ptsd Help....berta.... Someone..... Va Has Picked Me This Time!

[Ryan H.]

Hi all.... this place saved me once, maybe again.

I was rated in March of 2008, over 6 years ago. I have not been back to the VA since my rating. The time spend dealing with the claim process was one of the hardest times in my life. Since my rating, I have been fired twice, laid-off twice, divorced twice, had a child, remarried a third time, and have had 6 different jobs. The mother of my child does not let me have a relationship with her because of the issues I have. My problems are not better, I am not better. I have moved at least 10 different times. I have changed VA regional offices at least 4 times, and have lived over seas on two separate occasions for work. The VA tried to examine me for an increase in 2010, but due to me being overseas, and moving so often it was impossible to schedule the exam. In Jan of 2012 I was notified that the claim was closed, no changes were made. Today I go on ebenifits to check the status of the dependent adjustment I made in 2012, and found out that a claim type "predetermination" with the contentions of "Due Process/propose to reduce for PTSD (New)" was open on 25 Jan 2012, the day after my last claim was closed. I was NEVER notified of this claim being opened. I was NEVER scheduled for an appointment. It was NEVER requested of me to provide documentation on equip. The status of this claim is currently "Pending Decision Approval". Upon noticing the claim I called the VA and requested the information on what exactly this is. I was told it is not a "claim" it is a predetermination stating they will be reducing my my rating due to the fact they could not adequately contact me. Since the 2012 claim was initiated, I purchased a home using a VA loan, I also opened a dependent claim with the same VARO. NOT one single time did they notify me or request me attend a C&P exam. I promptly requested the VA lady help with this and clear the matter up prior to the Decision Approval, and then requested the file be transferred to the RO of the State I am currently living and not the International RO. She gladly did this, and was VERY helpful, but she also said that nothing is guaranteed. If a decision is made prior to the new info being reviewed there will be nothing I can do other than request a hearing. I also immediately called the DAV and requested the personally visit the office and ensure that I am more than willing to go to a C&P exam, and for them to schedule it immediately.

I realize the correct action is to go to therapy, go to meetings, but when there are people counting on my income for support, and I have to continually move from contract to contract to provide this income, the VA becomes a last priority. As most everyone holding down a schedule, a job, a live, a relationship with PTSD is hard enough. I cope, and deal the best ways I can. It has nearly cost me my life more than once, but it has provided for a better life for the ones who count on me. Being expected to go into meetings to talk about life enrages me. I cannot do it, and being expected to go is intolerable for me. SO WHY DOES THE VA INSIST ON MAKING IT EVEN HARDER BY REDUCING A STABLE RATING????? This is speculative. The decision has not been made, and this could be all for not, but it has me scared that my life and family will now suffer more at the hands of these people.

Now my questions are:

1) How can they legally reduce the rating after 5 years without an examination disclosing an improvement. The federal code (see below) is clear on this, and no examination has been completed.

2) How can they legally reduce a rating without due process of notification?

3) Can a "predetermination" type claim be withdrawn prior to decision approval?

4) What is the opinion of the members here when it comes to fighting this during a hearing if the VA decides to follow through with the reduction? Do I have a leg to stand on????

§3.344 Stabilization of disability eval- uations.

(a) Examination reports indicating im-provement. Rating agencies will handle cases affected by change of medical findings or diagnosis, so as to produce the greatest degree of stability of dis- ability evaluations consistent with the laws and Department of Veterans Af- fairs regulations governing disability compensation and pension. It is essential that the entire record of examina- tions and the medical-industrial his- tory be reviewed to ascertain whether the recent examination is full and com- plete, including all special examina- tions indicated as a result of general examination and the entire case his- tory. This applies to treatment of intercurrent diseases and exacer- bations, including hospital reports, bedside examinations, examinations by designated physicians, and examina- tions in the absence of, or without tak- ing full advantage of, laboratory facili- ties and the cooperation of specialists in related lines. Examinations less full and complete than those on which pay- ments 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 psy- chotic reaction, epilepsy, psycho- neurotic reaction, arteriosclerotic heart disease, bronchial asthma, gas- tric or duodenal ulcer, many skin dis-eases, etc., will not be reduced on any one examination, except in those in- stances 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 rep- resents 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 superimposed psychiatric disease will be borne in mind.

