ptsd New Here And Need Some Assistance

[wilson17 0]

Hello all. I retired from the Army this past February. I've been following this forum since I received my initial compensation letter from the VA in July. I've learned a lot here, but I'd like to throw out a few questions, as well as post a letter for your review.

I've been rated at 60%. (30% post hysterectomy, 30% PTSD, 10% right hip tendonitis, 10% thoracic spondylosis with scoliosis, and 10% tinnitus.) I also was SC at 0% for ten other conditions. The VA denied SC for eight more conditions.

I do not feel I need to appeal every condition denied, but I would like to appeal some of them, specifically the ones related to my chronic skin condition. Here are my questions:

1. How can the VA deny SC, when conditions are clearly diagnosed many times in my active duty medical record? Shouldn't I, at least, be given SC on these conditions with 0%?

2. I sent in a huge amount of my active duty military medical records (2 copier paper boxes full), with all diagnosed conditions highlighted. Does the case worker not even review these records?

3. The VA claimed they did not have the SS#s of my two daughters and could only pay me with one dependent (husband). So I immediately sent in a 21-4138 upon receipt of my rating decision, to include the missing SS#s and also to request reconsideration for one of the denied conditions (Coccydynia). The reason for the reconsideration on this particular condition, is because it was denied based on "The evidence does not show an event, disease or injury in service."... "Your service treatment records do not contain complaints, treatment, or diagnosis for this condition". The VA obviously missed this or it was not included in the evidence. I had a two page report from my active duty records that clearly diagnoses the injury, so I asked for reconsideration and attached a copy of the report. Was this the right thing to do?

4. I am considering appealing a chronic skin condition. The doctors throughout the years could never agree on a single diagnosis. It was called eczema, atopic dermatitis, neurodermatitis, contact dermatits, and simply rash. The VA denied all of those stated conditions, saying "The evidence does not show a current diagnosed disability." "While your service records reflect complaints, treatment or a diagnosis similar to that claimed, the medical evidence supports the conclusion that a persistent disability was not present in service." These skin outbreaks were documented at least 30 times in my active duty medical record. One other diagnosis for this skin condition was papular urticaria. The VA has deferred a decision on the papular urticara. The letter stated that they would be sending me to an additional C&P exam, but I never received an appointment time/place. On ebenefits, it says my claim is back in evaluation of evidence, so I'm assuming they are not going to send me to another exam after all. Should I go ahead and file an appeal on the conditions denied and have my doctor write a letter explaining that all the different diagnoses are referring to the same skin condition or should I wait for a decision on the one deferred condition? (I am having an outbreak now and am scheduled to see my PCP on Monday, at the time of my first C&P I was not having an outbreak, so the doctor had nothing to evaluate.)

5. The other thing I'd like to appeal is my rating for PTSD. They rated me at 30%, but I clearly meet the criteria for a 50% rating. Would I get a letter from my current therapist to support this? She is a licensed social worker and specializes in PTSD and EMDR treatment. What documentation should be included to support and help me win an appeal?

Sorry this was so long of a post. I hope some of you seasoned posters with lots of experience can give me some good answers on my specific issues. I dread the future fight with the VA, but I'm betting this forum will be an encouragment to keep going. Thanks in advance.

Edited August 16, 2012 by sharon
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[Berta 3,836]

“ How can the VA deny SC, when conditions are clearly diagnosed many times in my active duty medical record? Shouldn't I, at least, be given SC on these conditions with 0%? “

Were these conditions formally claimed?

“Was this the right thing to do? “

Yes

Should I go ahead and file an appeal on the conditions denied and have my doctor write a letter explaining that all the different diagnoses are referring to the same skin condition or should I wait for a decision on the one deferred condition?

(I am having an outbreak now and am scheduled to see my PCP on Monday, at the time of my first C&P I was not having an outbreak, so the doctor had nothing to evaluate.)

I would appeal what they denied. However the deferred condition---perhaps it would be a good idea to have your doctor clarify the diagnosis and submit this info with a 21-4138 form as a cover letter,tlling them it is in support of the deferred issue.

"The other thing I'd like to appeal is my rating for PTSD. They rated me at 30%, but I clearly meet the criteria for a 50% rating. Would I get a letter from my current therapist to support this? She is a licensed social worker and specializes in PTSD and EMDR treatment. What documentation should be included to support and help me win an appeal? "

Her letter could help the appeal. By all means if you believe your medical evidence warrants a higher PTSD rating, per the rating schedule, tell the VA why you meet the higher criteria.

What did the VA state in the decisions as to their rationale for the 30% and no higher?

You mentioned filing a Reconsideration request. Did you add new evidence to this request? Or point out something probative they missed?Remember, this is not a NOD and ,if the VA doesn't act on the request favorably, and the NOD deadline gets close, then you need to submit a formal NOD.

VA 'acted' like they were working on a Recon request I made years ago.They made some bizarre responses which I responded to with more legal evidence..It was a CUE claim I filed in 2004 and they continually failed to consider my legal evidence.

