Unsure if this is right forum..after knee replacement and already 100% p&t

[Jims]

Just a quick question..i have been 100% p&t for 19 yrs this month. Am 63 ys old .  Finally had to break down and get knee replacements..just finished right..left in Dec.  My va hospital has me community cared out to civilan ortho surgeon.

Will they reevaluate me due to knee replacements automatically?  I am not going to submit a claim or say anything as am already 100 %.  Should i worry about getting a reeval paper in the future?

Are the  Va hospitals and VA raters sort of like 2 separate entities? Will hospital report replacements to va raters

 

Thanks a million

Jim

Edited November 18, 2023 by Jims

[Dustoff1970]

Your 100% P&T rating is very close to the VA 20 year total protected rating status mark as after 20 years they cannot reduce or terminate your rating by law unless they prove you committed fraud in obtaining your rating.

If your knee replacement disability is separate from your 100% disability/s caused then you should be very safe in filing a claim for the KR if you have solid medical evidence for direct or secondary service connection to a VA diagnosed and rated disability.  Or you can file claim for aggravation of a non service connected disability.

After 19 years it is very highly unlikely the VA will reevaluate your other disability/s unless those disability/s are bone related to your KR.  Then you can file for SC of KR or additional increase of other bone disability for maybe SMC additional compensation.  Need to know what is your 100% for???.

A VSO officer at a VARO regional office or some VA hospitals can provide you with free of charge advice and assistance.

My comment is not legal advice as I am not a lawyer, paralegal or VSO.

Edited November 18, 2023 by Dustoff1970

[broncovet]

I agree with dustoff and will add:

Since you are over 55, you also have significant protection for VA to reduce your rating(s)

https://www.woodslawyers.com/va-55-year-old-rule/

"Fear factor" (of reduction) is the reason many people dont get the benefits they deserve, but instead "settle in" to live in poverty out of fear of reduction.  VSO's and VA employees sometimes add to this fear, by saying things like "dont poke the bear".  And the VA wonders, with advice like that, "why" we dont trust the VA!!!!  Its highly inconsistent with the 38 CFR's, one of which I will post below.  

Quote

§ 3.344 Stabilization of disability evaluations.

(a) Examination reports indicating improvement. Rating agencies will handle cases affected by change of medical findings or diagnosis, so as to produce the greatest degree of stability of disability evaluations consistent with the laws and Department of Veterans Affairs regulations governing disability compensation and pension. It is essential that the entire record of examinations and the medical-industrial history be reviewed to ascertain whether the recent examination is full and complete, including all special examinations indicated as a result of general examination and the entire case history. This applies to treatment of intercurrent diseases and exacerbations, including hospital reports, bedside examinations, examinations by designated physicians, and examinations in the absence of, or without taking full advantage of, laboratory facilities and the cooperation of specialists in related lines. Examinations less full and complete than those on which payments were authorized or continued will not be used as a basis of reduction. Ratings on account of diseases subject to temporary or episodic improvement, e.g., manic depressive or other psychotic reaction, epilepsy, psychoneurotic reaction, arteriosclerotic heart disease, bronchial asthma, gastric or duodenal ulcer, many skin diseases, etc., will not be reduced on any one examination, except in those instances where all the evidence of record clearly warrants the conclusion that sustained improvement has been demonstrated. Ratings on account of diseases which become comparatively symptom free (findings absent) after prolonged rest, e.g. residuals of phlebitis, arteriosclerotic heart disease, etc., will not be reduced on examinations reflecting the results of bed rest. Moreover, though material improvement in the physical or mental condition is clearly reflected the rating agency will consider whether the evidence makes it reasonably certain that the improvement will be maintained under the ordinary conditions of life. When syphilis of the central nervous system or alcoholic deterioration is diagnosed following a long prior history of psychosis, psychoneurosis, epilepsy, or the like, it is rarely possible to exclude persistence, in masked form, of the preceding innocently acquired manifestations. Rating boards encountering a change of diagnosis will exercise caution in the determination as to whether a change in diagnosis represents no more than a progression of an earlier diagnosis, an error in prior diagnosis or possibly a disease entity independent of the service-connected disability. When the new diagnosis reflects mental deficiency or personality disorder only, the possibility of only temporary remission of a super-imposed psychiatric disease will be borne in mind.

