ptsd Claim Status-almost There?

[crosssabers]

My husband filed a claim in August of 2007 for PTSD, L-5 S-1 Back issues, as well as hearing loss and tinnitus. We are already aware of the probability of receiving 0% for hearing and 10% for tinnitus. We submitted a stack of paperwork in support of his claim. Most of the medical evidence was either from his time in Active Duty Army (Attack Helicopter Pilot) or within the year and a half after discharge. He has had quite a few incidents causing him to seek help in the years after returning from Iraq. One key piece of evidence being a 5 page document from VA Mental Health including an AXIS stating PTSD, Adjustment disorder w/ mixed anxiety and depressed mood for Axis 1, Herniated Discs L-5 S-1 for Axis 3, and Severe: occupational difficulty aculturating back to society for Axis 4, and GAF of 50 all dated Feb. 2007.

He was scheduled for an audiology C&P exam in March 2008. Went to that and didn't hear anything further. No C&P's for the PTSD or back. Our VSO is not sure what will happen since she has never had a claim the exact same as this. We contacted the patient advocate from our nearest VA hospital and he directly contacted the rater 2 weeks ago today, then he gave us the news that the claim should be finished in about two weeks from then. Well, here it is, not that we expected everything to be final, as we do understand that these things take time. We have called the VA 1-800 # about once per week over the last month, and keep hearing some strange things. The 1st time we heard it left the rater once it was pending decision is because they needed a form that they didn't have in the file. Got that resolved with the file back in line on May 13th. The 2nd time they needed more info from the C&P. OK, done. They got that back on May 29th. Now it has left and been returned twice in June due to not having the stressor letter. That was sent to them back in Feb. of this year, but to be on the safe side his POA is making sure they get it yet again today.

Now, our question is this...does it seem like we're at the end of the line here? We just don't know what to expect and time is of the essence since my husband is having a really hard time at his job, he works on a military base and he is holding it together by a thread. The thought of this claim being finished and the possibility of applying for IU so he can devote some time to seeking help while keeping food on the table and diapers on our 9 month old is keeping him together. We are waiting with baited breath to see if he will be eligible in the first place. We know that he should be rated at 70% for PTSD alone, back is questionable as to how they will rate it. He becomes incapacitated at least a few weeks per year.

Any thoughts or advice would be very much appreciated. Thank you.

[Berta]

If he is employed and making wages at or over the poverty level the VA will not consider him for TDIU.

PTSD is rated as within the Rating schedule - at this link it will be found under Mental Disorders. It is often very hard to determine how they will rate PTSD.

http://www.warms.vba.va.gov/bookc.html

This recent BVA case explains what a combat stressor is and whether the stressor needs to be verified:

http://www.va.gov/vetapp08/files1/0806344.txt

I am sure you know all of this already and that he had definite combat stressors.

Did he receive the Combat Infantry Badge or any personal citations involving combat?

Or was he able to give accurate details as to the time and place of the stressors in case the Joint Services Records Research Center has to confirm them?

I would certainly think his MOS definitely put him into combat situations.

Not all vets who served in Iraq can succeed on PTSD claims:

http://www.va.gov/vetapp08/files2/0812083.txt

I suggest that any vet who needs to send a stressor letter to VA put in as much details as to time and place it happened etc- to make sure that- if they need JSRRC to verify it- this can be done with enough information from JSRRC.

[crosssabers]

Thank you Berta for your response.

Yes, we have researched everything as thoroughly as possible, though I thank you for taking the time to include the links.

He did put quite detailed info in the stressor letter. He received an Air Medal and was involved in some pretty horrifying ordeals which should be easy enough to verify. The letter was provided to them in February, and we did not hear anything else about it until this month, and that was just to say that they did not have it in the file.

We are confused as to why the issue of them not having the stressor letter is coming up now, when everything else has been completed to our knowledge. The patient advocate we use talked directly to the rater two weeks ago and he told us that it would be completed very soon (2 weeks) and that no C&P is a good thing, he even went as far as to say from what he saw my husband should be rated at 50-70% for PTSD. (He looked over the file and said it was enough to rate on since most of his care has been through the VA.)

Is it usual for them to up and change direction at this point in the claim process?

[Berta]

I am surprised that a patient advocate got those details from a VARO Rater.

This could go fast if he doesnt need an additional C & P.

If his stressors were directly from combat as defined in the BVA case link-they may not need to verify them-

I just hope that does not hold up the claim at this point.

[crosssabers]

I'm sorry-I think I wasn't as clear as I should have been in my last reply...oops!

The Patient Advocate said that from what he saw he's not surprised that a C&P wasn't needed, since my husband already had a document nearly the same as a C&P exam (but actually a little more informative) was in the system since it was written by a VA doc. Also, he had gone for a few visits and tests for his back issues shortly before filing the claim. So all that was in there. We understood the C&P in March for the hearing and tinnitus since he didn't have much for proof on those ones. At that time we asked if there were any more exams scheduled and VA told us no.

