How do you claim a known rated condition?

[wirat]

Hi all, I need some advice from those who know what I am seeking clarification on. How do I claim for what I already know is a rated condition?

I have been looking for go-bys and have found lots of instructions, but not really sure how to go about the descriptive wording to articulate what the claimed item is. For example, the samples on the claim form and the instructions say to "describe the disability", by symptoms, not by the scheduled diagnosis of the disability.

Let's take code 6604 Chronic obstructive pulmonary disease (COPD) as an example. The way I read the claim instructions, you would claim "difficulty breathing" or "pulmonary disease" or something like that rather than "6604 COPD". I understand the concept behind this is for the C&P exam/medical side and the VA to rate what the final diagnosed condition is, however, what if you already know you have COPD from extensive medical testing? Why should you have to beat around the bush and let the VA classify it when they may classify it as something else, in error, for less compensation, or whatever? 

Can't you simply claim what you have the evidence to show it is, and make them say yes or no?

Another example for instance, code 5203 shoulder AC separation, where the  clavicle is dislocated from the scapula, can't you just put that rather than "shoulder injury", etc., if you already know what it is from a Dr's diagnosis? So instead of them trying to say you have arthritis, or some other disability, how do you force them to address what you know is the correct rating classification for the  injury? For the VA I think it would be more of a verification issue than a diagnostic one.

Thanks for helping me understand a basic, yet confusing part of this process.

 

Edited January 26, 2019 by wirat

[brokensoldier244th]

Just claim it as that. That's all I've ever done, if I had a diagnosis.

[broncovet]

In order to be eligible for VA beneifts, a Veteran needs NOT ONLY a Phd in medical terminology, but another in VAola, plus a third Phd in VA law and diagnostic codes.  Otherwise, your claim will be denied, if your Phd is from a University that is not on VA's approved list.  

Seriously, not all Veterans are high school graduates, and I have met some that dont speak English!!!  Make sure you have 

a current diagnosis, an in service event, and a nexus, and that you apply on the applicable form, keeping a copy and sending it certified mail return receipt requested, since VA loves to lose your evidence.  

[toddt]

As long as you have the Doctor's diagnosis do as brokensolder244th said.  Include copies of the doctor's diagnosis.  Then the most important part will be that you have a nexus between the disabilities and a cause while on active duty.  The doctors have to say that x during your service was "at least as likely as not" the cause of the conditions you are seeking disability for.  The Caluza Triangle.

[ruby]

You can state your symptoms (symptoms are important)  and asked that it be rated as xxx at the percentage you think is correct for that dx.  I go to the CFR 38 chapter 4 find the exact wording the va says the percentage you think is correct and state your claim.  Then have you MD write it as such.  Submit your request, nexus,, medical notes, prescriptions (all evidence) medical articles including BVA decisions to support your claim.  No stone unturned.  The reasons for this is the effective date if it goes to a higher authority.

Example  dx code 8100 is for headaches to get 50% the va states this is for prostrating headaches and I had my doctor say that I had prostrating headaches.  No I didn’t get it as they forgot to rate or deny this claim.  

i asked for right and left cervical radiculopathy and that was granted for 30%  based on my mri and emg.  

i include the medication I’m prescribed for that condition and the side effects.

i also ask for the effective date if I know it for certain otherwise I don’t.  Such as I’m asking for eff 2008.  The DRO gave me eff 2006.

at the raters level I didn’t get anything I asked for at the DRO level I got everything I asked for.  I supplied abundance of evidence.

do as Bronco said never send anything that you don’t have copies of.  I have a VARO near me I drove there and date stamped every piece of paper I submitted.

good  luck

My purpose on somethings ie arthritis was to get it service connected and when it got bad I would ask for an increase as it was 0% at that time.

i once read  in a legal book to tell them what you want, it’s easier for them and your claim will go quicker.  I think I went from 30% to 100% secular in 3 yrs at the DRO level.

[wirat]

11 hours ago, ruby said:

"...You can state your symptoms (symptoms are important)  and asked that it be rated as xxx at the percentage you think is correct for that dx..." 

I may end up doing this. Just listing what the injury is and ask it be rated at what I think (know) it is. At some point you just have to point out the elephant in the room. I just want to say "why aren't you looking here and giving it this rating?". 

It's like an amputated foot is an amputated foot. And in my case, it's like the VA won't recognize or acknowledge the amputated foot, but gives 10% for arthritis instead of 40% for what the amputated foot is rated at. This must be an avoidance technique or something.

There are successful case appeals, my medical records are complete, it is already service connected. My current injuries all happened on active duty and I was treated in military hospitals. A no-brainier. There is no guessing involved, my only issue is that they failed to rate me with any %  a long time ago, and now older and wiser, I see there is a code for the exact same thing and many have been given 20% while they only gave me 0%.

Fighting the decision is not my issue, it's getting them to say you claimed "X" disability rating under code XXX, and yes we agree or no we don't and here is why...

If I ultimately get rated at the listed disability they originally gave me 0% on I'm going to consider a CUE for back pay because some things, like amputations, detached joints, etc. don't grow back and if it is rateable today it should have been back then.

Edited January 27, 2019 by wirat

[ruby]

If your service connect for amputated foot then ask for increase due to your current symptoms then say this  respresent 40% by CFR 38 xxxx then regurgitate what they say is 40%.  Remember your doctor needs to document your symptoms just the way the code says. Then you can add any BVA decision that backs your claim.

i include my medical records.

evidence:

dr va’s notes  dated xx xx xxxx. If I had a hundred of them I would document each and  everyone  by all doctors.

mri dated xx xxx xx dr xxxx regurgitate he’s findings.

the problem with arthritis is it’s usally rated by rom.  That’s rom without pain. If the pain starts at 10 degrees that’s where you stop.  Most people including me went as far as I could in pain.  My disability was 0%.  Read the regs for your disability , document the % the way they do make sure your doc does too.

like migraines are rated max of 30%. Whereas prostrating headaches under 8100 max is 50%.  It’s a game you have to play by their rules.  Regurgitate their rules in your claim.