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[Berta]

I think this was so important that the posts should be here in claims research.I probably buggered it all up though-copied it wrong---

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hadit.com Veterans Forum > VA Claims Research > FAQ's Veterans Affairs Claims/Benefits

P&t Reevaluation, Re-Evaluate I'm P&T What to expect Options

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Switch to: Linear+ Berta Today, 07:53 AM Post #1

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erax- do you have a legal citation on the lack of future C & Ps for AO P & T presumptives?

I have a vet- 2 PHs , and AO cancer, also Sec tion 1151-

50% PTSD

40 GSW and scarring

100% AO due to Sec 1151 medical screw up -

and SMC under "S" award

I cannot get the vet to comprehend- even though I got him the 100% under 1151- that his AO NHL lymphoma has been acknowledged and rated by VA at 100% with resulting SMC for colostomy-BUT they VA has NEVER paid him any hospialization benefit ,nor any convalenscence and NEVER paid him any AO SC comp. They just gave him the 100% because they almost killed him.

It is difficult to deal with him and he said the AO claim I wrote for him 3 years ago still sits on his dresssor and maybe-when I win-he will file his- we have the same Vet rep.

Luckily-since he is Nehmer class action- he can get retro whenever he files the claim.

He never nodded their decision under 1151 because he was afraid to yet it was wrong-

He got a letter for a Re-evualuation and cannot tell me what disability it is for-

of course he is so stressed out but yet cannot find it to read it to me- and cannot remember what it said- just set for re evaluation--he just calls me and gets angry and political etc ----

he has called his rep so many times about the re-evaluation but cannot remember what the rep said it was for and will not contact the rep again-

I cannot imagine- based on his overall SC picture why this is happening to him.

Dont get me wrong- I have been friends with this vet for 20 years- and I like him a lot-

and accept his difficult nature due to his PTSD-I guess I could ask our mutual vet rep what the re eval is for- but it might take hours to explain it to the vet-I dont think he should even be getting this eval and I think his PTSD is as "catastrophic" as they said Rod's was (my husband) and should be 100% too.

Can you give me the citation for what you stated?

This post has been edited by Berta: Today, 08:01 AM

--------------------

When thousands of Americans faced annihilation in the 1800s Chief Osceola's response to his people, the Seminoles, was

simply "They(the US Army)have guns, but so do we."

Sameo to us -They (VA) have 38 CFR ,38 USC, and M21-1- but so do we.

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Quick Edit erax Sep 11 2006, 07:31 PM Post #2

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One of the myths about the VA is "if your P and T they cannot re-evaluate you. Yes they can. The VA can re-evaluate any veteran anytime they desire based on a pereception that your condition has improved. Even if your 55 and older there is a sentence that says: ["In cases of veterans over 55 years of age, except under unusual circumstances." It is the "under unusual circumstances that opens the door for the VA to re-examine a veteran.

However, having worked for the VA there are certain circumstances when a re-evaluation will not be made and that is under the circumstances where vetean has been in combat and received specific combat awards, PH, CAR, CIB; and if the disorders are presumptive such as those listed under Agent Orange.

Patrick

First of all I’m must be a moron idiotic fool. I’ve got two Award letters One stating I’m 90% IU the other sating I’m 100% P&T with other then a dishonorable discharge. I have an Honorable Discharged under Medical reasoning. I don’t know where they got this from. Both knees combined at 50% -Depression which causes PTSD at 70%. The knees they said are in-operateble. Go figure, they said I was to young to do prosthetic replacement in 1999. Now they want to re-evaluate me and my disabilities. I’m fine with this. If they fix what they broke. Also, my daughter is preparing for college next year.

I am neck deep in it and can’t do nothing now but, bide my time. The anxiety feels like its killing me. The anger is fueling to the point of explosion. The VA drags you through the system with indecisive decisions doctors treat you like a Ginny pig and now I half to go thru this all over again.

