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  1. I was granted TDIU P&T. Part of it was sleep apnea 50%. Does that mean they will require me to use a CPAP machine? How do they know if you use it or not?
  2. I am currently rated at 70% P&T TDIU based solely on my service connection for mental illness. Will the VA reduce my income and take my benefits away other than whatever 70% pays when I turn 67 years old?
  3. The 5, 10, 20 year rules... Five Year Rule) If you have had the same rating for five or more years, the VA cannot reduce your rating unless your condition has improved on a sustained basis. All the medical evidence, not just the reexamination report, must support the conclusion that your improvement is more than temporary. Ten Year Rule) The 10 year rule is after 10 years, the service connection is protected from being dropped. Twenty Year Rule) If your disability has been continuously rated at or above a certain rating level for 20 or more years, the VA cannot reduce your rating unless it finds the rating was based on fraud. This is a very high standard and it's unlikely the rating would get reduced. If you are 100% for 20 years (Either 100% schedular or 100% TDIU - Total Disability based on Individual Unemployability or IU), you are automatically Permanent & Total (P&T). And, that after 20 years the total disability (100% or IU) is protected from reduction for the remainder of the person's life. "M-21-1-IX.ii.2.1.j. When a P&T Disability Exists" At 55, P&T (Permanent & Total) or a few other reasons the VBA will not initiate a review. Here is the graphic below for that. However if the Veteran files a new compensation claim or files for an increase, then it is YOU that initiated to possible review. NOTE: Until a percentage is in place for 10 years, the service connection can be removed. After that, the service connection is protected. ------ Example for 2020 using the same disability rating 1998 - Initially Service Connected @ 10% RESULT: Service Connection Protected in 2008 RESULT: 10% Protected from reduction in 2018 (20 years) 2020 - Service Connection Increased @ 30% RESULT: 30% is Protected from reduction in 2040 (20 years) 2022 - Service Connection Increased @ 50% RESULT: 50% is Protected from reduction in 2042 (20 years) ------- Second example for 2020: Example of protected percentages: • A Veteran gets awarded @ 30% in 1991. • The Veteran files for an increase and is awarded 70% in 2004. • The Veteran files for and is awarded TDIU status in 2005. --------- RESULT: In 2001 (10 years), the condition's service connection is protected. RESULT: In 2011 (20 years), the 30% is protected from reduction (except for fraud). RESULT: In 2024 (20 years), the 70% is protected from reduction. RESULT: In 2025 (20 years), the TDIU is no longer monitored yearly for income and is protected from reduction. In addition, the Veteran is automatically P&T. For clarity on the 5 year rule: This says the VBA must have proof of sustained improvement. An example might be when a Veteran has a mental health condition yet does not go to a psychologist/psychiatrist. Or, if the Veteran never has his service connected back status noted in the current medical records. Those situations would suggest a sustained improvement because the Veteran did not seek treatment or therapy or at a minimum get a current status noted in the medical records.
  4. I am rated at 70/50/40/40/10 (100%) scheduler AND 100% IU. My letter says P&T. My concern is that I have some issues that were dropped by the VA (specifically glaucoma) when they approved my 100%. As a note, I was 50/50/10/10/10 prior to C&P's that qualified me for the current ratings. I had submitted glaucoma with the UI and increase claim, and the glaucoma shows up as claimed but not service connected. I am trying to understand if I should push this to be SC? I am getting great care from the VA for my eyes, and I have to say, everything else. My concern is that I will eventually go blind and there may need to be modifications done to my home for mobility reasons. I would think the Glaucoma would need to be SC for those grants to have any chance for approval? My service health records has a lot about my eyes (I was ATC), and specifically says asymptomatic for glaucoma. I would have a good shot. My other concerns is that if I don't make it to the 10 years P&T, my wife won't rate DIC. (No jokes!! ). I have a couple other potential SC's that would meet the requirements, but I haven't submitted them yet since I am 100% Can I submit additional disabilities to be SC'd and not shake loose the hounds of H@%#ll? Thanks in advance!! My journey took a short (by comparison) 4 years from first submission to 100% P&T... It was in my HR, just needed to be brought out, highlighted and presented... It took a good lawyer, a few dark alleys with counterfeit scammers just trying to make a buck off us and not doing anything in return... and realizing that for the VBA it's not personal... they are just pushing paper...
  5. Has anyone here explored this? Cantrell v. Shulkin (2017) involves TDIU and full-time employment in a protected work environment. The veteran filed for TDIU and continued to work full-time after being granted special accommodations. After repeated denials, the CAVC granted TDIU. https://efiling.uscourts.cavc.gov/cmecf/servlet/TransportRoom?servlet=ShowDoc&dls_id=01204376046&caseId=87284&dktType=dktPublic Oddly, if I search M21-1 for Cantrell, it returns nothing... Since the BVA search is still down, I did a Google search and found a handful of cases where the BVA repeatedly denied TDIU claims despite the veteran being in receipt of special accommodations because the veterans worked full-time. Because the CAVC did not lend to the definition of "protected environment", the VA has not defined it further. It seems the VA treats the Cantrell ruling as an outlier as if it applies to just him and nobody else, despite it being from a three judge CAVC precedent ruling. Any thoughts?
