Jump to content
  • 0

Left Knee rating decision under ramp 7 months to decision


Richard1954

Question

Normally I would post this under winning claims, but because this was a claim rated under the ramp system I am listing the results here.

First , I don't actually have the envelope in my hands, I am going by what shows on Ebenefits, which in my case has been consistent when listing actual service connected disability.

I submitted my left knee claim secondary to my service connected right knee claim on Sept 2016, under the legacy system. I had provided an Independence medical opinion which indicated more likely than not. The C/P examiner  however indicated it was less likely than not, and  in fact went back ( I think it was ) 32 days later and come up with a different reasoning for more likely than not.  The VA is required to give the benefit to the veteran if the evidence is equally balanced, but in this case they ignored the IMO, and denied the claim in May 2017. Needless to say i appealed the decision, citing the IMO, and destroying the opinion of the C/P examiner who was a NP and had no business doing C/P exams.  I requested a DeNovo review.  In Sept 2018, against my initial decision, I reluctantly opted into ramp for this and other claims.  In Jan 2019 I was given another C/P exam, this time by a local Chiropractor,  who is also a Nurse Practitioner.  (I will never understand why the VA thinks anyone with a medical degree is qualified to do a c/p exam) I must admit I felt good about the exam and the examiner, but I have felt good in the past about other exams, and the examiner only to be denied, so I was expecting another denial regardless. ( The VA has us questioning our own feelings about many things this is just one).  I found on ebenfits that a decision was made and I was granted 10% for my torn meniscus. The effective date  was back to the Sept 2016 claim date. Until I actually receive the brown envelope I have not idea how the rater came to his conclusion, I suspect the IMO together with the new C/P examination results both indicated more likely than not.  So from the time I opted into ramp Sept 2018, to March 2019, seven months have passed.  I find that amazing, but this was not a hard case to decide, in fact, I also received a denial on my request for an compensated rating for my hearing loss presently rated 0%. 

Once I receive the brown envelope,  I will let the board know how and why it was approved.  

Most of you know that I am rated 100% just for my lung disease, because of use of oxygen. At one point I was also rated TDIU for my back disability that is rated 60%. The TDIU was revoked when I received my 100% rating in 2017.   If I were to lose my 100% rating on my lungs,  my ratings combined would still put me at 97 rounded up to 100%.  Yes I have a lot of medical issues. In fact I was admitted to the Hospital on 14 Feb 2019  for Blood clots in my lungs, and  I just go out of the Hospital again  ( 20 Mar)  after 6 days for a gall bladder surgery,   I still live on to fight the good fight.  And I give thanks every day for the Medical Professions of Darnell Army Medical Center, and Brook Army Medical Center.  My doctor actually saved my life when he discovered multiple blood clots in my lungs. And they went way out on a limb doing surgery on me because, of my lung disease, minor heart condition, and being overweight, They are my true heroes and my grandchildren love them for it......What a wake up call,  Now its time for a serious diet and to become more responsible for my eating habits.

 Some of you might ask why would I put myself thru the anguish of a new claim for a lousy 10% rating ( does not include the bilateral factor). The answer is simple, I do not believe the VA raters are out to get me, or any veteran,   all of my rating come from actual disability incurred  in  service or secondary to a service connected issue. I firmly believe  if you have a disability that you honestly believe should be service connected you should make the claim and see what happens.  I have never trusted the "so Called" expert Service officers, who  say lay low, the VA could decrease your rating.  I have never seen the VA go back and re-rate something that was not requested by the veteran.   I think most Service Officers are over worked, and under educated to actually understand the rating system. My case is complex, from TBI, to lung diseases , to back issues,  and many other small issues rated at 10%. If I had listened to Service officers, I would never have received my adapted housing grant, or increases in my A&A.  I advocate that any veteran no matter how small the rating may be, file the claim if you have faith that it is valid. 

