ptsd Advice W/ Increase.appeal Situation

[FalselinkUSMC]

Evening all,

I've scoured these forums for a little while now and normally I don't have to make a thread because I end up finding an answer however this is not the case this time.

I will try to keep this short and to the point. Any other information that might be needed I will provide.

In July 2012 I recieved my rating for 70% Service connected compensation and back pay to oct 2011. 10% of that was for an anxiety disorder. While attending school I realized I was very not normal and sent a nod and appeal to the VA in June 2013. Today I finally had an appointment with a va psychologist and he said that my anxiety disorder is severe PTSD. I don't want to get into the details but, I would assume I will now be at 100% as he kept asking me if I wanted to be unemployable..I said no I am only 26 years old. He then said you could always come back and get reevaluated.

Since I put in for an increase within a year of receiving my intial rating of 70% will this be considered an error in the rating of 10% and will I be getting back paid for this?

Also via ebenifits the appeal hasn't moved since July 2012 but my increase is currently at the decision phase..can I call them and tell them to delay whatever decision they were about to make as I just today got told I have severe ptsd even though I guess I've always known.

Any help from you would be greatly appreciated. It's taken me 5 years to actually realize I shouldn't act the way I do. Very interesting time if my life for sure.

Semper Fi

Edited August 22, 2014 by FalselinkUSMC (see edit history)

[Berta]

Did you specifically appeal the 10% rating?

If the doctor clearly documented what he said, with a rationale, then ,if I were you I would send a copy of that to the VA and ask for a reconsideration of the decision for the 10% based on that, and on anything else that has occurred ( such as treatment records, etc since they made the last decision.

You will fall into the 2010 PTSD regulations ( here in our PTSD forum) and they will consider (if you were OIF/OEF in theatre)

your 'fear of hostile activity etc," as the regulations state

if they re- characterize the anxiety disability to PTSD .

But with the 10% now, the VA surely has conceded a stressor so the new regs might not even be an issue.

You filed the NOD .already so I don't know how the Reconsideration request will be handled.

But it would be important if they turn down the appeal for an increase.

Do you have a vet rep?

You could fax this info to the VARO or even send them an IRIS advising of this additional medical information, but

you would need copies of the medical records from the psychologist,who indicated your rating was not only too low but should have been for PTSD ( which is an anxiety disorder but can have a broader scope than PTSD.

"Since I put in for an increase within a year of receiving my initial rating of 70% will this be considered an error in the rating of 10% and will I be getting back paid for this?"

I think you might need more evidence than the medical statement the VA psychologist made.

He might even be willing to prepare a detailed medical opinion, to support what he told you.

This is very concerning to me:

"Today I finally had an appointment with a va psychologist."

They paid you retro back to 2011 yet, this was the first VA doctor you were able to see?

Did he perhaps base his statements on the MMPI, or any other psyche testing he did?

If so the results of those tests should help with the claimed increase.

I am from the olden days.I guess because I am surprised at what the psyche doc said about your rating.

For 6 years one of my husband's shrink's never mentioned his rating at all ( 30 % PTSD then)

Then again my husband was a VA employee, and the VA made him see the VA employee psyche,for PTSD, so maybe that is why his rating was never discussed..

However, he was switched to another VA psychologist who had more experience with PTSD and based on that doctor's test results and therapy sessions, he went up to 100% PTSD, posthumously, with an EED to include 3 years with the VA employee shrink. There was much more evidence involved in that increase however.

You asked if the VA erred with the 10% but they cannot make an error on what they dont know about.

Others will chime in and possibly have better suggestions then me.

If you have a POA with a vet org who has a office in or near your VARO, maybe they can help more before the decision is made.

But I think you definitely will need to send VA the documentation of what the psychologist said and hopefully he gave a medical rationale ,,if it was even documented at all in your medical records.

Edited August 21, 2014 by Berta (see edit history)

[Navy04]

Sorry to hear of your troubles bud. God Bless and keep us posted.

[FalselinkUSMC]

Did you specifically appeal the 10% rating?

If the doctor clearly documented what he said, with a rationale, then ,if I were you I would send a copy of that to the VA and ask for a reconsideration of the decision for the 10% based on that, and on anything else that has occurred ( such as treatment records, etc since they made the last decision.

