Jay Johnson

This is true and I think this is whythe VA is TRYING to get away with these P&T C&Ps, but that's not what the exemption is for. The VA can order someone who is P&T back for an exam if A) They get new and material evidence, or :( There is reason to believe the P&T rating falls under clear and unmistakeable error. It does not, however, give broad discretion to the RO to order a C&P whenever they feel like it, because that would be going against existing evidence and medical opinion (which stated that the condition is permanent in nature). 501(a) basically says that the VA has the authority to collect evidence needed to carry out VA law and establish benefits under said laws. It doesn't give the VA the right to supersede existing laws in order to go on a fishing expedition. If the VA has some evidence that puts the P&T into question then they have complete authority to look intothe matter, but fishing for a reason to lower someone goes against medical opinion and the raters to do not have authority to supersede medical doctrine and established opinions. There's also other regs that blur into 3.327 like finality of decisions, which states that one RO cannot supersede another RO based on opinion, nor can one rater supersede another raters opinion because he/she feels the claim is too high (without CUE). In short, veteran's ratings are more protected then we think and the regs are clearly on our side, but the SOs, and many veterans, let the VA trounce all over those regs without penalty, which is the true reason why so many vets have a horrible time dealing with the VA.

Says so in 3.327 and it has be said numerous times by the BVA, CAVC and was recently said to congress by the VA's top brass. On top of that, it just doesn't make ANY sense. Perhaps one can argue that the VA has been too liberal with the designation, but that should mean they should become more strict about handing it out; not going around the law because they think they screwed up. Permanent means permanent...it doesn't mean kinda permanent or sorta permanent. If you don't offer them ANY reason to look at your file (IE - some form of new and material evidence) they have NO right to reopen your claim. But, they've gotten away with it in the past and SOs don't seem to object to it when they do....what I hear most is, "well, what do you have to hide", which completely misses the point. Calnight, One can argue that the medical record you've compiled is what can lead to them reopening your P&T case. If you have ONE good day, the RO can use that as justification for "new and material evidence" regardless of the overall disability picture....it is a way out of the regulations that they can use to protect themselves in ordering a C&P. If you are seeing a civilian psychiatrist and they try to order a C&P, first fight the appointment, then send in an eval from your civilian doc if you're pressed. The laws are VERY clear on lowering 100% and P&T cases.....they need a lot of evidence to get away with it (not saying they wont try though).

I don't really agree with that idea. Before we moved out here (and went through hell with this RO) the DE RO was in the process of archiving the wife's C-file despite JUST being found P&T several months earlier. It's kinda hard for an RO to make a surprise C&P without a C-file in my opinion. Now, I'm speaking mostly to PTSD vets, as it the most subjective disease the VA encounters and is episodic in nature.....physcically disabled vets almost ALWAYS get worse with time....thus is the nature of aging, so there's little to lose. But, for PTSD vets, I strongly feel it's best to seek treatment outside of the VA system. With that said, I do agree that PTSD vets should continue with some form of treatment in the civilian realm.....my wife still sees a psychiatrist for meds every month to every other month. She's given up on "therapy" though, as 99% of it is voodoo medicine at best, plus "therapy" only made her worse. By the way, I really wish people would stop accepting surprise C&Ps when someone is P&T. It is illegal and wrong, but they do it because we just accept it as status quo. If you are P&T and they schedule a C&P for NO reason (no new material evidence), then fight the appointment........otherwise, what's the point of P&T?

Berta, The letter is written and formatted brilliantly, but, for future letters, I would write out those acronyms, in full, before using the abbreviated form throughout the paper. Though many of us know the various acronyms used by the VA, someone inside of the Senator's office may not, so it may be wise to list those acronyms at least once in the letter. Proper format for acronyms is to first list the item in question in full, followed by the acronym in brackets, then you can use the abbreviated version throughout the rest of the letter. Example: "The Veteran's Affairs Regional Office (VARO) sent me a letter.....I feel the VARO was incorrect in its conclusions...". I know it's a small thing, but those little things can make a difference sometimes:-) Thanks for your efforts.

