How Should I Handle? Admin Review Reduction

[templar1231]

Last year, my claims were approved and I received a combined evaluation of 80% due to (PTSD - 50%, TBI - 40%, Migraines - 30%, Tinnitus - 10%). Recently, I received a letter stating that they had made a clear and unmistakable error and will reduce the TBI to 0% and my overall will go to 70% after an Admin Review.

I understand their reasoning since they feel the symptoms are overlapping and they can't apply my TBI facet levels that are higher than 0 towards TBI since they've already supported the 50% evaluation for PTSD. Where I disagree (potentially) is that I have other residuals that aren't "psychological" and are attributable to my other evaluations (e.g. Migraines).

The items/residuals that might still apply are subjective complaints of balance problems and vision changes (TBI residuals) that I don't think the doctor evaluated correctly at a 0 severity level. I have blurred vision, balance problems and hypersensitivity to light that do interfere with work, daily living, etc. I wasn't worried before when I got my evaluation because I thought what I had received was fair...but now they're attempting to reduce.

My VSO suggested I show the letter to my Mental Health doctor and see their opinion (and see if they'd like to write up documented opinion for me) and then try to request a hearing or denial.

Any suggestions?

[carlie]

Last year, my claims were approved and I received a combined evaluation of 80% due to (PTSD - 50%, TBI - 40%, Migraines - 30%, Tinnitus - 10%). Recently, I received a letter stating that they had made a clear and unmistakable error and will reduce the TBI to 0% and my overall will go to 70% after an Admin Review.

I understand their reasoning since they feel the symptoms are overlapping and they can't apply my TBI facet levels that are higher than 0 towards TBI since they've already supported the 50% evaluation for PTSD. Where I disagree (potentially) is that I have other residuals that aren't "psychological" and are attributable to my other evaluations (e.g. Migraines).

The items/residuals that might still apply are subjective complaints of balance problems and vision changes (TBI residuals) that I don't think the doctor evaluated correctly at a 0 severity level. I have blurred vision, balance problems and hypersensitivity to light that do interfere with work, daily living, etc. I wasn't worried before when I got my evaluation because I thought what I had received was fair...but now they're attempting to reduce.

My VSO suggested I show the letter to my Mental Health doctor and see their opinion (and see if they'd like to write up documented opinion for me) and then try to request a hearing or denial.

Any suggestions?

Welcome.

Please post all of and exactly what the recent letter states, minus personal info

such as name, address, claim #, etc . . .

[templar1231]

tbi reduction - Copy.pdf Sorry, meant to attach this before - see it

[jbasser]

The VA is trying to lump TBI and PTSD together. That is in it self a fraudulent activity as a TBI is a Trauma of physical nature to the brain. PTSD could be a result of that Trauma but items like gait, coordination and headaches are from the sustained trauma. Stand Alone PTSD is only and I say only a guess by a Phyc Doctor. Does anyone see the bull in this crap the VA is trying on you.

A case need to make it to the federal court to get a porecedent setting opinion of a final nature as the VA will continue to bullddoze veterans over with this crap.

J

[NavyWife]

Your VSOs advice sounds good.

Additionally, I would file for an increase to try and get the ptsd bumped up to 70 and the migraines to 50, if you think that you meet the higher evaluation. That would put you at 90 combined. Personally, I don't think the va will back down on this reduction, but ya never know.

Review the rating schedule here for PTSD & migraines

http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5

[broncovet]

Since this is a decision, if you dispute it, you need to file a NOD within one year.

Like other NODS, you should focus on their "reasons and bases" for decision and demonstrate where that is in error.

Dont try to tell them you are sick, need the money, etc., etc...just refute their reasons and bases. Most importantly, look at the rating criteria for TBI and PTSD...

Suggest if they made an error on the initial decision, it is likely that they could make an error on this one, too.

You blacked out the dates, and that is important. You said the decision was "last year"...was it more than a year ago?

Remember a decision becomes final in a year and the burden is on the VA to prove CUE, IMHO.

You should respond with 2 words, "Prove it" (Remember the criteria for CUE is very strict...look it up..it has to be undebatable...it has to manifestly change the outcome (outcome determinative) and it has to be based on evidence the VA had at the time. "new evidence" changes the picture in regard to CUE. Since they alleged Cue, be sure and read up on CUE..there is much here about it. You could still argue BOD because you dispute CUE.

[templar1231]

Thanks to you both, you're right in that I think I should focus on the symptoms that can't be attributable to PTSD or other awarded disabilities like blurred vision, balance, and hypersensitivity to light, etc that should be documented in my file. Only problem is I don't that facet level was rated accurately by the neuro - I think she was focused more on the psychological manifestations.