  6. I swear I looked in the pinned post, but I guess I didn't see anything, or it wasn't clear. I am ready to file a claim for TDIU. Currently at 90% combined with 70% of that being PTSD. So, I meet the 70/60/40 rule since one of my ratings is greater than 60%. Also, I have been fired from 2 jobs within the past year, and most recently, it was due to (my thoughts) my PTSD (we have filed a complaint with EEOC for that as well) because I missed too much work for doctors appointments and such. Background out of the way now... Is there a "How to file TDIU for Dummies" guide somewhere around here? Last claim I filed was on ebenefits, but as I understand that has now moved to VA.gov? I need to know where to start. I already have all my civilian medical records, I have letters from doctors/friends/family stating how it impacts my ability to work. I do not have a vocational letter (is this needed?). I need to put myself out there and go ahead and call me stupid, but where do I start? Thanks, Kevin
  7. Good Evening All, I have not posted in a long while, but I trust the knowledge of the crowd here on Hadit, and especially some of you really well VA versed people. My question is, where does it state - indicate, officially, that when you have been granted IU, after being 70years old or having IU when you become 70 years old, the you become P&T? ptsdlawyers oom - states: "Once the claim of TDIU is granted, many Veterans then wonder whether it’s permanent. While TDIU can be permanent, that isn’t necessarily so. If a Veteran receives TDIU, the VA may determine that their condition has improved sufficiently enough for them to sustain gainful employment. So if a Veteran receives TDIU and then becomes employed, or the VA determines that they could become employed, the TDIU benefits could be terminated. However, a Veteran may find that their TDIU is permanent if they are 70 years or older or have been receiving TDIU consecutively for 20 years." statesidelegal org - states: "Jim's Reply This is a current topic I'm discussing with a few folks at VA. The way that a "permanent" rating is assigned at VA makes little sense. It's interesting to note that in the VA lexicon, the word permanent doesn't mean that a benefit is permanent. Rather, it means the beneficiary is eligible for some enhanced dependents benefits and that there are no routine future exams (RFEs) scheduled. Otherwise the benefit may be reviewed and modified for cause at most any time. For now it appears that you'll wait until you're 70 years old, an arbitrary age that VA uses for other similar purposes. If you're trying to avoid the future exams with a permanent rating, I'd advise you wait it out. The longer you wait, the less chance there is that your ratings can ever be lowered. If you're seeking the additional benefits for dependents, again...I advise that you wait it out. VA is aware of the issue and I'm seeing some informal positive response to making sense of the P & T confusion." disabilitylawgroup com - states: "It is also possible for initially temporary TDIU benefits to become permanent. This happens either if you are 70 years or older or you have received TDIU benefits for 20 years or more consecutively." I am pretty darn sure I saw it in some form on M-21, 38 CFR, or another government source a year or more ago - just trying to ease my nerves? Have a Great 4th of July weekend - be safe
  8. I had a C&P exam this morning for an increase to my bipolar rating. I wanted to share my experience. It was a telehealth appointment. My first appointment was canceled, which was very fortunate because I was not prepared. I spent the time before the new appointment researching what to expect and the best way to approach the exam. I decided to make a page with a detailed list of my symptoms and a separate page with issues that I wanted to discuss. When the exam started I told the doctor that I was worried about forgetting something and that I had made notes as a reminder. She said that was a great idea and let me refer to my notes after every question. When she was done she asked if there was anything in my notes that we hadn’t gone over. Then we talked about that stuff. After the exam she told me that she was updating my diagnosis to Bipolar 1 with psychosis and mixed episodes. She then told me that she didn’t think I was getting the help that I need and asked if she could give me medical advice and information outside of the exam, which I gratefully accepted. Now it’s a waiting game for the rest of the claim process. For anyone with a Bipolar of Mental Health C&P coming my recommendation would be to write down in detail what symptoms you are having and how they affect different areas of your life. The exam can be tough and you shouldn’t trust yourself to remember everything on the spot.
