know.

[carlie]

§ 4.118 Schedule of ratings—skin.

Rating

------------------------------------------------------------------------

7800 Disfigurement of the head, face, or neck:

With visible or palpable tissue loss and either gross 80

distortion or asymmetry of three or more features or paired

sets of features (nose, chin, forehead, eyes (including

eyelids), ears (auricles), cheeks, lips), or; with six or

more characteristics of disfigurement......................

With visible or palpable tissue loss and either gross 50

distortion or asymmetry of two features or paired sets of

features (nose, chin, forehead, eyes (including eyelids),

ears (auricles), cheeks, lips), or; with four or five

characteristics of disfigurement...........................

With visible or palpable tissue loss and either gross 30

distortion or asymmetry of one feature or paired set of

features (nose, chin, forehead, eyes (including eyelids),

ears (auricles), cheeks, lips), or; with two or three

characteristics of disfigurement...........................

With one characteristic of disfigurement.................... 10

Note (1):The 8 characteristics of disfigurement, for

purposes of evaluation under § 4.118, are:

Scar 5 or more inches (13 or more cm.) in length.

Scar at least one-quarter inch (0.6 cm.) wide at widest

part.

Surface contour of scar elevated or depressed on palpation.

Scar adherent to underlying tissue.

Skin hypo-or hyper-pigmented in an area exceeding six square

inches (39 sq. cm.).

Skin texture abnormal (irregular, atrophic, shiny, scaly,

etc.) in an area exceeding six square inches (39 sq. cm.).

Underlying soft tissue missing in an area exceeding six

square inches (39 sq. cm.).

Skin indurated and inflexible in an area exceeding six

square inches (39 sq. cm.).

Note (2): Rate tissue loss of the auricle under DC 6207

(loss of auricle) and anatomical loss of the eye under DC

6061 (anatomical loss of both eyes) or DC 6063 (anatomical

loss of one eye), as appropriate.

Note (3): Take into consideration unretouched color

photographs when evaluating under these criteria.

7801 Scars, other than head, face, or neck, that are deep or

that cause limited motion:

Area or areas exceeding 144 square inches (929 sq.cm.)...... 40

Area or areas exceeding 72 square inches (465 sq. cm.)...... 30

Area or areas exceeding 12 square inches (77 sq. cm.)....... 20

Area or areas exceeding 6 square inches (39 sq. cm.)........ 10

Note (1): Scars in widely separated areas, as on two or more

extremities or on anterior and posterior surfaces of

extremities or trunk, will be separately rated and combined

in accordance with § 4.25 of this part.

Note (2): A deep scar is one associated with underlying soft

tissue damage.

7802 Scars, other than head, face, or neck, that are superficial

and that do not cause limited motion:..........................

Area or areas of 144 square inches (929 sq. cm.) or greater. 10

Note (1): Scars in widely separated areas, as on two or more

extremities or on anterior and posterior surfaces of

extremities or trunk, will be separately rated and combined

in accordance with § 4.25 of this part.

Note (2): A superficial scar is one not associated with

underlying soft tissue damage.

7803 Scars, superficial, unstable............................... 10

Note (1): An unstable scar is one where, for any reason,

there is frequent loss of covering of skin over the scar.

Note (2): A superficial scar is one not associated with

underlying soft tissue damage.

7804 Scars, superficial, painful on examination................. 10

Note (1): A superficial scar is one not associated with

underlying soft tissue damage.

Note (2): In this case, a 10-percent evaluation will be

assigned for a scar on the tip of a finger or toe even

though amputation of the part would not warrant a

compensable evaluation.

(See § 4.68 of this part on the amputation rule.)

7805 Scars, other; Rate on limitation of function of affected

part.

7806 Dermatitis or eczema.

More than 40 percent of the entire body or more than 40 60

percent of exposed areas affected, or; constant or near-

constant systemic therapy such as corticosteroids or other

immunosuppressive drugs required during the past 12-month

period.....................................................

20 to 40 percent of the entire body or 20 to 40 percent of 30

exposed areas affected, or; systemic therapy such as

corticosteroids or other immunosuppressive drugs required

for a total duration of six weeks or more, but not

constantly, during the past 12-month period................