There's a simple way to fix this: Hold the RO's accountable for their decisions. In my opinion, an RO is in contempt of congress every time they make a decision that is clearly erroneous. If someone files a claim with a 30 GAF and ALL of the evidence shows severe impairment, yet the RO hands down a 50% rating, the rater should have charges filed against him or her for contempt. The reason so many cases are in limbo is because the RO knowingly makes ridiculous decisions to which they KNOW the BVA won't allow, but the BVA remands it back to the RO so the RO can make another stupid decision....during this multi-year process they hope that the veteran filing the claim gives up or dies off. It may sound brutal, but I bet it saves them millions/billions. All of this can be stopped by simply holding the RO responsible for decisions that clearly violate VA regulations. But, as it stands now, the RO can do whatever it wants and there's not a single thing we can do about it.....if they do something blatantly wrong, the best we can do is hope the BVA fixes it (in several years).

Of course they can:-( But that shouldn't stop you from trying in most cases. If you have good records of all of your conditions and those records show a steady increase in severity, then go for it.

Which would make sense if the VA didn't award 100% ratings for people who can obtain gainful employment AND their 100% compensation. In the VA, not all disabilities are treated equally. The loss of (or loss of use of) appendages are awarded compensation on employability AND quality of life (in my opinion). Perhaps 40 years ago, the loss of two legs would mean a lot in the work force, but, today, one can lose both legs and be out playing basketball (without a wheelchair) in a year or less. Now, I'm not saying that those veterans do not deserve their compensation, but there *is* a double standard in the VA. To my knowledge, there is no regulation that states that a 100% vet cannot work (unless it's TDIU), yet the VA *says* that those ratings are based ONLY on one's ability to retain gainful employment.....so how can someone who is capable of retaining gainful employment be 100% disabled? In my opinion, the VA should compensate for loss of employability AND loss of quality of life to close these gaps in ratings.

I know that P&T stands for Permanent & Total Disability, but what does this really mean? P = Permanent T = Total I believe you can be permanent without being total; just as you can be total without being permanent. Basically, someone who is total means that they are completely disabled (IE - 100%). Someone who is permanent has a chronic condition in which there is no likelihood for improvement in the near future. Although ROs tend to grant this at varying times, the regs state that a permanently disabled vet should have a condition that has not improved for a period of 5, or more, years and that age is a factor. Do you have to be rated at 100% to get P&T? To be "T", (total), yes (either 100% or TDIU), but I'm not sure on permanence.....I've only seen permanent applied to folks with 100% ratings, but I'm not sure a reg states as much. Do you have to be unemploye to get P&T? Depends on the condition, but not in all cases. For instance, someone missing an arm and a leg can be rated at 100%, be P&T (obviously those appendages aren't going to grow back) and be employed making good money. Are there certain injuries that you have to have to get P&T? Nope. Either your condition is chronic and not likely to change, or it's not....either your condition is totally disabling, or it isn't. If your 100% do you have to request P&T or do they automatically give it to you? Either/or. Sometimes they offer it to you without asking and sometimes you have to fight for it.....if you believe your condition is permanent then request it.

Well, gather all the information you can (on the heart condition) and file an appeal for it. As vike said, it's even harder for them to mess with the PTSD rating if it's attached to the current denial for the heart condition because the DRO is only supposed to consider the issue being appealed. At least you're in a position to weather a long appeals process being that your spouse is already 100%.

TAP was in place when my wife was discharged (medically for PTSD) and did NOTHING to inform us about the inner-workings of the VA and how disability REALLY works. The only reason I even went to an AmVet rep, on base, was because my wife met a PTSD vet in the civilian mental hospital who gave her the run-down on the VA and SSD. TAP is a step in the right direction, but we really need a well informed person, in VA matters, to give a detailed briefing on how the disability process works and what records a departing veteran needs to retain/obtain.

Yeah, DIC is a big deal, especially with a heart condition. On the plus side, I don't think an RO likes to question itself....I think my wife's case is more of a "my RO is better than your RO" type of case. In all likelihood, your spouse's TDIU P&T should be fine, just be sure to get copies of the exam (for the heart issue) and don't offer up any personal details that do not pertain to the heart issue (unless asked). Again, the VA regs are on your side here, but there is NO penalty if an RO does not follow regulations, so they tend to break them from time to time. In the end, you'd likely win back anything they tried to reduce anyway, but it can make life hell in the meantime.

