Jump to content
HadIt.com Future: Zoom Meeting Dec 3, 2022 02:00 PM Mountain Time (US and Canada) - Join Us. ×
It Turns Out HadIt.com Is Not Dead Yet! ×
  • 0

VA Disability Claim Decision Rating Calculation


RBrogen

Question

Does anyone know if you can request that the VA provide you with the actual calculation they did to arrive at their final combined rating?  Something like this:

10% Left Knee Condition

Link to comment
Share on other sites

  • Answers 15
  • Created
  • Last Reply

Top Posters For This Question

Top Posters For This Question

Posted Images

15 answers to this question

Recommended Posts

  • 0
  • Moderator

Not exactly.  You can look up the criteria for your condition's in the 38 CFR's.  Then, you can compare your rating with the rating calculator on hadit to see if you "combine" them like VA math does.  These people would flunk math the way they do it.  If you dispute the decision, file a NOD..within a year.  

AFTER you get to the BVA, you can get a copy of the RBA.  Then you can see the rating sheet.  Talk about "due process" that's it.  

Edited by broncovet (see edit history)
Link to comment
Share on other sites

  • 0

If you go on eBenefits and hit the disabilities tab, it will show each condition and percentage.  It will also show not service connected claims, etc.

It will also show secondaries with the parent disability.

Hamslice

 

Link to comment
Share on other sites

  • 0

I use eBenefits all the time to see my over all percentage. The only problem it does not show which disabilities are considered bi-lateral where you get an extra 10% for each of those ratings. Flat feet will get you an extra 10% or left and right knee will also get you an extra 10%. I have 4 - 20% and 3 10% disabilities which are bi-lateral and I gain an extra 7% to the disability ratings.

 

Link to comment
Share on other sites

  • 0
1 minute ago, paulstrgn said:

I use eBenefits all the time to see my over all percentage. The only problem it does not show which disabilities are considered bi-lateral where you get an extra 10% for each of those ratings. Flat feet will get you an extra 10% or left and right knee will also get you an extra 10%. I have 4 - 20% and 3 10% disabilities which are bi-lateral and I gain an extra 7% to the disability ratings.

 

Hey Paul ... I use eBenefits all the time as well and am very familiar with the "VA Math".  I wish they did annotate which conditions were considered as bilateral in nature specifically.  I was just curious was there some way to actually get the VA to provide the breakdown of the exact calculation they used to arrive at the final combined rating percentage.  Without know exactly how they arrived at the calculation they arrived at, there's no way to double check and make sure you are getting an accurate rating.

Link to comment
Share on other sites

  • 0
  • Moderator

I think he means  

How does the VA come up with a %  of the disability its self?

not the calculation of the disability...as we all know is what our conditions is rating at or suppose to be rating at  from the rating CRITERIA schedule Sheet/Manual for our S.C.disability

Like bilateral combined ratings there's is a rating formula  for them  as they are a rating formula  criteria for them to decide how to rate our S.C. Disability

this is not in e-benefits

All I know is I look at my S.C. disability and look at the  criteria rating scheduled for that disability and the severity of that disability to make sure I'm not getting low-balled  or the wrong rating.

Link to comment
Share on other sites

  • 0
3 minutes ago, Buck52 said:

I think he means  

How does the VA come up with a %  of the disability its self?

not the calculation of the disability...as we all know is what our conditions is rating at or suppose to be rating at  from the rating CRITERIA schedule Sheet/Manual for our S.C.disability

Like bilateral combined ratings there's is a rating formula  for them  as they are a rating formula  criteria for them to decide how to rate our S.C. Disability

this is not in e-benefits

All I know is I look at my S.C. disability and look at the  criteria rating scheduled for that disability and the severity of that disability to make sure I'm not getting low-balled  or the wrong rating.

I am actually aware of what goes into the VA individual condition rating ... what I was/am looking for is to see if the va would provide the actual breakdown like my original post shows so that it shows exactly how they achieved the final combined rating, not the individual condition ratings.

Link to comment
Share on other sites

  • 0
  • Moderator

General Rating Formula for Mental Disorders

    Rating
Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 100
Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. 70
Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. 50
Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). 30
Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. 10
A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. 0

Note" for combined ratings maybe this link will help?

https://www.law.cornell.edu/cfr/text/38/4.25

 

Link to comment
Share on other sites

  • 0

@RBrogen In my decision letter it tells me, below is what I copied from my last decision from the VA.