At least 5 percent, but less than 20 percent, of the entire 10

body, or at least 5 percent, but less than 20 percent, of

exposed areas affected, or; intermittent systemic therapy

such as corticosteroids or other immunosuppressive drugs

required for a total duration of less than six weeks during

the past 12-month period...................................

Less than 5 percent of the entire body or less than 5 0

percent of exposed areas affected, and; no more than

topical therapy required during the past 12-month period...

Or rate as disfigurement of the head, face, or neck (DC

7800) or scars (DC's 7801, 7802, 7803, 7804, or 7805),

depending upon the predominant disability.

[Nathan104]

Carlie, thanks. Thats the rating criteria for scars. Ive reviewed that and it doesnt really answer my question. I know it would be rated at 0% if I claimed it. My question was is there any reason to claim it knowing I will get 0%? Does a 0% rating help in any way? And do scars have a tende3ncy to get painful or anything down the road that would give me a reason to claim it now? Right now Im not planning on claiming it because its no big deal. Im wondering if there is any good reason that I should.

The TDIU Dr's letter is the info Im really looking for though. Thanks.

[john999]

nathan

On the TDIU letter make sure your doctor says he has reviewed all your SMR's and current medical records and that you are unemployable due to your SC conditions.

[Berta]

Nathan- there has been considerable advice here lately (under a search you can find it all at hadit) as to what these IMos have to conform to.

The doctor has to state a "rationale" for their opinion- meaning what medical experience they have or expertise in the area of you disabilities to make their opinion valid.

If you have any treatises they could refer to- that would be very good also.

One things about treatises - I read an interesting CAVC decision the other day regarding an old BVA decision-

BVA is much better nowadays-

But the BVA had denied a claim , citing a medical treatise or abstract that was negative to the claimed SC and the inservice nexus.

The CAVC stated that the BVA cannot make conclusions based on any medical treatices, as the BVA itself had provided no medical rationale to support the denial or even the treatise-(not could they- they are lawyers at BVA-not doctors.)

We need to make sure that an IMO doc follows what the VA wants and also read over very carefully any VA "expert" crapola they use to deny as- if the VA doc does not confirm to the same criteria our IMOs must conform to- then the VA opinion can be challenged on this basis.

My IMOs challenged a VA opinion in many ways-plus they said the VA opinion was "medically inaccurate" and this was supported in the IMO.

Someone posted an IMO here the other day- it fully meets the VA's criteria.

Perhaps it could be printed off (with no names) and your doc could use it as an example.It is never too late- if an IMO has already be sent in, to send in additional expanded IMO statement.

[Berta]

Nathan- there has been considerable advice here lately (under a search you can find it all at hadit) as to what these IMos have to conform to.

The doctor has to state a "rationale" for their opinion- meaning what medical experience they have or expertise in the area of you disabilities to make their opinion valid.

If you have any treatises they could refer to- that would be very good also.

One things about treatises - I read an interesting CAVC decision the other day regarding an old BVA decision-

BVA is much better nowadays-

But the BVA had denied a claim , citing a medical treatise or abstract that was negative to the claimed SC and the inservice nexus.

The CAVC stated that the BVA cannot make conclusions based on any medical treatices, as the BVA itself had provided no medical rationale to support the denial or even the treatise-(not could they- they are lawyers at BVA-not doctors.)

We need to make sure that an IMO doc follows what the VA wants and also read over very carefully any VA "expert" crapola they use to deny as- if the VA doc does not confirm to the same criteria our IMOs must conform to- then the VA opinion can be challenged on this basis.

My IMOs challenged a VA opinion in many ways-plus they said the VA opinion was "medically inaccurate" and this was supported in the IMO.

Someone posted an IMO here the other day- it fully meets the VA's criteria.

Perhaps it could be printed off (with no names) and your doc could use it as an example.It is never too late- if an IMO has already be sent in, to send in additional expanded IMO statement.

[Nathan104]

Berta, thanks for the reply and info. I did see the IMO info in my search but thought those were only for having your dr try and service connect a disability. I couldnt find anything about the Dr writing one strictly for unemployability and thought there may be different requirements for that kind of letter. From all that I read while searching, if its not worded certain ways or include certain things they do not help. Im still trying to understand the VA puzzle.