I need to talk to someone off the Hadit Forum Board who can talk to me one on one. I really need some help! Cant bring myself to go to the VA because, of the bureaucratic nonchalant attitudes and fear of the physic ward and their team of Frankenstein’s staff.

Yeah I’m a little whacked here people……..But I do need some help on what to do.

Eric

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Patrick428 Sep 10 2006, 04:43 PM Post #3

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One of the myths about the VA is "if your P and T they cannot re-evaluate you. Yes they can. The VA can re-evaluate any veteran anytime they desire based on a pereception that your condition has improved. Even if your 55 and older there is a sentence that says: ["In cases of veterans over 55 years of age, except under unusual circumstances." It is the "under unusual circumstances that opens the door for the VA to re-examine a veteran.

However, having worked for the VA there are certain circumstances when a re-evaluation will not be made and that is under the circumstances where vetean has been in combat and received specific combat awards, PH, CAR, CIB; and if the disorders are presumptive such as those listed under Agent Orange.

Patrick

This post has been edited by Patrick428: Sep 10 2006, 04:45 PM

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jrfrog Sep 10 2006, 01:02 PM Post #4

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My understanding from somewhere in the foggy past is that they can recall any P&T prior to a 10 year anniversary of holding that rating. But it certainly sounds like you've got nothing to worry about.

You should "break out" and delineate any condition you have and apply for a separate rating for each condition. This can be done in one Claims Form submission, as I understand things. Every specific SC item you have commits the VA to providing care for that specific condition... in the future, they *may* start limiting their treatment to SC conditions only (just my personal suspicions).

ALSO, there have been instances where, if you don't utilize the VA system on an annual basis (I have also heard every 24 months) they can drop you from "active status" and it's a real bitch trying to get "back into" the system.

From what you've written, there are some very possible advantages to you to return for a C&P exam. AND you can request that someone (your service rep, etc) to be with you during that exam... so if you get flustered and forget something, they can remind you... and they can also take note regarding what was looked at and what wasn't. If the Dr. refuses to perform the C&P with someone else in the room (I've only heard of this happening once) you can request a reschedule of your C&P. You can speak to the Patient Advocate and also the Medical Information Officer (who is usually an attorney) and raise hell if that happens.

Keep your chin up... with your condition, I can't imagine you coming out any less than what you have now. Emphasize the worsening of the conditions and make sure the Dr. notes those statements. Don't make any off-handed statements about ANY KIND OF IMPROVEMENT to your conditions, like "Oh, yah, that might not be as bad as it was 5 years ago..." etc.. and stuff like that. Be truthful, but remember, the C&P examiner is NOT your friend.

Good luck with that....

-JR

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john999 Sep 10 2006, 11:09 AM Post #5

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Erax

If the VA can give you a new body then maybe they can reconsider your P&T status. I would file for housebound benefits if I were you. After this I would file for every single condition I have. I think it is your age they are considering. They just don't want to pay another 40-50 years at the 100% level.

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erax Sep 10 2006, 10:57 AM Post #6

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QUOTE(Philip Rogers @ Sep 10 2006, 11:00 AM)

Sounds to me like you shouldn't have much to sweat. If you are 55yo or older or have had your condition 5 yr without improvement you should be safe, also. I'd also contact the VA stating that you have been found P&T and it violates their administrative procedures to review your claim or condition without any specific evidence of improvement. jmho

Thank You for the reply. I'm 40 yrs old and have had the condictions for 18 yrs

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Philip Rogers Sep 10 2006, 10:00 AM Post #7

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QUOTE(erax @ Sep 10 2006, 07:41 AM)

I got a letter stating the VA re-evaluates certain disabilities. We have requested a physical examination of your SC disabilities so that we may review the severity of the conditions to ensure that you are properly evaluated.

First, I didn’t think a P&T vet could be reevaluated for the disabilities. I have avoided the VA hospital like a a scared little boy. I get infuriated by their lack of professionalism and treat me as another number passing thru the door.

