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Va Rating Of 100 Percent


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14 replies to this topic

#1 mgbemt

 
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Posted 25 April 2008 - 07:36 PM

Hey anyone,
I was just notified that I was rated 100 percent for PTSD. I have been rated since 2003 for this. It recently was increased based on severity. I was told that even being rated at 100 percent that I would not be eligible for CHAMPVA. I have a disabled child and two others whom are currently on medicaid due to my illness. With this new rating and without the health benefits of it my kids are going to be in eligible for the medicaid, which puts me in a world more hurt and stress. Why would the VA not make this P/T since I had it since 2003 and it's surely not getting better. I have a low GAF and find this almost hard to believe. Is it beauracacy or is there reasoning and where can I find the reasons. I been searching CFR 38 CH 4 perm disabilities and don't understand. The letter I was told will state future exam to be performed at date unknown. Thansk for help and maybe relieve some of my major stressor over this.



Thanks

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#2 mgbemt

 
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Posted 25 April 2008 - 07:38 PM

sorry about gramar and spelling

#3 Josephine

 
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Posted 25 April 2008 - 07:47 PM

mgbemt,

I am sorry that I do not know how to answer this for you, I apologize for the VA system.

Someone will come in to help you. My prayers are with you.

Always,

Betty

#4 Wings

 
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Posted 25 April 2008 - 08:00 PM

x
x
x

You have to be P&T for CHAMPVA.

I would file a Claim for P&T status and ask that them to expeditie this decision
for CHAMPVA eligibility. Explain dependents need for medical insurance.


~Wings

#5 Jazona

 
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Posted 26 April 2008 - 09:35 AM

mqbent,
Things you may want to consider before pressing for P&T...are you currently seeing a VA or private psychiatrist for your PTSD on a regular basis? Are they consistantly giving you a GAF score and symptom narrative consistant with your current diagnosis?

These two things are important to maintain your 100% diagnosis should they reexamine your disability if you try to push for P&T. I don't think they reopen you claim if you press for P&T but they will review continuity of symptoms and treatment to determine if P&T is warranted.

If you feel your rating is on strong ground, press for it. IMHO.

jaz

#6 Pete53

 
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Posted 26 April 2008 - 10:11 AM

If you have PTSD and are rated at 100% there is no cure. You should get P&T. In your situation I would not report the VA Income unless it had a box that says VA Disability. Its your choice but in the circumstances you describe you may not have any other alternative if you want your kids to have health insurance.

Good Luck

I think that you should ask for a review and point out your dilemma to the rater.


#7 luvHIM

 
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Posted 26 April 2008 - 06:34 PM

Are you receiving Social Security Disability, as well, for your PTSD? If so, their are programs that make your children eligible for medical services without it costing you an arm and a leg. Also, if you have a child that is disabled, have you applied for the child to receive disability benefits through SSA?

I am wondering if you could address this issue (by asking the same question) on the main forum where there is more traffic for more input? Best regards.

#8 Ricky

 
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Posted 26 April 2008 - 09:55 PM

Pete is correct.

However, the rater is probably just looking at the fact it was an increased rating and they normally do not give PT with an increase. Notice I said normally - however, there are many, many cases in which you get a seasoned rater and they just issue the P&T cause they know the rating will probably remain static so why clutter up the system.

#9 Philip Rogers

 
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Posted 27 April 2008 - 07:22 AM

If it has been 5 yrs since your initial award I'd request P&T, because the VA is supposed consider it static once you had it for 5 yrs. In your NOD you could also request the VA provide 50 or 100 cases where the veteran has improved, if they are denying you P&T. jmo

pr

#10 Berta

 
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Posted 27 April 2008 - 08:51 AM

I assume that you got some retro-this is a good time to invest into an Independent medical opinion- and even a vocational expert opinion- to show with medical rationale that you are P & T.

It appears they rated you 100% back to 2003 ?

They didnt rate my husband 100% P & T until he was dead.
I think a vet has to do all they can to obtain and send VA evidence- if they believe their 100% rating should be P & T.

#11 john999

 
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Posted 27 April 2008 - 03:35 PM

I got P&T as part of my appeal. The VA granted TDIU and denied Chapter 35. I appealed that and provided evidence that I was P&T. It took one year from the time I was granted IU to get P&T and it was retroactive. So now I have been P&T for about 7 years.

#12 mgbemt

 
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Posted 08 May 2008 - 09:08 PM

Thanks for all the handy advice !!!!

It means allot to see veterans helping veterans

#13 carlie

 
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Posted 08 May 2008 - 10:05 PM

I believe these are the regulation's pr is referring to.


3.327 Reexaminations.
(a) General. Reexaminations, including periods of hospital observation, will be requested whenever VA determines there is a need to verify either the continued existence or the current severity of a disability. Generally, reexaminations will be required if it is likely that a disability has improved, or if evidence indicates there has been a material change in a disability or that the current rating may be incorrect. Individuals for whom reexaminations have been authorized and scheduled are required to report for such reexaminations. Paragraphs (b) and © of this section provide general guidelines for requesting reexaminations, but shall not be construed as limiting VA's authority to request reexaminations, or periods of hospital observation, at any time in order to ensure that a disability is accurately rated.

(Authority: 38 U.S.C. 501) (b) Compensation cases (1) Scheduling reexaminations. Assignment of a prestabilization rating requires reexamination within the second 6 months period following separation from service. Following initial Department of Veterans Affairs examination, or any scheduled future or other examination, reexamination, if in order, will be scheduled within not less than 2 years nor more than 5 years within the judgment of the rating board, unless another time period is elsewhere specified.