Edited by Richard1954
spelling (see edit history)
Link to comment
Share on other sites

  • Answers 15
  • Created
  • Last Reply

Top Posters For This Question

15 answers to this question

Recommended Posts

  • 0

Richard, you said "I have never seen the VA go back and re-rate something that was not requested by the veteran."

I am in exactly that position.  I requested an earlier EED on my TDIU condition and they decided to reconsider my neuropathy rating.  It is at the DRO level and I am curious to see if they are going to try to reduce me.  I do not believe in the "don't rock the boat attitude" but never put anything past the VA.  This is the same RO that tried to sever one condition and reduce another when I was in appeals for a higher rating.

Link to comment
Share on other sites

  • 0
  • Moderator

Actually My VA Audiologist  filed a claim for increase  he seen I was s.c. for hearing loss but at 0%   so I guess he put in the increase for me? I never did .

only I had Appeal the 0%  so I guess the VA Audiologist  the guy who tested my hearing and word discrimination test did it.....I was increase form 0% to 50%   I had Appeal the 0% .....so yeah if you get a good friendly caring VA Doc they can put in for your increase if you meet the increase criteria.

Link to comment
Share on other sites

  • 0

Ok as I said I would post the information my letter contains when received.

It really says nothing or much of anything:

Left Knee found to be secondary of right knee injury,  10%

Compensable  rating for hearing denied remains at 0%

It really doesn't give a statement of the case and how they came to the decision,  only what the decision was

so I have requested copies of the C/P exams to see what the examiners said. 

 

I have already sent the appeal for my hearing off  to the BVA 

Link to comment
Share on other sites

  • 0
  • Moderator

As for me, I would not even consider filing for benefits where the best result would be to stay at the same compensation.  And I certainly would not appeal it.  You see, when you dont have a "single" 100 percent, that makes you ineligible for SMC S, statuatory.  So, adding another 10, 20, or even 50 percent wont increase your compensation, when you are already at 100 percent.  

It also would not appear to help your spouse get DIC either because you are unlikely to die of the SC conditions of hearing loss or a bad knee.  

In other words, it appears to be "moot" applying for or appealing knee issues or hearing loss when you are already at 100 percent.  

Link to comment
Share on other sites

  • 0
  • Moderator

I would appeal both and go get an IMO from A LICENSE CERTIFIED AUDIOLOGIST   use the VA Guidelines, and Maryland CNC Word test.

if your word test meets the VA Criteria  that will help but its very hard to get any degree rating for Hearing loss unless your darn near deaf,  but if you have bad word discrimination  (not understand what people said)   will help,  also if you have a ringing in your ears   this is known as Tinnitus   it pays 10% for both ears.

Same with your Knee...As Broncovet mention  there's not any more $$ in the pot  but if you get these rated now it can help you later on in the future for SMC.s ,

These small 10%/20%All % Add up   even if your 100%.at present.

Remember if your 100% and can get another  rating of 60% or combined ratings  you can meet the SMC Criteria.

Link to comment
Share on other sites

  • 0
2 hours ago, broncovet said:

As for me, I would not even consider filing for benefits where the best result would be to stay at the same compensation.  And I certainly would not appeal it.  You see, when you dont have a "single" 100 percent, that makes you ineligible for SMC S, statuatory.  So, adding another 10, 20, or even 50 percent wont increase your compensation, when you are already at 100 percent.  

It also would not appear to help your spouse get DIC either because you are unlikely to die of the SC conditions of hearing loss or a bad knee.  

In other words, it appears to be "moot" applying for or appealing knee issues or hearing loss when you are already at 100 percent.  

