[any opinions on this... have a claim for increase and TDIU]

at the end it says:

    The veteran has been employed numerous times and has been fired for
       tardiness or alcohol and drug use. He is currently working 5-6 hours per
       week for his mother's company. According to the previous C&P exam, he is
       not able to work many hours due to not being permitted to work inside of 
a
       bank due to his felony record. The veteran reported that he was "working"
       during his 10 years in prison selling drugs. He denied having any
       difficulties while in prison. The veteran is capable of following
       instructions and performing simple tasks. He is able to concentrate on a
       simple task and respond appropriately to coworkers and supervisors.  

[any opinions on this... have a claim for increase and TDIU]

DBQ being completed in conjunction with a VA 21-2507, C&P 
Examination
    Request?
    [X] Yes  [ ] No
    

                                   SECTION I:
                                   ----------
    1. Diagnostic Summary
    ---------------------
    Does the Veteran now have or has he/she ever been diagnosed with PTSD?
    [X] Yes  [ ] No

    2. Current Diagnoses
    --------------------
    a. Mental Disorder Diagnosis #1: Posttraumatic Stress Disorder
         ICD Code: F43.10

       Mental Disorder Diagnosis #2: Opioid Use Disorder, Severe, In early
          remission, on maintenance therapy
         ICD Code: F11.20

    b. Medical diagnoses relevant to the understanding or management of the
       Mental Health Disorder (to include TBI):
       No response provided.
       
    3. Differentiation of symptoms
    ------------------------------
    a. Does the Veteran have more than one mental disorder diagnosed?
       [X] Yes  [ ] No
       
    b. Is it possible to differentiate what symptom(s) is/are attributable to
       each diagnosis?
       [X] Yes  [ ] No  [ ] Not applicable (N/A)
       
           If yes, list which symptoms are attributable to each diagnosis and
           discuss whether there is any clinical association between these
           diagnoses: The veteran's symptoms are primarily related to his PTSD
           since he has not used substances in more than six months.
           
    c. Does the Veteran have a diagnosed traumatic brain injury (TBI)?
       [ ] Yes  [X] No  [ ] Not shown in records reviewed
       
    4. Occupational and social impairment
    -------------------------------------
    a. Which of the following best summarizes the Veteran's level of 
occupational
       and social impairment with regards to all mental diagnoses? (Check only
       one)
       
       [X] Occupational and social impairment with reduced reliability and
           productivity

    b. For the indicated level of occupational and social impairment, is it
       possible to differentiate what portion of the occupational and social
       impairment indicated above is caused by each mental disorder?
       [X] Yes  [ ] No  [ ] No other mental disorder has been diagnosed
       
           If yes, list which portion of the indicated level of occupational and
           social impairment is attributable to each diagnosis: The veteran's
           impairment is related to his PTSD.
           
    c. If a diagnosis of TBI exists, is it possible to differentiate what 
portion
       of the occupational and social impairment indicated above is caused by 
the
       TBI?
       [ ] Yes  [ ] No  [X] No diagnosis of TBI

 

  3. PTSD Diagnostic Criteria
    ---------------------------

    Please check criteria used for establishing the current PTSD diagnosis. The
    diagnostic criteria for PTSD, are from the Diagnostic and Statistical Manual
    of Mental Disorders, 5th edition (DSM-5).  The stressful event can be due to
    combat, personal trauma, other life threatening situations (non-combat
    related stressors).  Do NOT mark symptoms below that are clearly not
    attributable to the Criterion A stressor/PTSD.  Instead, overlapping 
symptoms
    clearly attributable to other things should be noted under #6 - "Other
    symptoms".
    
       Criterion A: Exposure to actual or threatened a) death, b) serious 
injury,
                    c) sexual violence, in one or more of the following ways:
                    
                   [X] Directly experiencing the traumatic event(s)

       Criterion B: Presence of (one or more) of the following intrusion 
symptoms
                    associated with the traumatic event(s), beginning after the
                    traumatic event(s) occurred:
                    
                   [X] Recurrent, involuntary, and intrusive distressing 
memories
                       of the traumatic event(s).
                   [X] Recurrent distressing dreams in which the content and/or
                       affect of the dream are related to the traumatic 
event(s).
                   [X] Dissociative reactions (e.g., flashbacks) in which the
                       individual feels or acts as if the traumatic event(s) 
were
                       recurring.  (Such reactions may occur on a continuum, 
with
                       the most extreme expression being a complete loss of
                       awareness of present surroundings).
                   [X] Intense or prolonged psychological distress at exposure 
to
                       internal or external cues that symbolize or resemble an
                       aspect of the traumatic event(s).
                   [X] Marked physiological reactions to internal or external
                       cues that symbolize or resemble an aspect of the 
traumatic
                       event(s).

