My finding and what I will be fighting

Ok first off percentages total 60* dod they will be marks by a *, VA 90%, contentions will be marked by a #

category 1, Unfitting and compensable and rateable
1. Total hip replacement code 5054 50% *
2. Left hip Osteo arthritis (FAI) 5003-5251 10% *

category 2 conditions
lumbago 20%
left peripheral nerve 20%
right peripheral nerve 20%
R shoulder strain 10%
L should strain 10%
Cervicalgia 10% ######
tinnitus 10%
L sciatica 10%
R sciatica 10%

zero's
right knee arthritis 0
bi lat hallux valgus/spurs 0
vericose vein removal 0
(now here is the funny thing they lumped the compartment syndrom/fasciotomy in with the veins/ the vein removal was in 2004 and on the interior of my leg, the fasciotomy was in 2012 and the anterior of my thigh)

sleep apnea 0% ( I have a sleep apnea index of 10, although the doctor did not write down hypersomonlence as a result of the apnea, he said the somolence was idopathic.)

hypertension 0%- even though I am on medication, my numbers are not high enough to warrant a rating, I thought this was a sure 10% because of the meds, but the findings state differently

status post hernia repair 0%
all scars 0%
toe nails 0%
pilionidal cyst removal 0%
headaches 0%

here is the conditions they say were not service connectable
ankle conditions (even though there was a bone scan showing uptake in both ankles done while I was stationed at lackland 6 years after my entrance)
Compartment syndrome right thigh- No evidence the problem ever existed (big miss on their part, Im guessing they lost/never had the surgical records showing the 2.8 litre blood clot removed from my thigh and the scar from hip to knee and even the C/P doctors notation that I had sever muscle damage as a result from it with internal scarring)
GERD- there was not enough evidence to support this, I never counted it
Voiding dysfunction-even though I have documented voiding problems, there is no absolute diagnosis, except for the C/P exam stating the problem and its result due to my elevated glucose levels, I counted this, but we shall see.

All in all, I am happy with the bulk of it, I think they clearly missed some items that i will have to fight for, the bad part is the neck should be 20% due to reverse lordosis as a result of spasm, the thigh should be 30/40% due to the muscle damage, the knee should be 10% because there is radiographic evidence of arthritis, but they said no evidence of painful motion, however that record was over a year ago now, so things do change. However I will have to go to a formal to have the neck/back/thigh etc. all listed as cat 1, then file my VARR.

Now for a question, say they deny my formal, how do I put in the records to appeal/NOD the totally missed thigh fasciotomy and resulting muscle damage?

 

[Weapons loader]

I was never profiled for the cat 2's because the cat 1 (hip replacement) was always the over riding factor. I am/will be trying to get the neck, back,thigh as unfitting, I originally did the IMR for the neck and back left hip and the IMR doc added the left hip and low back but not the neck.

I do not know any other way to get the VARR done for the cat ii's without having them moved to cat 1, otherwise I would be content with the 60% DoD rating, but I am not content with the 90, knowing for almost certainty that they either did not get or ignored certain evidence, and the wording in their decision supports my belief.

I am currently at 93% total VA, if I win the thigh i am 100, If I get the neck increased appropriately and the blood pressure icreased with some new evidence I found, I am 100%, if I get the sleep apnea correctly rated I am 100% etc.

Sleep apnea=should be 30%
Thigh=should be 30-40%
Blood pressure=should be 10%
headaches=should be 30% (but I would settle for 10 because I did not complain everytime I had a headache)
Voiding dysfunction= should be 20%-but even though they acknowledge condition exists, no diagnosis was made so 0%


In regards to DoD percentage, 75% DoD is less money for me than 100% va (only 17 year e-6), but if I win my FPEB, the DoD % will go up to 70% and 75% with just the neck being being corrected.