  9. Pro Se All The Way What one man can do another man can do (veterans). Like other vets who received prior poor, hostile or indifferent VSO assistance I learned beginning in 1985 to represent myself pro se in all claims and appeals to the VARO, BVA and even CAVC court. You do not need to put up with sorry VSO representation if like me you are willing to do your own research and learning on the convoluted VA disability system. For me it was challenging, learning and even a fun but time consuming experience over 35 years. Here is my 95% successful score card and you can do it to if you are motivated like me. 50% PTSD 1985 pro se with no help from DAV VSO 70% PTSD TDIU 1998 very limited assist from former DAV VSO P&T TDIU 2000 on my own pro se CAVC court win 2005 pro se own my own partial victory CUE 30% Heart Disea 2017 on my own pro se Agent Orange IHD/CAD 50% Sleep Apnea 2021 pro se BVA Appeal back dated 2017 SMC-S automatic 2021 pro se back dated to 2017 60% GERD 2022 pro se VARO initial claim approval 10% Tinnitus 2022 pro se VARO initial claim approval 100% P&T 2022 automatic from VARO My OSA Sleep Apnea appeal was helped by Dr. David Anaise medical nexus opinion stating my OSA was caused and aggravated by VA diagnosed long term PTSD and PTSD meds. I filed the claim and appeal forms and provided other medical evidence pro se. Only one claim flat out denied in over 35 years with no appeal by me for Hypertension. There is no chicken chit VSO or official VA representative that would have ever done all this for me. Only you really care about your disability claim and no one else. The VVA and Hadit and Lexus Nexus manuals plus BVA and CAVC, Fed Appeals Circuit court decisions are your friends and of tremendous help to me. Beware of misleading info from other vet websites. So cheer up and chin up. My comment is not legal advice as I am not a lawyer, paralegal or VSO.
  10. So I got my decision letter a week or so ago. I was denied increase fro 70% PTSD to 100%, due to me not meeting the criteria for 100% according to the CFR. I was also denied TDIU because my former employers would not send back the 21-4192. I had an appointment with my local VA office and they were clueless. They stated that since it was my responsibility to ensure that the 21-4192 were returned, and the employers didn't return, that is why my claim for TDIU was denied. However, So, the question is, what's the better option? Should I appeal the decision, or should I open a supplemental claim? I have also read that if the 21-4192 is not filled out by the employer, it cannot be used negatively against the veteran in the decision making process. How should I proceed? Thanks, Kevin
  11. In May 2000 I sent a claim to VARO asking that my PTSD TDIU rating of 1998 be made Permanent and Total and in August of 2000 the VARO did just that in a decision saying I was now considered permanent with my TDIU rating being considered Total. The VARO based their decision upon "review of my claims file" only with no C&P exam required or further evidence from me. Also in early 2000 I filed claims of CUE and VA INjury section 1151 that were included in an Equitable Relief Claim for Administrative Review that I sent directly to the VA Secretary with copies to the head of the VBM and to many U.S. Senators and Congressmen of many states. So all this played together for my benefit with several years of backpay of the original TDIU claim. If you think you have strong evidence to support your claim request then go for it as it does not hurt you one bit IMHO as there is very little downside. All they can do is say no or not respond to you. There are more than a few yahool experts in the open internet universe that along with other misleading information constantly tell vets they cannot receive a P&T rating simply by asking for it. This of course is pure BS as I am sitting here looking at both my un scanned claim filed as a statement in support of claim and also the actual un scanned official August 2000 decision letter from the Waco VARO. I will scan both documents when in the mood for future forum publication. I have copies of everything from 1985 forward and including Army medical records I have from Vietnam, Japan in 1970. Being a pack rat has paid off well for me. Always check with Hadit first before asking the yahoos at another point in space. It is always good to compare answers from different sources though. My comment is not legal advice as I am not a lawyer, paralegal or VSO. What works for me may or may not work for you. https://www.facebook.com/Veterans-Information-Journal-105893908788750/
  12. This may apply especially with TDIU. Remember, before 2015, informal claims for increase were allowed. CCK law explains, in Ingram, below, that the Va has a duty to consider both informal and formal claims: https://cck-law.com/blog/10-court-of-appeals-for-veterans-claims-cases-all-veterans-should-know-part-1/ And, Comer vs Peake points out when a Veteran seeks a claim for increase, VA has to assume the Vet seeks the maximum benefit: https://casetext.com/case/comer-v-peake Specifically, Comer says: Remember, a claim for tdiu, if you already have one or more disabilites, is a claim for increase.
  13. I just found my benefits summary letter on VA.gov has been updated. My combined schedular rating remains at 80%. My letter says that I will be compensated at the 100% rate due to my TDIU. It goes on to say that I am considered Totally and Permanently disabled. Two questions, actually...does this make me eligible for ALL of the 100% benefits in addition to the compensation?...and does Permanent & Total mean that it's locked in for life with no future exams or possibility of reduction or withdrawal? I understand that it can be revoked if I become substantially and gainfully employed, so we don't need to discuss that aspect. If I remain unemployed for the rest of my life, am I locked in for 100% compensation without being re-evaluated?
