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Jay Johnson
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Posts posted by Jay Johnson
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That's a very broad question...there are regs and tables for just about every disability that can be SC (and if there isn't one they are supposed to approximate it to an existing condition/table), but even those tables are at the discretion of the rater. If you could be more specific about the disability in question I'm sure someone here can find the appropriate table.
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Yes and no...it depends on where your claim is at in the appeals process. The VA has a duty to assist (actual regulation), so they have to allow you a C&P if one hasn't already been provided for you OR the one you had was not suficient to rate. If you have already had a C&P, but are not happy with the results then the VA has more discretion I believe. Even if they refuse another official C&P because you've already had one they must accept any civilian examinations as new evidence, which can bring up the greater of two evaluations regulations and/or reasonable doubt.
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The only area where I've had trouble understanding CUE is exactly what determines a final decision. I have a CUE in now (2 in fact) AND have my wife's claim in for DRO. The rep. I talk to in team 1 in Seattle RO said as long as a decision had been made and is "final" (IE - gone into effect, which just means that the RO decision has reached 60 days). Others have said that all appeals must be exhausted before filing CUE, but there is no concrete proof that this is true either.
I will keep the forum updated as to my wife's CUE(s) (which is kind of a slam dunk, as it involves clear violations of title 38 via scheduling a future exam for a finding of P&T AND a reduction based on a disagreement with a prior RO decision without new evidence {also against the law}). The VA has very limited info on CUEs on purpose IMO, and we'll just have to wait and see what happens in my wife's claim:-(
P.S. - If my contact is correct you can file a CUE and appeal it to the board while filing for DRO and appealing under normal means, which means 2 different tracks of appeal at the same time.
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CUE is mostly about the rule of law...where most people go wrong is attempting CUE based on mistakes by the RO in adjudication rather then clearly broken regulations. Basically, if you can directly establish a link between your claim and a regulation that was violated AND the violation is not open to interpretation, then you have a chance at a valid CUE.....if you feel they didn't give some evidence enough weight and/or merit, you really don't have a shot at a CUE.
A CUE must be very black and white...either the RO clearly broke a regulation or they didn't, if you can't come up with the evidence to support a regulations violation then you really have an uphill battle. With that said, it never hurts to write a CUE up and submit it (if all else fails)...the worst they can do is reject it, which puts you in the same position you would have been had you not filed CUE. The only downside is that you can only open a CUE once for a specific action, so it is best to wait until you have a solid case for CUE before filing (make sure your CUE is as good as you can get it, then you won't have to worry).
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Technically, he is totally diabled, but that doesn't mean he is permanently disabled. I agree with berta in that the VA rarely grants permanent on an initial claim...the rules for granting permanent are that one must remain at the same level of disability for a period of time (or symptoms must worsen). It would be difficult for them to grant a permanent rating without having a lengthy period of observation in which to compare the newest claim amount (IE - perhaps your husband was even worse a few years ago, or perhaps he has gotten worse over the last efw years....without the data and time they can't know this).
What I would do is keep good records of all of your examinations and reports for use at a future C&P AND try to keep the same doctors as the ones who said he was permanently disabled (they're less likely to go against their own diagnosis then a new doctor would). Also, if one of these doctors are civilian get them to do a full examination and submit it in place of the C&P doctor when your time for reevaluation is up (the VA must accept the civilian's examination as long as it is as full and complete as their own examiner would have done....and a treating psychiatrist will always hold more weight then a VA C&P).
Anywho, congratz on the rating and feel free to ask us any questions pertaining to how to handle your husbands problems in the future (as a spouse of a 100% PTSD vet I can assure you that you will need help handling your husband in the future:-)
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The wife was medically retired with only 7 yrs in service so we qualify for tricare...honestly, I think all vets should get tricare regardless of whether or not you are officially retired.
As for your bill....medical bills are handled differently then regular bills. The hospital/doctor cannot report to the credit bureaus unless you refuse to pay ANYTHING. As long as you pay something every month (even if it's only $5) your credit will stay clean.
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I would CUE it AND appeal it. I know many people here say you cannot CUE unless a decision has exhausted all appeals, but I have been told otherwise by several people inside of the Seattle RO and currently have my wife's claim in for DRO AND two seperate CUEs in as well.
I'm not claiming to be right on this issue, as my wife's claims have not gone through yet (only been a couple weeks), but the worst they can say is no and throw the CUEs in the trash, but, if I'm right, you can attack on two fronts and your claim will be able to go through another seperate person inside the RO.
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If you are retired (medically or otherwise) you should have tricare standard as a secondary pay insurance, which, typically, picks up everything medicare doesn't.
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Suicidal ideation is not, necassarily, reflected in your GAF score. Most clinics have their own "suicide scale" to determine exactly how probable any suicide attempt may be....some facilities have very strict charts on suicide and others have no chart/scale at all (nothing universal to my knowledge).
