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About JamesPT

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    E-3 Seaman

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  • Service Connected Disability
  1. Does anyone know whether it is mandatory to use the new NOD VA Form-21-0958. It's a type written NOD letter still valid in appealing a decision?, are letters no longer accepted by the VARO. I have always appealed via letters, never had any issues. Just my opinion, but I find this new form a bit of a pain to fill out. The form just seems to limit you in writing\explaining ones disagreements with their claims denials. I finished writing an NOD letter but upon reviewing their letter I noticed in the SSOC the statement to download the new NOD form. Advice, opinions are appreciated. Thanks. Jim
  2. Just received letter from VARO denying claim for "Increased Compensation Based on Unemployability". The letter states: Did not submit VA-Form 21-8940 as evidence not received. I am very confused as I submitted the form via certified letter on 04/11/2012; I have the signed receipt of Varo receiving it. I submitted the form immediately after a DRO Hearing held a few days after the hearing. My question is? Are multiple (VA Form 21-8940) forms supposed to be submitted for claim process? If that is the case then I am in the dark. I thought one form to be sufficient for TDIU claim process. During hearing in April 2012 and upon reviewing evidence at hand RO recommended I go with TDIU claim due to PTSD condition and service connected injuries. My VSO thought her recommendation to be a good idea, so we filled out Form 21-8940 and submitted it. Since then everything is in disarray; I have been through additional C&P exams, 6 in total or should I say12 since C&P have been for PTSD and for service connected injuries. If additional forms for TDIU were to be submitted then I was ignorant of it. If that is the case then now I'm back to square one. Opinions regarding this issue are welcomed. Thanks. Jim
  3. Hello all; just looking for some guidance regarding my denied claim requesting increase rating for PTSD. I recently posted explaining my situation. My dilemma is: I received the SSOC letter indicating denial for increase. I am beyond the 30 day or 60 day suspense dates. I recently obtained new and material evidence which includes support statements submitted to VARO two years ago but lost\misplaced by their mailroom personnel. When I brought it to their attention and showed them that the Nexus letters\support statements were submitted via certified mail (I showed them the receipts indicating these as received at their end) they casually mentioned documents perhaps being distributed to wrong Department and they cannot locate them. Anyhow, should I write an NOD and submit it with the new evidence. Just unsure as to where to mail this evidence to: Do I mail the NOD and new and material evidence to my local VARO? or do I mail it to the Appeals Management Center in DC?.. Correct me if I am wrong, but dont' they give you a year from date on SSOC to attempt and gather new and material evidence? Also, with the SSOC came a document titled: VETERANS REQUEST FOR EXPEDITED PROCESSING Waiver of AOJ Consideration of Additional Evidence & Waiver of the 30 day Waiting Period By signing this waiver, I understand that I waive two procedural rights in connection with my appeal: 1. I waive my right to have VA wait a minimum of 30 days before certifying my appeal to BVA. I request that my RO forward my case to BVA immediately 2. I waive my right to submit additional evidence for reconsideration by my RO. This means that if I locate and\or wish to submit additional evidence after today's date, I waive my right to have this case remanded (sent back) to my RO and request that BVA consider any new evidence during their adjudication of my appeal. I presume this document allows me to file appeal via NOD and recently acquired New and Material Evidence. Your responses are greatly appreciated. Just to reiterate; My VSO retired, the new VFW personnel are trainees. Thanks.
  4. Hello, I am looking for an answer as to how to proceed with denied IU claim. After having a formal DRO hearing in seeking an increased rating for PTSD; a hearing that my VSO and myself thought had gone very well, with the DRO agreeing with the various issues discussed; well, it all went down hill after the Hearing. We were looking for a 10% increase, the DRO suggested to file for IU claim to see if I could get a 100% rating. The stipulation she set was to undergo an additional C&P exam at the VA's compensation Dept at the VA hospital, not the Mental Health where I see a psychiatrist once every 3 months for meds management. As we wrapped up the hearing, we felt positive about how well things had gone during the hearing; the Review Officer was understanding and friendly and seemed to side with us as far as the issues discussed were concerned. Needless to say, I had the C&P exam soon after the hearing and this is where everything crumbled. The examiner was not Vet friendly, was indifferent and arrogant. I felt from the very beginning that this was not going to work as far as positive results from exam. This young VA shrink's deameanor had denial written all over his face. Then Bingo; I get the SSOC denying claim. The examiner's diagnosis statement in the SSOC's reasons for denial was a complete sham. this guy presented false, misconstrued, misleading statements. His diagnosis does not even concur with my VA's Mental health history. He stated to me that he had read my record, but his bogus statements make it clear he probably just casually leafed through a few notes. My question: I obtained "New and Material evidence" from an outside Psychiatrist who has actually written 2 Nexus letters that have been disregarded during the process. I showed him the SSOC and the examiners reasons for denial statements; he dissected the SSOC and all the errors and false statements and wrote a third Nexus letter addressing the misfacts. Do I proceed now by writing an NOD and request a BVA hearing, or request a re-consideration\review. If I go with NOD, do I submit the new evidence with the letter? The SSOC gave me 30 days to respond; I am now beyond the 30 day suspense date, it took a while to obtain the Psychatrists' outside opinion letter. Just need some advice opinions as to what path to take: BVA and NOD with new material evidence attached; re-consideration, perhaps another DRO hearing? It's been suggested I get the claim out of the VARO. I just don't know, just a bit confused. Thanks in advance for your responses. By the way, I no longer have a VSO, he retired due to illness.
