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Denied Increase In Ptsd And Tdiu


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#1 stever

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Posted 17 April 2012 - 11:48 AM

Received my envelope recently and needed time to think about claims. As I reported earlier I have a 50% rating for PTSD and since I do receive disability from social security I put in for TDIU.I don't think SS gave disability on PTSD alone, I just wanted to mention that. I also had a claim in for tinnitis which was granted so now I am at 60%. I was denied an increase in PTSD because they noted my degree of PTSD to them continues to most closely correspond with a 50% evaluations based on my symptoms and feelings.I felt my C&P went very well, my VSO also stated he thought the intern wrote up a good report, the only exception was she rated my gaf at 57 when it's been consistently lower around 50.I continue to take meds and go weekly to group therapy.I mentioned that I have limited social contact with the exception that I enjoy meeting weekly with other Vets and they made mention of that so I got blackballed for that statement.What I meant was that we PTSD vets look forward to group.

I thought I had a good case for uneployability, plenty of employer documentation and C&P doc stated that I was unemployable due to my PTSD.

I did file an NOD, so now I'll have a long wait.

Any input or encouragement would be appreciated.

Stever

#2 Berta

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Posted 18 April 2012 - 10:57 AM

You cant rely on a GAF score as the VA looks at the whole picture.

But this concerns me-

"C&P doc stated that I was unemployable due to my PTSD."

What medical rationale did the VA use in the decision to go against their own C & P doctor's positive statement? That sure doesn't happen often.

"plenty of employer documentation"

I assume this regarded how your PTSD affected your work performance?

Did the VA list and fully consider this as evidence?

If you go some retro for the tinnitus have you considered getting an IMO from an independent shrink?

Since the SSDI is not solely for the PTSD is there any other disability included in the SSDI report that could potentially be service connected?

Unfortunately the rating might well be correct at 50% when they compared the medical evidence they have to the Schedule of Ratings.

If your PTSD meds are ever increased in dosage, that could indicate need for higher rating.

"go weekly to group therapy." DO you also see a VA shrink one to one?

If you mean by group- a vet center (I volunteered at a vet center with the PTSD combat group and it changed my entire life)

I dont feel the VA blackballed you because you enjoy the group-

but I think a VA psychologist/psychiatrist would have possibly more ability to really gauge your symptoms as to severity than any documentation from the group leader.

At the combat PTSD group meetings I was at (I am a civilian but the vets voted me to attend)
nothing was documented at all.
It was the real Nam nitty gritty sometimes and then again many of the vets would not reveal too much.

If PTSD gives a vet anger problems,often only their spouse or significant other can really reveal that with a 'buddy statement'.

Many VA docs don't even know there are serious domestic problems at home due to PTSD anger issues, and only find out if they also have input from a family member.

I am not saying this regards you at all. Something for other PTSD vets to think about.

Also, have you ever applied for VA VocRehab and been turned down solely for your PTSD? If so this is obvious strong documentation of unemployability due to PTSD.

The C & P doctor had to have a rationale for his/her statement.I am surprised the VA rejected that opinion for TDIU.

Were you ever given the Combat related MMPI?

Maybe the C & P doc used those results and the rater overlooked them?

Can you scan and attach the decision here" (cover personal identifying stuff)and maybe we can help advise more as to how to appeal this?

#3 Pete53

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Posted 18 April 2012 - 12:04 PM

Sorry to learn of VA turning you down. Have you applied for Social Security Disability. If you are getting SSD it would bolster your claim. Your C&P indicates your C&P Doc thinks that you can't work.

If it was my claim I would read the Reasons and Basis with a fine tooth comb. You might see if your VA Doc would be willing to help.

Good Luck

#4 stever

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Posted 18 April 2012 - 01:46 PM

Thanks Berta and Pete
I will provide more information later, Thanks to you I noticed on the SOC RE: Evidence they have only my Psychiatric exam dated 11-29-11 but not the C&P exam that I had on 12-01-11 with the general Doctor who stated in his report that I was Unemployable.There is no mention of this what so ever.Could this be an error on va's side? Did they not read this follow up report.This was disturbing because they said that your claim for TDIU was denied because the evidence does not show you are unable to secure or follow a substanially gainful occupation as a result of service connected disabilities.

This is what that Dr said.

The review of the patient's clinical record and the personal medical history indicate that this patient is unable to continue performing activities consistent with his work experience and prior training in order to maintain a gainful employment. The patient is unemployable at least as likely as not secondary to mental changes secondary to exposure to traumatic events during the Vietnam war.

Stever
PS more to follow

#5 stever

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Posted 18 April 2012 - 02:28 PM

Talked to vso and he said everything is right on my claim, I guess I was barking up the wrong tree, I still don't understand it. As stated I'll try to send more info later and have you all look at it

Stever

#6 ketchup56

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Posted 18 April 2012 - 06:24 PM

Something to attack your recent denial in your case would be Hattlestad v. Brown, 5 vet.app.395(1993) and Blackburn v. brown, 4 vet.app. 524(1993) and VA Training letter 10-07, sept.14, 2010. You already have the va examiner's strong opinion as strong evidence of unemployability.Pound this evidence and these precedents rulings into your arguments on appeal and eventually someone who can READ AND COMPREHEND EVIDENCE will see this and do the right thing in your case.Tdiu cases are supposed to be considered on a case by case theory. The key to your situation would be that in determining entitlement to TDIU evaluations, a CLEAR explanation requires analysis of the CURRENT DEGREE OF UNEMPLOYABILITY ATTRIBUTABLE to the SERVICE-CONNECTED condition as compared to the degree of UNEMPLOYABILITY ATTRIBUTABLE to the NON-SERVICE CONNECTED CONDITION(S).