(2) No periodic future examinations will be requested. In service-connected cases, no periodic reexamination will be scheduled: (i) When the disability is established as static;

(ii) When the findings and symptoms are shown by examinations scheduled in paragraph (b)(2)(i) of this section or other examinations and hospital reports to have persisted without material improvement for a period of 5 years or more;

(iii) Where the disability from disease is permanent in character and of such nature that there is no likelihood of improvement;

(iv) In cases of veterans over 55 years of age, except under unusual circumstances;

(v) When the rating is a prescribed scheduled minimum rating; or

(vi) Where a combined disability evaluation would not be affected if the future examination should result in reduced evaluation for one or more conditions.

© Pension cases. In nonservice-connected cases in which the permanent total disability has been confirmed by reexamination or by the history of the case, or with obviously static disabilities, further reexaminations will not generally be requested. In other cases further examination will not be requested routinely and will be accomplished only if considered necessary based upon the particular facts of the individual case. In the cases of veterans over 55 years of age, reexamination will be requested only under unusual circumstances.

Cross Reference: Failure to report for VA examination. See 3.655.

[26 FR 1585, Feb. 24, 1961, as amended at 30 FR 11855, Sept. 16, 1965; 36 FR 14467, Aug. 6, 1971; 55 FR 49521, Nov. 29, 1990; 60 FR 27409, May 24, 1995]





3.340 Total and permanent total ratings and unemployability.
(a) Total disability ratings (1) General. Total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. Total disability may or may not be permanent. Total ratings will not be assigned, generally, for temporary exacerbations or acute infectious diseases except where specifically prescribed by the schedule.

(2) Schedule for rating disabilities. Total ratings are authorized for any disability or combination of disabilities for which the Schedule for Rating Disabilities prescribes a 100 percent evaluation or, with less disability, where the requirements of paragraph 16, page 5 of the rating schedule are present or where, in pension cases, the requirements of paragraph 17, page 5 of the schedule are met.

(3) Ratings of total disability on history. In the case of disabilities which have undergone some recent improvement, a rating of total disability may be made, provided:

(i) That the disability must in the past have been of sufficient severity to warrant a total disability rating;

(ii) That it must have required extended, continuous, or intermittent hospitalization, or have produced total industrial incapacity for at least 1 year, or be subject to recurring, severe, frequent, or prolonged exacerbations; and

(iii) That it must be the opinion of the rating agency that despite the recent improvement of the physical condition, the veteran will be unable to effect an adjustment into a substantially gainful occupation. Due consideration will be given to the frequency and duration of totally incapacitating exacerbations since incurrence of the original disease or injury, and to periods of hospitalization for treatment in determining whether the average person could have reestablished himself or herself in a substantially gainful occupation.

(b) Permanent total disability. Permanence of total disability will be taken to exist when such impairment is reasonably certain to continue throughout the life of the disabled person. The permanent loss or loss of use of both hands, or of both feet, or of one hand and one foot, or of the sight of both eyes, or becoming permanently helpless or bedridden constitutes permanent total disability. Diseases and injuries of long standing which are actually totally incapacitating will be regarded as permanently and totally disabling when the probability of permanent improvement under treatment is remote. Permanent total disability ratings may not be granted as a result of any incapacity from acute infectious disease, accident, or injury, unless there is present one of the recognized combinations or permanent loss of use of extremities or sight, or the person is in the strict sense permanently helpless or bedridden, or when it is reasonably certain that a subsidence of the acute or temporary symptoms will be followed by irreducible totality of disability by way of residuals. The age of the disabled person may be considered in determining permanence.

© Insurance ratings. A rating of permanent and total disability for insurance purposes will have no effect on ratings for compensation or pension.

[26 FR 1585, Feb. 24, 1961, as amended at 46 FR 47541, Sept. 29, 1981]

#14 Arch

 
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Posted 20 August 2008 - 05:53 PM

Hey anyone,
I was just notified that I was rated 100 percent for PTSD. I have been rated since 2003 for this. It recently was increased based on severity. I was told that even being rated at 100 percent that I would not be eligible for CHAMPVA. I have a disabled child and two others whom are currently on medicaid due to my illness. With this new rating and without the health benefits of it my kids are going to be in eligible for the medicaid, which puts me in a world more hurt and stress. Why would the VA not make this P/T since I had it since 2003 and it's surely not getting better. I have a low GAF and find this almost hard to believe. Is it beauracacy or is there reasoning and where can I find the reasons. I been searching CFR 38 CH 4 perm disabilities and don't understand. The letter I was told will state future exam to be performed at date unknown. Thansk for help and maybe relieve some of my major stressor over this.

I am in similar position, My budjet and Spouse need this benefit. I was increased to 100% Schedular a year ago. They told me the same thing, I have been almost in a daily fight with them, research etc. There is Some good advice from Carlie and Berta here in these posts. The VARO is "Sick" with power and nasty young man.
Go to your Senator and ask for help! I went to mine and I heard from their Veterans Liason who said they would be granting P&T status soon (that VARO for whenever they get around to it).
Also if you meet any of the Criteria for the Title 38 codes that Carlie posted here Then Consider going to the local U.S. attorney and file a petition for their misconduct to apply the US Codes as postscripted, There are criminal penalties for this malfeasance!!!

Arch



Thanks



#15 jbasser

 
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Posted 05 September 2008 - 10:31 AM

Go outside and get an IMO that states your issue ius static. Not much chance for recovery




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