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Buck52

A Veteran I am helping

Question

Posted (edited)

HE Served in Japan...had a tumor removed from his mouth  back malar  they removed the tumor and that left a gapping hole in his mouth where the tooth was...ok the surgeon mention to him he would need additional surgries for this   he was medically discharged after serving 4 years in US Navy ..He applied at the time of his discharge and 2 month later was awared S.C. AND 10% for this tumor that was removed while still on active duty 

He recieved this 10%s.c. award for this surgery as I understand it back in Feb of 2018  so he still is open for a NOD.

OK he is out now and went to the VAMC to require about theses other surgeries the VA Japan Dr mention he needed, the Stateside in Dallas Tx VAMC SAYS NO HE DON'T NEED ANY SURGERY  IT WILL ONLY MAKE MATTERS WORSE..

What can this veteran do  get a second opinion from a private Dr? he don't have any medical insurance and is not currently employed .

he currently lives with his parents....but I think they either want him to work if he is able to or get help with VA.

OK I KNOW WE NEED MEDICAL RECORDS  BUT HE WANTS TO FILE FOR INCREASE ON THIS...I WILL HAVE HIM TO NOD THE DECISION FOR THE 10% AND RE CHECK THE CRITERIA FOR WHAT THEY RATED HIM FOR (This type surgery)

I NEED TO SEE HIS AWARD LETTER? ...WE MAY SEND IN THE NOD and submit other evidence later  when we get his  c-file and other medical records from Japan, TO SEE IF ANY SECONDARY'S CAN BE FILED FOR OTHER CONDITIONS AT THIS TIME.?

the 21-526 ez IS THE FORM FOR INCREASE CORRECT? OR THE NOD FORM  21 -0958

This type claim is new to me.

Any help I can get or advise is much appreciated.

Thanks

Edited by Buck52

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It would be worth getting a second opinion about the surgeries. Ask for a review from a different oral surgeon or the dental clinic chief. It is possible the guy who said it could get worse is right or inexperienced.

Don't forget about secondary claims due to the results of the SC condition. I can only imagine the mental concerns about it due to what he had to endure. Secondary anxiety/depression, and possibly even PTSD could be factors. And then the medication they give him to treat his condition. Look for any side effects which produce a rate-able disability, SMC-K for ED, too. I imagine he is also being given NSAIDs, which can jack up his digestive system. If he has headaches, factor those in too.

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Code 9917: All benign neoplasms (tumors or oral lesions) of the mouth and teeth are rated on the main structures of the mouth that they affect. So if the tumor affects the teeth, it would be rated under code 9913. If it affects the hard palate, it is rated under code 9911. If it causes disfigurement, it is rated under code 7800, etc. 

Code 9911: If any portion of the hard palate is missing, it is rated under this code. If half or more has been lost and it cannot be replaced by a prosthesis, it is rated 30%. If less than half has been lost and it cannot be replaced by a prosthesis, it is rated 20%. If half or more has been lost and it can be replaced by a prosthesis, it is rated 10%, and if lessthan half has been lost and it can be replaced by a prosthesis, it is rated 0%

Code 9913: Regardless of how many teeth are missing, if they can be replaced by a prosthesis or false teeth, then it is rated 0%. If, however, they cannot be replaced, they are rated as follows:

All teeth missing is rated 40%. The loss of all the upper teeth or all the lower teeth is rated 30%. If all the upper and lower posterior teeth or all the upper and lower anterior teeth are missing, it is rated 20%. If only all the upper anterior teeth or all the lower anterior teeth are missing, it is rated 10%. If all the upper and lower teeth on one side are missing, then it is also rated 10%.

 

 

Sounds like he is rated on the hard palate damage? You need to know what his award says on this before appealing. 

 

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Yes  I agree with you both.

Were getting together Sat  he is coming to my home and hopefully he will bring his Award letter, and I can talk with him about it and other possible secondary's   if he has any? I'll let him know what his options are as for as filing these claims as secondary.

