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Fat

Question

Back in late 2010 I filed a claimed for chronic tonsillitis, I previously in early 2010 had surgery for my tonsils.

The issue for tonsils was listed in my military medical records and subsequent problems since 2003 forced me to have surgery in 2010.

The claim was denied based on "by not having tonsils, I couldn't have tonsillitis".

Crap..............

I began to consider the triumvarte (three levels) of evidence needed.

a. Inservice evidence (check)

b. current diagnosis (check)

c. continuous medical treatment or nexus letter (check)

An ENT diagnosed me with tonsillitis and that is what facilitated me to have surgery.

At the least should I have received a temporary 100 rating for recovery time from the surgery?

 

The VA rational is once I had surgery that eliminated the tonsillitis.

However I conclude, the tonsillitis was present since service and was medically dealt with through surgical means.

I either should be service connected for tonsillitis and the residuals that made me have to have surgery or I should receive temporary 100% percent status based on recovery from the surgery.

 

I am seriously thinking about getting the denial reopened and arguing the merits of service connection or 100% temporary status.

 

All answers and opinions are welcomed.

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  • Moderator

Starting with the basics is a great idea.  Not sure "where" you got the "triumvarte", but let me summarize the Caluza elements which may answer at least some of your questions.  

1.  Current diagnosis.  Sounds like you have that.  So far, so good.

2.  Documentation of In service "event" or "aggravation".  We are rolling.  

3.  Nexus, or doctors statement that your current diagnosis is at least as likely as not due to your in service event.  

     "Chronicity", which you mentioned in number 3, yes is important, too.  If you sprained your ankle in service, but have no medical conditions, or treatment and it resolved itself, you wont be getting compensation.  You need to have an issue that continues to bother you "now", not just in service.  

    To get compensation, you need to have "symptoms".    What are your symptoms of tonsillitis?  If you have no symptoms, even if you are able to get service connected, it will likely be at 0 percent.  The VA compensates us for "symptoms" especially those which interfere with our ability to earn a living.  You will need these symptoms documented, also, by a doctor.    

    Lets move on to temporary 100 percent.  Yes, you can get "recovery time" for surgery that is service connected, but you are gonna have to get it service connected, first.  No Service connection = no temp 100 percent for surgical recovery.  To get it SC, see the above.  

    As far as the VA's rationale that the tonsilectomy "cured your symptoms", now that may be a error.  The rating specialist is not a medical professional and his unsubstantiated medical opinion can not be substituted for a qualified medical professional who has opined otherwise.  

     Now, did you appeal this (denial)?  Was the denial within the past 12 months?  If the decision was in the past 12 months, then you can file a nod disputing the denial.  I do think you should do that provided that you continue to have symptoms from the tonsillitis.  If you have no current symptoms related to this, then my advice is not to appeal it "unless" there is a real chance that you could have secondary conditions related to tonsillitis.  A hypothetical example (not sure if applicable) would be if a doctor said your tonsilectomy led to your Obstructive sleep apnea that you are currently being teated for.    Again, if you have current symptoms, then appeal, but absent those symptoms, I think you will go nowhere slow.  

     

      

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  • HadIt.com Elder

Bronc has it pretty much nailed. Can't get the temp 100% unless it's s-c. I was looking up the diagnostic code for tonsillitis to see what the ratings would be based on your symptoms. Confusing to even find the dc. What are your symptoms now? What dc are you trying to connect to? You may have been wronged, but you have to have a current diagnosis based on symptoms, not what you went thru before.

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Well if I can get the time before the surgery service connected (Jan 2010 thru June 2010), then can I ask for temporary 100 for the service?.

I would be getting the tonsillitis and its residuals before surgery service connected. The claim was filed before the tonsillitis episode which led to surgery.

The inservice event, current diagnosis, and treatment were present.

Triumvarte is a Roman term. It acknowledges when the empire in its last stages had three Roman Emperors controlling different factions of the empire.

Summation dictates I was suffering from tonsillitis, had a in service bouts of illness, and suffered a subsequent bout with the illness that necessitated surgery.

 

The VA is wrong to concur because I had surgery that the tonsillitis was invalid.

The tonsillitis was valid during the claim and surgery fixed the issue.

 

I should at least be service connected for the time I was suffering from the illness and receive subsequent temporary 100% status for the surgery and recovery afterwards.

 

Is my logic not valid??????

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  • HadIt.com Elder

Fat\WHAT DID THEY SAY IN THE DENIAL?

What We Decided''?

I would think it could be service connected but now that  your tonsils  have been surgically  removed (2010?)   you might try'' loss of use''..if you can get a qualified Dr give a good medical rational as what they are used for.

I have no Ideal what are tonsils are for?

I never have heard a Veteran service connected for tonsils removal? 

you may  can look at the reason behind this (why the surgery) infected but why were they infected?  if an underlying problem ? then a secondary claim can be claimed. being tonsils are a part of our body  if the Military removed them while you were in  then loss of use criteria or secondary claim should be look at?

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  • HadIt.com Elder

I had a Navy Veteran had  some teeth extracted  and they left a deep hole in his mouth   penetrating the outer mouth. they gave him a cover up or some type of devise in his mouth where the teeth use to be (to cover the hole) (not  partials) but he has infections all the time and problems eating   were trying to get all this Service connected.

I am not sure what they call it  but he had mouth surgery after the tooth extraction and it literally left a hole in his mouth as to where out side air could get in if he was not carful placing the devise in his mouth...it looked awful..I never seen anything like it.

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  • HadIt.com Elder

Tonsils are supposedly used to help the body's protection from respertory infections. So Fat, do you have sinus and other breathing problems frequently. That would fit the "loss of" issue. Have to s-c it and get an IMO from a rep. doc to say that the removal has that frequency effect I should think. 

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