"Take back" is a tricky phrase.....can they review the decision and change it, without CUE, as per the regs? No. Have they done it anyway? Heck yeah. They did it to my wife when we simply changed regions. The decision to drop her from 100% P&T with A&A (just received several months before moving mind you) to 50%, was made because, and I quote, "the VA does not grant A&A for a person's willingness to hurt themselves (why they took away A&A)" and "The evidence does not warrant a 100% rating". They based this on a note saying she was able to handle her own finances (to get her out of the god awful fiduciary program). Eventually, we won the money back (all but the A&A, but we got homebound), but only because I fought them tooth and nail and got in touch with the director of the RO in Seattle. So, P&T is safe ONLY if you give them absolutely no reason to look at your file...once you open it up, you are subject to the rater's discretion, regardless of the regs saying they cannot do so. Filing appeals for separate disorders (once already 100%) is a judgment call...personally, I would leave well enough alone. The regs are certainly on your side in this matter, but that doesn't mean the RO cannot put you on the defensive and force you to win the rating back on appeals.

This has been on the books for quite some time, but not many people are actually discharged for PTSD. Unfortunately, PTSD tends to have a "delayed onset" of symptoms and even when folks do experience symptoms, while in service, they tend to play them down for fear of peer pressure/stigma. But, veterans leaving service *should* be told of this before hand...I think the average service member is grossly under-educated on what, exactly, the VA does and how their disabilities *should* be handled. How much easier would SC be, if every service member knew the process by which SC is granted?? If nothing else, I bet the average veteran would keep FAR better medical records and documentation.....

Sadly, the highlighted portion is the ONLY reason we'll ever see universal health care....democracy doesn't work when a select few (the rich) have a hugely disproportionate say in public policy:-( When the rich start to hurt, due to private insurance, you'll see a change in public policy......

Ask a doctor from another country with universal health care just how good America's system is....to them, we are a complete joke. The world health organization (WHO), and several other groups, have all put our health care system at around average, at best, or among the worst (depending on the group doing the study and "how" they measured the health care systems). The long and short of this is that the US DOES have the greatest health care in the world, but only for those who can afford to pay for high-end health care out-of-pocket, because the best doctors do not accept insurance. For the rest of us, health care is very dependent on luck....some areas have fairly good health care systems and some don't; it's really hit or miss. Now, the sad part about our system is that is is ALREADY government run. EVERY business gets government kick-backs (in the form of tax breaks) to furnish their employees with health care. So, in essence, we already pay for our "private" system with tax payer money. But, conservatives like the idea of profit above all else, so our current system allows individuals to get rich off of tax payer money and gives them more companies in which to invest their already inflated bank accounts. The solution is simple - we need a REAL universal health care system! If we were to give EVERY American health insurance (in one form or another...perhaps something like tricare, but less sucky) it would likely drive taxes up minimally, because our incomes should increase due to the lowered burden on businesses to provide the insurance (which can cost a business over $5/hr per employee). Also, I would do away with the VA health care system ALL together (as well as medicare, tricare, etc). With EVERYONE being covered there would be no need for the bloated bureaucracies.......The VA would consist of ONLY a compensation department at that point, which would SLASH their costs by billions (which could go to deserving veterans). One more note - a universal system should be based on income level (as to copays and such). Someone making over 500K/yr should, basically, be paying their entire medical bill (short of catastrophic claims); whereas, someone making 20K/yr should have little, or no, copays. A system like this would end up costing the average American very little because many folks currently covered would actually be paying more for insurance, but most Americans would end up paying less. But, this will NEVER happen because it makes entirely too much sense and it take profits from the rich. Our government is nothing more than a puppet for corporate greed, so I don't expect any legislation, anytime soon, that actually HELPS Americans. Perhaps if people actually paid attention when they voted this kind of thing could happen......