Anywho, for your exam I would just be yourself...do NOT try to impress the doctor or go out of your way to look "normal". Make sure you emphasize your bad days and try to stay play down your good ones...the way the regs read (and the way the docs are supposed to evaluate) is that they should take consider how bad you get and how often you get that way. Your good days should not factor into the evaluation, but the C&Ps I've seen do exactly the opposite....they play up your good days and rate you based on them, which is against the law, but it is a way for them to justify a low-ball rating at the VARO level.
So, in short, be sure to present yourself at your worst and do everything you can to play down your "good" days.
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Those that deny the existence of PTSD due to war, rape, molestation, etc are usually the ones with the deepest seeded problems. I have spent a lot of time researching people with PTSD and I have found that people who go out of their way to denounce the existence of such problems are usually sufferers themselves that do not have the strength to confront their own problems; therefore, they over compensate by belittling everyone else in order to prove to themselves that nothing is wrong. I also feel that these are the people most likely to actually snap and commit suicide and/or homicide.
A better example acn actually be found in the many victims in the country of sexual abuse. Most women I have met that have been raped/molested are quick to point out the flaws in other women who have been through similar circumstances...it's like by admitting that the other women are justified in their behaviour, as a result of sexual trauma, they must also admit their own faults (kind of like looking in a mirror). IMO, one of the reasons why rape is such a problem in this country is that other rape victims will not support one-another...it has taken the better part of 3 yrs to get my wife to empathize with other rape victims and to see herself through them. After all, the biggest problem with PTSD is admitting your own limitations and to admit the limitations of others is to admit your own.
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On the plus side, it is VERY difficult to lower a person with TDIU. The VA must show new MATERIAL evidence of EMPLOYABILITY that is sustained for a period of 3mnths or more...then , and only then, can they even attempt to lower a TDIU. Essentially, if you're not working they CAN'T lower your TDIU, unless you make it overwhelmingly clear that you can work but are choosing not to.
The downside is that the ROs do not follow title 38 and will likely try to weed out the weaker vets by unjustly lowering claims and hoping they commit suicide and/or don't appeal....not much can be done about this until these horrible SOs get off their collective a**es and start pointing out this HUGE problem with VAROs....but this would put the SOs out of work so it will never happen.
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All Veterans have a right to have their claim looked at and handled fairly. Making a political statement is also a right of any citizen.
Yes and no. The current administration has done a great job of making any decenting voice look like an anti-american terrorist......makes me miss the good 'ole mcarthy days.
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I met a woman awhile back who was in the hospital with my wife (Also had PTSD due to MST and was currently 100% SC)...anyway, she told my wife that she recently got medal for valor when she pulled some people out of a crashed helicopter 22yrs earlier (she had been medically retired for 18yrs). In her words, "I wish I could find the person who gave me this award after all these years, so I could shove it up their a**".
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"it's whether or not the RO has made a written final decision" that has never been appealed.
If you are within the year for timely appeal, I do not see how this would qualify as basis for a CUE claim at all.
Why would someone try to file a CUE when they have appeal rights that can fully correct the potential CUE situation by filing a NOD and pursuing all issues that are incorrect?
I dont see how the VA would even have jurisdiction over it such as within:
http://www.va.gov/vetapp05/files2/0508478.txt
I cannot imagine what your contact would mean by
"He also said that the CUE goes directly to the "coach of the appeals team" and shouldn't take longer then a few months AND this can be done WHILE my appeal is in for DRO."
I have been waiting for well over a year on 2 CUES that the DRO will handle .These are on final VA decisions that were never appealed or even in the appeals process, and the year for timely appeal has been over since 1997.
There are separate from my DRO appeal.
If your CUE scenario is based on the same DRO claim stuff-which is
in the appeals process now- I cannot imagine where this guy is getting his information-
I spoke with a few other people in the Seattle RO and they said, essentially, the same thing. A CUE is an argument based solely on the merits of regulation; whereas, an appeal is based on the medical merit of the claim. I understand what you're saying, but this is now like 5 people within the RO that have said that one may argue CUE (based on misrepresentation of regulations) while filing appeals through normal channels (IE - DRO). The two claims take seperate paths in that the CUE goes right to the top and is awarded based on regs alone and the appeal goes through a DRO reviewer and the entire case is looked at. Essentially, the CUE is reviewed by a different person then the DRO and your C-file is NOT taken into consideration...whatever evidence you provide the CUE reviewer is what he/she uses to rule on the claim and if you get a favorable review you can drop your DRo and vice-versa.
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I'm not sure where you're at in your claim, but the process goes like this: You file a claim(s) then the RO issues a decision on your claim (they may hold off and ask for more evidence and/or a C&P)...once you get the RO decision you will have 60 days to add any new evidence before the decision takes effect (IE - pay cut/increase). You can also NOD the decision at this time. Your NOD should say "notice of disagreement" because of "X" "Y" AND "Z". Approximately, 2 months later your NOD will be officially accepted and you will get a letter saying they got your NOD and that you can either A) Check the box for a DRO, B) Ask for a statement of case and that you wish to appeal to the BVA, or C) Do nothing and drop your appeal (I believe you have 60 days from receipt of this letter to make a decision).