Here is the downsides,
I am on 4 hour days, continuing to go in every day causes me great pain, its a long drive and a long walk to my desk, where I spend my short day, before doing it again, and whereas my chain is supportive, ultimately I dislike my situation to put it mildly.
I have been approved for SSDI, but no clue if they are gonna start off paying me right with all my dependents or not, or what date they are gonna use for back pay reasons. (if they go by my claim date, and pay me for my dependants from the start, I am looking at a healthy back payment).

I have been approved for SCAADL, but have not broached the va caregiver portion yet, so concern there.
I have no clue what I will need to do about tricare/medicare etc. or SBP, or DIC, or whatever.

Bottom line is, I dislike what I am currently going through at work, have been in this process for a very long time, and am mentally DONE, but I am still unsure about my financial future, 90% VA is not enough to live on, and without knowing my SSDI payments stuff yet, I am still financially "insecure", So it would be dumb of me to not "fight for the proper rating" while at the same time extending my pay and benefits until a time that I am more secure. but for my health and happiness, sometimes the smartest move is not the best.

I can totally empathize with you about work, I'm also AF and haven't been to work since December because of con leave but I will be returning in a week and a half. Before surgery I worked a max of 4 hours, but my schedule varies because of the unique profile my doc wrote. Because of my medications and the side effects I can leave whenever I like to take them, Flexeril/Percocet. I would really like to see something that more closely resembles the Army's WTU set up in the AF, I know we have something similar but there's is far superior.

 

[TSgt Twitch]

I can totally empathize with you about work, I'm also AF and haven't been to work since December because of con leave but I will be returning in a week and a half. Before surgery I worked a max of 4 hours, but my schedule varies because of the unique profile my doc wrote. Because of my medications and the side effects I can leave whenever I like to take them, Flexeril/Percocet. I would really like to see something that more closely resembles the Army's WTU set up in the AF, I know we have something similar but there's is far superior.

Yup, I try to avoid driving on the pills, yet its silly really cause I am on a pain patch as well thats just a slow release opiate, so even if I did not take the pills I am technically impaired.

I too am curious about the WW program side of the house for the af, kinda funny that my RCC is just now putting me in for it, but in the mean time I am gonna busy myself with going to taps again, trying to figure out if I can still wear my blues, going to my medical appointments, and trying to figure out what the heck I am gonna do sitting around here being crippled all day. So far being here and helping folks has been a big part, and then elder srolls online launches in a month, I am thinking fishing is gonna be a new old hobby I pick up, maybe a cheap boat, Still kinda tied to the house alot because of our farm critters so no world travel lol.

 

[Jason Perry]

Ok first off percentages total 60* dod they will be marks by a *, VA 90%, contentions will be marked by a #

category 1, Unfitting and compensable and rateable
1. Total hip replacement code 5054 50% *
2. Left hip Osteo arthritis (FAI) 5003-5251 10% *

category 2 conditions
lumbago 20%
left peripheral nerve 20%
right peripheral nerve 20%
R shoulder strain 10%
L should strain 10%
Cervicalgia 10% ######
tinnitus 10%
L sciatica 10%
R sciatica 10%

Have you crunched the numbers to see whether an increased DoD rating will matter? That is, given your years of service, which I understand to be roughly 15, you don't seem to be near eligible for CRDP. I am not sure if there are any combat related issues, but, if not, then you are solely looking at the greater of your AF or VA compensation. So, my question is whether or not your greater source of compensation is going to be AF or VA.

Do you have good chain of command or supervisor's support? Will they support that some/any of your CAT 2 conditions are significantly impacting your duty performance?

zero's
right knee arthritis 0
bi lat hallux valgus/spurs 0
vericose vein removal 0
(now here is the funny thing they lumped the compartment syndrom/fasciotomy in with the veins/ the vein removal was in 2004 and on the interior of my leg, the fasciotomy was in 2012 and the anterior of my thigh)

sleep apnea 0% ( I have a sleep apnea index of 10, although the doctor did not write down hypersomonlence as a result of the apnea, he said the somolence was idopathic.)

hypertension 0%- even though I am on medication, my numbers are not high enough to warrant a rating, I thought this was a sure 10% because of the meds, but the findings state differently

status post hernia repair 0%
all scars 0%
toe nails 0%
pilionidal cyst removal 0%
headaches 0%

Sounds like the scars are likely clearly wrong.