I guess this is were we will agree to disagree.  First to be sure I actually have 3 ways to get to a 100% rating.  One is a straight out 100% and if I were to lose it I would go back to  TDIU  or they would combined  me at 100% because of all my ratings.  I was automatically awarded Housebound with +60, then I applied for and got A&A at  L 1/2 . If I took your advice I would not have A&A @ L 1/2  right now. I also would never have gotten my Adapted Housing grant because it was denied the first time around. These 10% ratings add up fast, and in this case I also got the bilateral rating.  Let  me be specific. I have been rated 100% since Feb 2005 for my Lungs, from Nov 1999 until Feb 2005 I was TDIU my back issue.  Since my 100% rating, I have  received a 50% rating for apnea,  40% for a TBI, 30% for my eyes,  and 10% for my left Knee.  These added up real quick,  and  I was  already rated 60% for Asthma, 60% for my back, and  6 additional 10% ratings,  I have managed to go from a 80% rating with TDIU to a straight 100% rating.  All those other ratings add up to more compensation in SMC.   I had always advocated and will continue to advocate that if you have a condition that you think should be service connected apply regardless of your current rating. Since I am already 100% over 10 years, my spouse qualifies for DIC. When I went from TDIU to 100% my wife was awarded a second round of Chapter 35 benefits,  that is 8 years of college benefits paid for by Uncle Sam.  So even when you don't think you can benefit from the small ratings  in the present, they will add up to something in the future.  The bottom line, is that my military service really screwed me up and over the years I get worse and worse, and I have been medically retired from civil service because of my service connected disabilities. Damn if I am not going to try to get every little thing I can squeeze our of the government  especially since I gave them the best  years in my life from 17 years old on.  Also one other point, we never know when the VA or congress with change the rules  they  keep talking about taking away TDIU from those over 65,  eventually they will . It just makes sense to add up as many ratings as possible if you can regardless of your present rating. 

Link to comment
Share on other sites

  • 0
1 hour ago, Buck52 said:

I would appeal both and go get an IMO from A LICENSE CERTIFIED AUDIOLOGIST   use the VA Guidelines, and Maryland CNC Word test.

if your word test meets the VA Criteria  that will help but its very hard to get any degree rating for Hearing loss unless your darn near deaf,  but if you have bad word discrimination  (not understand what people said)   will help,  also if you have a ringing in your ears   this is known as Tinnitus   it pays 10% for both ears.

Same with your Knee...As Broncovet mention  there's not any more $$ in the pot  but if you get these rated now it can help you later on in the future for SMC.s ,

These small 10%/20%All % Add up   even if your 100%.at present.

Remember if your 100% and can get another  rating of 60% or combined ratings  you can meet the SMC Criteria.

Buck I agree .... I am going to see a licensed audiologist and get an IMO. I have been fighting the VA on my hearing for years.  Each year my hearing gets worse based on the test alone,  and when I have a test that indicates I qualify for a Compensable ratings  they then do a C/P exam where they increase the DB's so that I can understand most words. Normal hearing is at 50-60 DB when talking. They crank up the volume to 85 DB when doing the C/P and then say I don't qualify for a compensable rating. I know hearing ratings are hard to get, but it seems when you actually qualify they still deny it by changing the way the test is given. I even asked one examiner why they increase the DB when doing the test for a C/P and I was told flat out that when doing it for a C/P exam they must increase the volume by va rules , but when doing a test just  to verify hearing loss they are just looking for the range where hearing aids help. 

 

Link to comment
Share on other sites

  • 0
  • Moderator

Not exactly.  I did not suggest you "forego" applying for SMC.  But, an additional 10 percent or whatever isnt going to increase your compensation.  Only additional SMC..over and above, will increase it.  Since you are already A and A, it makes it particulary difficult for you to receive additional compensation with "%" ratings.  

You would need "loss of use" to get any additional compensation.  You dont have to agree..you can keep fighting...but for what?  Unless you have loss of use (SMC), then additional percent ratings wont help you.  

Link to comment
Share on other sites

  • 0
  • Moderator

Buck..Richard1954 is already SMC L1/2, according to his post, which means he can not get additional compensation UNLESS he can get a higher SMC.  And, all of the ratings higher than SMC L require loss of use, OR higher levels of A and A, such as if you need 24 hour nursing care.  To get higher levels of Aid and Attendance, you have to show that you need a higher level of caregiver.  

