ptsd Tdiu That I Did Not File!?

[FMFDoc77]

Hello I'm looking for a few questions in regards to TDIU. First of I am already rated at 60%. 50% PTSD with Major Depressive Disorder, 10% Irritable Bowel syndrome, 10% Tinnitus and 10% for Degenerative Arthritis Lumbar Spine. I also work for the VA, not a Regional Office but I do work in Release of Information and know a great deal in regards to claims as part of my job is assisting fellow Veterans in getting their records and fullfilling requests from Regional Offices for records wnen a Disability Claim is filed. With that being said I have had a lot of issues since my return from Iraq the second time when I was near the Balad Burn Pit for a year. I was diagnosed with narcolepsywhich has been in appeal almost three years along with a slew of other unknown issues. I recently had my Primary Care Doctor(PCP) at the VA fill out the VA FORM 21-0960Q-1 CHRONIC FATIGUE SYNDROME DISABILITY BENEFITS QUESTIONNAIRE. I also recently have been missing a lot of work due to a lot of these undiagnosed issues and had to get FMLA paperwork which my PCP filled out as well. The VA actually tried to talk me into a Medical Retirement. I have not gone through with this because I simply can't just quit work and draw the small retirement check along with my 60% in VA Disability. I know eventually in time it would all come together and I could request TDIU but I was waiting on my appeals to come through. Long story short I get on eBenefits today and there is a new claim that I did not submit. It is for chronic Fatigue Syndrome, Fibromyalgia and TDIU. Yes you read it right, I did not file for any of this. I did however send the Regional Office some evidence to add to my C-File which consisted of that Chronic Fatigue Syndrome paperwork in which I asked to be added to my appeal for the narcolepsy. I sent them my FMLA paperwork which shows a slew of iisues to include possible fibromyalgia and I simply put on the Statement in Support of Claim that I have been missing a lot of work...had to get FMLA paperwork...that the VA recommended I retire but I couldn't because all of my issues were in appeal. Pretty much I sent that stuff in as more evidence for my appeals and poof there is this new claim. Is this normal??? Who would put me in for TDIU because I did not. I'm all for it but really I did not file for it yet. I have also not claimed the fibromyalgia, although it is listed as possible on my FMLA paperwork and I have missed a lot because of it, it hasen't officially been diagnosed let alone a claim for it put in. Did the Regional Office just decide with all of my evidence that they submitted it for me? I am currently still working, although I miss a lot so how would they put me in for TDIU. Any input to this would be much appreciated because I'm confused!?

[jbasser]

DO you have a VSO/ Perhaps they did it for you?

If not, It could be an inferred issue.

How many years civil service do you have under Fers.

J

[FMFDoc77]

Just use the PVA peeps that I know in the VA. I sent them a fax the other day asking them to inquire on my appeals and explained my current situation of missing work, possible Medical Retirement and the fact that most of the issues I am retiring from are all tied up in appeal. I haven't talked to them since the holidays but I am certain they would have let me know. I have 12 years total. Have already been given my retirement benefits estimate from HR but told them I wanted to think about my options. Wouldn't the Regional Office laugh at a claim for unemployability if I'm indeed employed? I have dropped out of Voc Rehab three times as well because of the same issues and have letters from my OEF/OIF Doc as well that I have submitted but am baffled at this new claim.

[FMFDoc77]

I use the PVA inside the VA as I know them but they are only my Power of Attorny(POA). I usually do everything myself as I'm usually pretty knowleage unless it is regarding this TDIU. I have fax access etc. from work to send everything straight to the RO. I did fax the PVA peeps something before the holidays asking them if they could inquire on my existing appeals and let them know of my current situation with possible Medical Retirement and that I have been using FMLA for all of my issues that were in appeal. I would think they would have let me know if they put in a claim though. Wouldn't the RO laugh at a claim for TDIU when I am indeed employed and by the VA of all places? I do miss work a lot and have ample evidence but I am still an employee.

[Berta]

It seems to me that they have enough evidence to award you at 70% and then consider TDIU if you become unemployed......

"Wouldn't the Regional Office laugh at a claim for unemployability if I'm indeed employed?"

In essense they would not act on or advance the TDIU form....if you are still substantially employed.....

but they might send you one, as it looks like you will need to file it in the future.

" I have dropped out of Voc Rehab three times as well because of the same issues and have letters from my OEF/OIF Doc as well that I have submitted but am baffled at this new claim."

When a vet is un-vocrehabable solely due to SC, then they are unemployable solely due to SC.

Have the PVA peeps had any take on this?

Many PVA reps are very good.

[broncovet]

FMF Doc

I had to chuckle at the irony of this: You are a VA employee, and you ask Berta (and hadit) for advice on your claims. Does anyone see the irony of this besides me?

Berta, as usual, gave you good advice.

I will add:

If you review the regulations on Informal claims, you will see that there are instances when, you go to the doc and it amounts to an informal claim for increase. In other words, it is not always necessary to make a formal claim for benefits, once you have already submitted one formal claim. You dont have to submit a new formal claim each time you seek an increase. This is likely where your other claims came from that you did not apply for.

Also, the VA differntiates between "marginal employment" and Substantial Gainful employment (SGE) for TDIU purposes. If you have had regular employment income for the past 12 months, you should not be eligible for TDIU, and it will likely be denied.

