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So I am getting juggled a bit between VSO since my awesome last one retired so would appreciate the proper route to take.
I was just rated at at 50% Pes Planus with Plantar Fasciitis under 5276. This was a supplemental claim for only pes planus that was filed on 02/01/21 with a decision made on 03/12/21. After speaking with a VSO, who read me the decision letter and raters notes, he said there is no doubt the 50% for pronounced pes planus was justified, but was not sure why they arbitrarily added plantar fasciitis to the decision. I mentioned to the VSO that effective 02/04/21, a diagnostic code of 5269 - Plantar Fasciitis was added to the schedule of ratings - musculoskeletal system and if it was possible that they combined them under diagnostic code 5676, because that was how it was always done before and the rater did not read or know about the new diagnostic code. He said that could be the reason.
Just to note, I was diagnosed at the VA with bilateral pes planus in 2017 and given insoles. I was again seen by the VA for foot pain and bilateral pes planus was again affirmed in 2018 with a different set of insoles. This last January I again went in with foot pain where pes planus was again affirmed, had another set of insoles cast, and was diagnosed for the first time with bilateral plantar fasciitis and given steroid injections in each foot.
Ultimately I am looking to get the plantar fasciitis rated separately from the pes planus under the new diagnostic code of 5269, which due to the severity and being bilateral would be at 30%. In fact, my VSO had already submitted an intent to file for bilateral plantar fasciitis, arthritis of both great toes, patellar tendinosis of both knees, arthritis of both knees, and ITB syndrome as being secondary to the pes planus once it was service-connected. The history of my pes planus dates back to my final physical and I have been receiving treatment for it since 2017 in the form of insoles when it was originally diagnosed with the VA. It was only this last year that I was diagnosed with plantar fasciitis as a result of the pes planus.
So what route do I take on this supplemental claim? I feel like a High level Review won't allow me to submit the VA medical records showing that I have been treated unsuccessfully for pes planus since 2017. Is that something I can bring up in the phone conversation with the reviewer to get the plantar fasciitis rated separately under 5269? I am not submitting any new evidence so to speak, but literally VA medical records that were already in the system for years. The other question is, does the new diagnostic rating for plantar fasciitis even apply to me? I filed on 02/01/21 and the new rating schedule went into effect on 02/04/21.
I want to fight this decision because I am already rated at 70% with CAD, DMII, and Tinnitus. Getting the plantar fasciitis rated separately would be the difference between an 86% rating rounding up to 90% and 92% rounding down to 90%. This does not include the issues secondary to the pes planus like the arthritis and tendinosis that are under my current intent to file.
CUE =BVA - retro to 1985 for PTSD
There are over 2,000 CUE decisions at the BVA for 2020. Many of them were denied and those cases reveal why they were denied.
But persistence pays off:
This vet would not give up- the case shows the rigamorale he went through.
"ORDER The Veteran’s motion to revise the March 2007 rating decision that granted service connection for posttraumatic stress disorder (PTSD), effective October 7, 2005, on the grounds of clear and unmistakable error (CUE) is granted, and an effective date of April 9, 1985, but no earlier, for the award of service connection for PTSD, is assigned. "
This case involved not only CUE but 38 CFR 3.156.
Also the veteran appealed to the Court ( CAVC twice and apparently had a lawyer at that point who successfully represented him at the BVA for the CUE.
The veteran at some point reopened his claim in 2005 and gained a 70% rating in 2007 (retro back to 2005)
The BVA stated:
"Here, there is no question that the award of service connection in 2007 was based, at least in part, on the confirmation of the Veteran’s stressors completed through CURR research. So, it is clear in this case that the effective date provisions of 3.156(c)(3) were applicable. "
This vet Also had problems getting his stressors verified- problems that probably came from the VA itself-that is why it pays to do all you can to get a stressor verified via JSRRC and/or buddy statements. VA will lie about contacting CURR, when sometimes they never do that.
It took 22 YEARS for that to occur in this veteran's case.
Still the veteran knew that was wrong- and he proved with his lawyer that hi original 1985 claim for "delayed stress" ( PTSD was still new then and many vets with a PTSD diagnosis I met when I worked at a Vet Center, didnt really know what PTSD was, but they all had been diagnosed with it -from the Vietnam War.)
My husband's 1983 award was for service connected "nervous condition"" subsequently changed to PTSD, when PTSD formally went into the regulations.
In this case the original claim for "delayed stress" was clearly an established fact that the veteran had PTSD fro the Vietnam War.
In many cases ( such as a recent CUE question here) a re opened claim can only generate a potential valid CUE on the original claim, only when there is no doubt that the original claimed disability was exactly the same as the re opened awarded disability.
The only good thing VA ever did for my husband was diagnose him with PTSD immediately when he tried to choke a loan officer at the VA.
The Director,a VA psychologist, as I mentioned before, gave him a buddy statement, because my husband revealed one stressor to him and the psychologist- was called to the same scene at the Perfume River, Vietnam to treat Marines who were obviously seriously affected by the "volunteer job" they had to do.It was horrible. He was awarded within a few months after that for SC PTSD. 30% SC.