In other words, your wife could probably feed you, or help you to the bathroom.  But it would take a nurse if you need IV's, or other medical equipment.  Additional SMC is the only way for you to increase your rating, so if you want that to happen you should focus on that, and not concern yourself with "moot" percentage ratings.  Your compensation, since you are A and A, wont increase if you are at 200 percent, even if you get another 100 percent rating.  Additional compensation requires additional SMC.  

SMC is explained here:

https://asknod.org/2013/02/27/special-monthly-compensation-what-is-it/

Yes, the 10 percent here and there "add up", but they make no difference in compensation beyond SMC L.  

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

  • 0
1 hour ago, broncovet said:

Buck..Richard1954 is already SMC L1/2, according to his post, which means he can not get additional compensation UNLESS he can get a higher SMC.  And, all of the ratings higher than SMC L require loss of use, OR higher levels of A and A, such as if you need 24 hour nursing care.  To get higher levels of Aid and Attendance, you have to show that you need a higher level of caregiver.  

In other words, your wife could probably feed you, or help you to the bathroom.  But it would take a nurse if you need IV's, or other medical equipment.  Additional SMC is the only way for you to increase your rating, so if you want that to happen you should focus on that, and not concern yourself with "moot" percentage ratings.  Your compensation, since you are A and A, wont increase if you are at 200 percent, even if you get another 100 percent rating.  Additional compensation requires additional SMC.  

SMC is explained here:

https://asknod.org/2013/02/27/special-monthly-compensation-what-is-it/

Yes, the 10 percent here and there "add up", but they make no difference in compensation beyond SMC L.  

I have had a discussion with Nod concerning SMC's , he like myself is convinced that the way 38 USC 114(P) reads, entitles a veteran a 1/2 step increase for any multiple  50%  independently  rated or 100% independently rated condition however this conflicts with the M21 which indicates only one step increase is allowed.  So its going to take the BVA or court to determine which is the controlling authority.  My goal has never been about additional 10 or 20% ratings, but  sometimes you have to go in steps as I did with my back injury from 10% to 40 and finally 60%, or my lungs from  10 to 30 to 60 and finally 100%.. No one really wants to be found more disable, but that is the only way to get to the next level of compensation.  By the way, I am already rated loss of use of my left foot,  but I was never granted a separate rating  for it because it was considered part and parcel of my back injury, so I only received a SMC K for it.  If I were to request reevaluation of my back, I don't think I could get a 60% rating under the more recent rating guides, while I would  get a rating for the loss of use, (drop foot) and the damaged nerves would get rated,  they would all be lower ratings than my present 60%, We all know that its better to have a 60% rating than 2 or 3 lower ratings, because va combines the ratings.So I just leave that rating alone even though my back is always a problem, and I am using a wheelchair because of a combination of my foot, back, knees and lung problems,  Because of the foot drop,  I am also entitled to a converted ramp van with the  adaptive equipment. ( VA doesn't pay for the van , only conversation of the van which in my case was $43000 alone.)  I started this trip with a 30% combined rating in 1986, so it has been a long road to get to where I am now..  The biggest problem I see with getting fair compensation is someone like my self who is rated 100% because of the use of oxygen,  but  has 3 conditions under lung diseases,  while someone else may get rated 100% because of the use of oxygen but that person only has one condition. Technically, I am  rated  but not compensated for the two additional conditions ( asthma, COPD, and Sleep apnea).  And the VA doesn't grant additional SMC 's just because I have 3 separate conditions, technically I am more disabled than the guy with  one lung disease. It is what it is.. I just try to make the best out of it all....

Link to comment
Share on other sites

  • 0
  • Moderator

I apologize if I was wrong about going for the other conditions.

