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Appeal Process For Ptsd (Ro Level)


michaelr5343

Question

My husband has appealed his 70% PTSD rating and is trying to get to 100%. We have a meeting with his social worker therapist (he sees him weekly) on Tuesday and are taking the attached form (VA Review PTSD Disability Benefits Questionnaire, VA FORM 21-0960P-3) for him to fill out and sign, followed by a co-signature by the psychiatrist. Is there anything else that would be helpful to submit with it? And is there anything specific the therapist should include in the comments section? We have read extensively about the criteria and are confident he falls within the guidelines, but aren’t quite sure how to articulate "grossly inappropriate behavior; persistent danger of hurting self or others." The latest SSOC stated the current evidence did not warrant an increase in disability most notably due to his recent graduation from law school. We have failed to find anything directly on point with this issue and appreciate any thoughts or advice.

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Ok, I have an idea or two.

First, make sure when the doc says, "How are you?" ...that he knows the answer! The wrong answer wont be so good. A lot of times when people ask that question they really dont want to know how you are but are just making conversation. When the C and P doc says this, its probably not best to answer the classic "fine".

Instead, this is your chance.

Vets advocates recommend you tell the doc about your WORST day, and not the best, even if you are "fine" today. If, 2 weeks ago, the cops came because the neighbors heard you/your wife fighting, then this is a good time to say that!

To answer that, you might say, "Under the circumstances I guess as good as can be expected. Two weeks ago, the wife and I got into a fight and the cops were called. The police came and said I am required to get counseling, or will be arrested next time. I really dont know what I can do if I "blow up" again. I cant control it.

In other words, do not lie, but dont pretend like everything is hunkie dorie either. This is not the time to "suck it up, soldier".

Remember the criteria for mental disorders uses the term "such symptoms as..." This does not mean you have to have those symptoms to get your rating! You dont have to have all, or even any of those symptoms in the criteria! For 100% you have to have evidence of total social and occupational impairment.

So, when asked, tell the doc about your social and occupational impairment. If you got fired from your last job 3 years ago, because you could not get along with your boss, tell the doc that. If your last wife divorced you and ran off with the homeless guy living in your shed, then tell the doc that. Dont hold anything back. If you have sexual issues, such as ED, this is not the time to hide them.

If you are "appealing" at the RO level, this probably means a DRO Review or DRO hearing. If you dont have a copy of your C file, you should get one ASAP. Its not enough that you have PTSD, your PTSD has to be documented in your medical records, or, the VA will say you dont have it! If you think just because you sent the VA xxx document, they have it and will consider it, often you will be sadly mistaken. Shreddergate was discovered in 41 out of 57 RO's for good reasons. While the VA claims to have "fixed" shreddergate, I have seen multiple issues of mysterious disappearnaces of evidence to beleive they fixed it. The VA's idea of "fixing" shreddergate was to not do any more shredder bin inspections. Its like an ostrich who buries its head in the sand which makes bad stuff "go away".

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I agree with Bronco. I have an MBA and that does not change the fact I have PTSD. If I am not careful some things can set me off. Graduating from Law School does not mean he can hold a job, and having PTSD might be an impediment to employment due to perceived liability issues that may arise. Employment I think is the key. I don't want to be 100% disabled, but I honestly can tell you that there are days were I struggle to keep it together.

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Thanks for your input. He picked up the completed PTSD Benefits Questionnaire from the clinic today. It states total occupational and social impairment and has most of the symptoms checked. His VSO delivered it to the Board. Hopefully it will be what they need to award T&P.

I have attached the form for others who may need it as well as a great law review article about PTSD and how the VA rates claims.

VA Form 21-0960P-3.pdf

BACK FROM WAR—A BATTLE FOR.pdf

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