An odd claim situation... am I doomed?
I was originally rated almost 20 years ago, a few years after I separated (RE-1 code). I was rated 10% for lumbosacral strain, 10% for an ankle injury on active (multiple surgeries), 0% for R Knee issue (my MOS was very hard on the knees, plus had pain while in, and massive gait changes).
17 years later, my knees are getting really bad, so I post in a group on FB asking if this was something I should take to the VA, completely forgetting I had a 0% SC on it. I get a message from a guy who knows a guy, yadda yadda, I'm put in touch with REE. This is long before I knew anything about sharks/etc.
REE sends me to a local medical examiner (the type for pilots, insurance, CDL, etc). She goes through everything, measures everything, fills out the DBQ. I get it all back, review it all, it all looked good, and sent it in. I get moved to 90%.
Then, I start a MH claim (on my own, buddy statements, and two clear documented nexus in-service), go through an HLR, and come out with 70% MH, putting me to 100% P&T. At least the damage and demons I've been fighting for 20 years are getting recognized. Progress! That and now I'm heavily medicated. :/
Here's the odd part....
When I was on AD I had a tib/fib fracture in my ankle, requiring multiple surgeries to correct. I have documented complaints of knee pain in sick call. 3 years after I get out, I'm in a motorcycle accident. Same leg gets a tib/fib fracture below the knee.
I recently got my C-File, and found where my original 0% SC involved the rater reaching out to the examiner and asking "Are you sure this issue isn't from the motorcycle accident?" The examiner actually slaps the rater down and essentially says "Don't question me. It's clearly from gait changes following his tib/fib fracture, dumbass." (paraphrasing, lol) Score one for the C&P examiner!
Upon a recent review of my REE DBQ I now realize the doctor writes it up as:
"Other: Diagnosis #1: s/p fracture, proximal fibula, ICD Code S82.831A"
And then...
"2.A Describe History: 'The onset of disability occurred during military service. Pt experienced pain due to constantly working on xxx that included yyy, and zzz. The sx have progressed and continues to worsen over time.'"
I originally read the proximal fibula and thought it meant my ankle, not even thinking about my motorcycle accident part. So I didn't question this before I sent it in. The mismatch between the Diagnosis line being due to a post-service accident, and the description being due to in-service activities has me worried.
GPT tells me that this is just a coding error. That the VA cares about functionality, and that knee has already been service-connected with the rater questioning it and the examiner standing firm it was SC. Additionally, the whole file has been through an HLR (when I did the mental health).
With all the new AI talk, I'm feeling pretty confident this might be something that flags it. After my REE exam, I never got a C&P which I assume is because I had 17 years of supporting treatment at the VA as my PCP.
So my questions to all you sage VA experts...
How likely is this to be flagged, and if so, how likely for them to try to put a CUE or something else on it?
Is there anything proactive I should do, or would that be poking the bear?
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For what it's worth, I have an up-coming ortho appt in community care for that knee, as it's gotten worse again (not filing for increase, just preparing for a replacement) and recent imaging shows further degradation. So there shouldn't be any question at the VA about my knee being compromised, it's the difference between my first C&P (the 0% rating) and my last REE exam (took the knee to 40%, but coded the diagnosis to something post-service).
One last note.. my *other* non-SC knee was just replaced in my early-40's. Seriously, the service was murder on my knees. I originally assumed the 0% SC was awarded for the damage my regular MOS did, and was always confused why they rated my one knee and not the other. It wasn't until my C-File I realized the 0% was secondary to my ankle.
How screwed am I on this?
Thanks!