tdiu One Condition = 60%= 100% Tdiu

[Guest jangrin]

If a veteran has a condition with multiple SC ratings but the VA combines them for the purpose of TDIU and they equal 60% disabling --will that then qualify the veteran to the TDIU? For example,

PN (feet) bilateral 21%

Heart (CAD) 30%

DMII 20%

HTN/HBP 10%

________

60% - Does this then mean that because all the individual disabling processes are combined under DMII for TDIU thus making this veteran eligible for TDIU at 100%.

But then also if these disabling processes continue to worsen they also are rated serately in the event the verteran asks for an increase in the rating for any of these SC conditions.

Please correct me if my thinking is wrong on this.

[Guest Dataman]

No, but....

The Reg calls for one item at 40% and total of 70%, but it can be waved.

[Philip Rogers]

If a veteran has a condition with multiple SC ratings but the VA combines them for the purpose of TDIU and they equal 60% disabling --will that then qualify the veteran to the TDIU? For example,

PN (feet) bilateral 21%

Heart (CAD) 30%

DMII 20%

HTN/HBP 10%

________

60% - Does this then mean that because all the individual disabling processes are combined under DMII for TDIU thus making this veteran eligible for TDIU at 100%.

But then also if these disabling processes continue to worsen they also are rated serately in the event the verteran asks for an increase in the rating for any of these SC conditions.

Please correct me if my thinking is wrong on this.

jangrin, read 38 CFR 4.16b for your answer.

pr

Edited April 8, 2007 by Philip Rogers (see edit history)

[Guest jangrin]

Aren't all of the SC'd listed in this post related to a condition of one etiology?

Wouldn't that qualify as 60% (one etiology) =TDIU I would think that one could ask for a reconsideration if denied TDIU because of DMII and complications of secondarys.

§4.16 Total disability ratings for compensation based on unemployability of the individual.

(a) Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities: Provided, That, if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability:

(1) Disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable,

(2) Disabilities resulting from common etiology or a single accident,

(3) Disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric,

(4) Multiple injuries incurred in action, or

(5) Multiple disabilities incurred as a prisoner of war.

he SC'd disabilities related to DMII (one common etiology)?

[jbasser]

jangrin, what is the ejection fraction on the last heart cath. Was it less than 50.

[Guest jangrin]

according to the nuclear perfusion 59. The VA in Cal would not do a heart cath. The new doctor here in TEX has chuckles scheduled for new EKG and then she will address the heart cath. She has also increased HBP meds, DMII meds, mental health MEDS, and HTN meds. also took new blood and a second urine sample. Also has scheduled him for a doppler for his leg and feet circulation this next week.

Obviously things have gotton worse sense he was last examined but it took five months to get into the VA here because he is not SC'd yet. He finally got in during the last two weeks. But now the claim is suppose to have been rated and they did not get all this new information.

I think he will be low-balled on this rating. So I am planning on a reconsideration and I will send in all the new medical evidense from the new VA doctor here in TEX.

It is frustrating because if he had his appointments 30 days sooner the rating board woud have had all this new information.

Oh well, it won't be long just wondering about if they rate him as 60% I really think that is what is going to happen.

Jangrin

Edited April 8, 2007 by jangrin (see edit history)

[Guest RickB54]

If a veteran has a condition with multiple SC ratings but the VA combines them for the purpose of TDIU and they equal 60% disabling --will that then qualify the veteran to the TDIU? For example,

PN (feet) bilateral 21%

Heart (CAD) 30%

DMII 20%

HTN/HBP 10%

________

60% - Does this then mean that because all the individual disabling processes are combined under DMII for TDIU thus making this veteran eligible for TDIU at 100%.

But then also if these disabling processes continue to worsen they also are rated serately in the event the verteran asks for an increase in the rating for any of these SC conditions.

Please correct me if my thinking is wrong on this.

No.... this is wrong.

a veteran must be rated 40% for one disability with a combined rating of 70%

or

a veteran must be rated 60% for one disability (not a combination of disabilities)

It is possible but unlikely that a veteran who does not meet the requirements listed above could get TDIU, but for that to happen a decisions would have to be made in Wash DC. It does not happen very often.

In one of your post you indicated you think he will be given a low-ball rating. Why do you feel this way? I am always bewildered when someone makes a statement like this, like there is some conspiracy against veterans. Such nonsense. VA employees are good hard working people, some make mistakes but we all do. Help the veteran with his claim, and give the system a chance to work, because most of the time the system works well.

[Guest jangrin]

No.... this is wrong.

a veteran must be rated 40% for one disability with a combined rating of 70%

or

a veteran must be rated 60% for one disability (not a combination of disabilities)

It is possible but unlikely that a veteran who does not meet the requirements listed above could get TDIU, but for that to happen a decisions would have to be made in Wash DC. It does not happen very often.

In one of your post you indicated you think he will be given a low-ball rating. Why do you feel this way? I am always bewildered when someone makes a statement like this, like there is some conspiracy against veterans. Such nonsense. VA employees are good hard working people, some make mistakes but we all do. Help the veteran with his claim, and give the system a chance to work, because most of the time the system works well.

