ptsd Nod~ Dro~ Over 55 Rule And P&t 100%

[TCo67]

I started here over a year ago under my real name. That was a mistake. Now I am back with a username which I think will be safer. I was a real neophyte . It is amazing how much one learns in a year.

I wish all of my fellow veterans nothing but the best, and I fervently hope each of us receives the maximum allowable benefit commensurate with our disability, and then some! At first as I was pursuing my disability claim for PTSD and Ischemic Heart Disease, among other things, I felt a tad bit like one of the people that the conservatives are always bashing. But the more I looked at how screwed up my entire adult life has been since returning from Vietnam, and now complicated by all of the problems associated with my heart disease, bypass surgery, and post surgical issues; (with possible prostate cancer pending) and combine those with what all too often seems a clear attitude of "deny if we can" "grant if we must" attitude by some at the VA.... well let's just say that I have some new anger issues to deal with. I am working to maintain "an attitude of gratitude" in every aspect of my life. And I am truly grateful for the help received from the VA.

I have a number of questions which are somewhat convoluted, complicated and even confusing. But they bother me and I cannot seem to find anyone with answers. So please allow me the privilege of starting here, and we will see where it goes.

Recently after about 18 months of "doing the dance" I was rated 100% P&T for PTSD (66 year old Vietnam Vet -ground troup). I was also rated at 10% for Heart Disease, post CABG surgery, and a couple of other minor disabilities. In my award letter they actually listed two effective dates for the increase in my PTSD rating. They are paying me from the earlier one. They made a pretty clear mistake in rating my heart disease based on a "verbal METS interview" which never took place, and contradicted the evidence on the DBQ from my heart surgeon, and 36 separate rehab reports from the Cardio Rehab Unit. Short story there is I should have been rated at 60% for the heart disease absent the "made up" "interview" which gave me a mets score that was 7-10 in the face of my surgens DBQ shwing 3-5 and my Rehab Documents showing 3-5 and a 'real' interview showing 3-5 mets by another VA doctor doing a different exam .

Here is my dilemma: Because of the effective date of the increase in award for PTSD, my family loses the difference between my previous rating and 100 percent for a full year. (family of four) Additionally the disparity in dates prevents me from getting the life insurance, and cuts one of my kids out of the chapter 35 benefits. (all considered it is a pretty substantial sacrifice if I do nothing)

But I am very happy and grateful about the P&T aspect of my PTSD 100% going forward. Two of my kids and my wife qualify for the chapter 35 benefits, Champva medical, comissary privileges, etc. and the monthly compensation is a good bit higher than before. I have not worked for six years owing to the severity of my PTSD symptoms, so the financial part is a big part of making our lives more normal.

The additional year amounts to a fair amount. And if the IHD was rated at 60% that would entitle me to extra financial benefits which would help also.

The question is: Do I file a Notice of Disagreement as to (1) the effective date of the increase in PTSD to 100 percent and (2) the low rating on the IHD? Is there risk associated with asking a DRO to review the case on just those two issues?

I believe that I am entitled to the back pay all the way back to when I filed my claim almost two years ago. The VA only awarded me back pay for six months. But I am fearful that if I file the NOD they will look at me as being "greedy" and try to take away the 100% P&T and I will could lose the college and medical benefits for my family.

I need some really sage advice. I spoke with a lawyer, and he said.... let it alone. (but he stood not to make very much money under VA guidelines since the amount in question is not a lot of money to him.) I am equally concerned that if I don't file the NOD based on the effective date of the increase, the VA could wait until after the appeals date runs out, and then claim a CUE based on the two different effective dates, and then possibly try to change my rating; and I would have no recourse except to file a new claim since my appeal deadline would have come and gone.

If I thought that filing the NOD would ONLY address the two issues of the effective date of the increase, and the IHD rating and leave my P&T unchanged, I would be inclinded to go for it. But if by filing the NOD it would open up a can of worms and put at risk my current ratings and benefits; I would not file the NOD.