       Criterion C: Persistent avoidance of stimuli associated with the 
traumatic
                    event(s), beginning after the traumatic events(s) occurred,
                    as evidenced by one or both of the following:
                    
                   [X] Avoidance of or efforts to avoid distressing memories,
                       thoughts, or feelings about or closely associated with 
the
                       traumatic event(s).

       Criterion D: Negative alterations in cognitions and mood associated with
                    the traumatic event(s), beginning or worsening after the
                    traumatic event(s) occurred, as evidenced by two (or more) 
of
                    the following:
                    
                   [X] Persistent, distorted cognitions about the cause or
                       consequences of the traumatic event(s) that lead the
                       individual to blame himself/herself or others.
                   [X] Persistent negative emotional state (e.g., fear, horror,
                       anger, guilt, or shame).
                   [X] Persistent inability to experience positive emotions
                       (e.g., inability to experience happiness, satisfaction, 
or
                       loving feelings.)

       Criterion E: Marked alterations in arousal and reactivity associated with
                    the traumatic event(s), beginning or worsening after the
                    traumatic event(s) occurred, as evidenced by two (or more) 
of
                    the following:
                    
                   [X] Irritable behavior and angry outbursts (with little or no
                       provocation) typically expressed as verbal or physical
                       aggression toward people or objects.
                   [X] Hypervigilance.
                   [X] Exaggerated startle response.
                   [X] Problems with concentration.
                   [X] Sleep disturbance (e.g., difficulty falling or staying
                       asleep or restless sleep).

       Criterion F:
                   [X] The duration of the symptoms described above in Criteria
                       B, C, and D are more than 1 month.

       Criterion G:
                   [X] The PTSD symptoms described above cause clinically
                       significant distress or impairment in social,
                       occupational, or other important areas of functioning.

       Criterion H:
                   [X] The disturbance is not attributable to the physiological
                       effects of a substance (e.g., medication, alcohol) or
                       another medical condition.

    4. Symptoms
    -----------
    For VA rating purposes, check all symptoms that actively apply to the
    Veteran's diagnoses:
    
       [X] Depressed mood
       [X] Anxiety
       [X] Suspiciousness
       [X] Chronic sleep impairment
       [X] Disturbances of motivation and mood
       [X] Difficulty in establishing and maintaining effective work and social
           relationships

    5. Behavioral observations
    --------------------------
       The veteran arrived 10 minutes late for his appointment and was pleasant
       upon meeting. The veteran was oriented to person, place, situation, and
       time. His grooming and hygiene were adequate. He made appropriate eye
       contact and presented with a depressed mood with a congruent affect. His
       speech was within normal limits for tone, volume, and rate. His thoughts
       were logical, linear, and goal-directed. He did not evidence any 
psychotic
       symptoms, including responding to auditory or visual hallucinations and
       delusional beliefs.
        
       On a brief mental status exam he was able to freely recall two of three
       words presented after a brief delay. He was able to recall six digits
       forward and three digits backward. He was able to complete a serial seven
       subtraction task with no errors to seven places. He was able to spell the
       word WORLD forwards and backwards. He was able to complete a two-digit
       addition and subtraction tasks. He was able to compare an apple and 
banana
       and was able to reason abstractly when comparing a poem and a statue. His
       response to the proverb "don't cry over spilled milk" was good. He was 
not
       able to provide a response to the proverb "people in glass houses should
       not throw stones."
       
