Claim denied for 2nd total knee replacement

[Rhodesia]

I found out that I will not be receiving the 100% temp for my 2nd total knee replacement on the same knee, the person on the other end of the 1-800 could only tell me that the VA says I'm not entitled to a 2nd 100% temp claim you only get 1 100% temp claim per service connected injury no matter how many times you have surgery on that same injury, they also told me that the CFR will explain why I was denied. I find that really odd, but I was told I would have to wait and read the letter that the VA sent out explaining why I was turned down and their opinion. They could not tell me anything more and if I wish I could see my VSO and file a NOD for the denied claim. This whole claim has taken a wrong turn in the wrong direction. So as of right now I remain at 40%. with a whole new knee for the second time again, interesting how the VA can find some way not to pay when everyone says you are entitled to the 100% Temp including the VSO. 

 

Status of Your Claim

COMPLETE

• Submitted: 08/01/2018 (Compensation)
• Claim Closed: 10/26/2018
• Disabilities Claimed: total knee arthroplasty (Secondary), knee replacement (Secondary), Temporary Total Disability (New)
• Representative for VA Claims: OREGON DEPARTMENT OF VETERANS AFFAIRS
• Current Status: Complete

Edited October 27, 2018 by Rhodesia

[Vync]

I would ask the 1-800 folks which regulation states that you could only get it once per SC disability.

You should receive your decision letter/SSOC any time now. That should provide additional information which you can look up to verify.

[Rhodesia]

8 hours ago, Vync said:

I would ask the 1-800 folks which regulation states that you could only get it once per SC disability.

You should receive your decision letter/SSOC any time now. That should provide additional information which you can look up to verify.

I saw the The VSO I'm working with Monday and told her what I was told so she called and was told the same thing. she could not read the letter at the time she has the ability to do that even before I receive it in the mail. The letter was completed on Friday 10/26/2018 and the letter was sent on Friday plus they hung up on her when she was trying to challenge her why I was denied the 100% temp for a service connected total knee replacement which was my second one on the same knee. The VSO was trying to explain to her that she never heard that a Vet is only entitled to 1 100% Temp for a service connected injury.  I was in the office listening in on the speaker phone, she sounded very nasty and hung up on her before she could finish her sentence.   The sad part is the person on the other line for the 1-800 number never gives you their last name or call center, which there only thee call centers in the united states for the 1-800 number. I just have to wait until the letter comes in the mail explaining why I was denied the 100% temp which would have been for the 13 month Temp, sad part is I'm still going through therapy for the knee I was granted 7 more additional weeks and the VA approved it through Tri West. and I had the Total Knee Replacement on June 4th 2018. If anyone out there has had this problem before please let me know how you handled it. 

Edited October 31, 2018 by Rhodesia

[pwrslm]

" the VA says I'm not entitled to a 2nd 100% temp claim you only get 1 100% temp claim per service connected injury no matter how many times you have surgery on that same injury, they also told me that the CFR will explain why I was denied"

Problem with this is that they are obligated to put that in writing and give a reason and basis for everything that they say related to the denial of benefits. If they VSO had an issue, I would bee-line this straight to the WH hotline first off. Take 2 weeks, and if they dont reply, call the WH hotline again. They must tell you the exact CFR, USC, and VA Policy reg that they followed, no exceptions. 

 

 

[Rhodesia]

27 minutes ago, pwrslm said:

" the VA says I'm not entitled to a 2nd 100% temp claim you only get 1 100% temp claim per service connected injury no matter how many times you have surgery on that same injury, they also told me that the CFR will explain why I was denied"

Problem with this is that they are obligated to put that in writing and give a reason and basis for everything that they say related to the denial of benefits. If they VSO had an issue, I would bee-line this straight to the WH hotline first off. Take 2 weeks, and if they dont reply, call the WH hotline again. They must tell you the exact CFR, USC, and VA Policy reg that they followed, no exceptions. 

 

 

Thanks I will give that a try after I see what was written, The VSO said she was going to push the complaint and the head VSO in the office was going to elevate it with a few calls. I think the VA can use some customer service training. No wonder us Combat veterans always has negative impressions I get better care in the private sector than I do at the VA hospital, sorry to say that but in reality it's true.

[pwrslm]

2 minutes ago, Rhodesia said:

Thanks I will give that a try after I see what was written, The VSO said she was going to push the complaint and the head VSO in the office was going to elevate it with a few calls. I think the VA can use some customer service training. No wonder us Combat veterans always has negative impressions I get better care in the private sector than I do at the VA hospital, sorry to say that but in reality it's true.

You will eventually figure out that a few idiots in the office are responsible for 95% of the problem, the rest are fairly competent and mostly professional.

[Rhodesia]

6 hours ago, pwrslm said:

You will eventually figure out that a few idiots in the office are responsible for 95% of the problem, the rest are fairly competent and mostly professional.

Thank you for the reply back to my posting.