Ok, 2002 I was scheduled for both knee replacements. The head Ortho Dr and his resident Dr denied me the replacments the day before surgery. Their reasoning was I was to young and the option they gave me was to fuse my knees together then defuse them in ten tears. I decline ( no thanks) my (L) knee is trying to fuse on its own do to massive arthritis.I have no ACL (Removed ‘94), MCL and PCL tears and repairs, NO medial meniscus. I’v lost the capabilities to do common tasks at home and out an about (shopping ect…) I’m 40% for combined left and right knee. So I get 100% P&T. I have bilateral conditions with (L) ankle, which I have not filed a claim for. Figured I didn’t need to since they were taking care of me with prosthetics and special shoes.

My depression is worse. I take the meds but, it seems that I get no relief I’m 60% SC for this condition. I bide my time and try to make the best of every day. I want so bad to be a part of something like VFW, AMVETS ect. But I don’t have the social abilities anymore. I’ve become recluse.

Anyways, what should I expect and what should I do. The symptoms have only gotten worse and I want new knees so I’m not homebound.

Along with the disabilities I mentioned which I am SC for, I also have GERD, Hep “C”, fractured T-12 vertebrae, compressed L-1, bulged L-2, compressed L-3 and L-4. Compression and bulged disk in C-4 and C-5. Torn rotor cup (L) shoulder and a ankle that was described to me from a dr that it looked like it had been crushed. With all of these injuries its hard to stay focused. Please I need help. Also I need a ride to the VA facilities because I no longer can drive do to anxiety. Again what should I do?

Sounds to me like you shouldn't have much to sweat. If you are 55yo or older or have had your condition 5 yr without improvement you should be safe, also. I'd also contact the VA stating that you have been found P&T and it violates their administrative procedures to review your claim or condition without any specific evidence of improvement. jmho

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erax Sep 10 2006, 06:41 AM Post #8

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Current Rating %: 100% p&t

I got a letter stating the VA re-evaluates certain disabilities. We have requested a physical examination of your SC disabilities so that we may review the severity of the conditions to ensure that you are properly evaluated.

First, I didn’t think a P&T vet could be reevaluated for the disabilities. I have avoided the VA hospital like a a scared little boy. I get infuriated by their lack of professionalism and treat me as another number passing thru the door.

Ok, 2002 I was scheduled for both knee replacements. The head Ortho Dr and his resident Dr denied me the replacments the day before surgery. Their reasoning was I was to young and the option they gave me was to fuse my knees together then defuse them in ten tears. I decline ( no thanks) my (L) knee is trying to fuse on its own do to massive arthritis.I have no ACL (Removed ‘94), MCL and PCL tears and repairs, NO medial meniscus. I’v lost the capabilities to do common tasks at home and out an about (shopping ect…) I’m 40% for combined left and right knee. So I get 100% P&T. I have bilateral conditions with (L) ankle, which I have not filed a claim for. Figured I didn’t need to since they were taking care of me with prosthetics and special shoes.

My depression is worse. I take the meds but, it seems that I get no relief I’m 60% SC for this condition. I bide my time and try to make the best of every day. I want so bad to be a part of something like VFW, AMVETS ect. But I don’t have the social abilities anymore. I’ve become recluse.

Anyways, what should I expect and what should I do. The symptoms have only gotten worse and I want new knees so I’m not homebound.

Along with the disabilities I mentioned which I am SC for, I also have GERD, Hep “C”, fractured T-12 vertebrae, compressed L-1, bulged L-2, compressed L-3 and L-4. Compression and bulged disk in C-4 and C-5. Torn rotor cup (L) shoulder and a ankle that was described to me from a dr that it looked like it had been crushed. With all of these injuries its hard to stay focused. Please I need help. Also I need a ride to the VA facilities because I no longer can drive do to anxiety. Again what should I do?

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