Any pain on movement in the right knee? If so, this should warrant at least 10%.

here is the conditions they say were not service connectable
ankle conditions (even though there was a bone scan showing uptake in both ankles done while I was stationed at lackland 6 years after my entrance)
Compartment syndrome right thigh- No evidence the problem ever existed (big miss on their part, Im guessing they lost/never had the surgical records showing the 2.8 litre blood clot removed from my thigh and the scar from hip to knee and even the C/P doctors notation that I had sever muscle damage as a result from it with internal scarring)
GERD- there was not enough evidence to support this, I never counted it
Voiding dysfunction-even though I have documented voiding problems, there is no absolute diagnosis, except for the C/P exam stating the problem and its result due to my elevated glucose levels, I counted this, but we shall see.

All in all, I am happy with the bulk of it, I think they clearly missed some items that i will have to fight for, the bad part is the neck should be 20% due to reverse lordosis as a result of spasm, the thigh should be 30/40% due to the muscle damage, the knee should be 10% because there is radiographic evidence of arthritis, but they said no evidence of painful motion, however that record was over a year ago now, so things do change. However I will have to go to a formal to have the neck/back/thigh etc. all listed as cat 1, then file my VARR.

Yes, as you know, the VARR is only applicable to getting a re-evaluation for unfitting conditions.

Now for a question, say they deny my formal, how do I put in the records to appeal/NOD the totally missed thigh fasciotomy and resulting muscle damage?

Do you mean if they deny your request for a formal? They won't. It is yours as of right. If you mean what if you go to the Formal PEB and they do not change the findings? Recall that you still have the SAFPC appeal after the formal if you are unhappy with the findings of the FPEB.

If you are asking how to address the VA errors in rating you for not unfitting conditions, you will file a NOD once you are in a retired status and have your finalized VA ratings in hand.

From what I gather my process is the following,

1st, I have to request a formal to have the back, neck, fascitomy(compartment syndrome) added as unfitting
2nd I have to win those to do the VARR for them.
3rd If I do not win, my only option is to what, either appeal immediately upon receipt of dd214 or do I have to wait until they actually finalize the ratings? Can I submit the TDIU paperwork along with that appeal? Can I submit it with the VARR?

Since it is clear that they missed a huge section of records, for both the fasciotomy and neck, can I file a CUE? or would it be a NOD?

Thanks for your help. I do not often have questions, but when I do they are tricky lol.

1st point- yes.
2nd point- yes, (but, you can do the VARR AFTER your SAFPC appeal).
3rd point- You wait until your ratings are finalized and then submit a NOD. (CUE is for different circumstances, when you have been denied an appeal and want to essentially have the issue re-looked with the result being a potential entitlement of any grant of award being backdated to earliest time of entitlement).

As for the TDIU, I think it is fair game to argue it in the VARR. Whether they grant it or not, is a different issue; I tend to think it is unlikely that they would, but it is worth arguing in my opinion (and it makes clear your position and will invoke VCAA for later appeals, if necessary). Bottom line, nothing says you can't win, and no harm in asking for it, so why not ask for it if applicable.

A big problem with the VARR process is that it "falls between the cracks" of DoD and VA processes. Technically, the VA must abide by and apply all VA statutes, rules, regulations. The issue with the IDES and VARR process is that there is no jurisdiction for appeals that are readily apparent (though, perhaps, by a stretch, it is arguable the US District Courts have jurisdiction). To understad the framework, many VA regulations and the route of appeals have to flow through the Board for Veterans Appeals (and then appeals thereafter lie with the exclusive jurisdiction of the US Court of Appeals for Veterans Claims)- CAVC. Well, prior to the BVA, no one has jursidiction over the case. So, in order to get BVA appeal you have to submit the NOD. This can't be done until you get the finalized VA ratings. Once this has happened, the only route to appeal is through the BVA and then the CAVC. So, any errors in the IDES/D-RAS portion really leave little options for appeal. The District Courts would, I think, theoretically have a brief period of time when they could have jurisdiction. But, once the case progresses through the process, I think jurisdiction is lost because the BVA will eventually "touch" the case and thereby destroy jurisdiction. This is really a big problem in my view, but, I don't think there is any real way to address this absent an act of Congress.