Rickb54,

No I don't feel that it is a conspiracy at all. That's not what I am thinking. The reason i think this may be the case is because of the way the medical treatment and records came about.

It's somewhat complex and the records although have all the needed requirements for rating the actual records are "thin". My husband was DX by the VA for all of his ailment/conditions. The only other medical records are from the SSDI exam doctors and thier reports when he was awarded SSDI.

The VA refused to do a heart cath because they said it would not improve my husbands quality of life, but yet they tell us that but the heart doctor never put that in the medical recirds. The MD says he has PN in his hands and feet but the NP only lists the feet in her DMII C&P exam not the hands. THE SSDI doctor DX my husband with chronic PTSD/MDD but the VA C&P gives him anxiety with PTSD "Like" symptoms and depression.

It seems that the documentation by the VA is not as specific or thorough as it should be and the records keeping is on the spartan side. We are told one thing but the records do not reflect what we are told. More frustrating than anything.I just think that from the copies of the records that I have recieved I think this is how it will be interpreted. I know how the condition is and the severity. For example his heart condition that they won't do the cath for. He has a calcium score of 1720, anything around 300 is considered SERIOUS. They VA doesn't do this study, so they don't really know how to interpret this dangerously high score. SO high that the radiology center wanted to do the heart cath but the VA cardiologist said NO because it was better to wait. Then if my husband had a heart attack then they could do something. But the records do not totally reflect this. Sooo I think the rating will be 30% for the heart which should be higher because of the multiple areas of calcium that make him a non surgical candidate.

The problem is people do not have the time to document this stuff and the claims adjusters don't ask the veteran, if they did they might understand the evidense better.

Low-balled because I don't think they will be able to put this type of evidense together to form the big picture without the imput of the cardiologist to explain what a 1720 calcium score means and the ramifications. JMO- but not conspiracy-

Jangrin

I have a multitude of examples to support this- but I think you can see my point-

Edited April 8, 2007 by jangrin (see edit history)

[Guest jangrin]

jangrin, what is the ejection fraction on the last heart cath. Was it less than 50.

John, VA cardiologist would not do cath scan because the calcium is too extensive and any heart proceedures right now would not improve his quality of life. The NP at the C&P for DMII estimated the EF at 59. But it was only a guess as chuckles has failed the stress test , had a nuc. perfusion which showed problems and then the CT 84 slice MRI with the 1720 calcium score. He was told NOT to exercise because it would most like bring about a heart attack.Thus his DMII should be rated at 40% but they will most likely rate at 20% because they don't understand what the heart condition is about.

What to do,... you know???? I am hoping the new doctor may have some ideas. If we could even talk to her for more then 2 minutes. Everyone is so busy. Chuckles is not eligible for Medicare until December 07. Then maybe a private doctor will be able to help us.

Jangrin

Edited April 8, 2007 by jangrin (see edit history)

[Guest jangrin]

Scientific ... etiology. The cause or origin of disease.

Rickb54, Data, PR, are you sure this isn't another way to interpret this reg?

wouldn't DMII be the origin of those processes? If you read the DMII training letter it seems that DMII is the etiology of those problems in this veteran. Therefore, wouldn't that qualify as 60%? It seems logical now just to convince whom one would need to convice.HMMmm

I'm not looking for a loophole I'm looking to interpret this CFR correctly.

Jangrin

Edited April 8, 2007 by jangrin (see edit history)

[Guest RickB54]

wouldn't DMII be the origin of those processes? If you read the DMII training letter it seems that DMII is the etiology of those problems in this veteran. Therefore, wouldn't that qualify as 60%? It seems logical now just to convince whom one would need to convice.HMMmm

Jangrin

Jangrin,

I am sure that the only proper way to read it is what I stated before:

(a) Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities: Provided That, if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) Disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. It is provided further that the existence or degree of nonservice-connected disabilities or previous unemployability status will be disregarded where the percentages referred to in this paragraph for the service-connected disability or disabilities are met and in the judgment of the rating agency such service-connected disabilities render the veteran unemployable. Marginal employment shall not be considered substantially gainful employment. For purposes of this section, marginal employment generally shall be deemed to exist when a veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Marginal employment may also be held to exist, on a facts found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. Consideration shall be given in all claims to the nature of the employment and the reason for termination.

(Authority: 38 U.S.C. 501) (:D It is the established policy of the Department of Veterans Affairs that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Therefore, rating boards should submit to the Director, Compensation and Pension Service, for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in paragraph (a) of this section. The rating board will include a full statement as to the veteran's service-connected disabilities, employment history, educational and vocational attainment and all other factors having a bearing on the issue.

This is the rating schedule for diabetes:

Note1, indicates all complications of the disease are rated seperately unless used as part of the rating under 7913, for 100%.

Therefore, based on what you said, I don't see a way to get 60% under this rating.

