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bc0311

Reopening a PTSD claim

Question

I'm new to this site, and somewhat novice with claims as I've ignored them since my discharge in 2012, but I have some questions that I've yet to find answers for that hopefully someone can help me with:

In a nutshell, my story is I did my four years, two hellish combat tours to Afghan, got out in 2012, immediately filed my claims for a few disabilities like back and shoulder issues and got a 40% rating total. I've since not looked back as none of that concerns me. My issue now is that I was sent to a mandatory PTSD screening during one of my visits that year, and the examiner kind of went about the thing blase, and although I did tell her most of my traumatic experiences, she gave me 0% for "Combat PTSD not related to military service" as it says in their justification, whatever that means. I don't think they even attempted to listen to me as my experiences were extraordinarily traumatic and have been a detriment to my mental health and quality of life since. And yet I now have an effective date of a PTSD claim from day of discharge 6 years ago for 0%, says it right on eBenefits. I think you know where I'm going with this...

After 6 years of dealing with a slew of issues related to PTSD, I decided this week to start looking into trying to re open the case. My questions for you are.... Would I be entitled to any back pay if I could prove that I've suffered from PTSD since then, and that they made their original decision in error? And if so, how could I go about receiving the exact paper work / medical records from that one specific screening I had in 2012? I've looked everywhere and I don't really know how to navigate either of these situations... 

Thanks a lot!

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You "might" be eligible for "back pay".  

Did you apply for VA benefits (not military) within a year of exit from service??

Did you get a VARO decision that states you get "0%" for PTSD, or did you fail to keep VA notified of your address so you "may" have gotten a decision but did not know about it?  

Do you have pertinent "new and material evidence"?  If your "new evidence" is service records VA did not have, but you provide them, then yes, you could get back pay, assuming the evidence is outcome determinatave.  

(An example is your service records document a "PTSD event", such as seeing bodies, or horrific sights).  This is known as a "in service" stressor.

Are you currently in treatment for PTSD?  Its hard to get benefits for PTSD if you are not in treatment for it.  

 

It sounds like you have been awarded 0 percent for PTSD, which would mean you need to apply for an increase as its already been awarded.  

Other than new evidence, the realy only way to get back pay is through filing a CUE.  However, that is going to be tough for you.  You see, Cue needs to be undebatable, and apparently a VA rater has awarded PTSD, but judged it at 0 percent.  If someone else thinks you had 30 percent, that is not cue as it needs to be undebateable for CUE.  You dont usually get Cue for differences of opinion on your disability percentage award..if you are unhappy with the disability percentage, you need to file a NOD within a year.  

Edited by broncovet

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You stated:

"And yet I now have an effective date of a PTSD claim from day of discharge 6 years ago for 0%, says it right on eBenefits"

Do you have a decision yet on that and if so, can you scan and post the decision , to include their Evidence list?

Cover your C file# and name prior to scanning it.

"Would I be entitled to any back pay if I could prove that I've suffered from PTSD since then, and that they made their original decision in error? "

Yes, possibly- if you have a PTSD MH diagnosis and proven stressors or fit into the 2010 PTSD regulations available here under a search, and/or have the CVIB, CAR, or PH on your DD 214.

But the back pay isnt that easy-you need a new rating based on a claim for higher rating, and then if that is awarded, you might have the bases to file CUE on the older "0" decision and attain backpay (retro)

"And if so, how could I go about receiving the exact paper work / medical records from that one specific screening I had in 2012? I've looked everywhere and I don't really know how to navigate either of these situations... "

Why did you have a mandatory PTSD screening?

 "she gave me 0% for "Combat PTSD not related to military service" 

Can she spell Oxymoron???????? Was she a real MH doctor?

Where was this done? If at the same VAMC that treats you, their Privacy Acy Officer might have a brief form you can sign to obtain this record.

I would think it would be in your VA medical records , and you can request all of them, but asking for one copy wont take as long as the records request will take.

It is to you advabntage to have copies of all of you VA med recs, your VA cilem, aqnd your Military SMRs and inservice personnel file.

Have you formally filed a claim for PTSD? Or was this something that just popped up at benefits?

 

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Once service connected, PTSD is rated on the symptoms you have.  Generally, the more your symptoms affect your work performance the higher the rating.  For exxample, a 100 percent PTSD Vet has "total occupational impairment" that is, his PTSD is so severe he can not work at all.  

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I agree with Berta, here something is amiss.  Maybe you got a decision awarding 0 percent for PTSD, or maybe you didnt, but its not VA's fault if you failed to notify them of a change of address.  

Whenever possible, if you dispute a VA decision, you need to appeal it within a year.  (Sooner if its a BVA or CAVC decision).  

I think if VA awarded you 0 percent for PTSD BUT DID NOT INFORM YOU, then you have a CUE.  

38 CFR 3.103 says you have to be notified of a decision, and if you were not, then that is CUE.  Again, however, if VA sent you notice and you did not inform VA you moved, then its your fault, not VA's.  

More precisely, I think, the failure to VA to notify you and give you a notice you can appeal, "tolls" the one year appeal period, so you could still appeal.  (Of course, what do you appeal if you dont have a decision).  

You need to force the VA's hand.  

If you used a VSO, ask him for a copy of the decision if you dont have/didnt get one.  See if it was sent to your correct address.  

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Whoa, I really appreciate all the responses. Let me try to address most of what you're asking me. Remember I'm not at all experienced with this so bear with me...

I didn't change my address, I did receive this letter stating their decision in 2012. I did claim everything within weeks of my separation in 2012. I did tell the examiner my experiences for PTSD. I'm not sure why it was "mandatory" I think it was a new policy thing at the time for combat vets. I definitely didn't ask for a screening, I was trying to ignore my symptoms. But she said I should claim it anyway, so I did, and yes she gave me verbatim "PTSD - Combat, not related to military service: 0%". It's on all my letters from the VA and eBenefits.

My experiences in combat are about as severe as it gets. I was in daily combat, sometimes 3 engagements a day, for virtually every month I was in country between two deployments. I saw the utmost violence and carnage. I have 90gb of videos and pictures to prove it. I've been hit by two IEDs, but refused medevacs at the time and the Marine Corps refused to award a PH because TBI needs to be determined within 7 days by a Doctor, and we didn't even have a Dr. But I have 4 notarized witness statements from Sergeants, Gunny's and Lieutenants as well as pictures of myself and the vehicles I was in, and also hospital records from Bagram Afghan when I was eventually medevaced with TBI /stress symptoms. So as far as evidence goes, It's pretty cut and dry that I've at least been heavily exposed to years worth of traumatic crap. 

As far as TBI goes, the Marine Corps and VA have basically explained that too much time has elapsed to connect any specific IED incident. That's fine I guess. But I do certainly suffer from PTSD and it affects everything I do and my family. 

I will try to contact that VA center to get that specific record. 

As far as re-opening the case, I don't see any other option. You can't repeal after one year correct? It's been 6 years. My only options are to either re-open or re-claim. I know re-claim doesn't get back pay. I was just wondering if anyone knew of another way to prove that they made their original decision in error. I applaud the lady for telling me to claim PTSD, but kind of hate her now for ignoring everything I said after the fact. I've seen people get PTSD ratings for much less than what I've been through.

Thanks everybody...

Edited by bc0311

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