  5. Does anyone know if a DRO hearing can be re-scheduled? I filed for a DRO hearing for PTSD two years ago; I unexpectedly received a letter from VA Regional stating that I am scheduled for a DRO hearing March 27th. I will not be able to attend the hearing as I am out of state for medical appointments\therapy. My question is: can DRO appointments be re-scheduled, does the VA Regional permit\allow reschedules. This letter with appointment date was unexpected, it just suddenly arrived. Has anyone ever needed to re-schedule a DRO hearing due to schedule conflicts. As I mentioned I got hit wih this out of the blue so to speak. I would think they would let me know with plenty of notice or a phone call to schedule the hearing. Anyway, if anyone has experienced the issue of having to re-schedule or wheteher the VA even grants you request for DRO hearing please let me know. Your advice\suggestions are much appreciated. Jim
  6. Hello and thanks for your reply. As you mention in your reply, I am SC'd for PTSD and as you indicate: "To get an increase you need to meet the criteria (with medical evidence) for a higher evaluation. Your prior rating decision should state what is needed for a higher evaluation". My dilemma is that the Nexus letter I submitted meets the criteria needed for a higher rating, the medical evidence\diagnosis is throughly explained in my Psychiatrist's Nexus letter. The Nexus letter does state what is needed for a higher evaluation. The criteria in the Nexus letter was ignored, their decision was made according to the VA examiner's report. When reviewing the Nexus letter and the Examiner's report the latter report which was used for their lowball decision does not reflect an accurate true diagnosis of my condition. I just don't know how a Psychiatrists diagnosis stacks up to a Social Worker's diagnostic report. I would tend to think a Psychiatrist's medical expertise would outweigh a Social Worker's degree of understanding of the so very complicated PTSD mental condition. I had a similar situation happen in regards to my service connected injuries. The last C&P exam was performed by a Physicians Assistant who was, that particular day substituting for the Phycisian who was off for the week, when he submitted his report it was grossely diagnostically innaccurate; I obtained a copy of his report, presented it to the 3 orthopedic surgeons who have treated me for such injuries for the past 6 years; they wrote 3 Nexus letters indicating the innacuracies and wrong diagnosis of injuries. I have had two surgeries with another one pending later this year. It has been written\documented by Mental Health Doctors that my physical injuries are a major stressor that adversely adds stress to my PTSD condition; the reminder of how these injuries occurred in combat operations, the chronic pain, the surgeries and more pending; and yet nowhere in their "Reasons for Decision" reports do they make mention of the stressor\service connected injuries, (My private sector Psychiatrist brings all of it to their attention in his Nexus letter), I have discussed the issue with the VA therapist numerous times but for whatever reason the've ignored to make comment and the point that these injuries add tremendous stress to mental condition. Regarding my PTSD DRO hearing coming up, anybody have suggestions opinions in how to approach and get ready for the hearing? as I mention, the criteria required was explained in the Nexus letter; unfortunately they disregarded the criteria and used the VA examiners misconstrued reports. Thanks, your help is much appreciated. Just trying to find an angle for the DRO hearing. Jim
  7. Hello everyone. Two years ago March 2010 I was awarded a lowball rating for PTSD. I submitted an NOD letter for a review of discrepancies, innacuracies etc observed in their "Reasons for Decision". I requested a review for a higher rating. When I filed for a review I had for several months been seeing and getting counseling\treatment from a private sector Psychiatrist who wrote a very good Nexus letter stating symptoms and gravity of mental condition. I had to seek help from a private sector Psychiatrist because shrinks at the VA do not write support statements for Veterans. This was made very clear to me when I requested a support statement from my VA Psychiatrist, all it took was one word from her "NO!". The frustrating issue is that for the past 5 years I have been under therapy from a VA Social Worker, the Psychiatrist just manages my meds. As I read under "Reasons for Decision" it is apparent that the Social Worker has downplayed the severity of my condition; I imagine when the VA letter refers to "The Examiner" they are referring to the Social Worker. Well, the Nexus letter from the Psychiatrist and his diagnosis for more accurate PTSD condition was very minimally taken as evidence and consideration; they used the VA examiners (The Social Worker I presume) innacurate reports in my opinion as evidence for the lowball rating. I got into a tissy fit with the Social Worker last year, now I am just seeing the VA shrink for meds management. Just yesterday I received a call from VA Regional, they are going to schedule me for a DRO hearing regarding the issues. Does the Nexus letter still carry any weight to make a difference for a fair rating? Criminy, what is bothersome about the claims process, therapy sessions, meetings with Doctors etc; does a Vet have show up for these, unshaven, dirty, disheveled. Seems to me, if you comb your hair, have a clean shirt and pants they may just opine one does not suffer from PTSD condition?. Any suggestions in how to prepare for the DRO hearing would be greatly welcome and appreciated. Thanks. Jim
