DVT, Lifetime COUMADIN (Warfarin) ... Questions on rating and input

Petey

PEB Forum Regular Member
Registered Member
Hi there like most people in this forum, i am waiting on results from the MEB and thought i'd finally just throw a thread up here asking for input.. here's my situation:

-Developed DVT's in left leg and by left kidney (biggest was and still is 4cmx3cm)
-during this i had MSSA Bacteremia
-Vena Cava Filter was attempted to get put in but realized my anatomy is somewhat of a ratnest so they couldnt place the filter.
-prescribed compression stockings
-lifetime Coumadin 10 mg
factors: long traveling from previous deployment, the screwed up anatomy of my veins, and the MSSA

also claimed is :
-2 years ago - epididimitis
-passing out - just dehydrated

last i was told was to wait 8 weeks and if i havent been contacted then they most likely had an UNFIT finding and to give them a call.. i thought that was a little weird that ill have to call instead of them not continuously checking for updates and contacting me but im doing what i can.

any input is greatly appreciated!
thanks
 
Petey,

Check the VASRD for both respiratory and cardiac conditions for your guidance. After digging through the board here and poking around over the past year I have found that DVT's by themselves are rated on the effect that they have on the extremity they impact. They look for swelling, tenderness, pain in the leg that it originated in for example. Barring that, people being chaptered for DVT and life-long Coumadin use have been getting separation pay instead of retirement.

Under the Cardiac section of the VASRD:


7121 Post-phlebitic syndrome of any etiology:

With the following findings attributed to venous disease:
Massive board-like edema with constant pain at rest....................................... 100
Persistent edema or subcutaneous induration, stasis pigmentation or
eczema, and persistent ulceration................................................................. 60
Persistent edema and stasis pigmentation or eczema, with or without
intermittent ulceration................................................................................... 40
Persistent edema, incompletely relieved by elevation of extremity,
with or without beginning stasis pigmentation or eczema............................ 20
Intermittent edema of extremity or aching and fatigue in leg after prolonged standing or walking, with symptoms relieved by
elevation of extremity or compression hosiery............................................. 10
Asymptomatic palpable or visible varicose veins.................................................. 0

Note: These evaluations are for involvement of a single extremity. If more than one extremity is involved, evaluate each extremity separately and combine (under §4.25), using the bilateral factor (§4.26), if applicable.

Now if the DVT includes a Pulmonary Embolism or the pulmonary system, then we have a new rating under the Respiratory Section:


6817 Pulmonary Vascular Disease:

Primary pulmonary hypertension, or; chronic pulmonary thrombo-
embolism with evidence of pulmonary hypertension, right
ventricular hypertrophy, or cor pulmonale, or; pulmonary
hypertension secondary to other obstructive disease of pulmonary
arteries or veins with evidence of right ventricular hypertrophy or
cor pulmonale.................................................................................................... 100
Chronic pulmonary thromboembolism requiring anticoagulant therapy,
or; following inferior vena cava surgery without evidence of
pulmonary hypertension or right ventricular dysfunction................................... 60
Symptomatic, following resolution of acute pulmonary embolism.......................... 30
Asymptomatic, following resolution of pulmonary thromboembolism...................... 0

Note: Evaluate other residuals following pulmonary embolism under the most appropriate diagnostic code, such as chronic bronchitis (DC 6600) or chronic pleural effusion or fibrosis (DC 6844), but do not combine that evaluation with any of the above evaluations.

Now with your surgery (although unsuccessful) to install a filter, and the use of hosiery to alleviate the DVT symptoms I see elements of both ratings in your case. In my best guess, the MEB will likely forward your case to the PEB to judge the status of your case. The ratings that you'd be looking for are really anyone's guess though at this time, as the symptoms that you have presented don't necessarily fall neatly into any single category or rating. The guidance is to find the rating that best approximates your condition, but that enters a fair amount of subjectivity into the equation, along with any mitigating factors that the MEB/PEB/VA may need to look at that are possibly not included in your post. I would prepare to be found unfit if you are on life-long coumadin, and make sure to go over your paperwork (NARSUM,MEB,ETC) thoroughly to make sure all of the information is present before allowing your packet to go forth for consideration.
 
