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sbrewer

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sbrewer Rising Star

sbrewer

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Finally got a knew computer so everything is not going black at the bottom. I wrote in last week about my husband getting 100% and what was needed for the ID cards and so forth. We have now got all that taken care of, waiting on forms for me to apply for CHAMPVA, but I think we have everything else. Now, here's my question....

He recieved 70% but paid at the 100%PTIU for mental, however he was denied for his heart. Should he appeal that decision and if so what will happen. Can they take back the 100%PTIU or is it safe?

Thanks,

sbrewer

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Vike17 Experienced

Vike17

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sbrewer,

"Can they take back the 100%PTIU or is it safe?"

No, the VA cannot "take back" the 100%IU P&T on a DRO review or appeal, unless there was a CUE involved.

Vike 17

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Jay Johnson Experienced

Jay Johnson

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"Take back" is a tricky phrase.....can they review the decision and change it, without CUE, as per the regs? No. Have they done it anyway? Heck yeah. They did it to my wife when we simply changed regions. The decision to drop her from 100% P&T with A&A (just received several months before moving mind you) to 50%, was made because, and I quote, "the VA does not grant A&A for a person's willingness to hurt themselves (why they took away A&A)" and "The evidence does not warrant a 100% rating". They based this on a note saying she was able to handle her own finances (to get her out of the god awful fiduciary program).

Eventually, we won the money back (all but the A&A, but we got homebound), but only because I fought them tooth and nail and got in touch with the director of the RO in Seattle.

So, P&T is safe ONLY if you give them absolutely no reason to look at your file...once you open it up, you are subject to the rater's discretion, regardless of the regs saying they cannot do so.

Filing appeals for separate disorders (once already 100%) is a judgment call...personally, I would leave well enough alone. The regs are certainly on your side in this matter, but that doesn't mean the RO cannot put you on the defensive and force you to win the rating back on appeals.

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vaf Mentor

vaf

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My thought is if the condition, such as a cardiac condition, has the capacity to eventually, directly or indirectly, cause the veteran's death, I would fight the decision to deny service connection for that condition.

I'm thinking about DIC for the surviving spouse.

Just my opinion.

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Jay Johnson Experienced

Jay Johnson

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Yeah, DIC is a big deal, especially with a heart condition. On the plus side, I don't think an RO likes to question itself....I think my wife's case is more of a "my RO is better than your RO" type of case. In all likelihood, your spouse's TDIU P&T should be fine, just be sure to get copies of the exam (for the heart issue) and don't offer up any personal details that do not pertain to the heart issue (unless asked).

Again, the VA regs are on your side here, but there is NO penalty if an RO does not follow regulations, so they tend to break them from time to time. In the end, you'd likely win back anything they tried to reduce anyway, but it can make life hell in the meantime.

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sixthscents Experienced

sixthscents

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Yeah, Vike sorry but I have seen it done too. Nope they shouldn't be able to by the regs, but I've seen it happen. Personally I would open the box though, simply because of the DIC issue.

Bob Smith

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Ricky Grand Master

Ricky

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I have to agree with all below. A heart condition that should be SC'ed should be fought. If the veteran passes from a heart related disease it would be exteremly hard to SC it for DIC purposes at that point. If this was a recent award then I think you should be ok (just my opinion). Was it a solid SC for the mental issue or did you have to appeal in order to obtain SC?

Six good to see you again.

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