You will fall into the 2010 PTSD regulations ( here in our PTSD forum) and they will consider (if you were OIF/OEF in theatre)

your 'fear of hostile activity etc," as the regulations state

if they re- characterize the anxiety disability to PTSD .

But with the 10% now, the VA surely has conceded a stressor so the new regs might not even be an issue.

You filed the NOD .already so I don't know how the Reconsideration request will be handled.

But it would be important if they turn down the appeal for an increase.

Do you have a vet rep?

You could fax this info to the VARO or even send them an IRIS advising of this additional medical information, but

you would need copies of the medical records from the psychologist,who indicated your rating was not only too low but should have been for PTSD ( which is an anxiety disorder but can have a broader scope than PTSD.

"Since I put in for an increase within a year of receiving my initial rating of 70% will this be considered an error in the rating of 10% and will I be getting back paid for this?"

I think you might need more evidence than the medical statement the VA psychologist made.

He might even be willing to prepare a detailed medical opinion, to support what he told you.

This is very concerning to me:

"Today I finally had an appointment with a va psychologist."

They paid you retro back to 2011 yet, this was the first VA doctor you were able to see?

Did he perhaps base his statements on the MMPI, or any other psyche testing he did?

If so the results of those tests should help with the claimed increase.

I am from the olden days.I guess because I am surprised at what the psyche doc said about your rating.

For 6 years one of my husband's shrink's never mentioned his rating at all ( 30 % PTSD then)

Then again my husband was a VA employee, and the VA made him see the VA employee psyche,for PTSD, so maybe that is why his rating was never discussed..

However, he was switched to another VA psychologist who had more experience with PTSD and based on that doctor's test results and therapy sessions, he went up to 100% PTSD, posthumously, with an EED to include 3 years with the VA employee shrink. There was much more evidence involved in that increase however.

You asked if the VA erred with the 10% but they cannot make an error on what they dont know about.

Others will chime in and possibly have better suggestions then me.

If you have a POA with a vet org who has a office in or near your VARO, maybe they can help more before the decision is made.

But I think you definitely will need to send VA the documentation of what the psychologist said and hopefully he gave a medical rationale ,,if it was even documented at all in your medical records.

Thank you Berta for the reply.

Before I respond to your questions this is how today's events unfolded.

As I mentioned before although my C & P appt. was just yesterday my claim for an increase made it to the "Preparation for Decision" Tab over on eBenifits. So today I called the VA to ask them since I just had my appointment if the C & P results would still be looked at for this claim since my claim was past the "Gathering of evidence" tab. He said "Wow...Wow you just had your appointment and the report is already on file" which coiencides what my pyschologist told me he said his report would be with the Jackson MS RO yesterday or today. Anyway hopefully someone over in the mysterious world of VA actually looked at what he had to say in regards to me having severe PTSD and not just anxiety disorder because now my claim is one step further along and is at the "Pending decision approval" Stage. This all leads me to believe that either one the claim is going through without the evidence I just recieved or two my claim is being processed at light-speed. Another note is the VA person I talked to over the phone mentioned I might need to fill out a PTSD "stressor" sheet but he said it looks like the examiner already has what he needed and since I wasn't claiming PTSD and was just asking for an increase from my rated anxiety disorder to not send anything in unless asked for it. He also said it is likely that I will get back paid to my EAS date but also possible to get back paid from my claim of increase date which was still within the year of recieving my original rating.

Now to your questions....

Did you specifically appeal the 10% rating?

yes, I sent in an appeal letter and nod letter at the same time for and increase for (clusterheadaches/anxiety disorder)

if I were you I would send a copy of that to the VA

...how do i get a copy of my doctors report??I've read something about free information act or using myhealthevet website (which has nothing on it for me)

Do you have a vet rep?

No, I tried once but since then I have done everything myself. So far the waiting game is bad but at least I know everything is done correctly and letters are written professionally and in my words. Should I have one for this?

I think you might need more evidence than the medical statement the VA psychologist made.

He specifically said something along the lines of what he said is final. This was around the time he was asking me if I wanted unemployability and where I told him no i dont think that would be a good idea.

They paid you retro back to 2011 yet, this was the first VA doctor you were able to see?

yes. I dont much like going to the doctors. there is always some pill trying to be prescribed and i hate pills. However the times I have waited for a VA appt and been seen. I would tell them everything that is wrong with me and then they would just focus on one of the minor issues..prescribe some pill to help me sleep and that would be it. I only ended up with a C&P Exam and talked to the Pysch guy because I put in for the increase a little over a year ago now.

