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What is considered a Duplicate claim if filing for increase


ardodd

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My is I filed for Increase on my Service Connected Disabilities.

Service Connected Disabilities: 

Osteoarthritis Left Knee: 10%

Osteoarthritis Right Knee: 10%

Depressive Disorder: 70%

 

Claim:  

Increase Osteoarthritis Left Knee: 

Reason for Increase

1) Total Left Knee Replacement:

    A) Temporary Total Disability

    B) Umemployability

Secondary (New):

   A) Hip Condition

   B) Back Condition

Increase Osteoarthritis Right Knee:

Reason for increase

Secondary (New):

   A) Hip Condition

   B) Back Condition

   C) Ankle

 

My Question is will the VA consider this as Duplicate Claims?

Can the VA overrule and consider that the Secondary conditions are Bilateral and I can not make a Duplicate entry. I consider since both Knee's are rated at 10% because one is worser than the other.

My Left is the one that has been replaced and will be ( or should be rated differently ) rated  under replacement and not under plain Osteoarthritis. As a Secondary Condition I added Hip and Back Ankle as the Service Connected Disability has affected my healing. 

I asked for Increase or my Right Knee as it is not for ( Flexion - Extension - Pain ) all the 3 separate ratings possible under osteoarthritis. I then listed as Secondary Conditions ( Hip - Back - Ankle ) because although it would be considered a duplicate they are rated seperately.

Can I make them separate  conditions as my left side affects the left side of my hip and back from the Left Knee. And then the right side is differently because it affects the right ankle and hip and back differently on that side.

Can they be Rated Separately?

Or can the VA Deny them as Duplicates? 

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Wish I had an answer but I am following this as my friend has the same question. All of his VA ratings / award letters specify his left side - shoulder, hip and ankle from combat wounds. You may want to specify your conditions accordingly. Wishing you a positive outcome and looking forward to hearing an answer.

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8 hours ago, Balls_B said:

Wish I had an answer but I am following this as my friend has the same question. All of his VA ratings / award letters specify his left side - shoulder, hip and ankle from combat wounds. You may want to specify your conditions accordingly. Wishing you a positive outcome and looking forward to hearing an answer.

I wish i had definite answer myself. As I have been awaiting the outcome since November. In my last communication with the VA they denied my PTSD claim and in their stated that because I had Depressive Disorder Rating that they could only rate me under one condition. So I must await and see what they will for an increase to the Depressive Disorder, since they seem to want to rate me under it cause they could actually not increase my rating. Where as with PTSD they could possible have to increase it to 100%, but with Depressive Disorder they could find reasons to not increase. Such as he can get out of bed on his own - he can use the bathroom - he can talk and communicate with family. 

So I will just hold my opinion until a Certified Representative can help me understand why they are Denying PTSD and just considering a increase to the Depressive Disorder. If they decide there is a increase.

Wish you the best and hope you find the answers you are looking for.

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I will try to answer this.  

You need to understand that claims are rated based on symptoms, not diagnosis, once service connected.  

Pyramiding prevents you from getting benefits twice on anything.  

Knees, for example are rated based on the degree of loss of range of motion, pain, or loss of use.  

As  to what caused it, that is irrelevant whether its secondary to something else, or a primary condition.  You wont get paid BOTH for "secondary" knee issues and also "primary" knee issues.  

Let me explain using mental health disorders.  You could have depression, PTSD, or Bipolar, and you could have more than one of these.  

However, lets say you have the symptom of "not getting along with others" and you also have the symptom of "total occupational impairment".  You wont be getting paid for these for both PTSD, and depression, just the greater of the two if diagnosed with both PTSD an depression.  

Its the same way with knee disorders.  You get paid for pain, loss of range of motion, BUT NOT for the same symptoms again because its secondary to back issues, for example.  

So, I think the answer to your question is that is a duplicate, as you only have "one" set of symptoms even if you have primary, secondary, etc. 

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17 minutes ago, broncovet said:

However, lets say you have the symptom of "not getting along with others" and you also have the symptom of "total occupational impairment".  You wont be getting paid for these for both PTSD, and depression, just the greater of the two if diagnosed with both PTSD an depression.  

Its the same way with knee disorders.  You get paid for pain, loss of range of motion, BUT NOT for the same symptoms again because its secondary to back issues, for example.  

So, I think the answer to your question is that is a duplicate, as you only have "one" set of symptoms even if you have primary, secondary, etc.

Thank you sir for helping explain this to me. I guess I am way in over my head with this whole VA thing.

This is a Wish List I filed: "Like it shows it is a Wish List"

What you’ve claimed
  • HIP CONDITION
  • BILATERAL (secondary to left and right knee osteoarthritis previously denied as bilateral patellofemoral syndrome) (Secondary)
  • CHRONIC FATIGUE SYNDROME (secondary to L knee osteoarthritis) (Secondary)
  • TINNITUS (claimed as 2nd to L knee osteoarthritis) (Secondary)
  • ASTHMA
  • EMPHYSEMA & BRONCHITIS (claimed as 2nd to asbestosis
  • also as 2nd to R knee osteoarthritis) (Secondary)
  • ASBESTIOSIS (related to: Asbestos) (Reopen)
  • DMII (claimed as 2nd to L and Rknee osteoarthritis) (Reopen)
  • BACK CONDITION (now claimed as 2nd to L and R knee osteoarthritis) (Reopen)
  • HYPERTENSION (now claimed as 2nd to L and R knee osteoarthritis) (Reopen)
  • NECK CONDITION (now claimed 2nd to L and R knee osteoarthritis) (Reopen)
  • RIGHT KNEE OSTEOARTHRITIS (now claimed a bilateral patellofemoral syndrome) (Increase)
  • LEFT KNEE OSTEOARTHRITS (now claimed as bilateral patellofemoral syndrome) (Increase)
  • DEPRESSIVE DISORDER (now claimed as PTSD and PTSD 2nd to L and R knee osteoarthrits) (Increase)
  • UNEMPLOYABILITY (New)
  • SPECIAL MONTHLY COMPENSATION A&A (New)
  • SPOUSAL AID AND ATTENDANCE (New)
  • TEMPORARY TOTAL DISABILITY (clarified as 100% convalescent due to surgery on s/c L knee osteoarthritris) (New)
  • NEUROLOGICAL DISORDER (related to: Environmental Hazard - Camp Lejeune) (New)
  • RENAL DISEASE (related to: Environmental Hazard - Camp Lejeune) (New)
  • PARKINSON'S DISEASE (related to: Environmental Hazard - Camp Lejeune) (New)

I guess some where in my mind I remember my father not making any kind of claim from his service in Korea and Vietnam. And how he suffered before he died. And my mother struggled after his death since none of us knowed anything about VA benefits for him or her.

I think that's why I decided to claim everything i could think of as it would be on record for my family when I pass away.

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