Finally, I have read the reg that states that for VETS 55 years and older who are P&T and "static" in their disabilities (which I am), they should not be scheduled for any new exams for decided claims except under unusual circumstances. So I feel pretty secure if I do nothing. But my family loses the money, the life insurance, and my daughter loses the college under Chapter 35.

Does anyone have any sage input or advice?

Thanks in advance.

TCo67

Edited September 26, 2013 by TCo67

[Philip Rogers]

So it you again, huh?? Using a different handle are ya?? Sorry, just kidding! I don't know who, nor do I care, you are but couldn't resist having a little fun w/it. Sometimes I'm not as funny as "I think" I am. Sorry!!

I would do the NOD, altho you may just want to send them a little note explaining the problem(s) and request that they correct it. If it's a recent error, they may just correct it. If not I'd do the NOD. They VA can review you claim at "anytime." If they owe you money/bennies, I say go after it. jmo

pr

[broncovet]

Well, you need to get your cfile, and see if there are reasons for an eed. Assuming you think so, then you need to file a NOD. Your effective date is the later of the facts found or the date you applied, with some exceptions. One notable exception is 38 CFR 3.156 for new and material evidence. There are also other exceptions. If you are representing yourself, and it sounds like you are, remember the 5P's. Proper Preperation Prevents Poor Performance. Only with VA it is six P's, because you have to add persistence or perserverence.

[john999]

I think you should be entitled to effective date equal to the date you filed the claim. However, it is your claim and your peace of mine. I tend to appeal just about everything since I know the VA rewards persistence. I have been P&T for 12 years and I just filed for an increase in my DMII. During the period of being p&t I filed many claims including two CUE claims. I filed for money and not really to prove a point. I believe that if a vet gets 10% they can get 100%. I did it. I read CAVC claims and many vets have really weak claims, but over time they have won. There are many RVN vets claiming PTSD because they see retirement staring them in the face and they have nothing. You have won that Lotto game so far. It used to be so hard to get 30% for PTSD back in 80's. Probably 500,000 RVN vets were screwed out of PTSD compensation, so I say file for it. You notice when you go to VAMC you see a bunch of old guys with standard issue VA canes.

John

[TCo67]

Thanks for the responses thus far. I appreciate your input and advice. Will keep everything in mind as I ponder the decision. One question again. Is it true that if one submits a NOD and asks for the de novo review by a DRO on the specific items listed on the NOD form, they will not consider any other items? And is it true that with the items that are listed on the NOD form, the DRO cannot change a rating or eligibility decision to the Vet's detriment; but can only either grant or deny the requested change by the VET? In other words he or she can deny the requested change based on the disagreement, or can grant it in whole or in part (thereby improving the decision for the Vet); but cannot change it in a way that would adversely affect the Vet?

Thanks again

TCo67

[john999]

I think the VARO can do anything, but unlikely since they have backlog of new claims to deal with, and not mess too much with established claim. Are you still in Treatment? If you are going to file new claims be sure you keep going to the VAMC for treatment. This is just my opinion. If you have anything wrong with you at least get it into VA records. You want a nice long "problems" list.

[TCo67]

I have been seeing a private physician/psychiatrist for seven years. Only filed for benefits with the VA a year and a half ago. I did not know that there were any benefits available for Vietnam Vets. It was my heart surgery and advice/information from another heart patient that even got me into the VA system at all. (agent orange and CAD) I was interviewing with a county VSO regarding the heart surgery and heart disease, and during the interview she asked if I had any other medical or mental issues. So I reluctantly told her that I had been seeing a psychiatrist for 5 and a half years for PTSD and Depression. I do not want to change doctors after seven years. My wife switched employers and we lost our old insurance. The new insurance is an HMO and they won't pay for me to see my long time doctor; and I don't expect the VA will either. So I pay out of pocket every month to see my private doctor. I have told my primary care VA doctor about my PTSD and that I see a private physician. He did not refer me to a VA doc. I don't like talking about my issues much; but over seven years have built a relationship of trust with my psychiatrist, making it easier. I am not anxious to start over with someone brand new. (?)