ptsd Dro Appeal Question !

[Cavman]

As many of you know, I was recently rated 50% for PTSD and have got my appeal ready with my letter of disagreement, letter from wife, letter from mother. Diagnosed chronic PTSD, serious social/employment impairment, gaf 48 along with many other things that all fit the 70 & 100% score.

I just started a new treatment program with a new doctor and saw him to day for the second time. He is very sharp and I feel he really cares. He stated he can already see my serious PTSD condition and will give me a letter of unemployability, but wants to do a few sessions first.

The VA sent me a IU form when they rated me 50%. I never requested the form. Have no idea what that meant.

(1) What are your thoughts me getting rated 100%?

(2) What are your thoughts on how many treatments I should do before getting the letter & sending it in?

(3) I was diagnosed with chronic combat stress disorder and rated 0% back in 1980. He thinks I should be paid from that date and is willing to write a letter stating I was just as bad off back then as today. By the way this was a few months before the label PTSD originated. Thoughts?

Cavman

[Cavman]

Cavman,

If you don't remember filing a claim or anything like that, how do you know you're service-connected for something (in this case PTSD)? Does the records at VAMC where you were treated show this or does it show just being treated for PTSD. Just because you were treated for PTSD at a VAMC at any time doesn't mean you're service-connected for it by a VARO. The VAMC belongs to the VHA and the regional office belong to the VBA, two different animals.

If you filed a claim back then you or at least your power of attorney had to sign the claims application. If this occurred, did you move at any time during the process and did you notify VA of the move?

Do you have an actual rating decision from 1980 where it states that you're service-connected at 0% for this?

Just too many questions that need to be answered before I can even begin to give you a straight answer.

Josephine,

Scroll down a bit on this page and click "CUE" started by, I think, dougbo1943.

Vike 17

When I went for my C & P a few months ago my examiner told me I was diagnosed as SC and 0% disability. He gave me the doctors name and what he said in the report.

Cavman

[Vike17]

Cavman,

Ok, I did some reading of your past posts to find out exactly what is what. I think you may have somethings mixed up a far as your rating/denials go. For example, in an earlier post you stated that you were awarded 0% for cancer of the tosils, but in a couple of posts after that you stated that the VA denied your cancer related to AO exposure. When the VA denies a claim outright, it doesn't mean that you were awarded 0%service-connection. A denial of service-connection doesn't carry any percentages and means that the injury/disease is not due to your military service. When a veteran is awarded servcie-connection for a injury or disease, it means the VA has recognized that condition as related to their military service and will assign a percentage anywhere from 0% to 100%, depending on the current level of that disability. When a veteran receives a 0% rating it means that it is service-connected but doesn't warrant any monthly monetary compensation. I think this may be the case with your "0% for chronic combat stress disorder." You stated in this thread that the doctor diagnosed you as 'SC and 0%." The doctors do not determine service-connection, that is done by the VA regional office. The doctor can state anything they want in an exam, but the rating specialist makes the final determination. Furthermore, as I stated before, just because you were seen at the VAMC for something doesn't mean it is servcie-connected. To be awarded service-connection for something you have to file a claim for it. The only thing that may apply in this situation is sometimes, and I say this with emphasis, treatment at a VAMC may be considered an informal claim in certain situations. However, even if your treatment by VAMC in 1980 was viewed as that, you or your SO would still have more than likely needed to file a formal claim (that's the VA form 21-526). Also after looking at your prior post, you stated that you had filed a claim for PTSD recently. If you had to prove your stressor with that recent claim and obtain an actual diagnosis of PTSD, then I'm willing to bet that you were never awarded service-conection for this in 1980. If you were already service-connected for PTSD, your recent "claim" was a application for an increased evaluation and you wouldn't have had to prove your stressor event that took place while your were on active duty.

To answer some of your other quetions you presented in the other recent threads.

I'm not sure you have a basis for a CUE claim. and as far as how long thr DRo process takes, that all depends on how back up your regional office is. It can take any where from 4 weeks to over a year. Appeals are processed on the basis of the date of the appeal, not the original effective date. So, the sooner you submit your appeal the better. You can always add evidence later.

I hope this has helped somewhat.

Vike 17

[carlie]

Cavman,

I think this is what Vike is referring to in the last post.

carlie

38 CFR

§ 3.157 Report of examination or hospitalization as claim for increase or to reopen.

(a) General. Effective date of pension or compensation benefits, if otherwise in order, will be the date of receipt of a claim or the date when entitlement arose, whichever is the later. A report of examination or hospitalization which meets the requirements of this section will be accepted as an informal claim for benefits under an existing law or for benefits under a liberalizing law or Department of Veterans Affairs issue, if the report relates to a disability which may establish entitlement. Acceptance of a report of examination or treatment as a claim for increase or to reopen is subject to the requirements of §3.114 with respect to action on Department of Veterans Affairs initiative or at the request of the claimant and the payment of retroactive benefits from the date of the report or for a period of 1 year prior to the date of receipt of the report.