thanks for the info Carl! yea i've been looking through alot of discussions and they point me to 7121 and 6817.. and i have heard that long-term anti-coag therapy will probably be found unfit.. I suppose hearing it from a few different sources will give me a better answer.. i dont know.. just doing the good ole waitin game now. im going to give the PEBLO a call next week (exactly 8 weeks) and hopefully get an answer.

ill put on here then what they said.. and thanks again for crackin an egg of knowledge on me!
 
i did have another question.. diablo (another member on here) had a very similar story and he said he got 10% af, 70% VA... now correct if im wrong; does that mean he gets the 10% severance and then 70% retirement after that ? dumb question i know but I'm trying to make better sense of it
 
i did have another question.. diablo (another member on here) had a very similar story and he said he got 10% af, 70% VA... now correct if im wrong; does that mean he gets the 10% severance and then 70% retirement after that ? dumb question i know but I'm trying to make better sense of it

If he was rated at 10% for DVT then it was probably under 7121:

Intermittent edema of extremity or aching and fatigue in leg after prolonged standing or walking, with symptoms relieved by
elevation of extremity or compression hosiery............................................. 10

This would mean severance pay from the military (because you're under the 30% cutoff for medical retirement). Severance equals out to be your base pay multiplied by years of service by 2. (Using myself as an example: $3810*2*13 = $99,060) This severance pay is taxed as income at the going rates for your tax schedule. In the case above with a 70% VA rating, the individual is entitled to disability payment of 70% from the VA.

Find the compensation tables here:

http://www.vba.va.gov/bln/21/Rates/comp01.htm

A veteran with a spouse and child @ 70% receives $1,459/month. I believe however, that until the totality of VA benefits exceeds the amount of severance pay that one would not receive VA disability. I don't have a source for this unfortunately, but I believe that in this magic scenario I would need to wait (99,030/1,450=67.89 months) over 5 1/2 years before I could get paid from the VA while waiting on the offset to finish its course. If anyone can clarify my point or confirm it I would be grateful.
 
Ok, after digging a little bit more on the interwebs, it appears that the amount that the VA recoups is stated on your DD-214. If you separate now (post-1996) the amount recouped should be the post-tax amount, which would limit the above computations from the full 99,060 to something much more reasonable. (taking out 28% leaves you with a recoupment burden of $71,323 which would take 48 months to recoup instead of 5 1/2 years.

Bottom line is that in the above situation you'd receive a lump sum severance payment, and some time down the road (depending on the size of the payment) you'd be eligible for VA disability payments.
 
ahhh ok that makes more sense.. thanks for clarifying that.. now mine would be more like $20,000 since i only have 4 years under my belt so in that situation, i would only wait a small fraction of what you would.. thank ya Sir.

I've found that if I just keep myself busy I wont think about it but sitting here at a desk job instead of my actual aircrew position doesnt help at all.

ill be sure to update this when I hear anything if you're curious
 
his 10% rating for 7121 actually fits my story too.. Prescribed Compression stockings, still swelling, and on profile for running and walking greater than 1/2 mile
 
I'd love to hear any updates you're willing to share. I normally "watch" the threads that I participate in so I get emails when they're responded to. I also check my PMs on a semi-regular basis if you'd prefer to go that route - but keeping the information, particularly about the results of your boards, in the open can help other people trying to figure out what is down the road for them.

I find that once things start going well for people they stop coming to the boards for help and so we don't see all of the resolutions to the cases presented.
 
I also developed a DVT after surgery from a rupture achilles and I am awaiting my ratings. I took the coumadin and had to beg for a compression stocking. I was on the blood thinners for four months and in December 11 there was no sign of the clot. I still have a lot of pain in that leg and it is not resolved from wearing the stocking or elevation and still swells. When my ratings return I will post it and everything they annotate to assist you as well. Good luck with your situation and stay on your Doctors.
 
Wow I'm sorry to hear your still in pain! Kind of odd if it's no longer there though.. I developed the clots (a couple in my left thigh and 1 by my left kidney) in november 2011, in hospital for 3 weeks, and off work for 2
Months.. In march we did a follow-up and the biggest clot was still 4cmx3cm.. I've heard that sometimes it can just take a while to deteriorate so well see. . Yea thanks I'm definitely curious to see what you our ratings will be and how similar.. Geuss your waiting with me! Best of luck
 
So the results of my IRIS inquiry came back on my IDES file with the VA and my preliminary ratings were completed on 02 May 2012, so hopefully will hear something from the Army soonish. I'll post back when I get my results for those watching from home.
 
