ptsd Questions About Hubby's Denial

[Deltawife]

Hello again,

Well after two years of playing the "waiting game" my hubby received a denial on ONE of his claims.

Recap: We had a rep that put in a claim that hubby had PTSD, Colon Cancer and Prostate Cancer. HE DID NOT have any cancers....the rep put that on his claim to get "their attention"! After that we got a different rep with the DAV he had the cancers taken off the claim.

The new Rep put in a new claim for TDIU, PTSD etc. I am thinking the denial we received is from the first claim, however it say's we must file an appeal. Our Rep is on leave and we can't get anyone to answer the phone at the VARO to see if the other claim is still there.

I put a call into our Congressman's Office and got a call back. They said they could help us if we had an appeal in.

When I told him my husband received his initial rating of 50% PTSD an 10% tinnitus from some advocates WITHOUT seeing a Dr or Psych, he said "They surely had his medical records".....well guess what. I pulled out his paperwork and it plainly says "Medical records not available". Not sure if that meant from the VA or reg Dr.

Main question......Can 2 claims be in at the same time, because they are.

My husband is getting worse. He said the other night the rage is building and he's just waiting for someone to say something to him. He really feels like he's going to explode. This is the worse I've ever seen him. Since he's not working we cannot afford to go see an outside psych. His VA psych will not sign that he is unemployable because it's his policy.

As mentioned before....Hubby was in Vietnam Delta Force....3 purple hearts, silver and bronze star, avi wings, 9 air medals.......The young Vet that called from our congressman's office said he's never heard of anyone with 3 ppl hearts.

Oh, also hubby has shrapnel in his hand and elbow. It gives him pain and always has. VA says "it shouldn't hurt"........

We are so confused again!

TYSVM

Thank all of you fine men and women for your service and selfless sacrifice.

[71M10]

Deltawife,

The idiot Rep who filed for cancers when none were present should be reported. Technically filling for something that was known not to exist in legal circles is known as Fruad.

As to unemployability, if his VA doctor will not opine on unemployability and has put in writting he does not believe in/will not certify anyone for unemployability, they are saying they will not enforce the law as written that governs veterans benefits. You could try to force this individual by jamming rules and regulations down thier throat, but the outcome always seems to be less than favorable.

I would suggest a backdoor approach for this opinion. Your husband should apply for a rehabilitative training program. Before the VA will spend money on a program for your husband they will do an evaluation to see if a training program will be effective. This review may provide you with the medical statements necessary for a successful TDIU claim.

As for "he's just waiting for someone to say something to him. He really feels like he's going to explode. This is the worse I've ever seen him." Does he need to be moved to an inpatient program? This is a tough issue, but if you truly think he is going to explode, don't let his pride or your fear allow him to get into a situation with unreversable consequences!

If this was an intial claim and not a DRO or BVA appeal you have one year to file your NOD. Do not let the rep being on vacation stress you out (unless he never comes back).

Please thank your husband for his service for me and I thank you for standing up for your VET.

Best regards,

Edited July 25, 2012 by 71M10

[Berta]

71M10 certainly is correct that if Voc Rehab turns a veteran down or (any sort of vocational rehabilitation program) solely due to their SC disability)ies) as hindering their ability to fulfill the program, this is excellent evidence ,when documented, for TDIU.

Also a SSDI award solely for the same SC disabilty )ies) is excellent TDIU evidence.

What exactly was your husband denied for and what was the VA's exact reason for the denial?

It is most often a C & P doctor who determines unemployabiity due to service.

Has he had a TDIU C & P yet and does he have the results?

I dont understand this:

"The new Rep put in a new claim for TDIU, PTSD etc"

Was this denial regarding the 'new' claim ???

[Deltawife]

Thank you for the information. Berta, we don't know WHICH claim was denied. The Rep that filed for the cancers quit. His replacement was a very bitter woman who when we went to meet her for the first time, would NOT even look at us when we entered the room. No handshake, no eye contact....gave us bad information. She put in a claim also for PTSD while the previous claim still wasn't answered.

Then we got a rep with the DAV in the VARO in Oakland. He was shocked at what Hubby has been through. He put a claim in for hearing (hubby got hearing aids) TDIU and an increase in PTSD.

They NOD doesn't say which claim was denied. It just says it was denied for an increase in PTSD and tinnitus.