  14. I'm confused about the eligibility for premium waivers on the S-DVI. The rules say you may be eligible for no premiums if your disability prevents you from substantially gainful employment. This can only be substantiated by approval of TDIU, but then it contradicts it's self by saying that your Total disability cannot be effective PRIOR to your insurance coverage start date. How the heck can anyone possibly be eligible? Once you've been granted TDIU and they call it "totally disabled", you're disqualified as soon as you qualify. What am I missing here? Is this benefit only for those who started a policy before being rated Totally Disabled? Eligibility Requirements: You have a mental or physical disability which prevents you from performing substantially gainful employment. Your total disability must begin before your 65th birthday, and must continue for at least six consecutive months. Your total disability may not begin prior to the effective date of the policy. What do I need to do to apply for premium waiver? Once you submit your Application for Service-Disabled Veterans Insurance (S-DVI), our Insurance Claims Division can begin reviewing your information. If your application for insurance is approved, you will automatically be considered for waiver of premiums. Please understand that eligibility for premium waiver is based on information from your local VA Regional Office, and health and employment information concerning your non-service-connected impairments. What if I'm not approved for waiver of premiums? If you are not approved for waiver of premiums you will have to continue paying premiums for this insurance. If you do not want to pay the premiums you may cancel your coverage by sending a request to: Department of Veterans Affairs Regional Office and Insurance Center (RH), P.O. Box 7327, Philadelphia, PA 19101.
  15. I am now TDIU P&T and my summary letter says I will be paid at the 100% rate. But it shows my payment will be $3,303.49 instead of the current 100% amount of $3,332.06. Why am I being shorted $28.57 on my monthly payments?
  16. Found on: http://www1.va.gov/V...asp?pub_ID=1817 I showed this to my dentist several years ago and he finally agreed to have my teeth cleaned on a regular basis. 10. ELIGIBILITY FOR DENTAL CARE a. General (1) VA Dental Services examine and treat eligible inpatient and outpatient beneficiaries. Eligibility for dental care is governed by statute and provided in accordance with the provisions of existing law and regulations as cited in United State Code., sections 1710© and 1712, and Title 38 Code of Federal Regulations (CFR) sections 17.160 through 17.166. Dental eligibility is determined in a different manner than medical eligibility. The Business Office, Health Eligibility Center, holds responsibility for verification of administrative aspects of dental eligibility. It is the responsibility of the Dental Service Chief to make determinations on all clinical aspects of dental eligibility. (2) It is not the established mission of VA to provide dental care to all veterans or even to all those who are hospitalized. The extent of treatment is determined through an understanding of the patient's dental classification and the appropriate scope of dental care to be provided based on that classification. b. Dental Classification. The laws and regulations mandate dental care as a benefit for defined veteran groups. Specific dental classifications have been established that further define patient groups and the appropriate scope of care based on that classification. The nuances of the VHA HANDBOOK 1130.01 December 24, 2008 4 classifications are addressed in the Inpatient, Outpatient and Long Term Care sections of this Handbook. Also see Appendix A for the Scope of Care Quick Reference Guide. (1) The following patient groups are included in the defined dental classification scheme and are to be provided dental care in compliance with VHA regulations and Directives: (a) Residents of VA Residential Rehabilitation Treatment Programs, including Domiciliaries. (b VA Community Living Center (formerly known as Nursing Home Care Unit) residents. © Inpatients with compelling medical need for dental treatment. (d) Patients having a compelling medical need that requires completion of dental care initiated while an inpatient. (e) Outpatient Dental Class I through VI beneficiaries. (f) Outpatients with dental emergencies. (2) The following patient groups are included in the defined dental classification scheme and may be provided dental care if clinic capacity is available. (a) Hospitalized veterans whose dental conditions are not considered to be adjunct to their medical problems. (b Inpatients without other dental entitlement who are active duty military personnel or military retirees. © Specially designated inpatients and outpatients such as those provided for under approved sharing agreements. c. Professional Considerations. VA is obligated to fulfill the requirements of the statutes enacted by Congress and to follow their intent. Every Dental Service has the responsibility to provide care on the basis of the patient's dental classification. A clearly defined and documented treatment plan, consistent with the appropriate scope of care for that patient's classification, will be developed for each episode of care. (1) There is no authority to expand the scope of care beyond the veteran's level of entitlement in order to meet the demands of an educational program as a "teaching case." If a training program is dependent upon types of cases that are not available in sufficient numbers, the scope of that program should be reevaluated. (2) The patient's ability to pay for the cost of private dental care should not be a factor in determining the extent or limitation of dental treatment that will be provided by VA. December 24, 2008 VHA HANDBOOK 1130.01 5 (3) Dental care provided for reasons of medical necessity should not exceed the scope necessary to resolve the condition that is complicating a medical problem. For example, a patient's medical problem may require only the removal of foci of infection. Even though VA may edentulate a patient to resolve the dental condition's impact on a medical problem, VA is not obligated to provide prostheses for this patient. (4) Appropriate dental authorization for outpatient dental care for