Punisher

I'm going to jump in here, rather than start a new string. I am 50 years old, 100% P&T VA. Some of the more significant disabilities are PTSD (70%), Migraines (50%), and TBI (40%). I have not been able to work since the beginning of 2019. I applied for SSDI once I could no longer work and the VA actually did a great job breaking down how the mental health issues affect my ability to maintain gainful employment. I had SSA perform the expedited application process as they're supposed to for 100% P&T vets. Initial application was denied, giving false statements that I do not qualify for benefits because "you are not disabled under our rules." Under their "rules," it states: For Disabled Worker's Benefits: You must have the required work credits (check), and your health problems must: - Keep you from doing any kind of substantial work (check), and - Last, or be expected to last, for at least 12 months in a row (check), or be expected to result in death. The SSA never had me do a single exam with them, relying 100% on my VA records and exams. So, I appealed it with the "Reconsideration" process. Once again, I never saw a single SSA doctor for any exams and they continued to exclusively go by my VA records. My appeal was also denied, stating that they found the original decision to be "proper under the law." So now I'm stuck going to phase 3, the ALJ Hearing. I do not have a lawyer and I'm very cautious in hiring one, but recognize that one is finally needed. I don't typically trust them, especially to remain proactive, and "IF" I eventually receive approval, am not super excited to hand over a large percentage to someone else. Can anyone point me in the right direction on where to find a great lawyer who has experience working with 100% P&T vets? Any other insights on this process will be very appreciated.

I just saw this.... The first letter that came, stating that nearly everything was deferred, including PTSD, added that and referenced a specific C&P exam. The DAV never helped me with any of my claims package, but when I reached out to them about this, they said it was because of my migraines, which was the only decision in that first letter. They also pointed to the ref'd date. So naturally, I believed that until I looked it up in my calendar and saw it was a TBI/PTSD C&P (deferred by that letter). That's what also made me nervous since it was using an exam that wasn't approved. The migraine decision was simply to continue it (50%). Question to all: When someone receives a 100% P&T rating decision (schedular), does that apply to every condition/disability or does it really just apply to whichever condition deemed you P&T? Maybe that's a stupid question, but the VA does rate everything separately and just wondering how this plays out in the future.

All, I finally got my letter from the VA on Friday, with all the info included from the decision, and it's reflected on eBenefits too! They took away my Insomnia and replaced it with the PTSD rating since they combined the symptoms. They also combined TBI instead of waiting longer to separate the overlapping symptoms, but though the letter said the TBI would be combined, backdated to the same day as the PTSD (04/27/2020), there is still a "residuals of traumatic brain injury (TBI)," rated at 40%. I was surprised that, if I'm finally 100% P&T (officially now), in that big thick package, there was nothing overtly stating that, neither in writing nor in any checkbox like I've read about. They do show benefits we're eligible for that fit that category. Also, they used to show statements saying whether I'd have further exams or not, but that wasn't mentioned in there either. Any thoughts or comments on re-examinations? When you become 100% P&T, does that automatically apply to everything you're rated for? Thanks again everyone! I couldn't have done this without this Forum--I had no other outside help. Not even from VSO!

Berta, I apologize for my convoluted write-up, but it was pretty difficult to describe this craziness. That's what the DAV told me the VA had based it on, and after having SO many exams and appts in such a short timeframe, I also thought that day must have been my Neurology appt, but I finally looked at my calendar yesterday and saw I had a PTSD/TBI C&P Exam that day. So now I'm more worried than ever about my P&T if it's, in fact, based on an exam for a claim that's still "deferred" and pending. Have you, or anyone else here, ever seen the VA do that? I've never heard of that and I was even a Career Councilor during my military career and been a member here for years. (Still nowhere near an expert on these matters though) Are you referring to dropping the IU/TDIU? If so, I realize it could help with a few things, including a future SSDI claim as well, however, I feel my 100% Schedular P&T is safer and enables my kids to use it to pay for school now, rather than take any risks of NOT having it or waiting 20 years for a temp TDIU to become permanent. Also, the two forms they're asking for will be very difficult, mostly the employer one, as I haven't worked there for over 1.5 years and the people I worked for are no longer around, nor did they know much about my MH info. Therefore, I do not see the results being helpful in my case.