Six, Good points. What worries me about PTSD is that the affliction is SO subjective and there's no way to diagnose its level of severity outside of a doctor's *opinion*. Psychiatrists aren't mind readers, nor are they trained to tell if someone is lying and/or over/under-exaggerating....the best they can do is GUESS. Because of this, I think raters are given a LOT of latitude to "weigh" evidence however they see fit and to sift through evidence and cherry pick the parts that conform to the rater's *opinions*. When this is coupled with the high/low nature of most PTSD cases, you get very inconsistent ratings from the RO. So, if you go to your regularly scheduled psych appointment at the VA and you're having a "good" day (on a high) your VA doctor might note that you looked upbeat and alert....that information, in turn, can be used against the veteran as a justification to lower them despite the regulations stating that PTSD shouldn't be measured by its high; rather, PTSD should be measured at the low points and how often those low points occur. So, if the system were fair to mentally disabled veterans I would agree 100% Sixthscents, but it's not and, in my opinion, PTSD vets are better off using tricare/medicare to obtain a *good* civilian psychiatrist. But, if you trust that the system will always work out in your favor, by all means seek treatment at the VA........just remember that I told ya so when they use that treatment against you in a future eval:-) However, most other disabilities are far less subjective and VA documentation can actually HELP in future claims....to me, it's a terrible double-standard, but what can we do??

For any physical disability I would agree, but PTSD is so subjective and it only takes one A-hole doctor to make your life a living hell. I do, however, agree with continuing care....if a PTSD vet just walks away from the VA AND treatment all together, they will have a tough time if the VA goes digging into their files again. My wife maintains a psychiatrist, for meds, every month to 2 months (depending on how she's doing). This gives her ongoing treatment and shows proof that she still needs meds and other medical services. But, her psych is civilian, so the RO can't use every appointment as a basis for reopening her P&T claim with "new and material evidence"....if they want that, they better go to court for it:-)

Spike, I feel your pain:-( One of the reasons I suggest using a civilian psychiatrist (aside from keeping the VA out of your business) is that you have the ability to pick and choose which psychiatrist best fits your beliefs; both in how you feel your symptoms should be treated and your beliefs in general. This issue isn't just a VA issue; this is a world wide issue in regards to psychiatry. The reason I brought up Freud is that he represents a very dated way of thinking about psychological problems and it is his model that this “Satel" psychiatrist still follows. Basically, there is still a large block of individuals within the psychological community that believe, in essence, that psychological disorders are "mental" and not "physical". As diagnostic and imagery tools get better, we are learning that many psychological problems stem from physiological issues within the brain. Fear, anxiety, depression, hallucinations, etc. all have a chemical and biological basis, yet many treat them as if they're merely a made up fantasy inside of our heads; that we can, somehow, overcome if we simply talk ourselves out of it.....this is ridiculous, of course. The problem is that psychology is a billion dollar business that relies on the perception that one can simply be "talked" out of any given disorder. So, coming to the realization that many disorders have a physiological mechanism, essentially, puts them out of work (to an extent). Now, there are many within the psychology side of the equation who are coming to this realization and admitting that they cannot "cure" a disorder with words alone does NOT mean they are out of business; rather, it simply means that they are in the business of "treating" symptoms, which, in many cases, can give the patient a much better standard of living. But, the traditional psychologists don't want to give up on the idea that mere words can cure severe psychological disorders and they don't want to trivialize their contributions to the field. In the end, we, as a society, need to start calling a spade a spade and show this antiquated way of thinking for what it is. We need to stop going to thes therapists, psychologists and psychiatrists that subscribe to that nonsense and put them out of work. Fortunately, we live in a free-market system, so we CAN fix this problem, but we need a lot more education on this topic in order to do so. Most people on this forum probably think of a psychologist as a psychologist......we aren't taught that there are many different schools of thought in psychology and most therapists/psychologists subscribe to one, or more, of them. These "schools of thought" mostly believe in the idea that therapy (IE - words) can "cure" "mental" disorders...the only ones that don't focus on the "medical model", which tends to be linked to psychiatrists rather than psychologists/therapists because the medical model acknowledges a physiological problem that psychologists/therapists aren't licensed to deal with (IE - prescribing meds). Moral of the story - learn to ask questions about your psychologist/therapist/psychiatrist......see what THEY believe and what models THEY follow. If they say things like, "we can cure this, but you need to work harder", or "this is all in your head and/or irrational" fire them immediately....they are ignorant and need further educating. A SMART psych *should* say that there is no cure and that we really don't know how to "fix the problem", but that he/she will "do everything we can to treat the symptoms".....that is ALL that medical science has proven thus far; anything beyond that is an outright lie.

