prostate approved

[victor Gilkes]

Hi Everyone.  Rec'd approval for prostate cancer due to service connection with Herbicide exposure.  They gave me 20% after my C&P exam.  I told them I have go get up at night to use the bathroom 3-4 times and have to use bathroom during daytime every 2-3 hours.  They stated I would have gotten a bigger increase if I used the bathroom 5 times at night and every hour during the daytime. It already causes a inconvenience getting up 3-4 times at night and looking for a bathroom while out in public. 

Can I appeal the decision they made?  If so, what do I need to write up for the appeal?  Thanks for your support.

[doc25]

After doing some research for you there is a possibility that you were rated incorrectly. You may need to appeal.

I'm not trying to get your hopes up because this info requires it to be scrutinized by our more experienced members. I invite other members to please correct me if I'm wrong with any of the information provided.

 

You are SC for prostate cancer. – Prostate cancer, code 7528

Were you ever treated for it at a VA facility/other facility? Did you receive a temporary 100% rating while you were being treated for prostate cancer? Is the prostate cancer still active? Is it inactive now?

Code 7529: Benign tumors affecting the genitourinary system are rated based on how they affect the systems around them. For example, if the condition interferes with renal functioning, then it would be rated under the renal rating system.

 

Code 7528: Malignant cancer is rated 100% while it is active. This 100% rating will continue for the first 6 months after the last treatment. The condition will then be reevaluated. If it is no longer active, then it is rated on any lasting symptoms like a benign condition.

 

Notice the last sentence "If it is no longer active it is rated on any lasting symptoms like a benign condition". This is telling the rater to refer to code 7529.

7529 Benign neoplasms of the genitourinary system:
Rate as voiding dysfunction or renal dysfunction, whichever is predominant.

 

Code 7529 clearly states what you should have been rated as VOIDING DYSFUNCTION. Regardless, of what  your urinary frequency  symptoms are. Code 7529 clearly does not state to RATE AS URINARY DYSFUNCTION. It appears you were erroneously or deliberately rated to low-ball you. Why? This is the only rational explanation I could come up with below.

If they rated you as Voiding Dysfunction ; and your symptoms were to become worse (which they may get worse over time) Urinary Frequency is capped at 40%. VOIDING DYSFUNCTION is capped at 60%.

Urinary Frequency: A condition is rated under this system if it causes the body to urinate more often than normal. If you have to urinate 5 or more times during the night, or if you have to urinate more than every hour during the day, it is rated 40%. If you have to urinate 3 or 4 times during the night, or if you have to urinate every 1 to 2 hours during the day, it is rated 20%. If you have to urinate 2 times during the night, or if you have to urinate every 2 to 3 hours during the day, it is rated 10%.

Voiding Dysfunction: All urinary conditions that cannot be rated as urinary frequency or obstructed voiding are rated by this system. If the condition requires the use of a catheter or other urinary assistive appliance to remove urine from the bladder, or if the condition requires the use of absorbent materials (like pads or Depends) that must be changed more than 4 times a day, then it is rated 60%. If it requires absorbent materials that must be changed 2 to 4 times a day, then it is rated 40%. If it requires absorbent materials that must be changed only once a day, then it is rated 20%.

 

 

 

[broncovet]

Yes, you can appeal.  Mostly you need evidence that you qualify for the higher disability rating, to win your appeal.  If you have such evidence, I recommend an appeal  

[victor Gilkes]

Doc25, I appreciate your response.  I will look into it with my VSO.  I too felt they low balled me.  I have not given up the fight!  

[victor Gilkes]

On 2/13/2019 at 12:54 AM, doc25 said:

After doing some research for you there is a possibility that you were rated incorrectly. You may need to appeal.

I'm not trying to get your hopes up because this info requires it to be scrutinized by our more experienced members. I invite other members to please correct me if I'm wrong with any of the information provided.

 

You are SC for prostate cancer. – Prostate cancer, code 7528

Were you ever treated for it at a VA facility/other facility? Did you receive a temporary 100% rating while you were being treated for prostate cancer? Is the prostate cancer still active? Is it inactive now?