Hope this helped; and I hope you get all you deserve and have earned through your service!

 

[Warrior644]

Out of curiousity, why do you believe the Fasciotimy/compartment syndrome would be pyramiding? I have asked this question before and gotten several different answers, but the general consesus has been it would not be, since the rating for the THR is based on the joint intself and the limitation of motion of the joint, The fasciotomy on the other hand ( W/ compartment syndrome REMEMBER NOT EXERCISE COMPARTMENT SYNDROME but acute due to an arterial bleed after surgery) would be rated as the muscle damage of muscle group 14.

Now as to the neck/back, I did request an IMR for my neck/back/left hip to be added to the NARSUM, the IMR doctor added the left hip and the back, but not the neck. I should have requested the thigh at the same time, but in my LOE, I stated on going hip and thigh issues, but did not specifically state the thigh condition.

So from what I can gather by the "decision" paperwork.
1. The MEB and/or the va did not review the evidence for my neck that shows the reverse lordosis and spasm, and the c/p stated no spasms on that day. I have the x-ray report showing the reverse lordosis and at least 15 separate office visits in the last 18 months (all "new" records since my pcm obviously did not include any of them as I brought them in) showing moderate to severe spasms, The same paperwork also lists the spasms/injections for the low back although I am not contesting that rating yet, just for it to be found unfit.

2. The VA must not of gotten a large chunk of records I am nearly certain got turned into the peblo, but it was after the initial case was built. I know this because they say I was never diagnosed with compartment syndrome, yet I have 3 different doctors verifieng it, and the surgical reports that stopped the bleeding, removed a 2.5-3 liter blood clot from my IT band, that the entirety of the fascia was left open etc. etc. etc., this is the biggie, it should according to other similar instances in the VA's history been rated at 30-40% as muscle damage to xyz group. However the Va seems to of lumped it in to my varicose veins condition which is entirerly separate and a separate part of the leg.

The army spells out compartment syndrome requiring fasciotomy as a pottentially unfitting item, but the AF does not, so I may not have a case to get that added as unfit based on records alone, but I will try.

Hmm, no particular reason for your Fasciotimy/compartment syndrome to be potentially pyramiding; just following the DoVA D-RAS' potential determination.

In turn, I potentially applied their rationale of pyramiding to assume a zero percent rating when you are successful with separated it to be rated in another VASRD category. Overall, it really means nothing from my point-of-view!

As such, in your particular situation, I default to Jason's aforementioned sound insightful feedback for sure! Take care!

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!

 

[SFCNewGuy]

Just a side note, and your board may have already happened, but I was informed that the duty uniform for my Formal was ACU's. I noticed you were concerned about your Dress Blues.

 

[3threat]

TSgt Twitch, I'm glad your ratings are back but sorry that they are not entirely in your favor or what you expected. I just wanted to say thank you for all the advice you offer and good luck getting it all straightened out!

 

[TSgt Twitch]

Just a side note, and your board may have already happened, but I was informed that the duty uniform for my Formal was ACU's. I noticed you were concerned about your Dress Blues.

yeah board could be ABU's, it was never really a "concern" as much as the point of the matter. My main concern was the process and my personal beliefs, My fight was never with the PEB, but with the VA and it just felt TO ME, that I would of been fighting the wrong fight.

 

[TSgt Twitch]

TSgt Twitch, I'm glad your ratings are back but sorry that they are not entirely in your favor or what you expected. I just wanted to say thank you for all the advice you offer and good luck getting it all straightened out!

Thank you, I will prevail on the ratings in time, I coulda/shoulda stayed for the "good fight" but with my financial security in place due to award of SSDI and SCAADL etc. I wanted to finish up and close out the DoD side and take my fight to the VA asap.