7913 Diabetes mellitus

Requiring more than one daily injection of insulin, restricted diet,

and regulation of activities (avoidance of strenuous occupational

and recreational activities) with episodes of ketoacidosis or

hypoglycemic reactions requiring at least three hospitalizations per

year or weekly visits to a diabetic care provider, plus either

progressive loss of weight and strength or complications that

would be compensable if separately evaluated .................................................... 100

Requiring insulin, restricted diet, and regulation of activities with

episodes of ketoacidosis or hypoglycemic reactions requiring one

or two hospitalizations per year or twice a month visits to a diabetic

care provider, plus complications that would not be compensable

if separately evaluated ................................................................................

.......... 60

Requiring insulin, restricted diet, and regulation of activities .......................................... 40

Requiring insulin and restricted diet, or; oral hypoglycemic agent

and restricted diet ................................................................................

................ 20

Manageable by restricted diet only ............................................................................. 10

Note (1): Evaluate compensable complications of diabetes separately unless they are part of the criteria used to support a 100 percent evaluation. Noncompensable complications are considered part of the diabetic process under diagnostic code 7913.

[Ricky]

I agree with rick in that the only way for this to happen is for the VA to combine all of the ratings into a SINGLE rating of 60 percent. I guess one could argue the point if the VA used a hyphenated code but I still do not believe one would be successful in a claim for tdiu. The only hope here is to get one raised to 40 percent which could possible put the veteran at 70 at which point he would meet the requirements.

[Guest jangrin]

Ok,you got my attention. I think when I was interpreting it I was thinking the part about "except when used as part of the rating for 100%" I was thinking 100% as TDIU and not 100% as DMII.

So the way you are interpreting this is correct. Thanks for the disection of the CFR. Sometimes with me it takes a "brick". :D Appreciate the effort on your part, especialy as I can be a slow learner at times.

jangrin

[jbasser]

Jangrin a Nuclear perfusion scan only estimates the volume of blood being pumped by the heart. The only true Ejection fraction is by heart cath where the MD actually measures the EF.

If it is actually less than 50, Then the 30 percent rating should be increased to 60.

That would Hold the door open for IU.

I would recommend any Vet to get a heart cath is there is suspected heart disease. The Cath is the only true way to determine the scope of the disease. It also allows a doc to measure the pressure in the pulmonary arteries called a pulmonary angiogram if the patient has sleep apnea. If a patient has service connected heart disease and Sleep Apnea there is a chance of having pulmonary Hypertension.

Service connected PH is 100 percent schedular according to the directives under heart disease.

John

[Guest jangrin]

john,

thankyou for the post. Yes, you are correct about the heart cath. yes, the 59 is not accurate and the NP guessed as to the METS for the C&P exam (she said 7 METS).I don't know where she came up with the 7 METS.

All we have is VA for medical until 12/07. If the VA cardiologist is afraid to do the heart cath as it could cause more problems what are we suppose to do. The raters have no idea this is what is going on. So the rating will be low-balled because they have not been explained the whole picture. Records are not that clear from the VA and why they have made certain decisions.

If the raters had called to talk to us maybe it would have helped, but now we know that it has been rated and we should hear in the next month. I know we will have to ask for a reconsideration, as we gather current medical records that the VA has not seen yet. The new records are from first treatment in about 9 months. So things have changed alot in that time frame.

How do we go about getting the VA to do the heart cath when they don't want to take a chance.We thought that the heart cath would also determine the blockage and possible stent. The problem is the calcium is throughout the heart and on the cd of the cat scan there are multiple areas that are longer then the stents they make.

Jangrin

[Pete53]

No matter what your current rating is keep in mind that the rating can be changed if it is not correct. 30% can be cahnged to yield 100%. None of us are locked in by a formula the VA is.

Most here have started off with a lowball rating.

[jbasser]

Jangrin, I had to consult the expert.

The Cat Scan was actually called a 64 slice ct and it is a great diagnostic tool.

To ease your mind you need to ask Cardiology a few questions.

What is the extent of the calcifications given the score you have.

Are there any blockages and if so exactly where are they. Are they in the main artery or secondary arteries. ( Very important you get this answered)

A blockage in secondary arteries can be dealt with by cath. A blockage in the main requires surgical intervention.

As far as a cath being done, The docs are supposed to know best, however as a person also service connected for theat disease( CAD) I always get second opinions from other doctors.

If you can, email me the ct results and other information and I will have it translated into plain english.

John

Edited April 9, 2007 by jbasser (see edit history)

[Berta]

Jbasser- I got all this info from an ECHO report they did on my husband-

is that the same as a nuclear scan?

The ECHO report revealed arterial narrowing and calcification in percentages as I recall as well as the EF.

The ECHO helped me prove malpractice but do I understand you correctly that the ECHO is a limited means of determining heart disease due to atherosclerosis?

[jbasser]

Berta an echo is an ultrasound of the heart.

A Nuclear scan is where an isotope ( Radioactive) is injected into the blood stream.

After a certain amount of time 1 hour, the person is placed under a scanner to see the heart and blood vessels with the isotope.

None of these tests will outweigh a Cardiac Cath.

Did rod have a heart cath? If so you may want to look at it.