[FMFDoc77]

broncovet

Well glad you got a chuckle. Yes I do work for the VA, I did mention not a Regional Office(RO)-therefore I work at a VA Medical Center where we take care of Veterans medical care not an RO which takes care of benefits but I'm sure you know this. I do work in Release of Information so yes I work closely with all Veterans that need their information-wether it be for a second opinion in medical care, filing for benefits etc. and also work closely with processing requests from various RO's when they are also seeking information. I am pretty knowleagble on a lot of this but not TDIU and especially when I did not file a claim for it so I came here. I learned a lot of what I have learned from other Veterans different issues and doing what I do on a daily basis but I'm not an expert by any means and I see there is a lot of knowledge and experience here and I really appreciate the replies thus far.

Berta

That it what I thought but the claim is in. I will paste it:

Compensation & Pension Claim Status

• Return to Claims Summary

Details of Your Claim

Claim Received: 12/14/2012
Claim Type: Compensation
Estimated Claim Completion Date: 06/12/2013 to 09/11/2013

Contentions: chronic fatigue syndrome (New), fibromyalgia (New), unemployability (New)

Claims Status Process Skip the Claims Process and go to the current phase.

1. Claim Received

   Your claim has been received by the VA. If you applied online with VONAPP Direct Connect, you should see receipt in your list of Open Claims below within one hour. If you applied through the U.S. mail, please allow mailing time plus one week for us to process and record receipt of your claim.

   Phase Start Date: 01/10/2013

   Estimated Phase Completion Date: 02/03/2013 - 03/10/2013

2. Under Review

   Your claim has been assigned to a Veterans Service Representative and is being reviewed to determine if additional evidence is needed. If we do not need any additional information, your claim will move directly to the Preparation for Decision phase.

3. Gathering of Evidence

   The Veterans Service Representative will request evidence from the required sources. Requests for evidence may be made of you, a medical professional, a government agency, or another authority. It is common for claims to return to this phase, should additional evidence be required.

4. Review of Evidence

   We have received all needed evidence. If, upon review, it is determined that more evidence is required, the claim will be sent back to the Gathering of Evidence phase.

5. Preparation for Decision

   The Veterans Service Representative has recommended a decision, and is preparing required documents detailing that decision. If more evidence is required, the claim will be sent back in the process for more information or evidence.

6. Pending Decision Approval

   The recommended decision is reviewed, and a final award approval is made. If it is determined that more evidence or information is required, the claim will be sent back in the process for more information or evidence.

7. Preparation for Notification

   Your entire claim decision packet is prepared for mailing.

8. Complete

   The VA is sending a decision packet to you via U.S. Mail. The packet includes detailed information explaining your decision or award. Please allow standard mailing time for your packet to arrive before contacting the VA call center.

Next Steps:

We will review all available evidence and make a decision on your claim upon receipt of all requested information as outlined in the headings, "What Do We Still Need from You?" and "What Have We Done?".

Several factors will determine the duration of the "Development" phase, including:

• type of claim filed
• number of disabilities you claim
• complexity of your disability(ies), and
• availability of evidence needed to decide your claim.

Additional Details

• Your Designated Power of Attorney

  PARALYZED VETERANS OF AMERICA, INC.

• Regional Office of Jurisdiction:
  The Regional Office of Jurisdiction is the station that has primary authority over your claim and permanent jurisdiction of your claim folder.

  Muskogee

• Send Documentation To

  Department of Veterans Affairs Regional Office
  Regional Office
  Federal Building
  125 South Main Street
  Muskogee, OK 74401

Now again I did not submit this claim, however I do on a continuous basis send documentation in myself for each of my appeals which are for Chronic Sinusitis and Nasal Congestion, Migraine Headaches and Narcolepsy as well as an increase on my PTSD with Major Depressive Disorder. I do have the PVA as my POA but only to inquire into my appeals for me and hopefully speed things up, other than that I have always done everything myself. As I mentioned earlier right before the holidays I sent my friend in the PVA Office a fax asking her if she would check on my appeals for me as they have all been in for nearly three years and still sitting in the initial phases. I briefly explained my work situation with missing so much work that I have used all my sick Leave, Annual Leave and am now using FMLA and having to use Leave without Pay. I mentionedto her that HR and the Union recommended or said I could do a Medical Retirement. I then explained to her that I am missing all this work due to all of the very issues that are in appeal so can we look into seeing what is the hold up on these appeals because of the above... I also add very detailed Statements in support of Claims any time I send anything in to the RO. I also mention all of this to them along with things that my VA Providers have filled out such as the paperwork for Chronic Fatigue Syndrome, the personal letter my my OEF/OIF Doc and so on.

I have not talked to my PVA Rep since I sent her that fax but can only assume that she wold have called me if she did anything like that or called me with any update on the appeals. I was just shocked when I checked eBenefits yesterday to find the above claim. Now I am confused on should I go ahead and Medically Retire since the ball is rolling or is missing so much work and still being employed good enough?

Oh and yes I have had to drop from Voc Rehab three times for these reasons but they were prepaired to start me again so it wasn't like they gave up on me but I did let the RO know of this so they can add it to any evidence they may need to substantiate any of my appeals if needed.

So I will talk to my PVA Rep ASAP to see if she knows anything but if she didn't do this then the RO decided to do it based on what I have sent them? If so then they know that I am employed and still processed this so I would assume it would not be denied if evidence was strong enough that they opened a claim for me???