But its to the Veterans advantage if they do. (jmo)

 For Hearing loss and Knee conditions, but even though they may not be any comp for these conditions  it depends on what they are rated at.

The Hearing loss if its S.C. AT 0% he needs to get a private IMO hearing test from an ENT Clinic that uses a specialist, if his hearing is bad enough to get a 50% rating   that will help if he ever gets completely deaf.

an increase is a increase any any condition/disability.

Severe Profound hearing loss should be rated at some degree and not just 0%

As for as the VA Audiologist turning up the sound to conduct the word discrimination test/or ..you should spoke up and let the VA Audiologist know your only hearing a loud blast and can't understand a word they say.

They usually turn up the sound and ask if you can hear their voice commands ok?...this is the opening to say  I ONLY HEAR A LOUD BLAST AND I CAN'T UNDERSTAND A WORD YOU SAID.  or something close to this before the hearing test gets underway. They have to find a comfortable setting  so the Veteran can hear what he hears at a certain volume setting.

Its not a fair way to check hearing loss in my opinion   we don't live in a sound prof room and we don't wear headphones to amplify what we hear or don't hear  you either can hear or you can't.

I agree with Richard they do turn up the volume controls.

During the testing of each ear they are suppose to start out a 1000 Db and increase it from 1000.to 5000Db as they conduct the test as the Veteran hears what is coming through the head phones  the beeps high pitch sounds and what knot, if a veteran hears something  but not sure?  its better they increase the volume to make sure, if a person can't understand what is being said in a hearing test its best to not say anything or raise your hand /or press a button until your absolutely sure of what was said  or what you hear  never do it if its what you thought you heard.

  • Air conduction testing - sounds of different volumes and frequencies (low, middle and high) are played through headphones, and you press a handheld button when you hear them. The audiologist will gradually make them softer, testing the quietest sounds you can hear until they reach your ‘threshold’ of hearing at each frequency.
  • Bone conduction tests - a vibrating sensor is placed behind the ear to test how well sound travels through the bones in the ear (again, you will press a button when you hear a sound).  

The test results, which are recorded on a graph called an audiogram, will show the audiologist whether your hearing loss is likely to be conductive or sensorineural. They will explain this to you and you can ask for a copy of your audiogram if you wish.

Depending on what the hearing test shows, the audiologist may ask you to take some different tests. The procedure and results should all be explained to you, so do ask questions if you’re not clear about any of the details.

You will be asked a number of standard questions about your ears, hearing problems and any other symptoms you've been experiencing. You’ll be asked about your family history of hearing problems, general health and your lifestyle - for example, your leisure activities. These answers, along with the results of the hearing tests, are vital to help the audiologist establish what solution is most suitable for you. 

A lot of people with hearing loss has bad word discrimination, they may can hear but they can't understand what their hearing and guess of what was said  99% of the time  its never what you ''thought'' they said   

Link to comment
Share on other sites

  • 0

Buck52

You Said :

  "A lot of people with hearing loss has bad word discrimination, they may can hear but they can't understand what their hearing and guess of what was said  99% of the time  its never what you ''thought'' they said " 

This happens to be my biggest problem.. so they give me hearing aids, but all that does for me is  increase the sound, they do not help  me understand what I am hearing.  Eventually,  I just stopped asking  people to repeat theirselfs.  Using or not using the hearing aids results in the same question.. What did you say?  After a while people  also get tired of repeating what they say and stop associating with you as if you have some kind of disease they are afraid to catch.

 

Link to comment
Share on other sites

  • 0
  • Moderator

I certainly understand what your saying   it happens to a lot of veterans with hearing loss.  Happens to me everyday  with two highly priced Hearing aids blue tooth reay (which VA paid for them)  these are my 4th set of aids..if you have tinnitus that only increase this problem...but I learn to mask it a little but its still drives me batty.

 they are suppose  to rate the loss of hearing without hearing aids  this is why it's very important to make sure you absolutely hear these tones and beeps..if its a Low Fade beep or tone wait until the Audiologist turns up the Volume or Amplify;s the sounds so you can hear and hear  it good.

 and during the word testing   the more words you get wrong the less % on the word discrimination test .