veterans that have other rated, compensable service connected conditions of the head and neck area is sometimes confusing. Conditions such as loss of soft tissue, scarring or cranial nerve involvement may have significant impact on oral function even though there may be no physical trauma to the dental structures, per se. These non-dental conditions are not rated in the 9900 series of the Schedule for Rating Disabilities (See Appendix bb and are considered medical conditions. The decision as to whether or not dental care will be authorized as adjunctive care (either as Class III or Class VI) will be determined by the Chief, Dental Service, or designee and based on the same criteria as for other medical conditions. d. Scope of Dental Care. Once a patient's dental classification has been properly established, the appropriate scope of care for that patient must be determined. The scope of dental care to be provided can be categorized as Comprehensive, Focused or Emergent/Urgent. The intent of these categories is to facilitate a consistent standard of care throughout all VA dental facilities. (1) Comprehensive Dental Care. Patients eligible for Comprehensive Dental Care receive any dental treatment that is reasonably necessary and clinically determined by the treating dentist to meet the patient's dental needs. A recall program should be established for those patients who are eligible for comprehensive and repeat dental care. The goal of care is to attain and sustain oral health and function including prosthetic rehabilitation as indicated. (2) Focused Dental Care. Focused dental care is intended to resolve a specific dental condition dependent upon, and consistent with the patient's classification. Treatment may include relief of pain, elimination of infection, or improvement of speech or esthetics. It also includes treatment of adjudicated non-compensable service connected teeth (i.e. Class II and Class IIa.) The goal of care is to provide a specific improvement of the oral conditions that directly impact the medical condition (Class III and VI), assist in vocational rehabilitation (Class V), or to provide dental care professionally determined to be medically and functionally appropriate to their status for those in a VA Community Living Center or extended care facility. (a) Consultation requests, when applicable, from non-dental providers must identify the medical condition being aggravated or the management of which is compromised by the dental problem. The Dental Service Chief, or designee, will review the consult and make a final determination based on dental eligibility and scope of care. (b Dental treatment is generally limited and may include supportive periodontal therapy, endodontic therapy, restorative dentistry, and oral surgical procedures. VHA HANDBOOK 1130.01 December 24, 2008 6 © Treatment may also include the fabrication of removable and complete dentures as indicated in the approved treatment plan. Once the episode of care has been completed, subsequent treatment is the responsibility of the patient. (3) Emergent/Urgent Dental Care. Outpatient emergency dental care is provided as a humanitarian service to individuals who do not have established dental eligibility. Dental treatment is limited to that necessary to address acute pain, significant infection, uncontrolled bleeding, or any dental condition that is determined to be a serious threat to health or endangering life. The goal of treatment is to eliminate symptoms and/or remove foci of infection. Dental care is generally limited to one time palliative procedures and appropriate pharmacological therapy. (a) The provision of emergency dental treatment does not entitle the patient to subsequent or follow-up care unless the individual is eligible under some other provision. (b Individuals who are not eligible for VA dental care, but who are provided outpatient emergency dental treatment will be processed in accordance with VA policy and procedures as follows: 1. Veterans presenting at VA medical facilities requesting treatment for acute pain, significant infection or uncontrolled bleeding of oral origin should initially be seen for administrative processing and triage. Triage will include, if applicable, verification of any medical condition for which there is a potential for adjunct (Class III or VI) dental care. 2. If the patient is not eligible or has limited eligibility for outpatient dental care, the patient must be informed of this fact and advised that if emergency treatment is provided for which there is no eligibility, the patient will be billed for treatment. The eligibility clerk or designee will complete and sign the statement of ineligibility on VA Form 10-2570g, Dental Outpatient Emergency Referral and Treatment Record. The applicant will sign the statement of understanding related to the emergency dental care and billing prior to referral to the Dental Service. 3. Dental Service personnel will examine the patient to determine the appropriate course of treatment based on the following options: a. If the condition requires hospitalization, the patient will be returned to the admitting area with the necessary documents for admission. b. If the dental condition can be treated on an outpatient basis and does not require immediate attention, the patient will be referred to community resources at their expense. c. If the dental condition is considered emergent, appropriate care will be provided and documented. 