Improving on SC 0% or did I blow the chance

[CapnHaddock]

I was given service connected 0% for a bunion left foot and 0% for bilateral hammer toes.  After finally getting tired of the pain (and being ignored by VA medical) I went outside (other insurance) and had the bunion and one of the hammer toes repaired.  That surgery failed due the severity of the bunion and two surgeries later I now have a plate with 5 screws holding the big toe immobilized and the toe next to it was shortened to relieve stress on the foot.  The VA is giving me pain meds for the foot and I have not tried to increase the rating on this foot.  I probably should do this, but I am not sure if I blew that chance by having the surgery out in the civilian community outside of the VA.  My question is can I increase this rating now that I have had some repairs done to the foot by someone else than the VA?  The pain is less (but still requires meds on occasion and if I had waited longer the repair may have not even been possible).  I am SC 100% P&T for the last 6 years.

[ShrekTheTank]

I am sure you can have it increased, but the bigger question is why when you at 100% P&T?  Would this make it so you could get SMC?  

I just think you need to know if it is worth the fight.  If it is then go for it, but if it does nothing else then IMO it wastes a bunch of time an resources.  

[Lemuel]

I think the fights are worth it.  You do not want a big fight with a lot of issues like mine.  Take them one at a time as they come up and try to get them handled properly even if you have to give some back pay to a NOVA attorney or firm.

I have a lot of issues now and not sure how many CCK will want to bring up.  Too many at one time makes it harder to get justice on any one issue unless you are trying to get SMC and they all count to that.  Still seems it would have been easier to get SMC if all issues were resolved and no requests for additional ratings were needed.

[CapnHaddock]

I appreciate the thoughts - I will probably end up with going after SMC most likely sooner than later.  The degradation I am experiencing in a number of ortho issues is leading to that.  However, my question is really a simple yes or no answer - If an individual seeks outside treatment (Outside the VA Medical Arena) for a Service Connected issue, can that person still request a re-evaluation for an increase?  Will seeking outside treatment result in nullifying that request?

[broncovet]

Go for an increase AND for SMC.  (They could be one and the same).  Example:  SMC S is a single 100 percent, plus an additional 60 peercent, (combined) seperate and distinct.  While I dont know what your other disabilities are, this increase "could" get you SMC S, and an extra 450 or so per month.  

OR, if you have "loss of use" of your foot.  (And I dont know that), then ask for that as an increase also.  SMC for a foot loss of use will help, depending upon the rest of your disabilites.  

[Lemuel]

16 hours ago, CapnHaddock said:

I appreciate the thoughts - I will probably end up with going after SMC most likely sooner than later.  The degradation I am experiencing in a number of ortho issues is leading to that.  However, my question is really a simple yes or no answer - If an individual seeks outside treatment (Outside the VA Medical Arena) for a Service Connected issue, can that person still request a re-evaluation for an increase?  Will seeking outside treatment result in nullifying that request?

Veterans often get outside medical treatment and evaluations for "independent medical opinions."  (IMO)  And should do as you have done, because VA examiners, even the contract ones, go through training to do more than weed out false claims.  They have to strictly follow examination orders and cannot go anywhere the examination leads them contrary to 38 CFR Chapter 4.  

For example:  My thumb/wrist joint has been excluded from my wrist claim for years.  Still do not have an evaluation on the ankylosis of that joint.  Only the flexion of the wrist as a whole because I claimed a "wrist problem".  Same goes for a "hearing problem".  Any examination of the wrist is supposed to be of the wrist as a whole.  Any examination of a hearing problem should automatically include decibel loss and tinnitus.  You should not have to claim each joint separately, especially if multiple joints are involved.  You should not have to assess and define the audiology of your hearing loss. You are not a doctor and should not have to self-diagnose.

Those are the examiners problems that they have been trained to assess and should not be limited in assessment, according to 38 CFR, but somewhere in the VABA C&P process there is authority to limit examinations paid for by the VABA.

I do not know if CCK will get me EEDs that I made motions for in the BVA decision that was remanded by the CAVC.  Too few specifics in the joint motion for remand.  Not clear if the remand was for a "legacy hearing" or for AMA.  I was angry at the pro bono VA attorney who did not get specifics in the remand and in fact allowed the VA GC to get a vague limitation in the remand.

[Lemuel]

As a Navy medic, I was trained to not self-diagnose and treat.  Doctors are trained the same way.  We discuss diagnosis and treatment with our medical caregiver but we try to state the problem to cover all bases incase our thinking has left something out that is important that the caregiver is trained to draw out of us in pursuit of diagnosis so treatment is the right treatment.

I will bring this up to CCK in a short email.  It covers a lot of issues in my appeal.  Limited examinations cause physical damage as well as financial damage.  Something may have been missed by your PC that the C&P examiner may pick up if allowed to do so.

CAPN, ask your treating physician for an "etiology as well as a statement of disabling" in an Independent Medical Opinion report.  He should state how long he has been treating you and why you opted for his treatment instead of VA treatment.  VAHA physicians are also limited in not being able to discuss etiology in their medical documentation of treatment. This would be a good statement as an additional reason to not go to the VA if you can afford or have access to outside treatment.  Why have limitations put on your medical review that may cause other medical caregivers to miss something in your care.