MULTIPLE RATINGS FOR KNEE ISSUES QUESTION

[Galen Rogers]

Howdy all. I have a question regarding my rating approved for both of my knees. Originally the VA granted service connection for my right knee torn meniscus and subsequent repair (10% - DC 5259).  My current claim requested an increased rating for my right knee due to increased problems with it. I also requested secondary connection of my left knee due to a fall caused by my right knee giving out. They granted the left knee request at 10% and they left the right knee at 10%. I read on one of the VA law blogs that the BVA has ruled that we can get rated for multiple DCs for our knees if the meet the requirements of each one. I'm planning on submitting a NOD to disagree with the 10% for a single DC. I plan to state the right knee should be rated 10% under DC 5259 for the original medial meniscus tear repair, and 20% under DC 5258 for additional tears to both the medial and lateral meniscus caused by numerous falls by my knee giving out. I have the 2001 original MRI and the current one showing the increased damage.

I also plan to state that I disagree with only the 10% for the left knee due to pain and reduced motion. Not sure which DC they actually used for that one. I will state that I should be given that 10% and also an additional and separate 20% under DC 5258 for the various tears in the left knee meniscus. 

Both knees currently have effusion into the joint, have frequent episodes of locking, and painful motion. 

Finally the decision letter actually confirms I have "degenerative arthritis" in both knees and then states I am not entitled to the higher 20% rating for it so I will also challenge that. 

Should I also add that I should get the additional and separate 20% for the degenerative arthritis und DC 5003?

VA Claim Decision Ltr 08 Nov 2018.PDF

Redacted Right knee New & Old MRI Details.docx

[jfrei]

Make sure your receiving a bilateral factor rating since it’s both your legs. 

[Galen Rogers]

Not sure what you mean by "bilateral factor rating". They did give me 10% for each knee due to the Meniscus being torn.

[jfrei]

Left and right leg means you should be have a bilateral computation if those are the only two things it’s means nothing really but if you have other disabilities included it does...

[broncovet]

Ok.  Make sure you understand, we dont get paid for a "diagnosis".  While a diagnosis is one of the required Caluza elements, we get paid on "symptoms" not diagnosis.  

"Pain" is a symptom.  "Loss of range of motion" is a symptom.  "loss of use" is a symptom.  

Pyramiding prevents getting paid for a symptom, for the same joint or body part, twice.  

Disorders that are "asymptomatic" (that is, with a diagnosis, but no symptoms) are almost always rated, if at all, at zero percent.  

We dont get paid for suffering an injury in service.  Instead, we get paid for the symptoms this injury may have caused us, on a more permanent bases.  

As an example, I fractured my leg in service.  Do I get paid for that?  Nope.  However, if this fracture develops arthritis in that joint, has painful scars that have not healed properly, or it causes a loss of range of motion preventing me from earning a living, then that is what is compensable.  If you read the schedule of rating disabiliities, you will see that there is a direct relationship between the amount and degree of symptoms, and the disability percentage.  No symptoms equates to no compensation.  Multiple, severe, devastating symptoms garner the higher disability ratings, usually up to and including 100 percent if those symptoms prevent you from maintaining substantial gainful employment, that is, from working.  

[broncovet]

I hear VEts all the time expecting a similar disability rating for (diagnosis A) for a particular body part.

and also (diagnosis b) . 

This will only work if diagnosis A and diagnosis B have a seperate set of symptoms.  

If they both have the same symptoms, you normally dont get paid for both diagnosis.  

If you read the schedule for ratings of mental health disorders, for example, this should make sense.  

You could be diagnosed with PTSD, bipolar, depression and MST.  However, you will be rated ONLY on the worst set of symptoms, and you wont get "4" .  100 percent ratings, one for each mental health disorder diagnosis.  

 

 

[doc25]

1 hour ago, broncovet said:

Ok.  Make sure you understand, we dont get paid for a "diagnosis".  While a diagnosis is one of the required Caluza elements, we get paid on "symptoms" not diagnosis.  

"Pain" is a symptom.  "Loss of range of motion" is a symptom.  "loss of use" is a symptom.  

Pyramiding prevents getting paid for a symptom, for the same joint or body part, twice.  

Disorders that are "asymptomatic" (that is, with a diagnosis, but no symptoms) are almost always rated, if at all, at zero percent.  

We dont get paid for suffering an injury in service.  Instead, we get paid for the symptoms this injury may have caused us, on a more permanent bases.  

As an example, I fractured my leg in service.  Do I get paid for that?  Nope.  However, if this fracture develops arthritis in that joint, has painful scars that have not healed properly, or it causes a loss of range of motion preventing me from earning a living, then that is what is compensable.  If you read the schedule of rating disabiliities, you will see that there is a direct relationship between the amount and degree of symptoms, and the disability percentage.  No symptoms equates to no compensation.  Multiple, severe, devastating symptoms garner the higher disability ratings, usually up to and including 100 percent if those symptoms prevent you from maintaining substantial gainful employment, that is, from working.  

I agree. VA Symptomology 101 is in session.

Which is why it's also always beneficial to keep building medical evidence for symptoms related to SC conditions or secondary conditions.

Edited December 15, 2018 by doc25