4. Upon treatment completion, a brief description of the emergency treatment provided will be recorded, signed by the treating dentist and returned to the VA office responsible for billing. December 24, 2008 VHA HANDBOOK 1130.01 7 e. Refusal to Accept Dental Services. In those instances when patients refuse to accept Dental Service's recommendations or do not cooperate in receiving treatment, a statement of the facts will be entered into a progress note for consideration and appropriate disposition by the Chief, Dental Service, or designee. f. Treatment Continuation for Patients Who Relocate to Another Geographic Area. A key objective of VA Dentistry is to provide a consistent standard of dental care throughout VA dental facilities. If, however, a patient has a plan of treatment for a scope of care inconsistent with their dental classification, the receiving facility is not obligated to provide care beyond that which is justified. The Dental Service at the new facility will perform an evaluation, update the treatment plan and communicate any changes to the patient. g. Patient Responsibility in Making and Keeping Dental Appointments. Any veteran eligible for dental treatment on a one-time completion basis only and who has not received such treatment within 3 years after filing the application shall be presumed to have abandoned the claim for dental treatment. (38 CFR 17.164) 11. OUTPATIENT DENTAL PROGRAM a. Overview. The goal of VA Dental Services is to provide high quality, cost-effective dental treatment to eligible veterans. All VA dentists will be knowledgeable regarding the scope of care to be provided that is consistent with the patient's dental classification. b. Persons Eligible for Outpatient Dental Care. Statutory eligibility for outpatient dental care is granted to veteran beneficiaries and is provided in accordance with existing law and regulations. Classes of eligible dental outpatients are as follows: (1) Class I. (a) Veterans having a compensable (10% or greater), service connected dental disability or condition (combat or non-combat related) rated under the 9900 series of the Schedule for Rating Disabilities (See Appendix b are eligible for any necessary dental care to maintain or restore oral health and masticatory function, including repeat care. (b Appropriate dental authorization for outpatient dental care for veterans that have other rated, compensable service connected conditions of the head and neck area is sometimes confusing. Conditions such as loss of soft tissue, scarring or cranial nerve involvement may have significant impact on oral function even though there may be no physical trauma to the dental structures, per se. These non-dental conditions are not rated under the 9900 series, are considered medical conditions and are not eligible under Class I. The decision as to whether or not dental care will be authorized as adjunctive care (either as Class III or Class VI) will be determined by the Chief, Dental Service, or designee and based on the same criteria as for other medical conditions. (2) Class II. Veterans having a noncompensable, service connected dental disability shown to have been in existence at the time of discharge or release from active duty may be provided VHA HANDBOOK 1130.01 December 24, 2008 8 any treatment as reasonably necessary for the one-time correction of the noncompensable, service connected dental disability if all of the following criteria are met: (a) They are discharged or released from active duty under conditions other than dishonorable, from a period of active military service of not less than 180 days. In the case of Gulf War Era, Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans, they are discharged or released from active duty under conditions other than dishonorable from a period of active military service of not less than 90 days. (b Application for dental treatment is made within 180 days of discharge or release from active duty. © The certificate of discharge or release certifies that the veteran was not provided, within the 90 day period immediately before discharge or release, a complete dental examination (including dental radiographs) and all appropriate dental treatment indicated by the examination was completed. This certification is found on the DD214, line 17. (d) Scope of care for Class II. 1. One Episode of Class II Care. When Class II eligibility for a one-time episode of dental care has been exhausted by satisfactory completion of the authorized treatment, no further care will be provided. Class II dental beneficiaries who (through no fault of the VA) have not completed authorized treatment within 3 years after filing the application shall be presumed to have abandoned the claim for dental treatment. 2. Dental Prostheses and Implants Provided by VA. Class II dental beneficiaries are not entitled to long term maintenance of fixed or removable dental prostheses or dental implants. Once adjustments are satisfactory, the episode of prosthetic care is considered to be complete and subsequent treatment is the responsibility of the patient. 3. Periodontal Conditions. Specific treatment authorized for periodontal conditions of Class II beneficiaries is expected to provide maximum benefit by the time that episode of care is completed. When that treatment is satisfactorily completed as authorized, VA will not furnish any further treatment or follow-up for the periodontal condition. 4. Impacted Teeth. Impacted teeth are a developmental condition. Consideration for surgical extraction should be based on sound professional judgment to resolve existing disease or symptoms. 5. Malposed Teeth. Malposed teeth are considered a developmental abnormality and a pre-existing condition. VA will not provide orthodontic care in this circumstance. For cases in which trauma incurred in the line of duty resulted in malalignment of the teeth or when restorative procedures for which the patient is eligible require orthodontic intervention, orthodontic care may be provided. 6. Veterans with Orthodontic Appliances. When veterans arrive at VA facilities with orthodontic appliances for the purpose of correcting developmental malocclusion and have not December 24, 2008 VHA HANDBOOK 1130.01 9 had their treatment completed by the military prior to discharge, they need to be instructed to contact the dental clinic at their last active duty military assignment to arrange for completion of the care. If the military does not complete the orthodontic treatment, VA is not obligated to assume the responsibility of any phase of the orthodontic care unless directly related to rehabilitation of combat trauma to the maxillofacial region. 7. Service Connection of Dental Conditions for Treatment Purposes. Veterans Benefits Administration (VBA) may, upon request, provide documentation to the Dental Service defining service connection of specific teeth for dental treatment purposes. (38 CFR 3.381). The regulation provides for identification of teeth treated during military service, and applies only to Class II beneficiaries who have met the criteria as specified in Para. 11 b.