On June 9th when my husband talked to the Patient Advocate again, he called the RO in L.A. then called back to tell him that it would be about 2 weeks for the rating to be done.

Now, as of yesterday his VSO/POA has informed us that the stressor letter is not in his file...so we're wondering if that is just a T to cross before awarding the rating, or if it is the beginning of a whole new ball of wax?

[Berta]

"Now, as of yesterday his VSO/POA has informed us that the stressor letter is not in his file...so we're wondering if that is just a T to cross before awarding the rating, or if it is the beginning of a whole new ball of wax?"

This is a bad sign- if I were him I would send the stressor letter himself- with a 21-4138 (available at the VA web site) as a cover letter stating that he understood the stressor letter was missing from his C file.

I had to submit an autopsy to VA 12 times in the past-because oddly enough they kept losing this critical evidence.

My present AO claim was filed in early 2003-

oddly enough my critical IMos keep disappearing from my C file-

"The letter was provided to them in February, and we did not hear anything else about it until this month, and that was just to say that they did not have it in the file"

They have had plenty of time to lose it-

if they however sent it on to the JSRRC that might be why it isnt there-still there would be something in the C file to show where it went.

You have to keep on them-regarding significant evidence.

And keep sending it to them.

I had 2 claims that I could have won in months in the 1990s-

the VA strung them both out for over 3 years.

When I finally got smart and got a copy of my C file- I found a critical report that would have awarded my DIC in months and not years.

VA said they had never gotten this Peer Review report that supported my 1151 claim.

Both the VA lawyer and the doctor who prepared it for the VA lawyer disappeared-(retired) and I had no proof at all , except for their word this report had been sent to the VA.

Years later when I saw my C file-it was right at the bottom- the critical medical report of malpractice that the VA itself said did not even exist.

He needs to send in the stressor letter again-in my opinion-or find out if it went to JSRRC.

He might get some info from them by phone-this is only # I have for them-

1-703-428-6801

(JSRRC) U.S. Army and Joint Service Records Research Center

7701 Telegraph Road

Kingman Building Room 2 C)8

Alexandria, VA. 22315-3802

If his stressors are consistent with his participation in combat and raise to the level of how VA defines a stressor- then maybe JSCCR wont have to verify them.

He should send in the stressor letter again and get either a UPS tracking slip or a signed certified mail card to show he submitted this evidence.

[crosssabers]

His VSO said that the POA (American Legion) hand delivered it to the proper dept since they are in the same building. SO, hopefully they have it now. Again. We'll see. B) The last time he talked to them via the 1-800# they verified that they did indeed have it and that it was again awaiting decision...hopefully this is almost over. We're back and forth about thinking they'll request a C&P at this point. But wouldn't they have already done that if they were going to?

In his stressor letter he listed and described three things off the top of his head...

1. Seeing someone on his squad die a horrific death,

2. Constant mortars (he was there for the Invasion), &

3. A mission gone bad.

Hopefully that'll do it.

We used the IRIS system yesterday afternoon to inquire directly to the appropriate location as to the status of his claim, so I'll post again as soon as we get a reply.

[Pete53]

If you don't hear back soon I would consider asking for a Hearing. The lack of C&P's means that you are still stuck in development and an initial claim should be wrapping up before now.At least he had one C&P.

Good Luck

[crosssabers]

We just don't get why the Patient Advocate (great guy-very helpful to us over the last year or so for other issues as well concerning the VA health care system) would tell us that the rater said the claim should be finished in two weeks.

Also, the 1-800 # has said over and over that it is awaiting decision. We understand that they have limited info-but aren't development and decision two completely different things?

He provided more medical info to them at the start of the claim than it seems C&P exams involve. One one document alone it is written in similar format of a C&P, after a 3 hour conversation. VERY informative, with AXIS and GAF. Couldn't they decide on a rating using something like that?

[crosssabers]

Here is our response that just came in:

Discussion Thread Response (Department of Veterans Affairs)06/25/2008 10:46 AM Mr. XXXXXX:

Your claim is still pending. The file is out to the rating board. What they decided is still unknown. Once we receive the file back in we will enter the decision and sent out a letter. We hope to resolve this within the next 6 weeks.

Thank you for contacting us. If you have questions or need additional help with the information in our reply, please respond to this message or see our other contact information below.

Sincerely yours,

XXXXXX

Veterans Service Center Manager

[crosssabers]

Need advice: Does anyone think it would be beneficial to write back to amend the inquiry to ask if they have all documentation needed for the decision? Or is it plainly stated that they have all they need if it is in front of the rating board at this point? Just don't want to get denied beacuse they didn't request C&P's for the two biggest parts of the claim...