Berta, No worries, I really appreciate you taking the time to respond. You must read thousands of these! So this has gotten a bit messy, but first, for the exact reasons you stated (the benefits for my family) this is paramount for me to get it right. For a few days, I was going by the Regional DAV's response above, but turns out the first part was completely wrong. I got my letter and the only two things that were actually decided were 1) that I had basic eligibility to DEA based on 06/23/2020 and 2) that their evaluation of my Migraines, currently at 50%, is continued. So I was a bit confused when I read that. (Stick a pin in that for a minute...) I spoke to another National DAV guy who told me NOT to just call the VA over the phone as I told him I was going to do at that point (last Friday 7/10/2020) to clear everything up, including the whole IU/TDIU mess. He urged me to submit a signed statement for everything, so over the weekend, I did a 21-4138 and uploaded it to my claim, explaining just my reasons for not wanting to pursue IU/TDIU and to close or remove it, mark the two forms as no longer needed, and continue to process any pending claims in order to make a decision without further delay. That got things moving yesterday, Monday 7/13/2020, to the next phase (Gathering Evidence), but all they did with the IU and forms was to move the due dates 3 days to the right (8/3/2020) and the expected completion date moved up to Nov. Then today, I got a call from the contractor doing the C&P that they needed to schedule another exam............ for Migraines! That was literally the ONLY disability they actually made a decision on in the letter and I thought, per the DAV's explanation, that it was the connection which had qualified me for the P&T. Can you see where I'm really getting confused now? I also noticed, upon further inspection of the date the letter referred to (06/23/2020) going back to my calendar, that it was actually a TBI exam I had labeled as PTSD. Whoa! So I called the VA, spoke to the rudest, most condescending person I've ever encountered on the phone, (which has NEVER been my experience, probably just luck), and leaving that whole drama aside, he said he put in a message to remove the IU/TDIU, but beyond that, he wasn't helpful. Any thoughts? Even though this is SUPER painful for my psyche (remember what kind of issues I'm dealing with), I do figure that most of this SHOULD work itself out. That said, I'm very uneasy about my P&T being based on something that is supposedly "Deferred" and/or will be undergoing yet another exam. Sorry this has been so long in the tooth, but this is the most convoluted situation I've seen since embarking on this journey.

Those slowly showed up, one at a time as pending (PTSD, TBI, IU). The PTSD also is now listed at the bottom of the actual full list of my disabilities, but only says "Deferred." I received 2 letters from the VA yesterday, but they were both for the pending claim, even though the decision on the closed claim was supposedly mailed a few days earlier. I reached out to the Regional DAV, since they'd be able to see what's going on, and here is their response: "VA Rating Decision dated 06/30/2020 granted you 100% permanent and total (P&T) effective 06/23/2020, effective the date of the migraine examination because this brought your overall rating to 100% without the TBI and Mental Health (MH) issues. The VA is still going to work on those issues and resolve them as it would potentially give the 100% P&T and earlier effective date. The TBI and MH has gone back to the examiner for clarification. The VA has asked the examiner to try and separate the symptoms between the two conditions (TBI) and MH). No matter the outcome you will maintain the 100% P&T status but the outcome could provide an earlier date of the 100% P&T." That shed quite a bit of light on what's going, but whether or not they backdate the P&T, I don't see that making much difference as the timeline isn't very much and I was already at 100% Temp before. I've also been checking my other disability percentages and they haven't changed on that eBenefits page yet (i.e., Migraines 50 --> 100%) Thanks again for your response!

broncovet, so you're saying to just blow them off? That just doesn't "feel" like the right strategy--at least with anything else I've dealt with when it comes to the Federal Govt. I know you've got more experience in this department, but still... I think my biggest concern here is that it appears to be attached now to my PTSD and TBI review claims, so I just don't want to risk anything being denied or reduced with those if I merely blow them off without at least contacting them, explaining my circumstances/case, and requesting for them to cancel just that piece of the claim, letting them know explicitly that I do not desire to apply for the IU/TDIU. No? I do value your input and appreciate the response.

Thanks to everyone for the responses! I REALLY appreciate it. Based on feedback and what I recently found in the VA Benefits Summary Letter on eBenefits, stating I now have a 100% P&T rating, I definitely do not want to mess with it or pursue that IU/TDIU application. (for several reasons) I do, however, want the PTSD decision to be finalized as well as the RFE for my already connected TBI that was moved over to my PTSD claim from the other set of RFE claims submitted by the VA, which is now complete. So, does anyone have recommendations on how to handle having the VA cancel or remove the claim/application for the IU/TDIU without it somehow reflecting negatively on me or disturbing the rest of the claim? Would it be as easy, possibly, as calling the VA's 1-800 # and requesting that over the phone? This is now my most critical piece to solve. Thanks again!

Update to what I wrote earlier. Although I've been at 100% temporary schedular for the last few years, and my claim for PTSD now show as "Deferred" with the RFE for the TBI moved into that claim, the RFE claim for Migraines and Insomnia shows as complete and letter sent on 6/30/2020. I checked in the VA Letters page, then the VA Benefits Summary Letter, the one that includes whether or not someone is P&T, and it shows that I'm now 100% P&T as of 6/23/2020. There is probably something in the letter they sent that explains the new change, though the clock is ticking for the forms they're requesting to be completed for the IU/TDIU. If they've only finally determined my current disabilities to be P&T, without a decision on the PTSD, I wouldn't imagine more would hurt my case. So, if all that is going on, it makes even less sense to me that they opened an IU/TDIU application on my behalf. Again, I really do not believe I'll be able to complete the employer form, or at best, if I find someone to fill it out, they will not have knowledge of the crucial evidence.