       
    6. Other symptoms
    -----------------
    Does the Veteran have any other symptoms attributable to PTSD (and other
    mental disorders) that are not listed above?
    [ ] Yes  [X] No
    
    7. Competency
    -------------
    Is the Veteran capable of managing his or her financial affairs?
    [X] Yes  [ ] No
    
    8. Remarks, (including any testing results) if any:
    ---------------------------------------------------
       The veteran was administered a psychological measurement that is useful
       for interpreting the veracity of other data provided by an examinee 
during
       a psychological or neuropsychological examination. This assessment can
       assist in evaluating and making a clinical opinion regarding the veracity
       of an examinee's purported symptoms. Research has determined that this
       tool is a useful instrument to administer in order to screen for possible
       feigning of PTSD symptoms. The following results should be interpreted in
       light of the fact that the measurement that was chosen is a screening 
tool
       and not designed as a definitive measure of whether or not an individual
       is feigning mental illness. The Veteran's total score was not elevated
       beyond the cut-off score. Therefore, his PTSD symptoms are considered to
       be credible. 

       The veteran was administered the Minnesota Multiphasic Personality
       Instrument-2-Restructred Form (MMPI-2-RF), which is a self-report
       psychological assessment used to identify a variety of psychological
       syndromes. The veteran was provided a quiet, private room to complete the
       testing. It appears the veteran understood the items and responded to the
       items in a consistent manner. The veteran over-reported psychological
       dysfunction, which is evidenced by a considerably larger than average
       number of infrequent responses. The veteran also possibly overreported
       symptoms associated with non-credible memory complaints. Although there 
is
       evidence of over reporting of symptoms, the profile is considered valid
       and will be interpreted.

       Overall, the veteran endorsed considerable emotional distress that is
       likely perceived as a crisis. The veteran reported feeling sad and
       dissatisfied with his currently circumstances. He reported a lack of
       positive emotional experiences, a lack of energy, and a lack of interest
       in activities. He also reported experiencing various negative emotional
       experiences including anxiety, anger, and fear. The veteran also reported
       a significant history of antisocial behavior. This behavior includes
       involvement with the criminal justice system, difficulty with authority
       figures, conflictual interpersonal relationships, impulsivity, juvenile
       delinquency, and substance abuse. The veteran also endorsed various
       unusual thought and perceptual processes.

       The veteran endorsed a diffuse pattern of cognitive difficulties 
including
       memory complaints. He also reported past suicidal ideation and feelings 
of
       helplessness. The veteran endorsed feelings of anxiety, being anger 
prone,
       and experiencing multiple fears that restrict his activity inside and

       outside of the home. He also reported being unassertive and shy. The
       veteran endorsed not enjoying social events and avoiding social
       situations. He also reported disliking being around people. On a scale of
       personality pathology, the veteran endorsed being self-critical and
       guilt-prone. He also endorsed being pessimistic and feeling depressed.

       The veteran is currently diagnosed with Posttraumatic Stress Disorder and
       Opioid Use Disorder, Severe, In early remission, on maintenance therapy.
       The veteran currently lives alone and is not involved in a romantic
       relationship. He maintains phone contact with his daughter. He has a 
close
       relationship with his mother, sister, and two friends. He is currently
       working for his mother's company. He reported experiencing symptoms of
       PTSD. He is attempting to cope with his emotions without the use of 
drugs.
        

       The veteran has been employed numerous times and has been fired for
       tardiness or alcohol and drug use. He is currently working 5-6 hours per
       week for his mother's company. According to the previous C&P exam, he is
       not able to work many hours due to not being permitted to work inside of 
a
       bank due to his felony record. The veteran reported that he was "working"
       during his 10 years in prison selling drugs. He denied having any
       difficulties while in prison. The veteran is capable of following
       instructions and performing simple tasks. He is able to concentrate on a
       simple task and respond appropriately to coworkers and supervisors.  

       
       

 
/es/ ALLISON C HOULE, PHD
C&P Psychologist 

[inferred IU]

Should the VA have inferred my claim was automatically IU without asking for it?  I am 70 SC for PTSD and 20 SC Back condition as of March 31st this year.  Can I file NOD stating that this should have been an inferred claim.  I currently have a claim for increase in for those conditions.

[any advice would be appreciated]

The VBA has requested my medical history from the VA.  I know it takes a while for the VA to move, and so I got a copy of my file, how do I submit the request.  I stopped by the BVA and the lady said I needed the paperwork regarding the request.  I never received any paperwork...

[any advice would be appreciated]

Boy, this topic started one helluva crap storm!  Didn't mean it to.  I did file the compensation paperwork on 5/22 and 5/30.  The VA consolidated the claims and I have two C&P's, June 20th, and June 22nd.  Any suggestions?   BTW  How do I let the VA know that my employment is sheltered?