(b) Doubtful cases. If doubt remains, after according due consideration to all the evidence developed by the several items discussed in paragraph (a) of this section, the rating agency will con- tinue the rating in effect, citing the former diagnosis with the new diag- nosis in parentheses, and following the appropriate code there will be added the reference ‘‘Rating continued pend- ing reexamination lll months from this date, §3.344.’’ The rating agency will determine on the basis of the facts in each individual case whether 18, 24 or 30 months will be allowed to elapse before the reexamination will be made.

© 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.

[Slowlane]

You are at 80%. What do they want to reduce? What are your percentages that got you to 80???? and what part of the 80 do they want to reduce.

Be patient this is a lot of info to run thru the woodpile.

More data please

Slowlane

[Ryan H.]

70% Ptsd is what they are reducing. Originally Service connected in 05 increased in 08.

[jbasser]

You have to show continuity of treatment and not quit going to doctors or the snakes will bite you. You had better get to a Doc and get an update. Ask VA for a hearing before they reduce and also file for an increase. Ask for IU. If your woirking that may be a very long shot.

Basser

[Berta]

"I was rated in March of 2008, over 6 years ago. I have not been back to the VA since my rating."

I think that is the problem.


"I was told it is not a "claim" it is a predetermination stating they will be reducing my my rating due to the fact they could not adequately contact me."

I don't think that is the problem.

"ordinary conditions of life, as shown by full and complete examinations, can justify a reduction; these provisions prohibit a reduction on the basis of a single examination. See Brown v. Brown, 5 Vet. App. 413, 417-18 (1995)."
http://www.index.va.gov/search/va/view.jsp?FV=http://www.va.gov/vetapp13/Files4/1332468.txt

Jbasser is correct. The VA justifies compensation with ongoing continuous treatment.

Do you have any private treatment records for the PTSD? Since the 2006 rating?

If not I was going to suggest that you get an IMO and bring it to the hearing..but, if you are saying you have had no treatment, no meds, no therapy at all
for 6 years for your PTSD, then I dont know what an IMO shrink could base their opinion on.

You might want to think about talking to an IMO doctor now

Perhaps these factors, if proven to VA, will help you fight this proposed reduction:

"Since my rating, I have been fired twice, laid-off twice, divorced twice, had a child, remarried a third time, and have had 6 different jobs. The mother of my child does not let me have a relationship with her because of the issues I have. My problems are not better, I am not better. I have moved at least 10 different times. I have changed VA regional offices at least 4 times, and have lived over seas on two separate occasions for work. "

Íf they can be proven as directly attributable to your PTSD.

But that would take a shrink to determine that in a strong IMO.

"The VA tried to examine me for an increase in 2010, but due to me being overseas, and moving so often it was impossible to schedule the exam."

Actually the VA Overseas program does a fairly good job at helping vets living overseas to get C & Ps. I think they do it via the state department. We have vets at hadit who use the Overseas Program.

I worked with PTSD vets at a vet center, and since then with PTSD vets from the local VAMC.
And I married one.
Most of them had to contend with family, work, some with Voc Rehab as well, and all of them needed the continuous treatment they got from VA,and
in most cases they sure needed the meds too, to keep their jobs and families.

As bad as the problems with VA are, they provide the best PTSD counseling in the country., in my opinion.

."It has nearly cost me my life more than once"

if you mean your PTSD has caused you suicidal ideation and/or attempts, the proof of that might help fight this proposed action by the VA. Maybe I misunderstand what you meant here.

Others will chime in......I cannot adequately come up with a solution, but maybe someone else will.....

and of course, you have not received their reduction proposal letter yet.

In that letter they will tell you exactly why they are attempting to reduce you.

They did that to my husband long ago. I read the letter about 5 times.then wrote a short three paragraph NOD for him.