  8. Hello everyone. I have been gone for several months and justhave been dealing with health issues, claims process etc. The latest action taken by the VA was to deny my claim for secondary ailments, (feet, knees and back) as I wrote several months ago these ailments are the result of a primary service connected injury to right foot which requred reconstructive surgery. Secondary issues have been confirmed by my surgeon and 2 additional Orthopedic surgeons who have provided support statements explaining the issues. The VA sem to have ignored these support statements by established medical Doctors, they just refer to the C&P exams I had at the VA Hospital. I had my last C&P exal almost 2 yeats ago, it was performed by a Physicians Assistant who upon my meeting him said "I am substituting for your exam for Doctor -------- , I really don't know what to do so it shouldn't take too long" it was a real quick simple exam; first he took my blood pressure three times, the measurements were: 142/84 - 168/86 - 201/109 - Now something is wrong here, these BP measurements are way off incorrect, the PA made no issue of it so we went ahead with the physical exam which consisted of manipulation of both feet, knnees, hips and back; had me walk a short distance then said: "Ok, put your shoes on, we're done". I assumed at the time that this young man might be a Doctor on resident status but the C&Pt reports him as a PA. I have 2 Doctors appointments scheduled soon and a meeting with VSO, I will present a copy of the C&P performed by the PA; I need to find out if the C&P was or is valid as they denied my claims in accordance to that particular exam. The PA's diagnosis states that all secondary ailments are attributed to the age process. There are discrepancies in the report, and diagnostic comments are contrary to my Orthopedic Surgeon's diagnosis of my primary injury and secondary issues. My primary service connected injury was given a 10% rating 4 years ago. Anybody in the forum know if PA's exams are valid in the process of denial\approval of claims. Your opinions, answers are greatly appreciated. Jim
  9. No John, I am no longer working, lets say I was slowly forced to retire due to my PTSD condition in addition the meds for the mental condition made a great negative impact as the side effects are detrimental to focus and perform up to par; the fainting spells, dizziness, lack of energy, memory lapses and so on. An additional reason for not working any longer is that I have a combat connected injury which required surgical fusion of joints in my right foot, therefore my range of motion is severely limited; I have had a second surgery on same foot. That left me with pronounced limp and can't be on my feet for very long. I am on 4 different types of medication for the PTSD plus meds for my right foot injury. My left foot needs surgery as it has deteriorated over the years due to compensating for the right foot injury. Along come the secondary problems with knee, hips and back pain; the physical issues surgeries etc, furhter aggravates aggravates my PTSD condition. Anyway, I'll keep at it with the claims process, I'm hoping to make progress; I was 30% initially, then they gave me 40%, now I am 60% overall, hopefully the NOD will help a little more. Thanks for your help. Jim
  10. Thanks a bunch for your replies, and yes, I do feel like I got low-balled on the ratings. I got blind-sided when I had my very first PTSD evaluation. I thought it was going to be a short meeting with the Psychiatrist, instead it turned into a 3 hour nightmare, things got a bit out of hand, I was a basket case when it ended, It took a lot out of me, I regressed to the old bad days there in a little office, venting the nightmare to a total stranger; in my case I believe that the 3 hour meeting screwed me up worse. Anyway after the evaluation I was immediately taken to the VA hospital and put on meds. It's been a struggle and it's been tough going to therapy. It also makes it tough to get to the VA hospital as I live in a rural town. Anyway, for me it's frustrating because the VA Mental Center has all of it on file as I explained in my previous post, but in my opinion the rating letter contains watered down statements so to speak. I will get a NOD submitted. Thanks all. Jim
