Left Knee rating decision under ramp 7 months to decision

[Richard1954]

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 March 24, 2019 by Richard1954
spelling

[Richard1954]

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. 

 

[broncovet]

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.  

[broncovet]

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 March 27, 2019 by broncovet

[Richard1954]

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....

[Buck52]

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   

[Richard1954]

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.