I need some guidance or suggestions from the experts. I am currently at 100% schedular (temporary, not P&T). My higher Service connections are: Dermatitis with Psoriasis (also claimed as psoriasis guttate, eczema/dermatitis) = 60% Migraine including migraine variants - also claimed as decreased concentration = 50% Residuals of traumatic brain injury (TBI) = 40% Insomnia disorder - also claimed as sleep disorder and insomnia 10% and a dozen other 10% ratings for tinnitus, arthritis, degenerative disc/joint disease/lumbar spine, and as well as injuries to every joint. I submitted a PTSD claim and it was moving right along and I'd already completed all C&P exams for it as well as the ones for another set of RFE claims the VA submitted for three other conditions (Migraines, TBI, Insomnia) that are still temporary ratings. Now, two of the three RFE claims show as complete and the VA website says they sent a letter; however, one of the conditions (TBI) got moved over to my PTSD claim and the status went from the exams being complete and in the last phase or so, with a projected completion date sometime this month to December! On top of that, the VA started a claim for "IU" on my behalf without asking me, so they also added the couple of VA forms required with the due date of 7/31/2020. The IU part might not sound bad, but I was already 100% (temporary unfortunately) without the PTSD service connection and I believe I made a compelling case for at least 50% of that, if not 70% as I met most of that criteria. So, I've always heard, read, seen in videos, and even been told directly that when someone is at 100%, albeit temporary, it's not wise to apply for TDIU since it pays the same AND the VA may then reduce other percentages. Also, as you know, it can be easier for them to later remove the TDIU classification for technicalities. Lastly, those forms are the worst part for me. I DO NOT want to have to fill those out, especially the one you have to bring to your former employer. My company was located off-base, so they never even observed my daily performance. The military supervisors who were over me have since moved on as it's been over a year. Finally, I usually burned up PTO to cover all the time away for appts and physical therapy, which they knew about, but as for PTSD issues I was going through, I sure as hell did not disclose to them as it was none of their business, super private, embarrassing, and I would have been worried about my security clearance! The only thing about canceling the IU is that I don't want it to look like I AM capable of pursuing "gainful employment." I would just definitely prefer to retain my 100%, which should be even stronger with a PTSD condition/connection added to my current list. What is your take on all this? Do you know if there's a way that I can have them close or remove the IU portion and the required forms? Besides not wanting to apply for that or do the forms, I also do not want this to hold the rest of my claim(s) up or give them an easier way to assign lower percentages. Any help would be much appreciated.

Big Country, My dates were very similar. I received my service connection decision in October and was paid the regular monthly payment on November 1st. My effective date for everything is 1 June 2015 (My date of retirement). I actually filed in Jan 2015, but of course the date becomes the retirement date. I received my retro pay about a week ago, however, by my calculation, they owed me for June-September yet I only received 3 months worth. I got the statement a few days later showing they paid Jul, Aug, and Sept. I spent a week trying to get through to the VA about the month they shorted me, finally scheduling a callback after hours. When the lady from the VA called, she kept talking out of both sides of her mouth. (Long story) Bottom line, she said they do not owe the missing month's payment. So, to all you HadIt vets, does the VA need to pay us to our effective date, which is shown in our e-Benefits, or can they just decide to not pay us for the first month (like they're trying to tell me)? Thanks in advance!

Navy04, Belated congrats! Your story, and guidance here, has been one of the inspirations for me to keep plugging away. From one USN O-4 to another--"Fair Winds and Following Seas!"

Thanks John! I'm still waiting on my initial claim to come back. It's been at "Preparation for Decision" for nearly 3 months now. I am able to work, but needed to retire from Service because I couldn't take it anymore physically. I was fortunate enough to find a work-from-home job, so I'm able to get up whenever I need to, stretch my back out on a Swiss Ball, take breaks when I'm hurting too much, etc.. I'm hoping to get 100%, SC, but do not want to seek IU because I want to be able to keep working at home and not worry about it.

Any thoughts on how the C&P comments (2 posts ago) will affect/influence my claim?

That's definitely something I'll have to keep in mind. I'm actually hoping that my claim for Chronic Sleep Impairment, which is in that block of "Mental Disorders" as well. In fact I have most of what's in that block in red below, that supposedly is worth 30%. From the eCFR: General Rating Formula for Mental Disorders 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).30