The claim was awarded this past January as I had filed a NOD the last week of my appeal timeframe. I realize now VA had no intention at all of actually working on the request properly, or even the original CUE claim, and hoped they would piss away my NOD deadline with their ludicrous responses.

It didn't work but this claim took 7 years to award and I would use a different tactic if this happened again.

Mark your calendar for your NOD filing deadline date if they don't satisfy the recon request by that deadline.

Never give up on pursuing these claims.

Do you have a vet rep helping you?

[wilson17 0]

Thanks for answering, Berta.

How can the VA deny SC, when conditions are clearly diagnosed many times in my active duty medical record? Shouldn't I, at least, be given SC on these conditions with 0%? “

Were these conditions formally claimed? No, this was the my original claim, started on the BDD program and filed on my retirement, 01 Feb, 2012.

“Was this the right thing to do? “

Yes

Should I go ahead and file an appeal on the conditions denied and have my doctor write a letter explaining that all the different diagnoses are referring to the same skin condition or should I wait for a decision on the one deferred condition?

(I am having an outbreak now and am scheduled to see my PCP on Monday, at the time of my first C&P I was not having an outbreak, so the doctor had nothing to evaluate.)

I would appeal what they denied. However the deferred condition---perhaps it would be a good idea to have your doctor clarify the diagnosis and submit this info with a 21-4138 form as a cover letter,tlling them it is in support of the deferred issue. I'll see if I can work that issue. Maybe have him fill out a DBQ?

"The other thing I'd like to appeal is my rating for PTSD. They rated me at 30%, but I clearly meet the criteria for a 50% rating. Would I get a letter from my current therapist to support this? She is a licensed social worker and specializes in PTSD and EMDR treatment. What documentation should be included to support and help me win an appeal? "

Her letter could help the appeal. By all means if you believe your medical evidence warrants a higher PTSD rating, per the rating schedule, tell the VA why you meet the higher criteria.

What did the VA state in the decisions as to their rationale for the 30% and no higher? The VA stated that my case warrented the 30% rating. I have a feeling that is due to my C&P exam that QTC did. I was not very impressed with the exam. Another idea I was having was submitting a request for an increase with, again, a DBQ from my therapist. Ether way, I'm just not sure how much weight it would hold, since she is not a psycologist or psyciatrist.

You mentioned filing a Reconsideration request. Did you add new evidence to this request? Or point out something probative they missed?Remember, this is not a NOD and ,if the VA doesn't act on the request favorably, and the NOD deadline gets close, then you need to submit a formal NOD. Yes, I submitted a two page report with the request, that they either missed or did not have the report in the original submission.

VA 'acted' like they were working on a Recon request I made years ago.They made some bizarre responses which I responded to with more legal evidence..It was a CUE claim I filed in 2004 and they continually failed to consider my legal evidence.

The claim was awarded this past January as I had filed a NOD the last week of my appeal timeframe. I realize now VA had no intention at all of actually working on the request properly, or even the original CUE claim, and hoped they would piss away my NOD deadline with their ludicrous responses.

It didn't work but this claim took 7 years to award and I would use a different tactic if this happened again.

Mark your calendar for your NOD filing deadline date if they don't satisfy the recon request by that deadline. Will do it, Berta. And thanks again for answering.

Never give up on pursuing these claims.

Do you have a vet rep helping you?

[broncovet 3,691]

Well, Berta is the best, and I can only add this:

One person appealed his 30% rating for PTSD by filing a NOD and then "highlighted in yellow" his medical exam whenever it demonstrated a symptom in the criteria for 50%, 70% or 100% (all the mental disorders are rated using the same criteria)

He then demonstrated that he had 9 symptoms in the 70percent criteria, but only 4 symptoms in the 30% criteria.

However, not all symptoms are necessarily given equal weight. While you may have "flattened affect" this is probably not as bad as "a danger to self or others", for example.

[wilson17 0]

Just wanted to update my progress with you all here and get some feedback. On my deferred papular urticaria, issue #4 in my original post below, instead of appealing on atopic dermatitis, I did the following: sent in a 41-4138 explaining that all the skin diagnoses were actually referring to the same skin condition and that atopic dermatitis was the diagnosis in 40 of 50 military doctor visits and that papular urticria was only diagnosed one time; I sent in supporting evidence... 2 buddy statements from my husband and from my mother, 14 photographs of my current outbreak, DBQ from my doctor concurring with the diagnosis of atopic dermatitis, a spreadsheet compiling info from all my "in service" doctors visits that gives the dates, observations, diagnosis, Rx, and treating Doctor's name; and lastly, copies of my Rx for the last 3 years with the oral & topical corticolsteriods highlighted. These should all support a 60% rating for atopic dermatis or 30% -60% rating for papular urticaia (if the rater decides to stick with the papular urticaria diagnosis that was used by the doctor on my C&P, when I was not having an outbreak). I'm hoping once the rater reviews all the new evidence, he or she will change it to the correct diagnosis of atopic dermatits, even though they already denied it. Is there a chance that can happen with this deferred issue? Or will I end up having to go through appeal to get the diagnosis corrected?

Edited October 3, 2012 by wilson17