 

[iraqvet77]

I was never profiled for the cat 2's because the cat 1 (hip replacement) was always the over riding factor. I am/will be trying to get the neck, back,thigh as unfitting, I originally did the IMR for the neck and back left hip and the IMR doc added the left hip and low back but not the neck.

I do not know any other way to get the VARR done for the cat ii's without having them moved to cat 1, otherwise I would be content with the 60% DoD rating, but I am not content with the 90, knowing for almost certainty that they either did not get or ignored certain evidence, and the wording in their decision supports my belief.

I am currently at 93% total VA, if I win the thigh i am 100, If I get the neck increased appropriately and the blood pressure icreased with some new evidence I found, I am 100%, if I get the sleep apnea correctly rated I am 100% etc.

Sleep apnea=should be 30%
Thigh=should be 30-40%
Blood pressure=should be 10%
headaches=should be 30% (but I would settle for 10 because I did not complain everytime I had a headache)
Voiding dysfunction= should be 20%-but even though they acknowledge condition exists, no diagnosis was made so 0%


In regards to DoD percentage, 75% DoD is less money for me than 100% va (only 17 year e-6), but if I win my FPEB, the DoD % will go up to 70% and 75% with just the neck being being corrected.

Here is the downsides,
I am on 4 hour days, continuing to go in every day causes me great pain, its a long drive and a long walk to my desk, where I spend my short day, before doing it again, and whereas my chain is supportive, ultimately I dislike my situation to put it mildly.
I have been approved for SSDI, but no clue if they are gonna start off paying me right with all my dependents or not, or what date they are gonna use for back pay reasons. (if they go by my claim date, and pay me for my dependants from the start, I am looking at a healthy back payment).

I have been approved for SCAADL, but have not broached the va caregiver portion yet, so concern there.
I have no clue what I will need to do about tricare/medicare etc. or SBP, or DIC, or whatever.

Bottom line is, I dislike what I am currently going through at work, have been in this process for a very long time, and am mentally DONE, but I am still unsure about my financial future, 90% VA is not enough to live on, and without knowing my SSDI payments stuff yet, I am still financially "insecure", So it would be dumb of me to not "fight for the proper rating" while at the same time extending my pay and benefits until a time that I am more secure. but for my health and happiness, sometimes the smartest move is not the best.[/QUOT

do you have a CPAP machine? And if you do, you are suppose to be rated at 50% its in 38cfr Chapter 4. Did you apply for TDIU?

 

[TSgt Twitch]

no cpap yet, hence the 30%. Have not applied for TDIU yet as no DD214 until official retirement date for AF members (may 29 in my case), I will be including the TDIU application and SSDI award letter in my initial "document dump" to ebenefits for the final review of proposed ratings.

 

[iraqvet77]

So who diagnosed you with sleep apnea and why haven't you received a cpap machine?

 

[iraqvet77]

What did social security grant you for? You need to make sure you file TDIU ASAP since it takes a while to get it granted. When you file for it ask for effective date when you become unemployable not when you complete the application. You need to ask for to be considered scheduler and extra scheduler ratings in block 25 on the VA Form 21-8940.

 

[grizz13]

I have been approved for SCAADL, but have not broached the va caregiver portion yet, so concern there.
I have no clue what I will need to do about tricare/medicare etc. or SBP, or DIC, or whatever.

Twitch if you haven't figured out what to do with Tricare and SBP, I had posted info back in 2012. I just recently went through the caregiver and was awarded that. Also being that you have Tricare (due to retirement) plus the VA, DO NOT waste money on Medicare and/or Medicare Part D (unless you live in a remote back-country place and hours away from VA, which is what the free Tricare is for), you are already fully covered by the VA 100% on meds. Key thing is if any antibiotics/narcotics are written outside of direct VA care, the VA will not fill them. It sucks to have the VA wait for appointments, but you have no co-pays to deal with, you also can use your military hospital (which you already know.)