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USSOkiewife

Va Using Ssd Disability Rating

8 posts in this topic

We recently learned the VA has used an original SSD records for disability to establish a low SC rating for PTSD. My husband has all the criteria for SC PTSD - combat ribbons, etc. He was given a low 10% SC for PTSD as the SSD records hold no evidence of PTSD, but determine his serious mental health condition to be Schizoaffective disorder. Later medical evidence ( C&P) discovered the PTSD and established it as being the main mental health condition, even pointing out that without the trauma piece a correct diagnosis was possible. The VA agree his condition is severe but points to the SSD records done before his claim for SC PTSD as being the major mental health issue - one which, due to its lack of earlier connection - to be non-service connected. Has anyone elsehad this problem? He is appealing the low rating and it looks to be in his favor.

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Does the VA have your husband rated for PTSD or is it using Social Security to award to claim his PTSD is after his service?

What is 20% rating for?

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If your husband served in combat and got honorable discharge for a full period of service I think the schizoaffective disorder DX is suspect. He probably needs a private doctor to rebutt the VA's contention that PTSD is a minor % of his total disability. Was he ever treated for any mental health condition in the service? I think it is impossible to separate out MH disorders if there is a stressor like combat service. This stress could be the ultimate trigger for any MH condition. Probably many vets got medical discharges for MH conditions before PTSD was even recognized. When soldiers have complete nervous breakdowns due to acute combat fatigue what are the residuals of that in later life? No one knows.

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I have encountered several claims where the VA used reports from outside agencies to discredit a veterans claim. I was successful in having the reports from the outside agencies thrown out by a DRO. The reason the DRO will throw out the reports is because reports from the outside agency were not developed in accordance VA evidence rules.

You need to file an appeal for an increase in the 10% PTSD rating if you disagree. Have a service officer assist you. To support your appeal you can take a full attack. You need to discredit Social Security report and strengthen the claim for PTSD. It is most important to strengthen the claim for PTSD. In the long run the Social Security report should have no bearing on the claim. It is entirely possible that the Social Security report was not really the reason the claim was low balled. They could be citing Social Security report just to confuse you. You'll spend so much effort discrediting Social Security report that you will forget to strengthen the PTSD rating. You can file an appeal with no new evidence and hope a DRO will see through the problems. However, I would obtain new reports from clinicians as described later in this post.

Your first attack will be to identify exactly how the PTSD was rated. The exact language in the rating decision is important. Raters do not use any single criteria, measurement or descriptive language of the disability for the purpose of assigning a percentage. They are allowed to base their rating determination on what they perceive as the overall diagnostic picture. This incorporates GAF scores, records of hospitalizations, treatments, and negative impact on social and industrial functioning.

It appears that there have been no treatments or hospitalizations. You did not discuss any inability to obtain or maintain employment. You did not discuss any difficulties in interpersonal relations. You do say that the VA agrees his condition is severe. Who at the VA told you this? Was it some guy sitting behind a desk? What does the C&P exam say in regards to the disability.

It is hard to rely on reports from examining physicians. This includes Social Security and VA compensation and pension exams. The strongest evidence would be from treating doctors. I would recommend that your husband enter a treatment program either at a VA hospital or a veteran’s center. They pretty much know what to do. However, they need to assign a new GAF score. They need to identify how the disability affects employment and social functioning. The best way to advance a claim is with new and stronger evidence.

It should be fairly easy to shoot down for Social Security report. Especially since the C&P examiner commented that the schizoaffective disorder did not take into consideration the criteria for PTSD. The schizoaffective disorder diagnosis appears to me to have been based on a single exam. Did Social Security have any treatment notes available to them prior to the exam they performed?

It also appears that the rater may have over used or abused their discretionary power. The weight given to each diagnosis in a case which involves multiple diagnoses of mental conditions is performed by a clinician on a mental health exam. The C&P examiner should have identified how much of the disability is attributed to the schizoaffective disorder and how much of the disability is attributed to the PTSD. These questions are asked on the exam worksheet. It appears to me that this comparison was not performed because the C&P examiner thought that the schizoaffective diagnosis was based on incomplete information. In the absence of such a comparison by the C&P examiner I do not feel the rater has the authority or discretionary power to fill in the blanks.