[any advice would be appreciated]

Yes i am.  And thanks, I'll check it out.

[any advice would be appreciated]

How Can a Veteran Earn an Income while Receiving VA TDIU Benefits?

To answer this question, we need only look to the law.

For those of you that don’t know what TDIU is, I encourage you to read this post to get a basic understanding of the 2 types of TDIU Benefits.  To those of you trying to win your VA TDIU Claim, I encourage you to consider whether a copy of the VA TDIU Field Manual, or the VA TDIU eBook Package – will help you understand and improve your VA TDIU Claims.

38 C.F.R. §4.16(a) – the section of the Code of Federal Regulations that states the requirements for eligibility for TDIU Benefits, states the following:

Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities

Now, as I’ve discussed before on the Veterans Law Blog, the law does not clearly define what substantiall and gainful occupation is.

But the law DOES define what Substantially Gainful employment IS NOT.

Read the rest of 38 C.F.R. §4.16(a):

Marginal employment shall NOT be considered substantially gainful employment. For purposes of this section, marginal employment generally shall be deemed to exist when a veteran’s earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Marginal employment may also be held to exist, on a facts found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. (emphasis is mine).

So there you have it – the 2 ways that Veteran can earn an income while receiving VA TDIU benefits: when the employment is “marginal” and when the employment is “sheltered”.

We’ll look at them in more detail, below.

You might ask “Why” a Veteran is allowed to earn an income in these 2 scenarios while receiving TDIU Benefits.

Truth be told, I have no clue why Congress wrote the laws this way when they wrote them – someday I’ll dig into the legislative history to understand it.

But since Congress allowed it, there is NOTHING wrong with Veterans getting Marginal or Sheltered Employment income while receiving TDIU Benefits.

#1:  Marginal Employment & TDIU Benefits.

This is the type of income that many Veterans are aware that they can receive even after being granted TDIU Benefits.

Simply go to the US Bureau of Census website, and look up the “poverty threshold for one person”.  (Click here to see the historical poverty ratings tables from 1959 – 2015).

You will see that, for 2014, the poverty threshold for one person is  $12,316 per year (if you are under 65), or $11,354 (if you are over 65).  

Each year, the VA will ask you to verify your employment (or lack thereof) to determine whether you are eligible to continue to receive TDIU Benefits. They typically require that you use VA Form 21-4140 or 21-4140-1 to do this report.

The VA does cross check 2 databases that I know of:  Social Security databases that record your work/income history, and IRS databases that record your family income on your annual tax returns.  Word to the wise: if you are telling different income stories to different federal agencies, you are playing with fire, and may even be committing fraud.

If you indicate in this form that your income is higher than the poverty threshold, a proposal to reduce your TDIU benefits will be forthcoming.

It’s one of the few times that the VA acts with a sense of purpose – when they want to STOP paying you

 

WHY ARE YOU GUYS GIVING ME BAD INFO? WTH!.

[any advice would be appreciated]

and should i have an affidavit drawn up explaining it is a family business?  I still make under the 12,300 and some odd dollars allowed by law.

Quote

 

 

[any advice would be appreciated]

is that gross dollars, buck?

[any advice would be appreciated]

i do not have the work credits

[any advice would be appreciated]

Gastone, id you look at my initial question, I state this.   Will i have another C&P ? My last ones were in march and may.

[any advice would be appreciated]

   No.  There was no inferred claim.  I was satisfied with my rating at first.  But as therapy drags on and the fog begins to clear from the years and years of drug use, my symptoms are worsening.  I just need time to get well.  IU would allow me to have to not worry about my bills and focus all my attention on getting better.

[any advice would be appreciated]

What is IU?

Individual Unemployability allows VA to pay certain Veterans at the 100-percent disability rate even though their service-connected disabilities are not rated as 100-percent disabling. Veterans may be eligible for this rating increase if they are either unemployed or unable to maintain substantially gainful employment as a result of their service-connected disability (or disabilities).

What is substantially gainful employment?

Substantially gainful employment is simply full-time employment that provides a wage greater than the poverty level. (Note: In 2014, the U.S. Census Bureau considered a poverty-level, yearly wage for a person under the age of 65 to be $12,316.) For instance, if a Veteran has been trained to drive a truck, but can’t work because of service-connected back and stomach conditions, he or she may qualify for IU.

