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  • 14 Questions about VA Disability Compensation Benefits Claims

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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stever

Need Some Expert Advice

Question

I was just awarded 50% rating for PTSD going back to January 2005 and I'm truly greatful for that but I believe I should have received 70%. My gaf was 50 which they stated in my award letter denoted serious symptoms. I lost my job over a year ago due to my problems with PTSD and Major Depressive Disorder Should I immediately file a NOD or should I first discuss with my Doc to see where she thinks I should fit in? Because I want to file for TDIU also but I think you need the 70% rating in order to do so. I'm also going to file a claim for tinnitus as I do have documentation from the va and a private Doc. I would appreciate any input.

Thanks

Stever

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4 answers to this question

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I was just awarded 50% rating for PTSD going back to January 2005 and I'm truly greatful for that but I believe I should have received 70%. My gaf was 50 which they stated in my award letter denoted serious symptoms. I lost my job over a year ago due to my problems with PTSD and Major Depressive Disorder Should I immediately file a NOD or should I first discuss with my Doc to see where she thinks I should fit in? Because I want to file for TDIU also but I think you need the 70% rating in order to do so. I'm also going to file a claim for tinnitus as I do have documentation from the va and a private Doc. I would appreciate any input.

Thanks

Stever

My personal experience (yours may vary) is that VA docs strenously avoid the compensation piece and stick to the clinical ... i..e, they have no problem talking about why you rate a certain GAF score, but if you go in there with a ratiing scale and ask them "where do you think I fit on this scale," they won't want to play.

My NON-expert view is that you should assess why you disagree with your rating and what clinical or other evidence supports your disagreement.

My NON-expert view is that the GAF is not the be-all end-all of your rating. It's a snapshot in time as to how you were doing that day, and when combined with other GAFS taken over a decent length of time should give an overall view of how you're doing overall. I've included the schedule of ratings for mental disorders and the GAF below (you'll notice some verbiage from the GAF appears in the schedule of ratings, but I would be careful about falling into a GAF X = Rating Y mindset). I think it's helpful to know about the GAF because some docs don't pay as much attention as they should and fail to ask certain questions that might make a difference in your score. Sometimes, you'll want to get the answers to these questions "on the record" even when they haven't asked.

Best of luck

Bill

GAF ranges

100-91 Superior functioning in a wide range of activities, life’s problems never seem to get out of hand, is sought out by others because of his/her many positive qualities. No symptoms.

90-81 Absent of minimal symptoms (e.g., mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities,socially effective, generally satisfied with life, no more than everyday problems or concerns (e.g., an occasional argument with family members).

80-71 If symptoms are present, the are transient and expectable reactions to psycho-social stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork).

70-61 Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful relationships.

60-51 Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).

50-41 Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).

40-31 Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school).

30-21 Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day; no job, home or friends).

20-11 Some danger of hurting self or others (e.g., suicidal attempts without clear expectation of death; frequent violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g., smears feces) OR gross impairment in communication (e.g., largely incoherent or mute).

10-1 Persistent danger of severely hurting self or others (e.g., recurrent violence)OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death.

Schedule of Ratings

100 - Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name

70 - Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships

50 - Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships

30 - Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events)

10 - Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication

0 - A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication

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Apply for IU yesterday. Appeal the 50% and show that you are unemployable.

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Bill is giving good advice. Look over the criteria for 70% and point out the obvious to them about why you should be 70%. I went through this process earlier this year, same rating and everything. I recieved some great adivce on here, so I'll say what I can to help from what I've learned. Also, as Bill has stated, your GAF is what they rate you at for it for the day of the exam. I have seen people with higher GAF'S get increases while lowers don't. I do not believe it weighs as much as some think on their claim, although it dosen't hurt.

Go ahead and put in another appeal, and if this has effected employment, make sure your VSO (Or whoever you have representing you) puts in a TDIU claim also. (This will save some big time down the road) I didn't put in for TDIU when I went for my appeal when I got 70%, and now I'm still stuck in that process right now. Tell them all the symptoms you have, and dress appropriately. (This isn't a job interview, dress just as you do at home, and shower when you regularly do) Don't change anything, let them see you how you are every day. Don't change how you act or anything. Don't be rude, but you don't have to be super polite either. I've noticed when I'm cooperative with the examiners, they seem to be a bit more understanding. Next, if you are married, have your spouse write a letter in support of your claim for PTSD, telling about all the signs they have noticed. Spouses often notice much more than yourself as I have also learned. If you're not married, have a close family member or friend write one up. If you have problems driving, make sure you tell them also that it makes it hard on day to day life not being able to get around like you used to. If you have sleep problems, tell them everything about them. (Night Terrors, Waking up and checking locks on doors, vehicle locks, etc)

I appologize for not remembering all the advice I was given, but it was alot. I hope this helps somewhat though. Also, did you file for Social Security Disability? You can do so online in about 1 1/2 hours or so. I would file for this right away as it backdates, and if it turns out you're eligible, you won't be throwing more money away by waiting. Remember, it never hurts to try for benefits you're entitled to if you're disabled. Make the system work for you.

The last piece of advice I can give, is DON'T GIVE UP! The VA will wear and tear on you, and make you wait and wait, but stay positive and keep your chin up. It gets almost depressing and can make your anxiety go through the roof, I know, but if you keep at it and don't let them slam the door in your face, odds are you will get what you are working towards.

Thank you for your service and good luck!

Edited by Sapper

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Stever,

When were you discharged ?

Are you a OIF/OEF vet ?

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