Once again, I want to restate the importance of strengthening the evidence for the PTSD diagnosis. I do not see how you can obtain a high rating for PTSD if the C&P examiner did not identify a significant impact on employment and interpersonal relations. The exact terminology could very. However, a low GAF score combined with the identification of the impact on employment and interpersonal relations would be necessary. Hospitalizations and treatment programs also add to the diagnostic picture.

I am pretty sure that there is a link on hadit to an explanation of how mental health disability is rated.

Edited by Hoppy

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Excellent info Hoppy!

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I have encountered several claims where the VA used reports from outside agencies to discredit a veterans claim. I was successful in having the reports from the outside agencies thrown out by a DRO. The reason the DRO will throw out the reports is because reports from the outside agency were not developed in accordance VA evidence rules.

You need to file an appeal for an increase in the 10% PTSD rating if you disagree. Have a service officer assist you. To support your appeal you can take a full attack. You need to discredit Social Security report and strengthen the claim for PTSD. It is most important to strengthen the claim for PTSD. In the long run the Social Security report should have no bearing on the claim. It is entirely possible that the Social Security report was not really the reason the claim was low balled. They could be citing Social Security report just to confuse you. You'll spend so much effort discrediting Social Security report that you will forget to strengthen the PTSD rating. You can file an appeal with no new evidence and hope a DRO will see through the problems. However, I would obtain new reports from clinicians as described later in this post.

Your first attack will be to identify exactly how the PTSD was rated. The exact language in the rating decision is important. Raters do not use any single criteria, measurement or descriptive language of the disability for the purpose of assigning a percentage. They are allowed to base their rating determination on what they perceive as the overall diagnostic picture. This incorporates GAF scores, records of hospitalizations, treatments, and negative impact on social and industrial functioning.

It appears that there have been no treatments or hospitalizations. You did not discuss any inability to obtain or maintain employment. You did not discuss any difficulties in interpersonal relations. You do say that the VA agrees his condition is severe. Who at the VA told you this? Was it some guy sitting behind a desk? What does the C&P exam say in regards to the disability.

It is hard to rely on reports from examining physicians. This includes Social Security and VA compensation and pension exams. The strongest evidence would be from treating doctors. I would recommend that your husband enter a treatment program either at a VA hospital or a veteran's center. They pretty much know what to do. However, they need to assign a new GAF score. They need to identify how the disability affects employment and social functioning. The best way to advance a claim is with new and stronger evidence.

It should be fairly easy to shoot down for Social Security report. Especially since the C&P examiner commented that the schizoaffective disorder did not take into consideration the criteria for PTSD. The schizoaffective disorder diagnosis appears to me to have been based on a single exam. Did Social Security have any treatment notes available to them prior to the exam they performed?

It also appears that the rater may have over used or abused their discretionary power. The weight given to each diagnosis in a case which involves multiple diagnoses of mental conditions is performed by a clinician on a mental health exam. The C&P examiner should have identified how much of the disability is attributed to the schizoaffective disorder and how much of the disability is attributed to the PTSD. These questions are asked on the exam worksheet. It appears to me that this comparison was not performed because the C&P examiner thought that the schizoaffective diagnosis was based on incomplete information. In the absence of such a comparison by the C&P examiner I do not feel the rater has the authority or discretionary power to fill in the blanks.

Once again, I want to restate the importance of strengthening the evidence for the PTSD diagnosis. I do not see how you can obtain a high rating for PTSD if the C&P examiner did not identify a significant impact on employment and interpersonal relations. The exact terminology could very. However, a low GAF score combined with the identification of the impact on employment and interpersonal relations would be necessary. Hospitalizations and treatment programs also add to the diagnostic picture.

I am pretty sure that there is a link on hadit to an explanation of how mental health disability is rated.

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