They dropped the idea with the NOD I wrote. I used the regs they based their reduction idea on, against them,

and I used plain common sense to prove their idea had no legal or medical merit whatsoever.

It is the wording of the actual proposal letter that will give you the reasons you need to overcome.

I hope you realize that, if you can combat this proposal to reduce, the VA WILL expect you to get treatment for your PTSD.

But if you are unwilling to get future treatment, why even fight this at all.

Edited May 23, 2014 by Berta

[Ryan H.]

Thank you. I have only been here in Virginia since last July. I have contacted the local VA med center. I have to Register here, and be assigned a primary care DR before getting an appointment with a mental health dr. I am not opposed to treatment, just am not very fond of the group meetings. I have actually been regressing a bit in the last few months. It's been a roller coaster ride for sure. I'm more reclusive, and substantially more quick tempered. The position I have now for work is probably the best situation I could be in. I am left alone to do my job, and am respected for my results. Luckily, I don't have to interact with many people, and have a very regimented schedule. I do not want UI, or even to be rated higher than my current rating. I am a 100% supporter of the ratings system if done properly and fairly. If i am evaluated and the evidence supports a reduction then I will accept it and continue on. From everything I have read, and researched in the last 24hrs, this is my fault, and as long as I allow the VA system to treat me then I SHOULD not have any further issues. The regs say that if I present myself as available for an exam and go to the exam then the rating will be based on federal regulations in place protecting me from an unwarranted decrease. I was in a bit of a panic last night. The thought of going through the system again is daunting, and it brings up the feelings I try to keep down, with ease. In summary, I have done all that I can at the moment. The DAV rep @ the Pittsburgh RO will go there Tuesday and attempt to put a hold on the decrease and request a C&P exam. If they follow through with a decision, I can request a hearing within 30 days, and express that I am available and willing to be examined. The regs say that they have to accept this and schedule the exam. If, at that point, I do not show to the exam then the decided rating is enforced, and I will have to request an increase. Basically, it's all on me. I put myself in this situation, and I have to do what the VA wants to get out of it.

[Ryan H.]

§ 3.655 Failure to report for Department of Veterans Affairs examination.

(a) General. When entitlement or continued entitlement to a benefit cannot be established or confirmed without a current VA examination or reexamination and a claimant, without good cause, fails to report for such examination, or reexamination, action shall be taken in accordance with paragraph (b) or © of this section as appropriate. Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant, death of an immediate family member, etc. For purposes of this section, the terms examination and reexamination include periods of hospital observation when required by VA.

(b) Original or reopened claim, or claim for increase. When a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. When the examination was scheduled in conjunction with any other original claim, a reopened claim for a benefit which was previously disallowed, or a claim for increase, the claim shall be denied.

© Running award.

(1) When a claimant fails to report for a reexamination and the issue is continuing entitlement, VA shall issue a pretermination notice advising the payee that payment for the disability or disabilities for which the reexamination was scheduled will be discontinued or, if a minimum evaluation is established in part 4 of this title or there is an evaluation protected under § 3.951(b) of this part, reduced to the lower evaluation. Such notice shall also include the prospective date of discontinuance or reduction, the reason therefor and a statement of the claimant's procedural and appellate rights. The claimant shall be allowed 60 days to indicate his or her willingness to report for a reexamination or to present evidence that payment for the disability or disabilities for which the reexamination was scheduled should not be discontinued or reduced.

(2) If there is no response within 60 days, or if the evidence submitted does not establish continued entitlement, payment for such disability or disabilities shall be discontinued or reduced as of the date indicated in the pretermination notice or the date of last payment, whichever is later.

(3) If notice is received that the claimant is willing to report for a reexamination before payment has been discontinued or reduced, action to adjust payment shall be deferred. The reexamination shall be rescheduled and the claimant notified that failure to report for the rescheduled examination shall be cause for immediate discontinuance or reduction of payment. When a claimant fails to report for such rescheduled examination, payment shall be reduced or discontinued as of the date of last payment and shall not be further adjusted until a VA examination has been conducted and the report reviewed.