I'm not sure where you heard that Freud was a child psychologist, but I don't believe this is true. He started out as a neurologist and never studied children at all, despite developing the psychosexual model of development which focuses solely on early childhood development. Also, I've never heard of Freud studying his own children. Other famous researchers have, such as Piaget, but not Freud. Either way, he was a "quack" who had severe issues with women and, likely, had childhood trauma himself (my guess is he was molested)....he was completely fixated with childhood sexuality and seemed to blame every psychological disorder on sexual development (which is absurd). By the way, Freud focused a lot of his attention on "female hysteria", and did seem to have issues with women. He was also an avid cocaine user and often used the drug for "therapeutic" purposes. P.S. - Did you know that "hysteria" is derived from a Greek word meaning "womb"...the word we use for "crazy" literally means woman:-(

Good points stretch. This is a typical tactic used by politicians to sell an outrageous idea....they conflate something that is moderately true (early intervention can help) with something that has NO proof like claiming that 100% (severe) PTSD vets can be "cured" by sending them to work. I just found it disturbing that no one even questioned those claims or asked for even a hint of proof. Sure, therapy helps some vets deal with PTSD symptoms, but it is very rare that therapy will have any large impact on a very severe PTS case, because severe PTSD involves sooo many other factors (depression, suicidal/homicidal ideation, hallucinations, OCD, GAD, etc, etc). The real disturbing thing to me is this notion that PTSD can be "cured" at ANY level. How can one cure something when they don't even know what it is?? Ask ANY psychiatrist what PTSD is (be sure that they don't merely list "symptoms")...they can't do it, because they don't truly know what causes it. "Curing" PTSD would be like saying you "cured" a broken arm with morphine. What you've really done, in that example, is treat a symptom, which is all therapy and drugs can do for PTSD. The best one can hope for with PTSD is to learn to diminish their symptoms and/or learn to live a decent life with said symptoms. Interesting fact: Did you know that parkinson's disease is basically identical (physiologically speaking) to schizophrenia (and other symptoms like depression, hallucinations, etc)? They both involve abnormal levels of dopamine (one being too high and one being too low). Could you imagine a parkinson's patient walking into a doctor's office and being told, "it's all in your head; get a job and use self-talk"?? No, that would be absurd. Yet, we tell people with physical problems in their heads (PTSD) that they should, in essence, "walk it off". It's a huge double standard and the field of psychiatry doesn't want to admit it because they want people to keep coming to them for a "cure". The future of psychiatry is in the bio-medical side of things. PTSD, and other afflictions, are PHYSICAL disorders and, in time, we will know exactly how and why people have PTSD. But, for now, we let these over-educated retards spout their opinions as if they're facts, just because they spent 8 yrs in college and studied that idiot freud. P.S. Interesting fact on freud: His theories are basically bent on the idea that all of our current problems have ties to childhood. Did you know that freud never studied children? How does one make such strong ties to development at a young age without ever having done studies on kids? What a joke:-)