60% from 02/23/2016 (Bilateral factor of 2.7 Percent for diagnostic codes 5279, 8520, 8520)
60% from 03/13/2016 (Bilateral factor of 2.7 Percent for diagnostic codes 5276, 8520, 8520)
70% from 09/13/2016 (Bilateral factor of 4.2 Percent for diagnostic codes 5276, 8520, 8520)
80% from 09/25/2017 (Bilateral factor of 6.3 Percent for diagnostic codes 5276, 8520, 8520, 8526, 8526)
90% from 05/26/2018 (Bilateral factor of 7 Percent for diagnostic codes 5276, 8520, 8520, 8526, 8526, 5251,
5251)

Let me know if this is what you are looking for.

Thanks Paul

 

Link to comment
Share on other sites

  • 0
1 minute ago, paulstrgn said:

@RBrogen In my decision letter it tells me, below is what I copied from my last decision from the VA.

60% from 02/23/2016 (Bilateral factor of 2.7 Percent for diagnostic codes 5279, 8520, 8520)
60% from 03/13/2016 (Bilateral factor of 2.7 Percent for diagnostic codes 5276, 8520, 8520)
70% from 09/13/2016 (Bilateral factor of 4.2 Percent for diagnostic codes 5276, 8520, 8520)
80% from 09/25/2017 (Bilateral factor of 6.3 Percent for diagnostic codes 5276, 8520, 8520, 8526, 8526)
90% from 05/26/2018 (Bilateral factor of 7 Percent for diagnostic codes 5276, 8520, 8520, 8526, 8526, 5251,
5251)

Let me know if this is what you are looking for.

Thanks Paul

 

That is very close Paul ... yes 

Link to comment
Share on other sites

  • 0
  • Moderator

The VA is supposed to explain the decision and why they arrived at a certain percentage.  Its remandable error when VA fails to give an "adequate reasons and bases for decision".   They should show how your condition meets the rating critieria in the CFR's but no higher.  If you feel they should have assigned the bilateral factor, you can likewise appeal it.  

Shinseki tried to get rid of the required "reasons and bases" for decision.  Im glad he did not.  

If you feel their reasons were gone for bilateral factor, you can appeal it, arguing you are entitled to bilateral factor, citing the regulations.  

Bilateral factor means both joints are involved, such as the right knee and left knee.  Often, if you injure one knee, the other will suffer similar symptoms.  You body "limps" for the injured knee and inflicts damage to the better knee.  If you have symptoms documetented in your file showing both joints are affected, then I suggest you appeal for the bilateral factor.  

Its one thing to be blind in one eye, quite another to be blind in both eyes.

If they failed to explain the bilateral factor, then your remedy is appeal.  

The reasons and bases for decision is where they explain it.  There are attorneys who literally make a living appealing on an inadequate reasons and bases for decision.  The CAVC will remand it every time..if the reasons and bases are inadequate.  

Further, the VA has to rationalize their decision based on the criteria.  They can not rate on "non criteria", which is everything else but the criteria found in the cfr's.  You can appeal if they denied for "non criteria" reasons.  

For example, I was denied hearing loss because "it was too long since military service".  I looked in the criteria.  "Length of time since military service" was not there.  I had an in service event (excessive airplane noise), a diagnosis of hearing loss, and my audioligist had also provided a nexus linking my hearing loss to exposure to loud jet engine noise because my barracks was at the end of San Diego airport runway...I showed them on a map!!  

When they denied based on "length of time since service" it was a "bluff".  Its non criteria.  But, if I bought it and did not appeal, it would become final in a year.  This is a tactic VA often employes.  They make stuff up, and if you dont appeal, it becomes final in a year.  

Edited by broncovet
add more.. (see edit history)
Link to comment
Share on other sites

  • 0
1 hour ago, broncovet said:

The VA is supposed to explain the decision and why they arrived at a certain percentage.  Its remandable error when VA fails to give an "adequate reasons and bases for decision".   They should show how your condition meets the rating critieria in the CFR's but no higher.  If you feel they should have assigned the bilateral factor, you can likewise appeal it.  

Shinseki tried to get rid of the required "reasons and bases" for decision.  Im glad he did not.  