(2)(a-c). The Chief or designee can use the document to assist in development of appropriate treatment recommendations. (3) Class IIA. Those veterans having a noncompensable, service connected dental disability adjudicated as resulting from combat wounds or service trauma are eligible for repeat care and maintenance or replacement of the involved tooth/teeth. A Dental Trauma Rating (VA Form 10-564-D) or VA Regional Office Rating Decision letter (VA Form 10-7131) identifies the tooth/teeth eligible for care. Public Law 83, 84th Congress, Chapter 52, H.R. 5100, Approved June 16, 1955 invalidates old dental ratings and eligibility letters dated before 1955. Prior to 1955, teeth that received routine dental care while the veteran was on active duty were listed as "service connected". Patients with these dental ratings are not eligible for repeat care for the listed "service connected" teeth. (4) Class IIC. Veterans who were Prisoners of War (POWs) are eligible for any needed dental care, including repeat care. (5) Class III. Veterans with a dental condition professionally determined by VA to be aggravating or complicating the management of a service connected medical condition under active treatment are eligible for care to treat the dental condition. The goal is to provide focused care to treat only the oral conditions that directly impact the management of the service-connected medical condition. Eligibility for each episode of dental care must be predicated on referral (consult), followed by a new dental evaluation. (6) Class IV. Veterans whose service connected disabilities have been rated at 100 percent (total) or who are receiving the 100 percent rate by reason of individual unemployability are eligible for any needed dental care, including repeat care, with the following exception: a veteran awarded a temporary total disability rating by the Veterans Benefits Administration is not eligible for comprehensive outpatient dental services based on an opinion by VA General Counsel (023) to the Under Secretary for Health (16), February 24, 2006, VAOPGCADV 2-2006. Determination of temporary status is the responsibility of the eligibility section of the Business Office. (7) Class V (a) A veteran who is actively engaged in a Chapter 31 vocational rehabilitation program is entitled to dental care to the extent needed to meet any of the following goals listed: VHA HANDBOOK 1130.01 December 24, 2008 10 1. make possible his or her entrance into a rehabilitation program, 2. achieve the goals of the veteran's vocational rehabilitation program, 3. prevent interruption of a rehabilitation program, 4. hasten the return to a rehabilitation program of a veteran in interrupted or leave status, 5. hasten the return to a rehabilitation program of a veteran placed in discontinued status because of a dental condition, 6. secure and adjust to employment during the period of employment assistance, or 7. enable the veteran to achieve maximum independence in daily living. (b Requests for dental care will be forwarded to the Dental Service by the Chapter 31 Vocational Rehabilitation Program on VA Form 28-8861. This form needs to be provided for each episode of care requested. Dental care should not be provided beyond the anticipated rehabilitation date as specified on the form. (8) Class VI (a) Any veteran scheduled for admission or who is receiving outpatient care under 38 U.S.C. may receive dental care if the dental condition is clinically determined to be complicating the non-service connected medical condition currently under VA treatment. Eligibility for each episode of dental care will be predicated on referral and consultation, followed by a decision based upon clinical judgment. The goal is to provide focused care to treat only the oral conditions that directly impact the management of the non-service connected medical condition. (b Certain homeless and other enrolled veterans also are eligible for a one-time course of dental care per VHA policy, Public Law 107-95 and Title 38 United States Code (U.S.C.) § 2062. Dental workload for veterans participating in this program is recorded under the Class VI dental outpatient classification. (9) Other Beneficiaries. Other beneficiaries who may be eligible for dental care in VA dental clinics on an outpatient basis, subject to and consistent with the provision of existing laws, VA regulations, and the availability of VA resources are: (a) Armed Forces Personnel on Active Duty. Authority from the Commanding Officer of the military installation should accompany the request for dental treatment. However, if extenuating circumstances are present, treatment of the emergent dental condition may be accomplished prior to the receipt of authority. Emergency dental treatment for members of the Armed Forces on active duty will be limited to such treatment as is found necessary for the relief of pain and control of acute infection, trauma or hemorrhage. December 24, 2008 VHA HANDBOOK 1130.01 11 (b Armed Forces Personnel in VA Polytrauma Centers. Active duty military personnel with spinal cord injury, traumatic brain injury or blindness who are receiving treatment in a VA polytrauma center are eligible to receive dental care under a direct resource sharing agreement in accordance with Department of Veterans Affairs and Department of Defense Memorandum of Agreement regarding referral of active duty military personnel with effective date January 1, 2007. Dental services will be billed at the interagency rate, where one exists, or at actual cost as appropriate. © VA Employees. VA employees may be provided emergency dental treatment only to the extent necessary to permit the employee to remain on duty. Provision of care is predicated on referral from the employee health program. Employees with emergent conditions that may require follow-up care will be advised to seek private care at their expense. Injuries incurred in the performance of duty may receive necessary emergency treatment. (d) Beneficiaries of Sharing Agreements. Treatment provided will be dependent on the specific language of the agreement. (10) Disability Evaluation Examinations for Compensation and Pension Rating Purposes. Requests for an oral examination are submitted to the Dental Service at the request of the Regional Office. Examination findings must be accurately and comprehensively reported and the patient coded as a Category 20. Examinations must be completed within the timeframe required by VBA.