I believe he is rated under the hard palate DC 9911...I need to recheck that, He mention they did make him a partial plate where the Back Molar was extracted and the tumor removed  but he contends there is still a hole there  when he takes the partial plate out.(reason for the surgeries I would think?)....also many more questions to ask him about other condition's he may or may not be experiencing. ?

PTSD maybe a good start?

 

Thanks Vync & pwrslm

 

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Posted (edited)

I met and talk with this young veteran today, USN  

This surgery was after he finish boot camp and was at his duty station in Okinawa Japan  Approx four months into his military service. OF 2014 &.  SERVED 4 YEARS

He had two molars extracted  the one on the right side  gave the dentist problems and this is when they found the tumor under his 3 molars on his right side,After extraction of these 3 teeth to remove the tumor they had to cut the bone (gums) back completely and 3 inches leaving a gaping hole at this spot &   bone /skin graft was necessary  to build up to fit a partial plate, they took a big gap from his left leg thigh area about the size of a 3/1/2 inches  by 7 1/2 inches out of this part of his leg...leaving a big big scar. (big scar)

He was flown from Okinawa Japan to San Diego Navel Base to have this surgery  after a few weeks in the hospital he was flown back to Japan to finish his tour of duty about 4 years.

He was Honorably Discharged not medically discharge like I had mention earlier.

He used a VSO at the VMC, She filed a 21 526 ez and also a ITF,  she filed 1st week in Jan 2018 and he got his decision Feb 14th 2018..fast claim turnaround. (Not with RAMP) Just traditional claims process.

I am thinking because he had all this while on Active duty.

He had a few other conditions they filed on  and they filed on the tumor or where the tumor was leaving a gaping hole,but was fitted with a partial plate and since they fitted him with a partial plate it is consider a prosthesis and rated at 0% according to the rating criteria for this particular surgery   also they filed on a scar  as to a skin graft they use in his mouth where the tumor was... the scar is about 7 inches long and about 3/1/2 wide   it is painful to him when he moves a certain way and his paints rub on the scar, he says it bothers him from being numb ..

He has Patellofemoral pain syndrome in both knees, they S.C His right knee at 10% but S.C the other knee at 0%...He is going to disagree on this.

He has the form  21 -0958 NOD to appeal.

He is going to NOD THE 10% As the Rating critera for that according to his pain and ROM should be either 20%or 30%   he will say he disagrees with the 10% and rate the knee to its highest degree allowed by Law set forth in the Rating Criteria in the CFR's (give the #) and ask for all his S.C. Condition be rated  allowed by Law according to the rating criteria #

He went to the VA Dentist about his tumor problem (the hole it left in his mouth) Dentist was a dentist that usually does fillings   this dentist look at it and mention to him the surgery is to much of a risk  than can or may cause bacteria infections and don't recommend he have the surgery...although this Dentist was not qualified to render a medical opinion such as this...he should have been referred to a specialist to inquire about this type surgery...he does have a partial plate to wear over the gaping ole in his mouth.

I requested to him to go Back to the Dallas dental clinic and request a specialist...the dentist he seen for it back in Feb 2018 was not qualified to render his opinion,   so he needs a specialist to say what his options will be?   have the surgery for more bone/skin grafts or do nothing? and ask for a reason why? THIS IS  CODE 5314

AT 40%

http://www.militarydisabilitymadeeasy.com/scars.html

I think he can get 20/30% rating for his Knees (Patellofemoral Pain Syndrome) And something for his big scar?

I need to check the rating criteria  but at lest the hard part is over  they S.C him. at 0% for all these other conditions.

What should he ask for on the surgery and skin graft scar?

Any advise or more information is greatly appreciated.

 

Thanks Everyone!!! 

Edited by Buck52

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Everyone, This is the Navy Veteran who served in Okinawa Japan

I got him to join Hadit, this is the Veteran I am helping out and everyone here  is certainly welcome to chime in.

His screen name on hadit is Palikat

Welcome to Hadit Palikat. glad to have you on board buddy.

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