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Re Evaluation


catt02189

Question

I was wondering if anyone might have gone though this:

I have been rated at 70% with 100% IU for about 5 years for PTSD. For the last couple of years, I have been recieving a form from the VA asking me if I have worked. I fill it out no and send it back. I got one this February and sent it back. In April, I got two seperate letters talking about my family possibly being eligible for CHAMPVA in one letter and Chapter 38 education benefits in the 2nd letter. I finally called the VA and asked if I had been made P&T. The person I spoke to on the phone said that they are no longer able to see if someone is P&T in the computer. I explained about the letters and they said I must be if I was getting those letters. I asked about future exams and they saw none scheduled. They then asked me if I had asked for my case to be reviewed and I said I hadn't. They told me it was before the board. At that point, there wasn't much I was going to ask and figuered I had gotten the letters as some action taken.

On Friday afternoon (I just love how they do that), I recieved a letter in the mail that I am to report for a C&P exam on 9/11 in connection to my claim. I have no clue what is going on and when I had spoke to the VA before 3 years ago, they told me I will not need representation for a re eval.

Anyone? And what can I expect during this exam?

Thank You.

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It is likely that information has crossed over in the mail. To me it sounds as if originally you IU with future examinations. Sometimes the VA will reveiw a case that has future exams and determine if your P and T. Is your letter stating that you are eligible for Chapt 35 benefits and also ChampVA? Or is it an informational letter describing what each of these benefits are?

I would also suggest refraining from calling the 800# because 9 out of 10 times the information you get is inaccurate. Suggestion!! get a hold of a VSO for one of the military organizations and have then run it down. Your going to get a better answer from a VSO than you will on the 800#. If you already have a VSO, call him or her pronto to get this straightened out. The last thing you want to do is have another C and P when maybe there is no need to have one. I know the VA can reveiw anything they wish at anytime, but protocol says that you have to initiate something in order for the VA to react to it.

Get a VSO ASAP and go from there!

Patrick

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Dear Vet

Most vets after 5 years get PT without having to attend any examinaton. Get copys of your past medical records and make sure they are consistant with your disablity. Make sure the rulings they make are consistant with the medical records.

Terry HIggins

It is nice to know that once again, I get to be an exeption. I never initiated anything. I just want to be left alone. As to the medical records, they have everything that has stated forever and ever what happened and what the results to me were, so I am not sure what i could add to it.

What can I expect during a second eval for PTSD if I have to go.

Thank you.

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It sounds to me like they're trying to take away your IU before you hit the magic 5 year mark. Once you've been at a particular rating for 5 years, it's harder for them to lower it - legally. I'd check to see when you'll hit the 5 year mark and try to delay the C&P until after.

Angela

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If you have dependents, and you've been rated 100% TDIU for 5 years, and there's been no change to your employment status - then you have an excellent opportunity for a P&T rating. The only real threat to a TDIU rating is if you suddenly become employed! If your still FUBAR, tell 'em at your C&P - and tell 'em that you would like your dependents to benefit from CHPT 35 and CHAMPVA. ~Wings

§3.327 Reexaminations. (2) No periodic future examinations will be requested. In service-connected cases, no periodic reexamination will be scheduled: (i) When the disability is established as static; (ii) When the findings and symptoms are shown by examinations scheduled in paragraph (b)(2)(i) of this section or other examinations and hospital reports to have persisted without material improvement for a period of 5 years or more; (iii) Where the disability from disease is permanent in character and of such nature that there is no likelihood of improvement; (iv) In cases of veterans over 55 years of age, except under unusual circumstances; (v) When the rating is a prescribed scheduled minimum rating; or (vi) Where a combined disability evaluation would not be affected if the future examination should result in reduced evaluation for one or more conditions.

§3.340 Total and permanent total ratings and unemployability. (b) Permanent total disability. Permanence of total disability will be taken to exist when such impairment is reasonably certain to continue throughout the life of the disabled person. . . . Diseases and injuries of long standing which are actually totally incapacitating will be regarded as permanently and totally disabling when the probability of permanent improvement under treatment is remote. . . . The age of the disabled person may be considered in determining permanence.