(b) Doubtful cases. If doubt remains, after according due consideration to all the evidence developed by the several items discussed in paragraph (a) of this section, the rating agency will continue the rating in effect, citing the former diagnosis with the new diagnosis in parentheses, and following the appropriate code there will be added the reference “Rating continued pending reexamination ______ months from this date, § 3.344.” The rating agency will determine on the basis of the facts in each individual case whether 18, 24 or 30 months will be allowed to elapse before the reexamination will be made.

(c) Disabilities which are likely to improve. The provisions of paragraphs (a) and (b) of this section apply to ratings which have continued for long periods at the same level (5 years or more). They do not apply to disabilities which have not become stabilized and are likely to improve. Reexaminations disclosing improvement, physical or mental, in these disabilities will warrant reduction in rating.

    I dont know what you are SC for, but in what world does your knees getting worse so bad you need surgery, means you improved?  If your leg gets blown off by an IED, and VA gives you a wooden leg, is the VA supposed to say, "Ah heck, what do you need more benefits for?  You seem to be walking on your wooden leg, so why should we pay you for the one that got blown off?"  

    No, the VA does not cut your benefits because you persisted and were able to overcome at least some of the difficulties of having a missing leg with your wooden prosthesis.  

   Here is a well known example:

https://www.duckworth.senate.gov/about-tammy/biography

   Bottom line:  Go ahead and apply for any increase you deserve, such as SMC (housebound), SMC Aid and attendance, SMC K, Smc for loss of use, as applicable to your situation.    Ratings do not stop at 100 percent, they go up to SMC R2, which is over $10,000 per month.  ITs a common misconception that you cant go over 100 percent disability rating with VA.  I personally earn over and above the 100 percent rating.  https://www.va.gov/disability/compensation-rates/special-monthly-compensation-rates/ with SMC S.  aka "Statuatory" housebound.  

   

   

[Jims]

Thank you..my other disabilities are PTSD, bilateral hips, bilateral ankles, lower back, hips and ankles and back  secondary to knees, right shoulder, and a couple other things  All in all it totalled over 200 percent but with their method of adding, they got it to 100 %..a lot of djd because of my gait etc ffom the knees

I understand about SMC.  Thank you

If I dont apply for anything, am I required to report the replacement to them?  Or will VA hospital do that?  Or will they just know?

 

I went through the hassles of getting my rating to 100 percent..the nightmare many of us know.  19 years ago it took me 14 years of that game to get there.  Really dont want to reenter it if I can avoid it.

Thanks folks

Jim

 

Edited November 18, 2023 by Jims

[Dustoff1970]

Usually and ordinarily the VA hospital medical system does not automatically report their treatments for you of either service connected or non service connected conditions unless you file a claim for their treatment or diagnosis.  Then the VA raters will request the VHA medical records in order to adjudicate the claim.  VHA will not send medical info to the VA raters unless requested by you or the raters for a claim you filed including claim for increase.

If you are hospitalized for a 100% temporary condition then I understand the VHA may report this to the VARO raters.  Others can fact check me on this and provide more clarifications.

My comment is not legal advice as I am not a lawyer, paralegal or VSO.

Edited November 18, 2023 by Dustoff1970

[broncovet]

If you are 200 percent, there is a great chance you qualify for SMC S (statuatory housebound).  It happens when you have a "single" 100 percent disability, plus an additional 60 percent combined "seperate and distinct".  

The VA should have considered/awarded you for this "when" you got your 100 percent.  

If the VA did not award this, and you meet the above criteria, in bold, you should apply for it.  

If awarded, you should get back pay to when you first met the criteria.  A c and p exam should not be required for you to get SMC S (statuatory) housebound.  It sounds like you may already meet the criteria, so dont throw away  about $400 per month, plus backpay, if you qualify.  

    If you already have more money than you need, you can still apply and donate some/all of it to hadit and/or others of your choosing.  

[Dustoff1970]

As usual Broconvet is very correct in his advice to you. 

Quote

 

My comment is not legal advice as I am not a lawyer, paralegal or VSO.