ptsd Could Use Some Help And Advice?

[AJ2058]

Good Morning Everyone,

I am still new here at Hadit, but am in need of some help. Just a month ago or so my wife applied for Chp 35 Dependents Education benefit, and about a week or so ago we received the letter say that it was denied due to myself not being P&T. So now at this point I am not sure what to do, with it they included a form that I believe was a "statement of claim," cannot think of the claim number and do not have it in front of me.

To give a little backround, I am rated at 100%. It was nothing but an uphill battle. I discharged from the Marine Crops in March of 2007, due to a condition in my legs that incurred(partially, ill explain more) while in Iraq the second time in 2004. It is called compartment syndrome, and when they finally figured out what was wrong with my legs in 2005 they decided to operate on my left leg first (bilateral condition) the doctor cut a nerve and I can no longer feel the lower half of my leg and foot, and there is also some motor problems now. Obviously I decided it was not in my best interest to have the operation on my right leg and was medically seperated with only 10%. The military failed me, in that they told me I could only go to the MEB for on condition so I decided on the problems with my legs, even though I was already being seen for PTSD, TBI, and numerous other problems.

To jump ahead, when I was already discharged and received my first award letter from the VA I believe it was for either 30 or 50%, and started appealing. Each time it was raised. Finally I had enough and went to the regional office and began talking with the Director of our regional office. Now at the time I was a 27 (maybe 28) year old Jarhead, and I am sure that he though I would just be a push over and eventually just go away, especially seeing as I didnt have a lawyer and no law training of my own. The key is I know how to read. Basically I have read the VASRD from cover to cover and found every peice of information that they have in it that would play in my benefit. When he finally started to see that I wasnt just going to go away he scheduled an appointment with me and my wife (shes about the only one who can calm me down when I start getting upset), himself and a claims rater. Before this I went and went through the whole VASRD again and marked in my medical records what the rating should be based on the Sch of Ratings, and why based on the VASRD they previously rated me wrong. The meeting concluded and when I received the award letter it was for 100%.

So this is where my problems begin. I noticed then that no where did it say I was P&T, but because I was fighting for so long and finally got the 100%, in a way I just did not want to "beat a gift horse in the mouth" even though I know that it wasnt a gift, it was earned. Since then though, I have just basically stopped going to the Dr, partially because I just do not trust any of them, and also because of the dozens of things I have tried, nothing helps. They sent me to Physical therapy for my legs, knees, and ankles, which I went to for months only to have the physical therapist tell me we should stop because there is no improvement. It took me years to finally find a psychologist that I trusted and could open up to, only to have him quit the VA a couple months later. A primary care Dr that I had, checked pulses with his thumb, I mean come on even I know you shouldnt do that cause the thumb has a pulse of its own! On top of that, it was just tiring, I would go to the VA basically every Friday for appointments, and be there 5, 6, 7 hours going through all the different appointments, and that was every week. Not to mention the drive, it just doesnt seem beneficial for me to drive 30-50 miles (depending on the clinic) just to have the same result each week.

So basically now, I am just not sure what to do. Many of the Dr's have told me that the conditions will not get better, and I know that obviously at this point PTSD is not curable, nor do I believe is any of my other conditions, but I do not think the doctors have written it in my records or notes. In some ways I am worried if I were to appeal the decision for benefits they would see that I have not been going to the Dr's and decide to try and lower my rating. I know I need to get in there and start being seen again, and have since made numerous appointments with many of my Dr's, and am trying to find a psychiatrist local to me that I can go and see, because the PTSD is certainly not getting better. I know that for a fact when my wife will come right out and tell me I am getting worse!

Again though, I am just looking for advice and help on what to do. I have heard of people appealing and having their ratings lowered out of spite in a way. I have also tried reading through many of the forum posts but none that I could find seemed to fit my situation quite right. One I did read though suggested to someone who was denied as well stated that they should just refile for the benefits, not to appeal, just refile. Then it went on and said that if you do appeal you are appealing to the Chp 35 people, and not to the rating department so you should be fine?

Thank you all very much for your time and help, and dedication to the veterans. For some of us there may really be no place else to turn! I appreciate all the help I can get. Sorry for the length, but this is the very condensed version. I could go on for days! Thanks again.

Semper Fi!

[Chuck75]

The VA has a paper based system. If it's not on paper (or the electronic records, it doesn't exist!)

It looks like your immediate problem is to get things properly documented, be it by VA doctors, outside doctors, or some combination, and then file for P&T.

If you don't have an accurate or complete copy of your "C" file you need to request one under FOIA. If PTSD is also involved, you may have to get that part or all of the file sent to a doctor you trust.

You also have the right to a C&P exam or exams in order to determine the severity of your conditions.

The C&P route is the VA's preferred method, although it has some serious drawbacks, mainly for the veteran.

It seems the the C&P examiners are more often interested in minimizing the problems/condition, rather than rating them fairly and honestly.

It's worthy of note that unless fraud is involved, the VA's desire to lower a rating is challengeable . You have to be careful to make sure that you do the right things

in a timely fashion. On receipt of such a VA proposal, just to start, you immediately file a notice of disagreement, and so forth. This make the VA start going through all the

required steps, and decreases the VA's chances of actually getting a reduction to occur. It also makes getting legal representation "legal" if you need to do so.

Remember that the VA likes veterans to just give up, instead of fighting back.

Edited August 24, 2011 by Chuck75

[Berta]

Is the 100% entirely for the leg problems or for PTSD too?

"which I went to for months only to have the physical therapist tell me we should stop because there is no improvement"

"Many of the Dr's have told me that the conditions will not get better" =did they document that in your med recs?