I just finished listening to the entire hearing posted below. I can't stress enough that the veteran community needs to start pushing back HARD against the VA and, more importantly, congress in regards to this issue. This idea of "curing" PTSD vets (to which there's NO real evidence of this happening in severe cases) and/or forcing veterans to work as a form of "therapy" is a HUGE problem, especially when it's coming from the medical community. Also, this timing couldn't be worse given the influx of new PTSD cases due to the Iraq war.....we could soon find P&T PTSD vets under review and forced into temporary work programs as a means of lowering the amount of 100% cases. I think those with TDIU have the most to fear in this, as work seems to be the key factor in the discussions to the VA panel. Make no mistake about it, this is pseudo-science at its worse. This Satel person clearly has a conservative agenda and does NOT have the veteran's best interest at heart. Time and time again her, and some others, glossed over the fact that jobs are the most stressful part of 99% of American lives.....not all of us are doctors getting paid 7 figures for our "opinions". Rather, we are typically faced with jobs we don't like, in highly stressful situation in which we are forced to choose between a horrible working situation or not having the money to feed our kids or keep a roof over our heads. Work *IS* the stressor for most veterans for this reason. If there is to be ANY type of work incentive from the VA it MUST be tied in with guaranteed compensation as a means to reduce the stress associated with gainful employment. Also, the panel failed to address social implications of PTSD and its impact on the quality of life for veterans......as has been pointed out (by myself and the recent PTSD study), physically disabled vets can receive payments for simply being injured up to and including the 100% level despite being able to lead a relatively normal life with gainful employment. So, the ONLY reason the VA, and these wanna-be doctors, are pushing the job issue is because PTSD is linked to work and has no basis in social impairment....I've never seen a 100% PTSD veteran who is gainfully employed while retaining that 100% level; yet there are plenty of 100% physically disabled veterans who do. This is a fishing expedition to cut the compensation benefits to PTSD vets, because of this war. It is disgraceful and we (being the entire veteran's community) need to speak out now, or we're all going to find ourselves without compensation and shaking our heads. One more note - this panel's blatant disregard for human life is appalling. They were honest enough to mention that 5000 vets commit suicide each year, but they didn't want to make the connection as to how many MORE vets would commit suicide if forced off of the 100% level and into work.....is saving some tax dollars worth a 10-50% higher suicide rate? I bet Satel believes it is!

Wow, that is truly disgusting. Why aren't the SO's doing anything about this?? This "psychiatrist" is making claims to congress based on personal experiences and has NO scientific evidence to back up a single claim of her's? The evidence on the effectiveness of the therapies she mentioned (behavioral, psychotherapy, etc) are all very limited.....every one of those is far from a guaranteed cure and most have proven ineffective for severe mental conditions. Psychotherapy is perhaps the biggest joke the medical community has ever come up with.....it reminds me of drilling holes in people's heads to "let the spirits out"; it is THAT useless and baseless of a therapy, yet millions subscribe to it. This is the typical conservative "bootstrap myth" that says that anyone can do anything if they work hard enough. Ironically, the "bootstrap myth" has been disproved for decades by sociologists and psychologists alike. It's shameful that congress allowed this idiot to speak. By the way, didn't we just have a report done that said the opposite of what this pseudodoctor is proposing?

The wife is 100% (schedular) for PTSD, with housebound and P&T. She was initially rated 100% right out of the military, was bumped to 100% P&T with A&A upon her first scheduled C&P (2 years after initial rating) and, due to several months of hell, reduced to her current rating (housebound from A&A). No unresolved issues and we didn't argue the A&A because I "hope" to be able to work outside of the home again.... some day (though, I don't forsee this anytime soon given her current condition).

It's the least I can do and that quote I highlighted seems to be very powerful to me:-) "Required" is a very strong and blunt statement that really leaves no room for interpretation and being that it was made by the VA top brass to congress (likely under oath), I don't see how the VA can ignore it or try to skirt around it. Simply put, if you are P&T and the VA is scheduling C&Ps for you, they are breaking the law.

One more note on this - I know some folks will say, "but the VA says it cannot be limited under 3.327, so they can send P&T vets to a C&P"....this is wrong in my opinion. That discretion, on the VA's part, is limited to new and material evidence and/or CUE type claims...they cannot simply send a P&T vet to a C&P because they feel like "checking in on them". The reg states as much, it has been said many times in BVA decisions and the VA top brass has expressed it to congress, but, despite all of that, it's the spirit of the designation and simple common sense. If a disorder will not likely improve, than it's a waste of time/resources to keep investigating it and once someone is deemed "P&T" they should never lose that designation unless new and material shows a clear improvement or there was fraud in determining the original status. SO's should be all over the VA if they try to pull this nonsense, but they don't seem to care and most vets just accept it without question....this has to stop.