Are there any other eligibility requirements?

In order to qualify for IU, you must have one of the following:

1) a 60-percent or more disability evaluation based on a single service-connected disability or,

2) a 70-percent combined disability evaluation based on multiple service-connected disabilities, with at least one disability rated at 40 percent or more.

In these cases, VA will consider a Veteran’s eligibility for IU, if there is evidence showing he or she cannot work due to service-connected disabilities In both instances, VA reviews all the evidence of record and decides if a Veteran’s disability is, by law, severe enough to grant IU.

Let’s use a hypothetical situation. Say a Veteran claims he can’t work and doesn’t understand why he isn’t getting IU. He is service-connected at 30 percent for post-traumatic stress disorder (PTSD) and 10 percent for irritable bowel syndrome (IBS)

Since the Veteran has only two service-connected disabilities, both the Veteran’s PTSD and IBS have to be evaluated at a higher combined rate and be the reason he can’t work to receive IU.

How is the way VA decides total disability different from other agencies?

The law requires different criteria for other government agencies that process disability benefit claims. The Social Security Administration, for example, requires a claimant to be totally disabled after considering age, education, and prior work experience in order to be eligible for social security disability. VA only considers service-connected disabilities when considering entitlement to IU, and those disabilities must be the reason the Veteran can no longer be gainfully employed. IU is meant to compensate Veterans unable to work because of service-connected disability or disabilities that do not meet the VA Rating Schedule requirements for a total evaluation at the 100-percent rate.

If you think you fall into this category, I encourage you to work with a Veterans Service Organization, a state or county service officer, or see your public contact team at your nearest regional office. You can also find more information on our IU website, http://www.benefits.va.gov/compensation/claims-special-individual_unemployability.asp. I am also happy to answer your questions in the comments section.

[any advice would be appreciated]

i make less than the fed poverty level

 

[any advice would be appreciated]

also I work for family 10 to 15 hours a week.  It isn't gainful and I suspect it ore so that my family can keep an eye on me.  Will this be a problem?  I make roughly a thousand dollars a month.

[any advice would be appreciated]

additionally, i want to get the VA to give me a referral for a service dog, any ideas?  Who do I need to talk to?  Do they do service dogs for PTSD?  Or would it have to be solely for the physical disability?   

[any advice would be appreciated]

I was recently SC for PTSD as a result of military sexual trauma, 70 percent, and SC for Lumbosacral strain 20 percent.  I currently have a tinnitus and hearing loss appeal in.  I filed a NOD and asked for DRO.  Additionally I filed a secondary comp. claim for obsessive compulsive disorder and hep c, SMC for erectile dysfunction.  A week later I filed a claim asking for a raise of my service  connected rating and IU.  Voc rehab recently declared me unfeasible for its program and I submitted the unfeasible letter as proof for my IU.  Have I piled too much on too quickly?  My docs at the VA are now treating me for the Hep C.  MY PTSD symptoms are out of control, and I'll be attending Bay Pines in September.  I feel entitled to this compensation especially in light of my symptoms worsening.  Any advice on my winning my claim.m  And will I have to do a new C&P considering I just had one in march?  Whatcha think guys and gals?

[appealing decision]

Even DRO?

[appealing decision]

If I file an nod does that stop my rating?  Or can they lower my rating?  Would you appeal everything trying to seek a higher rating if you felt you deserved it?

[if I appeal...]

If I appeal a decision does that stop my current rating?  Or perhaps, could they lower my rating?

[What should I do?]

Do you guys think because i have secondary opiate use disorder secondary hepc will be easy to prove?  What should I watch out for?

[do I have to worry?]

no, no lies.  I've actually had back surgery as a result of that service connected injury, and the VA had the gull to call it a muscle strain...wth?  Admittedly I probably worry too much, PTSD, anxiety, OCD.  I guess I'm always looking around the corner for the boogeyman.

[What should I do?]

thanks fellas

[Creative organ...]

Is there a form or do I have to fill out a new comp form for ED due to PTSD?   Will they accept lay evidence?

[do I have to worry?]

I am service connected 20 percent for lumbosacral strain for my back.  I have good days and I have really bad days.  Do I have to worry about some investigator coming to my house seeing me cutting the lawn-on one of my good day- screaming fraudulent claim!?