You should write to the VA requesting Permanent and Total status and tell them of anything such as what the PT and docs said but it will need to be backed up in writing from any doctor who can state, with full medical rationale, that your SC conditions are permanent and total.

It would even be worth it if you need to pay for an independent medical opinion for that status.

I am a Chapter 35er and the VA paid around 10,000 to 12000 towards my degree.

Also I use CHAMPVA as supplement to Medicare and this too comes for your dependents with a P & T status.

These 2 programs are well worth thinking if you might need to invest in an IMO or an opinion from a Voc Rehab specialist.

DO you have copies of your VA med recs? Perhaps there are notations in them that wold support the P & T status.

One thing you need to do however, is to continue any VA treatment they offer.

The VA expects vets to get continuous treatment for their SCs- otherwise they can say you don't need the comp anymore ,suggesting the lack of treatment means you have improved.

Welcome to hadit.

CHAMPVA is an Excellent medical program.

[broncovet]

The first thing, of course, what does your decision say? Does it say "no future exams are scheduled"?

The VA is not very forthcoming always on P and T.

Assuming the decision is either silent on future exams or says that it will have future exams, and your doc(s) have not offered an opinion as to whether or not improvement is likely, then you will need an IMO/IME as Berta said.

Of course, VA rating specialists dont read well, so your documentation for P and T could be right there, sometimes even in the decision!

If you DO have documentation, for example, that one or more of your docs stated that your conditions were unlikely to improve, then you could simply appeal the denial of Ch. 35 and cite the doc who said you were P and T.

[AJ2058]

Thank you to those so far with advice, although your replies have sparked some other questions for me.

First Chuck (or anyone else), I do not quite know what a "C File" is? I have a copy of my veterans medical records, although it is old and should probably request a new one to have it updated and on hand, but is that what a "C File" is?

And Berta (again or anyone), I have read this in other threads as well that people say you should write them and request P&T, what is meant by this? As in, are you actually opening a new claim, and who are you writing too? As for your other questions back to me, my rating is spread across many conditions. I cannot think of all of them off hand, but I believe it is 70% ptsd, 30% for my legs, cant remember the % for the rest but some of them are TBI, tinnitus, lower back pain which I think they considered sciatica(spelling ?), ptergium, bilateral knee condition, and the list goes on...My doctors have told me that my conditions will not get better, but I cant say for certain if they documented it. I doubt they did because mostly it seemed more like casual conversation with them. We know PTSD is not curable, you can only hopefully manage the symptoms, my legs well the orthopedic surgeon I saw said they could have probably saved my nerve in my leg if they would have done something within the first year, but sometimes as far out as two years but no one decided to do anything till it was too late. And for the nerve problems I have heard this from many many doctors, although not all mine; my wife just had a operation to fix a nerve problem last week so over the last few months I have met many doctors who have said the same thing. TBI, well I have never heard of that getting better, again just manage symptoms.

I do know that I need to start seeing the Dr's again, and on a more regular basis. You know ive explained it the psychologist that I have along with my Social Worker, that really I just get depressed and do not care so I dont go. I know I should but, I just dont. I do have some appointments in the next couple weeks one is with my PCP, and I am trying to have it authorized for me to have the ability to go to a psychiatrist in my town, just waiting to find out. Am I able to ask my PCP for a letter though? If so how do you go about doing it?

I know these additional benefits of P&T are worth it, its just kind of scary to consider with all that I have been though. Id really like them to pay for my wifes school, for her it would probably amount to almost 25k, since she is going to start working on her MBA, which I for one think she definately needs to get. I dont know how much longer I am going to be able to work, or at least work where I am at. It hurts just to move around, let alone walk up the stairs in my house.

Well thanks again for the help, and to anyone else who might add suggestions. It really is appreciated. Have a nice day.

Andrew

[AJ2058]

BroncoVet- Looks like we may have been typing away at the same time. The last decision letter I received stating I was at 100% is some what confusing to me. It seems like it is very vague, in that it does not have all the conditions that I am rated for listed. It seems more like it is only the conditions that they changed the rating for when I went and sat down with the Director of the VARO and the Rating specialist. It does not state in the letter that I have no future exams scheduled, however at one of my appointments with my Social Worker (not long after the decision), she looked it up and it said no future exams scheduled. The denial letter though from the Chp 35 benefits though did state that I wasnt P&T, could I still be P&T? As for an IMO/IME who do I go to for this? And lastly, you said I could appeal the denial of Ch 35 providing documentation of doctors saying I am P&T, how do I appeal directly to Ch 35?

Thanks for the help and sorry if it seems like I have a million questions. In actuality I probably do, but I like to be the best informed I can be. Thanks again.

Andrew

[broncovet]

Andrew

If you want specific answers to your questions, then you may consider "posting" your decision, but you would want to white out your name, ssn, and address. The decision should say if you are P and T or not, but it is often "in code". If it says, "no future exams are scheduled", that means P and T. Also, my decision stated that I WAS eligible for DEA Chap. 35.

A c-file is your complete copy of VA records. You can request one through your RO (recommended). It sometimes takes months to get it.

It has been my experience you can get your medical records at your local VA much quicker, by simply going to the "Release of Information" section at your VAMC and request it. If your records are long, then you will probably have to wait for them in the mail, but my VAMC hands you a few pages of medical records right now as long as you sign a release.

After you obtain your records, see what the doc said, carefully reviewing your medical records, especially the C and P exam(s). Did he say your condition is unlikely to improve? You can use this medical exam as evidence in your appeal if he did.