#7 donna68

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Posted 18 April 2012 - 07:14 PM

It looks like you have a 50% and a 10% with a total of 60%. To qualify for schedular IU you need specific %. You need one service connected disability evaluated at 60% or more OR one at 40% or more and another condition which when combined with the 40% equals 70%. So they may not have ignored to doctors opinion, but determined that due to your current evaluation you don qualify. I grabed this from the VA website.
What Is Individual Unemployability?
Individual Unemployability is a part of VA’s disability compensation program that allows VA to pay certain veterans compensation at the 100% rate, even though VA has not rated their service-connected disabilities at the total level.
What Is the Eligibility Criteria for Individual Unemployability?

A veteran must be unable to maintain substantially gainful employment as a result of his/her service-connected disabilities. Additionally, a veteran must have:
  • One service-connected disability ratable at 60 percent or more, OR
  • Two or more service-connected disabilities, at least one disability ratable at 40 percent or more with a combined rating of 70 percent or more.


#8 stever

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Posted 19 April 2012 - 06:52 AM

Thanks for the input, I knew with only 50% I didn't meet the requirements, that's why I put in for IU with the hope I would get an increase to 70%.since I am on SSD.

Stever

#9 iceturkee

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Posted 19 April 2012 - 06:53 AM

It looks like you have a 50% and a 10% with a total of 60%. To qualify for schedular IU you need specific %. You need one service connected disability evaluated at 60% or more OR one at 40% or more and another condition which when combined with the 40% equals 70%. So they may not have ignored to doctors opinion, but determined that due to your current evaluation you don qualify. I grabed this from the VA website.
What Is Individual Unemployability?
Individual Unemployability is a part of VA’s disability compensation program that allows VA to pay certain veterans compensation at the 100% rate, even though VA has not rated their service-connected disabilities at the total level.
What Is the Eligibility Criteria for Individual Unemployability?

A veteran must be unable to maintain substantially gainful employment as a result of his/her service-connected disabilities. Additionally, a veteran must have:

  • One service-connected disability ratable at 60 percent or more, OR
  • Two or more service-connected disabilities, at least one disability ratable at 40 percent or more with a combined rating of 70 percent or more.



i got iu with a 60 percent overall disability, including 40 percent for my back!

#10 carlie

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Posted 19 April 2012 - 07:15 AM

It looks like you have a 50% and a 10% with a total of 60%. To qualify for schedular IU you need specific %. You need one service connected disability evaluated at 60% or more OR one at 40% or more and another condition which when combined with the 40% equals 70%. So they may not have ignored to doctors opinion, but determined that due to your current evaluation you don qualify. I grabed this from the VA website.
What Is Individual Unemployability?
Individual Unemployability is a part of VA’s disability compensation program that allows VA to pay certain veterans compensation at the 100% rate, even though VA has not rated their service-connected disabilities at the total level.
What Is the Eligibility Criteria for Individual Unemployability?

A veteran must be unable to maintain substantially gainful employment as a result of his/her service-connected disabilities. Additionally, a veteran must have:

  • One service-connected disability ratable at 60 percent or more, OR
  • Two or more service-connected disabilities, at least one disability ratable at 40 percent or more with a combined rating of 70 percent or more.


But that is only part A information of the reg.
Part B doesn't always get a grant for IU - but sometimes it does.

http://ecfr.gpoacces...1.98.11&idno=38

38 CFR 4.16 B states :

(b) It is the established policy of the Department of Veterans Affairs that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Therefore, rating boards should submit to the Director, Compensation and Pension Service, for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in paragraph (a) of this section. The rating board will include a full statement as to the veteran's service-connected disabilities, employment history, educational and vocational attainment and all other factors having a bearing on the issue.

[40 FR 42535, Sept. 15, 1975, as amended at 54 FR 4281, Jan. 30, 1989; 55 FR 31580, Aug. 3, 1990; 58 FR 39664, July 26, 1993; 61 FR 52700, Oct. 8, 1996]


#11 helpme

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Posted 13 April 2013 - 10:01 PM

Hello all, I put in for an increase in my disability and received a C&P appointment about 8 months ago.  I recently received a letter from VA asking me if i had anything else to add to my case or they will begin the rating process.  Today, i received another letter from MSLA stating that they are going to hold two more appointments for me, one is a general appointment (don't know what that is) the other one is for (Mental Health) since I'm already service- connected with PTSD.  Could any tell me what this mean!



#12 Chuck75

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Posted 14 April 2013 - 09:11 PM

A "general " C&P is just that, a medical C&P.  What may be interesting is that you may find that the "general" C&P is actually limited to whatever the RO requested.

Pay particular attention to questions concerning existing rated disabilities, and any that you have applied for. If it's a general C&P in truth, any other non rated issues/conditions

can be assessed (or ignored) by the examiner.  

The Mental Health C&P is a separate C&P (obviously).  Both may be conducted the same day if so scheduled. 






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