P.S. - You have 1 year to file a NOD on any decision by the VARO, but only 60 days to ask for a DRO/BVA appeal. I could be a bit off on some of these as I am new to the process myself, but this is how I understand it thus far.
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I believe your confusion is in the "total" part....I do not believe that you must be "totally" disabled in order to be "permanently" disabled. But, either way, technically you are totally disabled by reason of unemployability, even though your rating may only reflect 80%.
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I was recently told by my contact in the Seattle RO (part of team 1?) to file a CUE based on the regulations broken in my wife's recent decision. When I posted the CUE(s) I had written to Hadit I was told that I could not file CUE until we had exhausted her appeals process, so I decided to hold off. Today, I spoke with my contact again and he clarified the process for me....he said not only could I file a CUE right now (just putting in for DRO as well), but both my DRO and CUE will be handled seperately (IE - I can appeal the CUE decision AND appeal the DRO decision if both turn out to be unfavorable). He also said that the CUE goes directly to the "coach of the appeals team" and shouldn't take longer then a few months AND this can be done WHILE my appeal is in for DRO. If I do not agree with the "coach of appeals" decision I can appeal it to the BVA along with any appeal I may have for the pending DRO.
Now, this is one man's opinion on the matter and I am just starting the process, but this individual works with the rating teams (he puts together all of your evidence, claims, etc and personally brings them to the raters). So, I will try to give updates to the case to see if this is, indeed, the truth.
P.S. - He isn't the first person in the RO to tell me I could CUE whenever I wanted....apparently, finality isn't whether you have exhauste appeals, it's whether or not the RO has made a written final decision (which is just the beginning of the appeals process). If this turns out to be correct we could go after the RO on two fronts at once....cross your fingers:-)
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lithium has a LOT of side effects and probably shouldn't be used as your using it. I would fire the doctors you have and find some that are willing to listen to your concerns.
P.S. - Ativan can be a good PRN med to relax your muscles and xanax can also be used. I'm not your doctor so don't take my word for it, but there are plenty of other meds available to you if you wished to try them (to which your doctor should be open to).
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Why keep puffing and hacking and complaining that cigarretes should be illegal cause they make you cough when you smoke them?
That sounds somewhat political...I quit:-)
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It should be more then enough honestly, but PTSD isn't easy to get these days. I wouldn't worry too much as I'm sure you'll win eventually through the appeals process. You may want to formally submit the letter from your CO as new evidence if you plan on a DRO. Also, you may want to cite "benefit of the doubt" if you feel the evidence in hand is already enough to weigh in your favor. Either way, keep digging for more info and start preparing as if you're going to the BVA.
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SSDI is usually quite easy. The wife recently had her review, which consisted of a letter asking her if she was employed, if she had been hospitalized recently and if her condition has improved. She sent the letter back and within 3 weeks she got another letter saying that her claim was approved and not to expect to hear from them for about 5 to 7 yrs.
If only the VA were so easy.....
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I believe the law says income from employment. Stocks, interest on accounts, property ownership, etc, do not qualify as employment to my knowledge, but I'll defer to someone else for the actual reg as it's late and I'm tired:-)
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Jay
How does this law affect those using ChampVA? As paranoid as I am I want all the medical insurance I can get including Part B for me and my wife. I would not rely on the VA to treat my dog if I had a dog. My wife has ChampVA and has many years before having to deal with medicare.
I'm not terribly familiar with ChampVa as we use tricare, but I did manage to find a link that explains medicare as it relates to ChampVA for you - ChampVa .
As far as I can tell ChampVa was not affected by the same law as tricare, though there does seem to be some older laws (2001) which link medicaer and ChampVA. Hope the link helps.
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Va and medicare are seperate issues. You can opt. out of medicare part B and still get 100% coverage from the VA as a 100% SC vet. What you are refering to is a new bill passed in Jan. 05 that forces those eligible for part B AND tricare (retired military) to use medicare part B as their primary insurance. If you do not use tricare and/or civilian health care in general then you have no need for medicare part B, but if you used tricare prime in the past you MUST opt. into medicare part B as tricare will only pay as a secondary insurance if you are "B" eligible.
In other words, if you never used tricare then call/write SS and tell them to remove you from part "B"...you have no choice on part "A", but it is free (hospitalizations).
P.S. - The new bill does NOT affect your dependents. They can still be enrolled in tricare prime at a reduced rate as you will not be enrolled yourself.
Is Their A Rate For Amnesia?
in VA Disability Claims Research
Posted · Edited by Jay Johnson
Codes for dissociative issues -
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Dissociative Disorders
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9416 Dissociative amnesia; dissociative fugue; dissociative identity disorder (multiple personality disorder)
9417 Depersonalization disorder
From title 38 under mental disorders.