§3.343 Continuance of total disability ratings. ( c) Individual unemployability. (1) In reducing a rating of 100 percent service-connected disability based on individual unemployability, the provisions of §3.105(e) are for application but caution must be exercised in such a determination that actual employability is established by clear and convincing evidence. When in such a case the veteran is undergoing vocational rehabilitation, education or training the rating will not be reduced by reason thereof unless there is received evidence of marked improvement or recovery in physical or mental conditions or of employment progress, income earned, and prospects of economic rehabilitation, which demonstrates affirmatively the veteran’s capacity to pursue the vocation or occupation for which the training is intended to qualify him or her, or unless the physical or mental demands of the course are obviously incompatible with total disability. Neither participation in, nor the receipt of remuneration as a result of participation in, a therapeutic or rehabilitation activity under 38 U.S.C. 1718 shall be considered evidence of employability. (Authority: 38 U.S.C. 1718(f))

(2) If a veteran with a total disability rating for compensation purposes based on individual unemployability begins to engage in a substantially gainful occupation during the period beginning after January 1, 1985, the veteran’s rating may not be reduced solely on the basis of having secured and followed such substantially gainful occupation unless the veteran maintains the occupation for a period of 12 consecutive months. For purposes of this subparagraph, temporary interruptions in employment which are of short duration shall not be considered breaks in otherwise continuous employment. (Authority: 38 U.S.C. 1163(a))

§3.344 Stabilization of disability evaluations. (a) Examination reports indicating improvement. Rating agencies will handle cases affected by change of medical findings or diagnosis, so as to produce the greatest degree of stability of disability evaluations consistent with the laws and Department of Veterans Affairs regulations governing disability compensation and pension. It is essential that the entire record of examinations and the medical-industrial history be reviewed to ascertain whether the recent examination is full and complete, including all special examinations indicated as a result of general examination and the entire case history. This applies to treatment of intercurrent diseases and exacerbations, including hospital reports, bedside examinations, examinations by designated physicians, and examinations in the absence of, or without taking full advantage of, laboratory facilities and the cooperation of specialists in related lines. Examinations less full and complete than those on which payments were authorized or continued will not be used as a basis of reduction. Ratings on account of diseases subject to temporary or episodic improvement, e.g., manic depressive or other psychotic reaction, epilepsy, psychoneurotic reaction, arteriosclerotic heart disease, bronchial asthma, gastric or duodenal ulcer, many skin diseases, etc., will not be reduced on any one examination, except in those instances where all the evidence of record clearly warrants the conclusion that sustained improvement has been demonstrated. Ratings on account of diseases which become comparatively symptom free (findings absent) after prolonged rest, e.g. residuals of phlebitis, arteriosclerotic heart disease, etc., will not be reduced on examinations reflecting the results of bed rest. Moreover, though material improvement in the physical or mental condition is clearly reflected the rating agency will consider whether the evidence makes it reasonably certain that the improvement will be maintained under the ordinary conditions of life. When syphilis of the central nervous system or alcoholic deterioration is diagnosed following a long prior history of psychosis, psychoneurosis, epilepsy, or the like, it is rarely possible to exclude persistence, in masked form, of the preceding innocently acquired manifestations. Rating boards encountering a change of diagnosis will exercise caution in the determination as to whether a change in diagnosis represents no more than a progression of an earlier diagnosis, an error in prior diagnosis or possibly a disease entity independent of the service-connected disability. When the new diagnosis reflects mental deficiency or personality disorder only, the possibility of only temporary remission of a super-imposed psychiatric disease will be borne in mind.

(c ) Disabilities which are likely to improve. The provisions of paragraphs (a) and (b) of this section apply to ratings which have continued for long periods at the same level (5 years or more). They do not apply to disabilities which have not become stabilized and are likely to improve. Reexaminations disclosing improvement, physical or mental, in these disabilities will warrant reduction in rating.

Review Examination for Post-Traumatic Stress Disorder (PTSD) Changed February 9, 2005

http://www.vba.va.gov/bln/21/Benefits/exams/disexm56.htm

Edited by Wings
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It sounds to me like they're trying to take away your IU before you hit the magic 5 year mark. Once you've been at a particular rating for 5 years, it's harder for them to lower it - legally. I'd check to see when you'll hit the 5 year mark and try to delay the C&P until after.

Angela

I will check the date on that. I have no idea. Thanks.

Andrea

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Thank you for all of the information.

I got someone to represent me today. She called around to find that the regional office of the state I moved to has not requested anything further, but that I am scheduled to be reevaled in Feb, 2007. They recommended that she call the hospital that the C&P is scheduled with and ask why. She called the hospital and they told her the office she had just spoken to had requested it, although they claim they haven't. The two letters of entitlement that I recieved were from the state I moved from that decided my claim to begin with. I tried calling the DAV there to ask them to look it up in that state and send me a letter stating my status, but I got the run around and will have to call back tommorrow. Basically, I have learned nothing and it ended with her writing a letter including the letters of entitlement, asking that my C&P be moved to a different location or cancelled, and that I be made P&T. Who knows. Their all confused.

Thanks.

Andrea

Edited by catt02189
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