90% word discrimination is fairly good   a lower % is worse like a 58% that means your having problems understanding words and sentences.

Note: some think that the higher the word discrimination testing is the worse the percentage but its the lower percentage.

I was denied hearing loss on my original claim  appeal and got S.C. AT 0%   I appealed that and with a different Audiologist at  The VA  He ask me if I was getting a percentage for my S.C. Hearing loss? I said no not yet I appeal the 0% 

 anyway he let me know I have a severe profound hearing loss...after this audiologist sent in this test  I was approved for 50% hearing loss,,,at the time HAD I known to appeal the EED I could have got more retro  but hine sites 20/20 .

I wish I had known then what I know now and read about and research over the years  here at Hadit  and learn from the hadit elder members...this was about 22 years ago (in 5 years of Appeals) but won my claim in Feb 2002 ,,,>16 1/2 years ago so they make that my effective date. Although I  first filed for hearing loss and S.C. in 1998

Edited by Buck52 (see edit history)
Link to comment
Share on other sites

  • 0

In Sept 2018 my word discrimination  was 68% for the right ear and 80 for the left, this was at 35 DB.   I had another  c/p exam in Jan by a private examiner but I do not have a copy of the results yet.

in Sept 2017 they had me at 80% for both left and right ears at 100 DB. I complained that the test was tainted because 100 DB is too loud for normal hearing.... 

In Aug 2016 the test had me at  r 94% at 95 DB and L at 96% at 75 DB

In my appeal I indicated that it doesn't seam right that the examiners kept raising the level of sound so that I could better understand the words 

I have appealed the recent denial to the BVA , but I will see a private examiner to test me under va rules to see what they come up with. 

I would not have opened this claim unless I thought I had a compensateable claim.

I am not very happy when reviewing my hearing test back to 2013  where the  word discrimination was

60% on my right at 65 DB  then examiner then raised the db's to 80 and that gave me a 76% word discrimination ,  the left was 92% at 65 DB. 

 

It just seems to me that there is no standard for the word discrimination test that examiners just raise the level of the volume to get what they consider a better result and every time I open a new claim the VA shoots it down, by giving me another exam for C/P that again raises the volume of the test

Frustrated to say the least. Been rated at 0% since 2005.

The VA has  been giving me new hearing aid every 5 yeas ever since 2005, most days I don't even bother putting them in because of the increased background noise and because  I hear some noises that are unpleasant to listen too,  on top of that like you I have tinnitus that gets worse  toward the end of the day.  

It has been confirmed that the right ear is worse than the left and they even did CT scans of my head to make sure it was not something else causing the loss on the right side 

 

Link to comment
Share on other sites

  • -1
  • Moderator

Go get a Private Hearing test Make sure the Dr uses the test in concede-ration of VA Guidelines and use the Maryland CNC word test   they can call the VA Audiology Clinic and get the Maryland CD or let them know where they can get it.

  Most Audiologist do know and may have the Maryland CD  to test you  its the only word test the VA will Allow for compensation Purposes 

Take you old test from the VA and after the private Dr gives you his test  ask him to compare the results of both test...if you show A PROFOUND HEARING LOSS ask this Dr to give his opinion of his test and the level of hearing loss...Most Dr will do that (you might say that you may purchase some Hearing Aids from them in the future...(but you don't really need to because you can get them from the VA For free (just saying)

Use a Specialist ...if the VA has two Dr with different medical test  they usually will go with what the specialist says.

He needs to put his/her credential down and experince. (that Helps) rebute the VA Dr.

If your Service connected at 0%  thats a good start  now you just need a rating   based off your hearing test #'s

Link to comment
Share on other sites



×
×
  • Create New...

Important Information

{terms] and Guidelines