Jump to content
  • 0

How Should I Handle? Admin Review Reduction


templar1231

Question

Last year, my claims were approved and I received a combined evaluation of 80% due to (PTSD - 50%, TBI - 40%, Migraines - 30%, Tinnitus - 10%). Recently, I received a letter stating that they had made a clear and unmistakable error and will reduce the TBI to 0% and my overall will go to 70% after an Admin Review.

I understand their reasoning since they feel the symptoms are overlapping and they can't apply my TBI facet levels that are higher than 0 towards TBI since they've already supported the 50% evaluation for PTSD. Where I disagree (potentially) is that I have other residuals that aren't "psychological" and are attributable to my other evaluations (e.g. Migraines).

The items/residuals that might still apply are subjective complaints of balance problems and vision changes (TBI residuals) that I don't think the doctor evaluated correctly at a 0 severity level. I have blurred vision, balance problems and hypersensitivity to light that do interfere with work, daily living, etc. I wasn't worried before when I got my evaluation because I thought what I had received was fair...but now they're attempting to reduce.

My VSO suggested I show the letter to my Mental Health doctor and see their opinion (and see if they'd like to write up documented opinion for me) and then try to request a hearing or denial.

Any suggestions?

Link to comment
Share on other sites

Recommended Posts

  • 0

Last year, my claims were approved and I received a combined evaluation of 80% due to (PTSD - 50%, TBI - 40%, Migraines - 30%, Tinnitus - 10%). Recently, I received a letter stating that they had made a clear and unmistakable error and will reduce the TBI to 0% and my overall will go to 70% after an Admin Review.

I understand their reasoning since they feel the symptoms are overlapping and they can't apply my TBI facet levels that are higher than 0 towards TBI since they've already supported the 50% evaluation for PTSD. Where I disagree (potentially) is that I have other residuals that aren't "psychological" and are attributable to my other evaluations (e.g. Migraines).

The items/residuals that might still apply are subjective complaints of balance problems and vision changes (TBI residuals) that I don't think the doctor evaluated correctly at a 0 severity level. I have blurred vision, balance problems and hypersensitivity to light that do interfere with work, daily living, etc. I wasn't worried before when I got my evaluation because I thought what I had received was fair...but now they're attempting to reduce.

My VSO suggested I show the letter to my Mental Health doctor and see their opinion (and see if they'd like to write up documented opinion for me) and then try to request a hearing or denial.

Any suggestions?

Welcome.

Please post all of and exactly what the recent letter states, minus personal info

such as name, address, claim #, etc . . .

Link to comment
Share on other sites

  • 0
  • Admin

The VA is trying to lump TBI and PTSD together. That is in it self a fraudulent activity as a TBI is a Trauma of physical nature to the brain. PTSD could be a result of that Trauma but items like gait, coordination and headaches are from the sustained trauma. Stand Alone PTSD is only and I say only a guess by a Phyc Doctor. Does anyone see the bull in this crap the VA is trying on you.

A case need to make it to the federal court to get a porecedent setting opinion of a final nature as the VA will continue to bullddoze veterans over with this crap.

J

Link to comment
Share on other sites

  • 0

Your VSOs advice sounds good.

Additionally, I would file for an increase to try and get the ptsd bumped up to 70 and the migraines to 50, if you think that you meet the higher evaluation. That would put you at 90 combined. Personally, I don't think the va will back down on this reduction, but ya never know.

Review the rating schedule here for PTSD & migraines

http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5

Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.

Guest
Answer this question...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.



  • veteranscrisisline-badge-chat-1.gif

  • Advertisemnt

  • 14 Questions about VA Disability Compensation Benefits Claims

    questions-001@3x.png

    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
    Continue Reading
     
  • Most Common VA Disabilities Claimed for Compensation:   

    tinnitus-005.pngptsd-005.pnglumbosacral-005.pngscars-005.pnglimitation-flexion-knee-005.pngdiabetes-005.pnglimitation-motion-ankle-005.pngparalysis-005.pngdegenerative-arthitis-spine-005.pngtbi-traumatic-brain-injury-005.png

  • Advertisemnt

  • VA Watchdog

  • Advertisemnt

  • Ads

  • Can a 100 percent Disabled Veteran Work and Earn an Income?

    employment 2.jpeg

    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

×
×
  • Create New...

Important Information

{terms] and Guidelines