  11. Hello everyone, again opinions, suggestions are greatly appreciated. I posted a couple of weeks ago that the VA had raised my overall\combined rating from 40% to 60% .... In their letter they break down the PTSD compensation thus: "Old Percent assigned 30% - New Percent assigned 50% I have an additional 10% for service connected injury. Anyway, my wife and I decided to leave town for some peace and quiet, took my VA documents with us to try and digest the VA's decision and evidence used for the new 60% overall rating. In carefully reading the section "Rating Decision For Your Review, It Provides a Detailed Explanation of our Decision" we found various discrepancies between the C&P examiners report and the information the VA obtained from the Veterans Mental Health Center. In their explanation for the decision they are twisting my condition to seem or appear to be less serious than what it is. I received treatment from a private sector Psychiatrist and submitted his IMO statement; in their explanation regarding the IMO, little consideration was taken into account. What concerns me the most is the misinformation they say they obtained from the VA's Mental Care Center; I have serious PTSD issues, I am in therapy with a Social Worker at the VA but somehow the gravity of my condition has been misconstrued and interpreted wrongly. I will write a NOD letter; my question: is it best to request a DRO review and hearing or go with the BVA process which I think it's a longer process. Thanks everyone, your are all much appreciated. Jim
  12. Thanks for the reply Carlie; I guess I still don't have a hold on VA mathematics. My question; if I was 30% PTSD how did I get to the new 60% rating? I am guessing the VA chucked the 30% and put me in the 50% category? plus the 10% for service connected injuries = 60%? ,,, Also if you don't mind, I may be out of line with the following question as it might need to be posted in different forum. John999 below indicates "if unable to work to file for TDIU"; is this process very tidious? do I have to file and submit all medical records. support statements from Doctors etc. all of which the VA already has on file? ,,, I am not able to work, the PTSD meds which help very little with my mental condition do tend to make me zombie like so to speak; memory lapses (thinking and acting more slowly), lack of focus, I could go on and on with side effects. Also my physical injuries, the surgeries which have resulted in overall limited range of motion plus the meds for physical pain in addition to the meds for mental condition; well again, it goes on and on. Just looking for an answer regarding filing for TDIU. I am sorry, I am still ignorant regarding the claims process. Regardless, I will take John999 suggestion and submit a TDIU form. Thanks again, your responses are appreciated. I will look in the forum for more info, but I guess the TDIU form is submitted to VA Regional? Jim
  13. Hello everyone, received a VA letter last week stating that my new overall rating is 60%. I was 30% for PTSD and 10% service connected injury, 40% total. I filed for a PTSD increase late last year so for PTSD they have awarded me an additional 20%. I have an additional claim in process for secondary ailments, if that claim is approved and I am I'm taking a wild guess, the VA might award an additional 10% which will add up to 70% total? I am speculating on percent increases as I read somewhere that by law the VA awards increases in 10% increments only? ... Anyway, thanks for everyones advice, opinions and in particular the "HADIT" web site which has been of great help in navigating the VA's claims process. Thanks. Jim
  14. Hello everyone, I've been gone for several months recovering from my third foot surgery, lengthy recovery it's just too debilitating, stress meter way up; just to cut to the chase regarding claims, I've explained it all in previous posts but this is my current situation: I have a 40% rating, 30% for PTSD and 10% for service connected combat injury. I submitted a claim for secondary physical problems (left foot serious issue, knee, hip, back problems). Claim for secondary issues submitted 2 years ago, had 2 C&P exams which turned out to be just chats with the VA Doctor, his medical reports state "Inconclusive" contrary to support statements I submitted from my surgeon and additional medical Phycisian's IMO support statements. ..... they tell me this additional claim (secondary issues) it's still in process. I submitted a claim for an increase for PTSD condition last year, I saw a private sector Psychiatrist for 5 months for secondary opinion and IMO support letter which I submitted to VA Regional. My question is: Is having 2 separate claims delaying the process? I submitted all support statements from all Physicians, Surgeons etc. until I had no more to submit. The statement in the VA examiner's report "Inconclusive" makes me ask and wonder; where do we go from here. As far as my PTSD claim for increase goes, the VA keeps sending me letters stating "they are still processing claim, they'll be in touch in 90 days" My VFW Rep. says it is just a matter of being patient, we can't do anything but wait for their decision. Is he correct? Do we just sit and wait who knows how long for a response whether positive or negative? In the meantime the 90 day notices keep coming. I don't know, I just have the premonition that there is something I should be doing to get more info about claims status. I have been undergoing treatment at the Veterans Mental Health for 4 plus years, They are aware of my condition but do not help Vets with support statements. Anyway, suggestions, answers, opinions are appreciated. Thanks a bunch. Jim

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