  17. Hi all!! It’s been a while, hope everyone is well!! For those who don’t have any background on me, I’m 80% TDIU for PTSD. At my last C&P, doc found no change in my condition, so benefits were continued, P&T status granted. That’s where the good news ends, unfortunately. I’m struggling with feeling very detached from society lately; certain unwelcome thoughts have entered…. I simply don’t know what else to do aside from getting out there and trying to contribute. I know it’s ill-advised for someone to try working on TDIU, and I understand the risks associated with it… But my VA benefits mean nothing if I’m no longer with us… I just know I can’t sit around and do nothing anymore, so I’m going to try getting a part-time job near my home. I have done my fair share of research on what might happen as a result of this… but I refuse to let my fear dominate me. Worst case scenario, benefits are stripped and my story ends. If they want to challenge me for it, so be it. But I will no longer feel ashamed for wanting to work… for wanting to be a part of the machine that keeps our economy alive…. To serve a purpose… A bit unsettling that I may be digging my own grave here…. but when compared to another alternative I have in mind, it doesn’t seem like such a bad idea when all factors are considered… My question is, should I retain a lawyer to be ready for VA shenanigans, or wait until they propose a reduction? I expect a call or letter after I report income… I get so caught up in the thought of fighting the VA that I don’t even consider not being able to handle work anyway…. guess I’m just holding onto faith that I can somehow live a normal life before my time is up. be well, everybody :]
  18. I just found out the VA made a decision on a supplemental claim I filed only a week ago concerning a now 30-year-old claim. The matter involves an earlier effective date for TDIU to match the recent grant of an earlier effective date for service connection for GAD. They denied the EED for TDIU based primarily on the now-defunct date of service connection for GAD in 2017 so I sent them that decision along with evidence supporting my inability to earn a decent living for almost thirty years. I averaged over that time, $6000 dollars a year. How much consideration went into records that support a retroactive rating the same as my current of 70% I don't know but most of the supporting documents are long-gone. I made the unavailability of those records as a part of my argument as I was granted the EED for service connection for GAD under 38 cfr 3.156(c) where service records are added to your file later on that prove your case. Nervous because they decided so fast - 7 days. Has anyone else had such a lightening-fast decision and if so, how'd it go? Disclaimer: I understand I only have to wait a few days for an answer but I'm now caught in that guessing frame of mind that won't abait until I found out.
  19. I am permeant, total, IU 100% for several years now, I'm no 70w years young . I have heard somewhere that I could get a TSA number for myself & spouse at no cost, if I have a Commissary Letter, but I don't know if that is the way to go since there has been changes to eligibility to commissary privileges. I have online eBenefits Premium, not sure if that will help. Traveling from Boston to Hawaii mid February/2022. Where would I go if I have to go the commissary route - there is a Hanson AFB here near Boston. Thanks & Mahalo
  20. Hello all, My new appointed VSO seems to just want to do the TDIU request. Meanwhile, I am gathering more and more evidence toward 100% P&T. Can I have him do just the TDIU request, because the monthly increase of money comes sooner (I think), and after we finalize the TDIU then do I drop him so I can submit things on my own? When I went to eBenefits to "Manage my Representative" I could only see options of choosing between an Attorney POA, or VSO, or Claims Agent (I think). Where and how do I establish that I am representing myself when I want to submit new claims or request increases?
  21. Hi, Last week, I was awarded P&T TDIU for a claim that was previously awarded 70% mental health disability rating. Should I now appeal the 70% mental health rating? The word "total" is difference between a 70% and 100% mental health rating, as I read the information. Is P&T unemployable possibly considered as a 100% disability rating? Thanks
  22. I just had my appeals hearing with my ALJ I presented her that I am 100% TDIU PTSD 70 Back 40. I have a caregiver as well as my mental health doctor who wrote her opinion that I cannot maintain employment. What are my chances for a favorable decision. Thanks in advance
  23. Was approved for TDIU ON FEB1, 2021. I am having issues getting any straight answer from the VA as to when i will receive my pay raise and retroactive pay. I spoke with the fiduciary hub today and they told me that the funds were approved for release on Aug 17Th, and now its up to the Appeals Management Center to do whatever it is they do to make the deposit happen. does anyone know how long THAT could take, or did i just get another canned answer? Any advice, encouragement, or the number to the AMC would be greatly appreciated. Everyone i talk to have said that i shouldn’t have waited this long. thanks!
  24. Hello everyone, I have a quick question concerning TDIU. My last employer terminated me because of my service-connected disability. If approved for TDIU, will the VA back pay me to the date that I signed the TDIU form and submitted my claim, or will they back pay me to the date that I put on the TDIU form that I last worked? My VSO initially told me that I would be paid from the date I last worked. Then on another day he told me that I would be paid from the date I submitted the claim. So I just want to get the correct answer. Thanks for any replies.
  25. I swear I looked in the pinned post, but I guess I didn't see anything, or it wasn't clear. I am ready to file a claim for TDIU. Currently at 90% combined with 70% of that being PTSD. So, I meet the 70/60/40 rule since one of my ratings is greater than 60%. Also, I have been fired from 2 jobs within the past year, and most recently, it was due to (my thoughts) my PTSD (we have filed a complaint with EEOC for that as well) because I missed too much work for doctors appointments and such. Background out of the way now... Is there a "How to file TDIU for Dummies" guide somewhere around here? Last claim I filed was on ebenefits, but as I understand that has now moved to VA.gov? I need to know where to start. I already have all my civilian medical records, I have letters from doctors/friends/family stating how it impacts my ability to work. I do not have a vocational letter (is this needed?). I need to put myself out there and go ahead and call me stupid, but where do I start? Thanks, Kevin
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