Did he perhaps base his statements on the MMPI, or any other psyche testing he did?

I have no idea what that is. Somehow he got me talking. He knows what happened in afghanistan. Halfway through our meeting he said you have severe symptoms of PTSD.

I am surprised at what the psyche doc said about your rating.

This was a VA pyschologist he had my information right in front of him. So i dont know.

with an EED to include 3 years with the VA employee shrink

what is an EED? I keep seeing that abbrivation

again thank you for the great response. and for all the help this forum provides.

Semper Fi

[FalselinkUSMC]

Moderators still need to approve my messages so I am unsure as to when this will post. However, I have come to a startling realization today. Please view pictures then description.

My claim recieved July Lasy year 2013

My claim finally under review March 2014...

Now this is where it gets interesting. It took until just yesterday to get my appointment and take a look at what happened.

That gathering of evidence was complete the same day (Aug 20 2014) that my appointment happened. The Pysch did say that he will have this in 'whoevers' hands by the end of the day or the latest the next day.

My claim was prepared for decision before I called the VA today at 3pm. and then finally..

So what happened here... Did the VA seriously just push my claim through after my appointment in less than a day? Isn't this unheard of? Because this happened so fast I can assume one of two things. They were waiting patiently for my evidence to deny my increase OR were waiting patiently to just get something from a doctor to approve it. What do you guys think?

Edited August 22, 2014 by FalselinkUSMC (see edit history)

[georgiapapa]

EED (Earlier Effective Date)

[FalselinkUSMC]

Noted. Ty

[Berta]

Wait, I am wrong, the time for a possible reconsideration has passed....SORRY

I think I was confused on this......

"Since I put in for an increase within a year of receiving my initial rating of 70% will this be considered an error in the rating of 10% and will I be getting back paid for this?"

It looks like they sent you a TDIU form (21-8940) and I don't see any mention of the C & P. in the snapshots...

If the C & P exam was done by a VAMC, all you need to do is go there to their FOIA Privacy Records Access Officer (they have a form for getting a copy of the exam) or write to them and ask under the Privacy Act, 5, USC 552, for a copy of the C & P results.

Dont use FOIA.for your own records......that is within the same regs as the Privacy Act but FOIAs are handled much differently and can become time consuming.

These C & P records are yours....you just need to cite the Privacy Act.


"So what happened here... Did the VA seriously just push my claim through after my appointment in less than a day? Isn't this unheard of? Because this happened so fast I can assume one of two things. They were waiting patiently for my evidence to deny my increase OR were waiting patiently to just get something from a doctor to approve it. What do you guys think?"

I think you are right.Either way the VA cannot possibly prepare an adequate decision without all of the probative medical evidence.

Your post is the third one here in about a week that I noticed involved the VA doing the right thing in some specific situations.

They are under the gun as we all know and although the stress level is probably very high at VA these days, maybe they are becoming more willing to abide by 38 CFR and M21-1MR.


"Did he perhaps base his statements on the MMPI, or any other psyche testing he did?

I have no idea what that is. Somehow he got me talking. He knows what happened in afghanistan. Halfway through our meeting he said you have severe symptoms of PTSD.

I am surprised at what the psyche doc said about your rating.

This was a VA pyschologist he had my information right in front of him. So i dont know"

Looks like the doc did the right thing too.Dont even worry about the MMPI.

As I posted:
"You will fall into the 2010 PTSD regulations ( here in our PTSD forum) and they will consider (if you were OIF/OEF in theatre)

your 'fear of hostile activity etc," as the regulations state


if they re- characterize the anxiety disability to PTSD .

But with the 10% now, the VA surely has conceded a stressor so the new regs might not even be an issue."

PTSD is of course an anxiety disorder.

If I were you I would file out and send in the TDIU form ....maybe you did already per the snapshots here.....

and consider filing for SSDI as well, as you can receive both SC TDIU and SSDI. There is a work credit amount you need ( they will add your military time to your work credits and the SSDI web site has more info on that and also an SSDI application.

If the doctor felt you should not be working , I think that was good advise.

[FalselinkUSMC]

Update. The claim moved to preparation for notification today. Now under historical claims there is a "claim type" Predetermination....what is that? any ideas?