Entitlement to pre and post surgery ratings to NOW service connected injuries.

[ArNG11]

I've been trying to find some guidance on ratings for scars and residual ratings for different grades of damage GRADE 2 and GRADE 3 on knees and hips but now am curious on ratings for all items that have been service connected.  Am I wrong in stating that these should have been done when service connections was established and the operative reports were in the  VA C FILE.  Hips, knees , and Nissen Fundlipication.  I am under the understanding that it will be 0 for scarring unless higher criteria is met but pre op and post operative ratings would apply. What I am finding is a 100% temporary rating for the recovery period 4months. Am I wrong in reading this.?

5054 Hip, resurfacing or replacement (prosthesis): For 4 months following implantation of prosthesis or resurfacing 100% 

The knees have the same 100% for 4 months following surgery with resurfacing noted as well.

Some guidance or references, I have been look under the CFR Part 4 Subpart B, are there any others?

[broncovet]

You asked:

Quote

Am I wrong in stating that these should have been done when service connections was established and the operative reports were in the  VA C FILE.  

No you are not wrong, you are correct.  Unfortunately, its often a "long winding road" to try to get VA to correct errors, such as not including issues which are in the record.  You may need to submit a "formal claim" for the benefit you are seeking, to get things rolling.  Once VA has "overlooked" this informal claim, its up to you to point it out to them, by applying, and seeking informal claim date.  

Prior to Feb. 2019, "Informal claims" were allowed.  One Vets advocate pointed out you could claim benefits written on a napkin.  

There are 2 tests for an "informal claim" (3, now, because informal claims are not allowed.  The 3rd test is the "date", that is, was the informal claim made before they were disallowed in Feb. 2019) When AMA was enacted in Feb. 2019, informal claims were abolished, and the applicable claim form was required.  But, if you have an informal claim prior to that date, it should be grandfathered in, in reference to your effective date.  

1.  An informal claim "for increase" has to be in writing.  I had an informal VOICE claim approved because, I called VA and the person I spoke with DOCUMENTED my claim.  (That is, wrote it down in my record).  

2.  The Veteran needs to "specify the benefit sought".  One such case I read indicated the Veteran "could point to the body part" to which he wanted to apply.  If the doctor indicated, "the Veteran pointed toward his left knee", that can suffice.  

     Source:  

Quote

(Authority: 38 U.S.C. 5110(a)) (b) Claim. Once a formal claim for pension or compensation has been allowed or a formal claim for compensation disallowed for the reason that the service-connected disability is not compensable in degree, receipt of one of the following will be accepted as an informal claim for increased benefits or an informal claim to reopen. In addition, receipt of one of the following will be accepted as an informal claim in the case of a retired member of a uniformed service whose formal claim for pension or compensation has been disallowed because of receipt of retirement pay. The evidence listed will also be accepted as an informal claim for pension previously denied for the reason the disability was not permanently and totally disabling. (1) Report of examination or hospitalization by Department of Veterans Affairs or uniformed services. The date of outpatient or hospital examination or date of admission to a VA or uniformed services hospital will be accepted as the date of receipt of a claim. The date of a uniformed service examination which is the basis for granting severance pay to a former member of the Armed Forces on the temporary disability retired list will be accepted as the date of receipt of claim. The date of admission to a non-VA hospital where a veteran was maintained at VA expense will be accepted as the date of receipt of a claim, if VA maintenance was previously authorized; but if VA VerDate Mar2010 14:46 Sep 09, 2014 Jkt 232146 PO 00000 Frm 00209 Fmt 8010 Sfmt 8010 Y:\SGML\232146.XXX 232146

 

Edited February 9, 2023 by broncovet

[ArNG11]

3 hours ago, broncovet said:

You asked:

No you are not wrong, you are correct.  Unfortunately, its often a "long winding road" to try to get VA to correct errors, such as not including issues which are in the record.  You may need to submit a "formal claim" for the benefit you are seeking, to get things rolling.  Once VA has "overlooked" this informal claim, its up to you to point it out to them, by applying, and seeking informal claim date.  

Prior to Feb. 2019, "Informal claims" were allowed.  One Vets advocate pointed out you could claim benefits written on a napkin.  

There are 2 tests for an "informal claim" (3, now, because informal claims are not allowed.  The 3rd test is the "date", that is, was the informal claim made before they were disallowed in Feb. 2019) When AMA was enacted in Feb. 2019, informal claims were abolished, and the applicable claim form was required.  But, if you have an informal claim prior to that date, it should be grandfathered in, in reference to your effective date.  

1.  An informal claim "for increase" has to be in writing.  I had an informal VOICE claim approved because, I called VA and the person I spoke with DOCUMENTED my claim.  (That is, wrote it down in my record).  

2.  The Veteran needs to "specify the benefit sought".  One such case I read indicated the Veteran "could point to the body part" to which he wanted to apply.  If the doctor indicated, "the Veteran pointed toward his left knee", that can suffice.  

     Source:  

 

Thanks Bronco I will look more into this, I don't want to start another battle with the VA but to be frank they started the WAR. Dang if Im not obliged to respond accordingly.

[ArNG11]

I did find some references on pre and post operative ratings.  Depending on whether the body part was service connected and whether it was a major or minor joint.  4 months of 100 % rating if major/ minor is what I have been finding.  I still have to see what Muskogee Regional Office is going to do. They didn't rate it in the last decision because they stated they did not have the operative reports, whether they ignored them is another matter, but I know I submitted them in those years of surgeries.  I was really just trying to take care of myself since the VA wouldn't so I used private insurance for these operations, not that it should have any effect.  Hmm, I may have some pondering to do after the decision Muskogee puts out.  Hurry up and wait.   Proactive , reactive , obsessed, maybe a little bit  of remorse in there as well, I'll just have to wait and act accordingly and try not to let those feelings cloud my judgement.