Question about opening a new claim

[toomnyhats]

I have a few separate questions.

I was granted 100% P&T, no exams required, along with the rest of the benefits (Chapter 35, Commisary, etc) based on cervical neck aggravation in service. We discovered later after discharge that I have a narrow spinal canal, I am now an incomplete tetraplegic with some remaining function in my left arm and not much in my right.  They granted 20% for neck with the following secondaries: 100% loss of use of legs, 70% Right Arm w/loss of use, 30% on left arm radiculopathy.  I also have an independent 60% on bladder granted almost immediately after filing my claim in 2015, because they found in my str where I had gone in for bladder spasms, however it is not listed as a secondary to the neck. I also have 10% tinnitus.

I had to have my colon removed and an ileostomy placed due to neurogenic bowel.  This was never addressed in the nod. When I mentioned it, I was told that they would see the secondaries automatically or we could file a new claim.   My neck claim never went to the board because I had two good letters (IME and IMO) stating that aggravation was more likely than not caused by service.  So after the Form 9 was filed, they eventually granted the items listed above.   My question is should I file a new claim for the neurogenic bowel.  I'm not looking at it from a monetary standpoint now, but looking at the future. If I were to get a bowel obstruction and die, my husband would not get anything since it's not service connected.  

Question number two relates to the bladder.  I'm am deteriorating in my hand and arm function to the point that it is difficult to intermittently cath.  My urologist thinks it is time to place a supra pubic catheter.  I saw somewhere that this is rated at 100%..does anyone know if that is correct? If so, then I assume the 60% for bladder would go up.  

Question 3 relates to the fact that I have loss of use of both legs, loss of use of both sphincters.  If they connect the neurogenic bowel, would that put me in the SMC O category?

And one last comment, I'm being urged not to rock the boat because there was no documentation regarding my neck, however the IMO did a great job documenting clearly why he would not expect me to seek treatment for neck pain because it typically starts at a low level (as mine did) and most people just treat it at home via OTC and heat.  There is also a steady stream of continuity of treatment starting 2 years after I was discharged.  He also specifically said that my degeneration occurred at a much more rapid pace than it would have had I not been doing the strenuous work I was doing.  I believe that, along with a great letter from my VA SCI doc plus full exam is what got me granted but I'm sure it was sitting on the fence and could have gone either way.  I am, of course very happy we avoided having to take it to the board of appeals.  So asking all the experts out there...would I be rocking the boat to request the connection of my neurogenic bowel?

Thanks much!

 

 

[Berta]

"When I mentioned it, I was told that they would see the secondaries automatically or we could file a new claim"

Who told you that? 

Nothing is automatic with the VA. But the Modernization Act is making them do a better job (hopefully) to seek secondaries-

"would I be rocking the boat to request the connection of my neurogenic bowel?

Thanks much!"

A veteran should claim anything they believe should be service connected-or could cause their death.

 

Thanks for thinking of your spouse! My dead husband seemed to know more about DIC than I did in his lifetime-

Hours before he died- (which was very unexpected) he feared if he died, VA would not pay me DIC.

I dont understand this:

 

"100% P&T Effective Date 11/15/2015

10/30/1990   0% hematoma-abdominal wall with numbness and dysesthesia  

11/30/2015   60% Neurogenic bladder, 10% Tinnitus  

11/15/2015   20%  degenerative arthritis, spinal stenosis, and incomplete paraplegia due to spinal cord injury C5-6 from ruptured disc, s/p cervical

       Secondaries:  100% loss of use of the lower extremities, 30% radiculopathy - left upper extremity, 70%  loss of use of the right upper extremity"

 

Do you mean they awarded the 100% -as secondaries, and also awarded 60% for the bladder?

 What level of SMC  are you at now?

[Berta]

"First, currently the Veteran has a 60 percent rating for neurogenic bladder from August 23, 2013.  This is ratable under 38 C.F.R. § 4.115a, Diagnostic Code 7542 voiding dysfunction criteria.  The criteria for rating neurogenic bladder require the wearing of absorbent pads which must be changed at least 2-4 times per day for a compensable rating based on voiding dysfunction.  38 C.F.R. § 4.115a.  This is not shown prior to August 23, 2013, and so the criteria for a separate rating for neurogenic bladder prior to August 23, 2013 are not met.  Additionally, the Veteran's neurogenic bladder is rated at the 60 percent maximum schedular rating from August 23, 2013, and so no higher schedular rating can be assigned for voiding dysfunction.  

