I don't know what the VA thinking is but I was denied the 100% Temp for my 2nd total knee replacement on the same knee which is service connected, the VA states I did not meet 38 CFR 4.30 and in big block letters on the letter that I just received even through it was dated Oct 29th 2018 it says 'Your claim for 100 % temp for the total knee replacement for a service connected injury is hereby DENIED' and it does states that. It also goes on to say that while in the process of having the knee replacement I failed to meet a VA certified doctor appointments (I never received any letters or phone calls on this issue) to evaluate why I need the second knee replacement before the surgery but the funny thing is the VA approved it an so did the VA doctor That I see once a year at the VA before I had it done on the outside because of the choice care program. The letter also says that is also the reason why I was denied. What the hell is their thinking because I did not have to go through this mess on my first knee replacement at all. The last part of the letter does states that since I did not meet 38 CFR 4.30 and failed to meet with a VA certified Doctor before and after the care I may be subject to paying the VA back for all expenses for the total knee replacement. The letter does go on to say that the VA has made some major changes in how they meet the needs of the veterans under some new law that was passed. I could not find a thing on that issue. I was sent out in town BY THE VA under the choice care program and Tri West the carrier that is contracted by the VA to pay for the surgery and the Doctor was the only one on the list because he was the only orthro Doctor that would except payment form the VA because the other orthro doctors in the city would not even touch me because they have had NON PAYMENT problems from the VA.
I'm in the process in seeing what my VA rep to see what she can do, but she seems to be gun shy on even trying to pursue this issue. I did receive all the VA standard forms in the letter packet to file a NOD or paperwork for an appeal but these take up to 1 to two years to process. I will keep you all posted on what course she will take, I hope I don't hear the words I can't help you on this issue
I don't know if it would be in my best interest to re-file this all over again as a new claim again.