Code 7529: Benign tumors affecting the genitourinary system are rated based on how they affect the systems around them. For example, if the condition interferes with renal functioning, then it would be rated under the renal rating system.

 

Code 7528: Malignant cancer is rated 100% while it is active. This 100% rating will continue for the first 6 months after the last treatment. The condition will then be reevaluated. If it is no longer active, then it is rated on any lasting symptoms like a benign condition.

 

Notice the last sentence "If it is no longer active it is rated on any lasting symptoms like a benign condition". This is telling the rater to refer to code 7529.

7529 Benign neoplasms of the genitourinary system:
Rate as voiding dysfunction or renal dysfunction, whichever is predominant.

 

Code 7529 clearly states what you should have been rated as VOIDING DYSFUNCTION. Regardless, of what  your urinary frequency  symptoms are. Code 7529 clearly does not state to RATE AS URINARY DYSFUNCTION. It appears you were erroneously or deliberately rated to low-ball you. Why? This is the only rational explanation I could come up with below.

If they rated you as Voiding Dysfunction ; and your symptoms were to become worse (which they may get worse over time) Urinary Frequency is capped at 40%. VOIDING DYSFUNCTION is capped at 60%.

Urinary Frequency: A condition is rated under this system if it causes the body to urinate more often than normal. If you have to urinate 5 or more times during the night, or if you have to urinate more than every hour during the day, it is rated 40%. If you have to urinate 3 or 4 times during the night, or if you have to urinate every 1 to 2 hours during the day, it is rated 20%. If you have to urinate 2 times during the night, or if you have to urinate every 2 to 3 hours during the day, it is rated 10%.

Voiding Dysfunction: All urinary conditions that cannot be rated as urinary frequency or obstructed voiding are rated by this system. If the condition requires the use of a catheter or other urinary assistive appliance to remove urine from the bladder, or if the condition requires the use of absorbent materials (like pads or Depends) that must be changed more than 4 times a day, then it is rated 60%. If it requires absorbent materials that must be changed 2 to 4 times a day, then it is rated 40%. If it requires absorbent materials that must be changed only once a day, then it is rated 20%.

 

 

 

So my condition has gotten worst.  This has caused an increase of voiding dysfunction.  I am using the bathroom at least 5 times at night and every hour.  I have been going to an urologist at the DC VA med center.  He has prescribed two meds, Mirabegron and Tamsulosin to curb the amount of times I go to the bathroom.  Sometimes it works and most times it does not!  I need to put in for an increase.  It also has caused ED to become frequently.  It must be from the side effects of the meds.  Is this under voiding dysfunction?

So my condition has gotten worst.  This has caused an increase of voiding dysfunction.  I am using the bathroom at least 5 times at night and every hour.  I have been going to an urologist at the DC VA med center.  He has prescribed two meds, Mirabegron and Tamsulosin to curb the amount of times I go to the bathroom.  Sometimes it works and most times it does not!  I need to put in for an increase.  It also has caused ED to become frequently.  It must be from the side effects of the meds.  Is this under voiding dysfunction?

[GBArmy]

Victor, this is an old thread. Did you appeal your decision for a higher rate as advised before? What is the status of it?

[victor Gilkes]

On 9/11/2019 at 5:09 AM, GBArmy said:

Victor, this is an old thread. Did you appeal your decision for a higher rate as advised before? What is the status of it?

So my condition has gotten worst.  This has caused an increase of voiding dysfunction.  I am using the bathroom at least 5 times at night and every hour.  I have been going to an urologist at the DC VA med center.  He has prescribed two meds, Mirabegron and Tamsulosin to curb the amount of times I go to the bathroom.  Sometimes it works and most times it does not!  I need to put in for an increase.  It also has caused ED to become frequently.  It must be from the side effects of the meds.  Is this under voiding dysfunction?

So my condition has gotten worst.  This has caused an increase of voiding dysfunction.  I am using the bathroom at least 5 times at night and every hour.  I have been going to an urologist at the DC VA med center.  He has prescribed two meds, Mirabegron and Tamsulosin to curb the amount of times I go to the bathroom.  Sometimes it works and most times it does not!  I need to put in for an increase.  It also has caused ED to become frequently.  It must be from the side effects of the meds.  Is this under voiding dysfunction?