VA Disability Claim Decision Rating Calculation

[RBrogen]

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

[Buck52]

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

 

[paulstrgn]

@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

 

[RBrogen]

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 

[broncovet]

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 March 19, 2019 by broncovet
add more..

[RBrogen]

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:

Here is what my C&P wrote:

[broncovet]

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.