The Veteran also has a 60 percent rating for incontinence of bowel from September 3, 2013.  This is ratable under 38 C.F.R. § 4.115, Diagnostic Code 7332 for rectum and anus impairment of sphincter control.  Bowel incontinence rating criteria provide for a 0 percent rating for healed or slight impairment, without leakage; a 10 percent rating for constant slight or occasional moderate leakage; a 30 percent rating for occasional involuntary bowel movements necessitating the wearing of a pad; a 60 percent rating for extensive leakage and fairly frequent involuntary bowel movements; and a 100 percent rating for complete loss of sphincter control.  "

https://www.va.gov/vetapp17/files3/1714129.txt

The above 2017 BVA decision might help you to determine how they should rate this for the bowel disability and you sure might want to check the bladder rating in this case, as well.

[Berta]

There is a lot in this case as well:

https://www.va.gov/vetapp18/files2/1812580.txt

[broncovet]

As far as "dependents eligibility for DIC", then you need to understand this:

There are at least "2" ways for your dependents to get DIC if you pass.

1.  If you die of a service connected condition.

2.  If you die for "any reason" once you have been 100 percent P and T for 10 years.  

     You did not mention how long you have been SC.  And, you did not mention the level of SMC you are now, and whether or not you need A and A, (SMC L), but that sounds like its a given, considering the level of disabilities you have posted.  

       So, it would appear the only thing you have to gain by continuing to persue claims is one or more levels of SMC, and DIC for your depenedents if you die.  

       This is pretty much a choice only you can make.  You probably know better than we do how likely you are to pass away in 10 years after the decision awarding 100 percent.  

        As far as SMC goes, well there are at least 3 levels of SMC L (aid and attendance), depending on the level of care you need.  If you need a full time, round the clock nurse, then your expenses will be higher and so will be your compensation level.  There are also SMC levels for loss of use of arms, legs, even reproductive organs, if SC.  

         I can see both schools of thought.  The first is to keep on keeping on, and get every benefit to which you are entitled.

        Another is for you to relax and enjoy life, and not stress about VA appeals, claims, etc, especially if you have enough to live on.  

        Either of these choices is a good one, but you need to decide which is the best for you.  

        Knowing what I know now, Im not sure I would have kept on fighting VA for the past 10 years, I was already 100 percent in 2006.  (Of course, I had to fight them for that effective date, too).  

        For me, I have turned mine over to the lawyers, and I let them fight.  Im tired of fighting them.  Its well worth 20 percent to me, even tho I mostly dont have to pay that 20 percent attorney fee because I hired an attorney at the right time:  right after a BVA denieal, so EAJA has paid "virtually all" of my attorney fees.  

        This plan of turning it over to attorney's works for me, even tho I am at least as knowledgeable of VA law as most of the people on this board, except for Berta and Alex.  

         Its much more fullfilling for me to help others, than to worry about my own claim.  

[toomnyhats]

Thanks for all the information Berta!  My VSO is the one that told me that.  She said they could go back and reverse their decision.  I don't understand that because from what I read, since I have 100% rating for loss of use of legs, don't I fall under the "5 year protection" where they can only reduce or reverse if there is clear evidence of improvement (that's not going to happen..been like this since 2003 and just getting worse).  I'm also 56 years old and I read that they look at 55 as the age where it would be difficult to make a living with a veteran's disabilities if they are high enough.

"Do you mean they awarded the 100% -as secondaries, and also awarded 60% for the bladder?"   They awarded the bladder and tinnitus and then we filed the NOD and form 9.  The bladder was linked because in my str there is a reference to bladder spasms a week or so after I had a c-section.  To me that's a CUE but again...."not supposed to rock the boat".   The bladder and the bowel should both be secondaries to the spinal cord injury in my neck...that is when both were diagnosed outside of the military.  Plus it's a no brainer that those two almost always go hand in hand with the significant damage to my cord.  I surmised that maybe they awarded because they felt the bladder could have been damaged during the c-section since they have to move/pull off the bladder in order to access the uterus but there was really no clear explanation.  

 What level of SMC  are you at now?  I am at an M

•  K for loss of hand
•  l for loss of both feet
• l and a half for loss of three extremities
• m due to the separate 60% bladder and 100% loss of legs (again, they don't see them as related)  

 

And this is where I saw the supra pubic rating.  I can't remember where I read that it should be rated at the higher rate but none the less, here is where it is mentioned:

7516 Bladder, fistula of:
Rate as voiding dysfunction or urinary tract infection, whichever is predominant.
Postoperative, suprapubic cystotomy	100

 

And I'm still not sure about the loss of use of legs with loss of sphincter putting me at an O.

Thanks,

toomnyhats

 

[Berta]

Could you possibly scan and attach here the part of the decision you are appealing and also the Evidence list they used?  Cover your C file name, address prior to scanning it .

I cannot possibly see them reducing you- I think many VSOs make that crap up- it means less work for them.

Many of them don't do much work anyhow.

I will go over all of your past posts-to see if I can find anything there to help me understand this more.