(Authority: 38 U.S.C. 5110(a))

(b) Claim. Once a formal claim for pension or compensation has been allowed or a formal claim for compensation disallowed for the reason that the service-connected disability is not compensable in degree, receipt of one of the following will be accepted as an informal claim for increased benefits or an informal claim to reopen. In addition, receipt of one of the following will be accepted as an informal claim in the case of a retired member of a uniformed service whose formal claim for pension or compensation has been disallowed because of receipt of retirement pay. The evidence listed will also be accepted as an informal claim for pension previously denied for the reason the disability was not permanently and totally disabling.

(1) Report of examination or hospitalization by Department of Veterans Affairs or uniformed services. The date of outpatient or hospital examination or date of admission to a VA or uniformed services hospital will be accepted as the date of receipt of a claim. The date of a uniformed service examination which is the basis for granting severance pay to a former member of the Armed Forces on the temporary disability retired list will be accepted as the date of receipt of claim. The date of admission to a non-VA hospital where a veteran was maintained at VA expense will be accepted as the date of receipt of a claim, if VA maintenance was previously authorized; but if VA maintenance was authorized subsequent to admission, the date VA received notice of admission will be accepted. The provisions of this paragraph apply only when such reports relate to examination or treatment of a disability for which service-connection has previously been established or when a claim specifying the benefit sought is received within one year from the date of such examination, treatment or hospital admission.

(Authority: 38 U.S.C. 501)

(2) Evidence from a private physician or layman. The date of receipt of such evidence will be accepted when the evidence furnished by or in behalf of the claimant is within the competence of the physician or lay person and shows the reasonable probability of entitlement to benefits.

(3) State and other institutions. When submitted by or on behalf of the veteran and entitlement is shown, date of receipt by the Department of Veterans Affairs of examination reports, clinical records, and transcripts of records will be accepted as the date of receipt of a claim if received from State, county, municipal, recognized private institutions, or other Government hospitals (except those described in paragraph (b)(1) of this section). These records must be authenticated by an appropriate official of the institution. Benefits will be granted if the records are adequate for rating purposes; otherwise findings will be verified by official examination. Reports received from private institutions not listed by the American Hospital Association must be certified by the Chief Medical Officer of the Department of Veterans Affairs or physician designee.

[26 FR 1571, Feb. 24, 1961, as amended at 27 FR 4421, May 9, 1962; 31 FR 12055, Sept. 15, 1966; 40 FR 56434, Dec. 3, 1975; 52 FR 27340, July 21, 1987; 60 FR 27409, May 24, 1995]

[Cavman]

Cavman,

Ok, I did some reading of your past posts to find out exactly what is what. I think you may have somethings mixed up a far as your rating/denials go. For example, in an earlier post you stated that you were awarded 0% for cancer of the tosils, but in a couple of posts after that you stated that the VA denied your cancer related to AO exposure. When the VA denies a claim outright, it doesn't mean that you were awarded 0%service-connection. A denial of service-connection doesn't carry any percentages and means that the injury/disease is not due to your military service. When a veteran is awarded servcie-connection for a injury or disease, it means the VA has recognized that condition as related to their military service and will assign a percentage anywhere from 0% to 100%, depending on the current level of that disability. When a veteran receives a 0% rating it means that it is service-connected but doesn't warrant any monthly monetary compensation. I think this may be the case with your "0% for chronic combat stress disorder." You stated in this thread that the doctor diagnosed you as 'SC and 0%." The doctors do not determine service-connection, that is done by the VA regional office. The doctor can state anything they want in an exam, but the rating specialist makes the final determination. Furthermore, as I stated before, just because you were seen at the VAMC for something doesn't mean it is servcie-connected. To be awarded service-connection for something you have to file a claim for it. The only thing that may apply in this situation is sometimes, and I say this with emphasis, treatment at a VAMC may be considered an informal claim in certain situations. However, even if your treatment by VAMC in 1980 was viewed as that, you or your SO would still have more than likely needed to file a formal claim (that's the VA form 21-526). Also after looking at your prior post, you stated that you had filed a claim for PTSD recently. If you had to prove your stressor with that recent claim and obtain an actual diagnosis of PTSD, then I'm willing to bet that you were never awarded service-conection for this in 1980. If you were already service-connected for PTSD, your recent "claim" was a application for an increased evaluation and you wouldn't have had to prove your stressor event that took place while your were on active duty.

To answer some of your other quetions you presented in the other recent threads.

I'm not sure you have a basis for a CUE claim. and as far as how long thr DRo process takes, that all depends on how back up your regional office is. It can take any where from 4 weeks to over a year. Appeals are processed on the basis of the date of the appeal, not the original effective date. So, the sooner you submit your appeal the better. You can always add evidence later.

I hope this has helped somewhat.

Vike 17

Yes Vike, I was awarded 50% ptsd, sc 0% malaria w/2 relapses, denied AO for tonsil cancer, sc 0% 2 ph`s (many scars/no pain. I was sent an IU form. I filed the appeal already with doc`s letter to follow. He has diagnosed me as unemployable already, but wants a few more sessions before sending the letter to the VA. Says it will help my case. I have filed a claim for tinnutis, gerd/barretts as secondary to ptsd, insomnia as secondary to ptsd in the last few days. Thats the deal and I`m sorry for confusing you. Thanks for the help my friend.

Cavman