If you feel their reasons were gone for bilateral factor, you can appeal it, arguing you are entitled to bilateral factor, citing the regulations.  

Bilateral factor means both joints are involved, such as the right knee and left knee.  Often, if you injure one knee, the other will suffer similar symptoms.  You body "limps" for the injured knee and inflicts damage to the better knee.  If you have symptoms documetented in your file showing both joints are affected, then I suggest you appeal for the bilateral factor.  

Its one thing to be blind in one eye, quite another to be blind in both eyes.

If they failed to explain the bilateral factor, then your remedy is appeal.  

The reasons and bases for decision is where they explain it.  There are attorneys who literally make a living appealing on an inadequate reasons and bases for decision.  The CAVC will remand it every time..if the reasons and bases are inadequate.  

Further, the VA has to rationalize their decision based on the criteria.  They can not rate on "non criteria", which is everything else but the criteria found in the cfr's.  You can appeal if they denied for "non criteria" reasons.  

For example, I was denied hearing loss because "it was too long since military service".  I looked in the criteria.  "Length of time since military service" was not there.  I had an in service event (excessive airplane noise), a diagnosis of hearing loss, and my audioligist had also provided a nexus linking my hearing loss to exposure to loud jet engine noise because my barracks was at the end of San Diego airport runway...I showed them on a map!!  

When they denied based on "length of time since service" it was a "bluff".  Its non criteria.  But, if I bought it and did not appeal, it would become final in a year.  This is a tactic VA often employes.  They make stuff up, and if you dont appeal, it becomes final in a year.  

I did get a decision letter and it does explain for the most part how they reached their decision. I found that they left out several things when applying the rating:  For instance, I have a 2 claims, one for each knee. I'll post thee Right Knee as both are the exact same issue as I've had meniscus tears and scope surgery on both, 2x on Left and 1x on Right).  They only gave me Arthritis for each knee at 10%.  Shouldn't that be at least 20% because there are meniscus tears, popping out etc on both?

Here's what my decision letter has:

image.png.01c30a3e9f028e2a9c8f73e16194e631.png

Here is what my C&P wrote:

image.png.f5e0470cc9f8a2273b2a65975a667b88.png

Link to comment
Share on other sites

  • 0
  • Moderator

There may be "overlap" of symptoms between the arthritis and meniscal tear.  

Example:  Pain in your knee.  This could be caused by either, or both.  Maybe for loss of ROM, also.  

Pyramiding prevents you from being paid for the same symptoms twice.  In other words, if you are getting paid for "pain"in your knee from arthritis, you probably wont get paid again for pain in the knee from meniscal tear.  

You see this with mental health disorders a lot.  You could have multiple diagnosis..PTSD, depresstion, bipolar, schizo, etc.  

HOwever you will only get compensated for "1" set of symptoms, even if they are caused both from depression and bipolar, for example.  

Go ahead and appeal, but I would not be suprised if pyramiding prevents you from getting paid for both.  

Link to comment
Share on other sites

  • 0
1 minute ago, broncovet said:

There may be "overlap" of symptoms between the arthritis and meniscal tear.  

Example:  Pain in your knee.  This could be caused by either, or both.  Maybe for loss of ROM, also.  

Pyramiding prevents you from being paid for the same symptoms twice.  In other words, if you are getting paid for "pain"in your knee from arthritis, you probably wont get paid again for pain in the knee from meniscal tear.  

You see this with mental health disorders a lot.  You could have multiple diagnosis..PTSD, depresstion, bipolar, schizo, etc.  

HOwever you will only get compensated for "1" set of symptoms, even if they are caused both from depression and bipolar, for example.  

Go ahead and appeal, but I would not be suprised if pyramiding prevents you from getting paid for both.  

I'm not actually asking about pyramiding ... the claim for my knee should be 20% because of the meniscus not in addition too ... I wasn't sure originally if the VA would rate in addition to arthritis but only want the correct rating and to understand how/why the rating was given or not whichever is the case.

 

Link to comment
Share on other sites

  • 0
13 hours ago, broncovet said:

If you read this over, you can probably find your answer:

http://www.danaise.com/understanding-rating-for-knee-injury/

Great info Broncovet ... thank you.

Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.

Guest
Answer this question...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.



×
×
  • Create New...

Important Information

{terms] and Guidelines