Glad to see your having progress! If you don't mind me asking, if your situation is similar to mine at least, what'd your ratings look like?
 
I haven't actually seen my ratings yet. They need to get "approved" by big Army first, then they'll come down to me here at my base on my DA199 if I understand the process correctly.
 
Well i was on leave in the local area all last week... Came in Yesterday asking for an update and she said oh yea they found you "unfit" on the 16th (my birthday btw). so now its sent to VA to determine rating (roughly a month) and then to AFPC (roughly another month).

Ill let ya know what my rating ends up being.

at least know i finally know what the hell is going to happen
 
So a buddy of mine referred me to the Ebenefits site.. it might be awesome to be able to check some sort of progress but it also raises questions and doesnt help me keep my mind of it .. but 4 june it states 'claim received' and 6 June it now says in the closed claims status 6/6/12 'Appeal is possible- Decision Notification Sent' ... correct me if im wrong but that means the VA is done with the rating process and is getting sent to AFPC for final approval? and it sounds to me like i will not be able to just see what my proposed ratings were until its back officially from afpc i take it.. i was told roughly a month for VA to rate and a month for AFPC. so if thats accurate then im about 3 weeks ahead of schedule so ill allow it:D
 
so i just spoke with my peblo... i got 40% DOD and the VA rep wasnt available.. my question is::: how are you paid with the 2 percentages? they made it sound like a crazy formula. lets just say for example.. i have my 40% dod annnd 60% VA. what would i get monthly? im Single. been enlisted 4 years. no dependants.
 
so i just spoke with my peblo... i got 40% DOD and the VA rep wasnt available.. my question is::: how are you paid with the 2 percentages? they made it sound like a crazy formula. lets just say for example.. i have my 40% dod annnd 60% VA. what would i get monthly? im Single. been enlisted 4 years. no dependants.

Petey, how you are payed depends on a couple of factors.

1. Were your injuries determined to be the result of combat?
2. Do you have 20 qualifying years for retirement?

I believe if the above answers are both "No" then you are only paid the higher of the two, with the VA amount being tax free.

To give an example from my information, I was awarded 30% DoD and 40% VA earlier this week. My 30% DoD amounts to about $950/month. (this value will vary because its based on your high-36 value which is the average of your highest 36 months of being paid.) My 40% VA value equates to $727/month ($667 for being a veteran with spouse and child, and an extra $30/month per child for my other two children.

As my DoD amount is higher, I will likely elect to receive that every month. Now the part that I need to clarify is that I believe the $727/month from the VA will offset money from the DoD, causing that amount every month to be tax-free. Again, I still need to verify this information with my VA rep as I haven't had this conversation with her yet.

For your information I would be surprised if you came out with 1/2 the amount I'm listing for your 40% DoD. Let's ballpark 400/month. This will be slightly different depending on when you got which promotions/etc. VA @ 60% for a single guy is $1009/month. In this case it would be a pretty easy choice to take the VA money and then just keep the retirement benefits from service (TRICARE Prime for life @ about $50/month for you and your family is not an insignificant benefit since the premiums are frozen for medical retirees).

For more exact information and probably better advice, you need to talk to your VA representative. Present her with your DA199 when it becomes available (or equivalent document if you're not in the army, its the findings from the PEB) and they will start the necessary paperwork for determining benefits.

v/r

CarlB
 
And an update for the board members looking on:

I was awarded for 30% after one Pulmonary Embolism (didn't meet the threshold to be determined chronic) and lifetime anticoagulant therapy.

The anticoagulant therapy is not a condition that rates disability payments, but it IS service disqualifying, and the single PE got me 30% for the "symptomatic PE following resolution" under the VASRD.
 
thanks alot for the info Carlb! .. yea im on leave back in PA until the 25th and im meeting the peblo and va rep the 26th.. just was curious as to how it works... ill let ya know for sure how it pans out!
 
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