He DID have a C & P with an outside psych.....when he walked in she said "oh I see you are rated at 50% PTSD.....that is very high" . His GAF stayed at 50% but she did write down "unemployable".

As for his rage....it comes and goes. He openly admits that he has it and knows he has to control it. Right now I think a lot of it is being caused by this mess with the VA. He gave his "all" (Like the rest of you). And feels like he's been forgotten.

He is getting a new Psych (closer to home) at a smaller VA medical center. His first appt is the end of August. I asked him to call and see if he could get in earlier. He said that was the earliest they had. I told them to tell them it was and emergency and he should give them the details of how he's feeling. He said they would take him in for observation and he doesn't want to do that.

One thing that is bothering me is that he use to shave every day, and get his hair cut every 4 weeks.....he's really slacking on that.

I needed to vent, so thank you for listening. None of my friends understand......they are just flabbergasted at the treatment he's received from our VA system.

Thank you ALL for your Service......and help!

I think we probably have 3 claims in......we knew nothing about the VA for the last 11 years. (Still don't, lol)

[Berta]

“They NOD doesn't say which claim was denied. It just says it was denied for an increase in PTSD and tinnitus.”

I think you mean the decision said that. We,as claimants , prepare NODs as notices of disagreements with VA decisions.

“He DID have a C & P with an outside psych.....when he walked in she said "oh I see you are rated at 50% PTSD.....that is very high" . His GAF stayed at 50% but she did write down "unemployable".

I think you mean a QTC C & P. DO you have a copy of the actual results?

That seems odd- did the C & P results specifically show he was unemployable due to his SC PTSD???

If so, that can be used as evidence when he files a NOD. But it should have been listed as evidence in the denial.and fully addressed in the decision.....?

This all is confusing to me too ----

Can you tell us exactly the way VA worded the denial or scan and attach the denial here as to the VA Reasons and Basis? (cover personal stuff.

I am concerned as to the PTSD rating in your case but I foresee no way to get a higher rating than 10% for tinnitus whic I assume he has 10% for now.

“Tinnitus is assigned a 10 percent disability rating; the maximum evaluation authorized under 38 C.F.R. § 4.87 Diagnostic Code 6260 (2010). “

http://www.va.gov/ve...es1/1109979.txt

Edited July 30, 2012 by carlie
font & size

[etihwr]

In January of 2008, the US Supreme Court ruled on a DAV suit that Tinnitus is only a 10% rating. Appealing for more is a waste of time.

It is my experience that people don't know what is expected of them when they do a C&P exam and they talk TOO much and give out information that is determental to their claim. See the link below and look up every issue the DVA will do a C&P exam on. If you feel the exam was done incorrectly, get the local fax number to your RO (or fax to the Roanoke RO at 540-597-1792) with a statement from you as to why you should get a second C&P exam. Don't give opinions, give facts. They didn't do such an such. The doc spent five minutes with you and was constantly interupted, the doc voiced the opinion from the get go that you were faking it etc. You will stand a much better chance of getting the best possible outcome.

Also when it comes to your limbs, you need to move extremely slow and stop at the beginning of pain. If your talking about headaches, and you take off work early and return to work the next day, you didn't take off for a couple of hrs but instead took off for a day. They are looking at severity and how it affects your ability to work. USE their rules, not yours.

http://www.vba.va.gov/bln/21/Benefits/exams/index.htm

[Deltawife]

Okay, I'm back! I was looking for all the info you had asked for. On Friday we called the VARO in Oakland. They said they would schedule a call back on Monday......they DID call. The letter and personalized book my husband received, along with a letter stating that he was staying at 50% PTSD and 10% tinnitus, and a form on how to file an appeal was evidently sent out to everyone! The VA said it was the stupidest thing they had ever done and have been flooded with phone calls since they started mailing them out.

His claims are still in the "rating" process. They keep telling us it will be 2 1/2 mos. We call after 2 1/2 mos, and they tell us it will be another 2 1/2 months. Sheesh...So sorry to cause all the confusion, but now if someone else receives the booklet (while they have a claim pending) Everyone can tell them "not to worry".

If he does get denied we are going to have him tested for TBI as he was shot down 3 times and had head injuries. At one time the VARO told us they were looking at his file for TBI, but we never filed for it. I think they were confusing him with someone else. ?????? Who knows, with them.

Thanks again and God Bless to all!