P&t Pernanent & Total Disability

[Charleese]

Hi,

I know that P&T stands for Permanent & Total Disability, but what does this really mean? Do you have to be rated at 100% to get P&T? Do you have to be unemploye to get P&T? Are there certain injuries that you have to have to get P&T. If your 100% do you have to request P&T or do they automatically give it to you?

Thanks in advance for your answers.

[calnight]

JAY,

I AGREE WITH YOU I ONLY MENT TO SAY IS YOU MUST CONTUNIE YOUR CARE AND YES A PRIVATE DOCTOR IS WAY BETTER THEN THE VA. BUT FOR ME I ONLY HAVE THE VA NO PRIVATE INSURANCE. IF I HAD A CHOICE I WOULD GO TO A PRIVATE DOCTOR ALSO. I GUESS WHAT IT COMES DOWN TO IS KEEP UP YOUR DOCTOR APPT. EVEN IF YOU ARE P&T.

[john999]

Jim

Your rating is protected after 20 years from being reduced except by fraud. If you are IU you must realize that you can't ever go back to work even if you are P&T. If you were rated 80% IU 20 years ago the VA cannot reduce your 80% rating except for fraud. They could reduce the IU if you went back to work making more than poverty level work. If it was me I would not earn one dime ever after getting IU no matter how long it had been. I don't think you have anything to worry about as long as you don't go back to work, and never tell the VA you are feeling better.

[john999]

If you are rated IU for PTSD the only way they can take it away is if you have material improvement in your condition while maintaining or actively seeking gainfule employment. What is the chance of that for most of us? After 5 years and age 55 it becomes even harder. Unless the congress changes the meaning of IU I don't think we have much to worry about. If you are rated 100% for PTSD then apply for housebound. Now you have a 100% disabled vet who is housebound. Hard to reduce and what justification would there be to reduce a person who can't leave their home?

[Jay Johnson]

If you are rated IU for PTSD the only way they can take it away is if you have material improvement in your condition while maintaining or actively seeking gainfule employment. What is the chance of that for most of us? After 5 years and age 55 it becomes even harder. Unless the congress changes the meaning of IU I don't think we have much to worry about. If you are rated 100% for PTSD then apply for housebound. Now you have a 100% disabled vet who is housebound. Hard to reduce and what justification would there be to reduce a person who can't leave their home?

Very true john...one would think:-) But they did "attempt" to lower the wife just several months after getting 100% P&T WITH A&A all for PTSD alone. Believe me, I used every reg in the book that you mentioned above to get back the 100% P&T, but only got housebound back rather than A&A (Lost the will to fight mostly).

The disconnect seems to be that the RO ignores many of those regulations when making decisions (especially PTSD decisions), yet I think the BVA is more likely to uphold VA law. As I've said many times here, we need to hold the ROs accountable then they pull this nonsense, or they'll keep doing it and drawing claims out needlessly.

Jim,

The regs for finality of decisions is under 3.104 and 3.105. Basically, they just say that any decision is to be considered final and binding on all ROs unless there's clear and unmistakable error. Differences in opinion must be remanded to the "central office" for approval....an RO cannot simply disagree with itself, or a different RO, without getting authorization before hand (which I've never heard of).

As for 20yr+ protection - John summed it up nicely. If you have a rating for 20+ years they cannot reduce it unless you obtained said rating under fraudulent circumstances (very difficult to prove) or you, in essence, say you're all better and don't want the money. However, as John stated, IU is ONLY for someone who is unemployed, so if that status has changed they can reevaluate the designation.

[theotherguy]

Jim,

38 CFR 3.951(:( A disability which has been continuously rated at or above any evaluation of disability for 20 or more years for compensation purposes under laws administered by the Department of Veterans Affairs will not be reduced to less than such evaluation except upon a showing that such rating was based on fraud. Likewise, a rating of permanent total disability for pension purposes which has been in force for 20 or more years will not be reduced except upon a showing that the rating was based on fraud. The 20-year period will be computed from the effective date of the evaluation to the effective date of reduction of evaluation.

38 CFR 3.104(a) A decision of a duly constituted rating agency or other agency of original jurisdiction shall be final and binding on all field offices of the Department of Veterans Affairs as to conclusions based on the evidence on file at the time VA issues written notification in accordance with 38 U.S.C. 5104. A final and binding agency decision shall not be subject to revision on the same factual basis except by duly constituted appellate authorities or except as provided in §3.105 and §3.2600 of this part.

( Current determinations of line of duty, character of discharge, relationship, dependency, domestic relations questions, homicide, and findings of fact of death or presumptions of death made in accordance with existing instructions, and by application of the same criteria and based on the same facts, by either an Adjudication activity or an Insurance activity are binding one upon the other in the absence of clear and unmistakable error.

I believe what Jay is trying to say is that they should not be actively seeking additional medical evidence (such as with future examinations) once permanency is established based on the disabilities of record and percentages established at the time of the decision which determined entitlement to P&T status. It is incredibly poor practice to assign P&T status when they view a certain condition which was the basis of establishing permanency as having likelihood of improvement.

I think Jay's assessment is very good and I would also add that your POA should immediately identify whether or not you have a future examination diary once permanency has been established. He/she should ask the VA why this is happening to "head them off at the pass" so to speak. All they have to do is get that diary cancelled and the future examination goes bye bye.

Having said that, I can understand why they would re-examine additional conditions like cancer or other disabilities which are likely to improve when permanency has been established for say PTSD since there is potential impact on the level of SMC entitlement.

Example of one I have seen recently:

The veteran is 70% for PTSD and has been receiving IU for six plus years. He files a new claim for s/c prostate cancer based on his service in Vietnam and is awarded 100% based on having the active cancer. During this time, he is receiving a statutory award of SMC based on housebound status for having a single 100% with an additional disability (PTSD) rated higher than 60%. He eventually had a radical retropubic prostatectomy and he was later determined to be cancer free. The rating criteria required them to complete a future exam for the prostate cancer and I believe they later rated his residuals at 40% and gave him a "k" for loss of use. There was a change in his compensation though since he was no longer entitled to the housebound rate of SMC. This is just a n example of the ones I have seen have future exams when permanency had already been established.

Just my 2 cents worth

[Charleese]

Hi everyone,

I am totally confused by your answers to my questions. All I want to know do you have to be 100% to get P&T and does P&T mean you have to be unemployed?

Please just answer does to questions for me.

Thanks!