Jim,
I have just found out today, through my "non-VA" OB/GYN, that I have to have a full hysterectomy (right and left ovaries and uterus). I have fibrosis in my uterus, and both the left and right have cysts. The right also has a tumor. I am service connected 10% for ovarian cysts.
I just recently sent in a fully developed claim notice in regard to my service connection for lumbar and thoracic back strain. I have no idea how long that will take, and I only have the VA and one other doctor who treats me for this condition.
As for my new developments. How should I act on this? In December, 2010, I had cervical/neck surgery. Of course I was misinformed that this would qualify for 100% temporary convalescence pay while I was recovering, because of my lumbar and thoracic strain. It was not, 12 months later it was denied. I am now appealing with the help of an attorney.
I am to have another ultrasound on March 5, and then should nothing have changed, I will undergo the needed surgery and chemo. Should I - can I - request temporary convalescence pay for this surgery and re-coop. I am financially a wreck because of the neck surgery and the belief of "somebody" at the VA Regional office. (he said I would have my temp pay by Jan 17, 2011).
If yes, how should I go about it. Do I apply first or wait until after the surgery date? Do I file a new claim or do I file a fully developed claim with all records attached, including the surgery? Will the "uterus" be considered a new claim? Do I file it secondary to ovarian cysts?
Any insight would be helpful. I appreciate you.
Reply:
I'm really sorry to hear of the health problems. You're in my thoughts and prayers as you face all of this.
VA has a tremendous backlog of claims that gets worse every day. You'll have to plan your life as if you'll never get a dime from VA. To plan as if there will be a check to help you soon is always a mistake.
Your neck surgery convalescence claim was denied (as I understand the sequence of events) because you aren't rated for that. That you have a claim in process has no weight. You must have a rating affirmed before you can claim a secondary condition.
The gyn surgery you're planning will be complex to sort out as a claim. You tell me that you have a 10% rating for ovarian cysts. You don't say that there is a rating for the fibroid uterus.
You say that there is "tumor" in the right ovary. A tumor may be cancerous or benign so I'm not sure if that is the primary reason for a complete hysterectomy with removal of ovaries and fallopian tubes? You mention chemo so I'll assume a firm diagnosis of a cancer has been made. It may also be that the fibrosis and cystic ovaries are causing you so much pain and trouble that the surgical removal makes good sense.
In any case, you can't file ahead of time. VA would reject that because you can't claim an event that hasn't happened. There are any number of things that could prevent the surgery from happening.
I'd advise that you file a claim for an increase to the service connected ovarian condition. The ratings are:
7615 Ovary, disease, injury, or adhesions of.
Symptoms not controlled by continuous treatment 30% Symptoms that require continuous treatment 10% Symptoms that do not require continuous treatment 0%
This will set an effective date for the claim. You'll ask for 30%.
Once surgery for complete removal is scheduled, you can supplement the claim by notifying VA of the scheduled date for the operation.
If you have the surgery done at a VA Medical Center, the rest will pretty much be automatic. The VAMC will notify the VARO of your status and the claim for convalescence will be automatic. If your surgery is done at a civilian facility, it will be up to you to file a claim, provide VA with medical records and so on.
After the convalescence you should be scheduled for a C & P exam to determine a permanent rating based on residual effects of surgery.
Those ratings are:
7617 Uterus and both ovaries, removal of, complete:
For three months after removal 100% Thereafter 50%
Although this should be routine, there is nothing at VA that is simple or easy.
You're doing the right thing by preparing in advance.