Even with treatment for years for the PTSD here in NY, he was awarded 100% P & T posthumously for SC PTSD because PTSD can get worse over the years. Severe stressors never go away.
I hope this case above will help someone out there who thinks they have CUE and/or 3.156 potential.
Any vet rep or VSO who can read, would be able to understand what a valid CUE is by reading this case, and be able to determine if you should file or re open in that regard.
My last post on CUE here yesterday will also help any POA rep ,VSO , or claimant understand what a CUE is and how a re -open can gain a better EED, as explained in that post and in this very recent BVA award.
In August 2020, I filed a HLR for heart attack and was just called by a DRO. The DRO indicated the decision was in error because it was based solely on the wrong condition (atrial fibrillation) and did not address the heart attack at all. They will go over everything, including the strong "more likely than not" IMO from my non-VA board certified doctor. They said they would try to grant based off of the evidence of record. Of course, if granted, I would get another heart C&P for rating purposed. Should know something within the next couple of weeks.
I've got a question concerning my ratings code sheet. The info enclosed below is depicted on all three of my Ratings Code Sheet (Original - 2013; IU - 2019 & PTSD RFE 2020). Does this mean that I'm service-connected for Sinusitis at 0% or is this just a VARO mistake (maybe a CUE)? Is there any additional action that I should or could take? Thanks in advance.
There are 1954 BVA decisions regarding CUE in 2020 alone.
Many were denied, some were re-file-able, "without prejudice "( meaning the claimant needs to perfect the CUE and re file it) and CUE is NOT a one shot deal, as many reps etc try to say, and some certainly were awarded.
rebabevets posted a question in VA Disability Compensation Benefits Claims Research Forum,I already get compensation for bladder cancer for Camp Lejeune Water issue, now that it is added to Agent Orange does it mean that the VA should pay me the difference between Camp Lejeune and 1992 when I retired from the Marine Corps or do I have to re-apply for it for Agent Orange, or will the VA look at at current cases already receiving bladder cancer compensation. I’m considered 100% Disabled Permanently
Ddsr posted a question in VA Disability Compensation Benefits Claims Research Forum,The 5, 10, 20 year rules...
Five Year Rule) If you have had the same rating for five or more years, the VA cannot reduce your rating unless your condition has improved on a sustained basis. All the medical evidence, not just the reexamination report, must support the conclusion that your improvement is more than temporary.
Ten Year Rule) The 10 year rule is after 10 years, the service connection is protected from being dropped.
Twenty Year Rule) If your disability has been continuously rated at or above a certain rating level for 20 or more years, the VA cannot reduce your rating unless it finds the rating was based on fraud. This is a very high standard and it's unlikely the rating would get reduced.
If you are 100% for 20 years (Either 100% schedular or 100% TDIU - Total Disability based on Individual Unemployability or IU), you are automatically Permanent & Total (P&T). And, that after 20 years the total disability (100% or IU) is protected from reduction for the remainder of the person's life. "M-21-1-IX.ii.2.1.j. When a P&T Disability Exists"
At 55, P&T (Permanent & Total) or a few other reasons the VBA will not initiate a review. Here is the graphic below for that. However if the Veteran files a new compensation claim or files for an increase, then it is YOU that initiated to possible review.
NOTE: Until a percentage is in place for 10 years, the service connection can be removed. After that, the service connection is protected.
Example for 2020 using the same disability rating
1998 - Initially Service Connected @ 10%
RESULT: Service Connection Protected in 2008
RESULT: 10% Protected from reduction in 2018 (20 years)
2020 - Service Connection Increased @ 30%
RESULT: 30% is Protected from reduction in 2040 (20 years)
broncovet posted an answer to a question,While the BVA has some discretion here, often they "chop up claims". For example, BVA will order SERVICE CONNECTION, and leave it up to the VARO the disability percent and effective date.
I hate that its that way. The board should "render a decision", to include service connection, disability percentage AND effective date, so we dont have to appeal "each" of those issues over then next 15 years on a hamster wheel.
Ztmiller8 posted a question in Appealing Your Veterans Compensation Disability Claims NOD, DRO, BVA, USCAVC,Finally heard back that I received my 100% Overall rating and a 100% PTSD rating Following my long appeal process!
My question is this, given the fact that my appeal was on the advanced docket and is an “Expedited” appeal, what happens now and how long(ish) is the process from here on out with retro and so forth? I’ve read a million things but nothing with an expedited appeal status.
Anyone deal with this situation before? My jump is from 50 to 100 over the course of 2 years if that helps some. I only am asking because as happy as I am, I would be much happier to pay some of these bills off!
Joey Ross posted an answer to a question,I told reviewer that I had a bad C&P, and that all I wanted was a fair shake, and she even said, that was what she was all ready viewed for herself. The first C&P don't even reflect my Treatment in the VA PTSD clinic. In my new C&P I was only asked about symptoms, seeing shit, rituals, nightmares, paying bills and about childhood, but didn't ask about details of it. Just about twenty question, and nothing about stressor,
Picked ByJoey Ross,