ptsd Help From The Senior Members Please...

[Plinky]

Hello,

I am a long time reader of this forum, first time poster. I filled a claim for PTSD a year ago this month and just saw that today my claim was completed. I was awarded 50% SC. I have not yet received the BBE detailing everything, just saw the basic info on ebenefits.

I plan to file an appeal. My question is this; I have read many times on this forum that if you are receiving SSDI for PTSD then the VA is supposed to acknowlegde that and take that into consideration when determining your disabalilty level. I am currently receiving SSDI soley for PTSD and both the IMO and VA C&P Examiner marked the 70% criteria: Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. I also filed an application for IU with my original claim. I know they lowballed me on purpose so they wouldn't have to grant me the 100%.

Can someone please point me to the regulation that states if you are receiving SSDI then the VA should award 100%?

This will give me some ammo when I file my appeal.

This is my first claim ever so I am trying to do everything right the first time so as not to get caught up in a never ending battle.

Any help would be appreciated.

Carlie and Berta your info on this forum in invalubale. Thanks for all the great advice. It has helped me to keep my sanity over the last year.

[NavyWife]

25. Evaluating Evidence to Establish Entitlement to IU, Continued

f. When to Obtain SSA Reports Obtain and consider complete copies of the Social Security Administration (SSA) reports, if available, when

⦁ evidence of record is insufficient to award increased compensation based on IU, and

⦁ the record shows that the veteran is receiving Social Security (SS) benefits because of disability.

Note: Decisions by SSA regarding a veteran’s unemployability are not controlling for VA determinations (and vice versa).

References: For more information on

⦁ requesting information from SSA, see M21-1MR, Part III, Subpart iii, 3.A, and

⦁ the effect of SSA decisions regarding unemployability on VA determinations, see Murincsak v. Derwinski, 2 Vet. App. 363 (1992).

My understanding of this issue is that Yes, VA must review and consider your SSDI records as long as you tell them you are receiving SSDI. However, the M21-1MR states the decision of one agency does not mean the other agency MUST agree with it. VA and SSDI each have to make their own determination regarding unemployability.

When you receive your decision in the mail, review the "Evidence" section and be sure the VA did list your SSDI records. If not, that would be the first place to start.

Have you actually been denied TDIU yet? or is it deferred????

If you get to the point of desiring an appeal, personally I would go with a reconsideration instead. It is also called a reopen with New and Material Evidence. You would simply have your private doctor fill out the DBQ and discuss why he feels your symptoms meet the higher ratings and this would be filed as an increase. This would most likely be decided much sooner than an appeal.

If in fact the TDIU has been denied, then the advice above from Gastone regarding getting a letter from Voc Rehab is golden. If you don't want to deal with VA, then find a Vocational Rehabilitation counselor on your own and have them review your records and write a statement that you are "unemployable solely due to your service connected disabilities".

And by the way, Congratulations on getting this far!!!!

[john999]

I got a rating of 70% and I had SSDI at the time. I had already claimed TDIU. The VA found some reason to deny my TDIU claim even though I was approved for SSDI and for OPM disability. I had to appeal and it took about a year and a couple of IME's to get the TDIU and then another IME to get P&T. There is no sure thing with the VA. When I lost my job I was 30% and I worked on the claim steadily until I got P&T. I appealed every decision and every low ball or denial. If you have money to pay for IME/IMO I would appeal to DRO because it takes about a year to even get to the DRO. Meanwhile your condition can be IME'ed and you can gather evidence to win. When I was turned down for TDIU I got statements from Voc Rehab, Vet Center, various doctors, wife, brother, SSDI file, OPM, workers compensation etc all saying I could not work and was paranoid and crazy. It worked. I am paranoid and crazy plus have TDIU, P&T and "S" eventually.

[broncovet]

I may have missed this, but this is the "400 pound gorilla" in the room:

What does you Social Security Decision say you are disabled FOR? They list the conditions which they used to justify your disability.

KEY HERE: If you social security disability says you are disabled because of PTSD (or other service connected condition) you should get 100 percent VA.

BUT...if your SSDI says you are disabled for xxx conditions, some or all of which the VA has NOT granted service connection, then its much much harder to get 100 percent disability with VA.

The issue: Are the conditions to which ssi granted disability service connected? You see, social security makes no distinction, but VA disabilites must be service connected for compensation. Many people have issues which are service connected and other issues which are not.

I reccommend: Chill out until you get the BBE. If you want to do something, gather your service records and start reading them, and check the criteria for 100 percent PTSD.

Edited November 9, 2014 by broncovet

[broncovet]

I never recommend filing a nod until you get the envelope. Reason:

The VA has to list a "reasons and bases" for denial. You take their "reasons" and refute them. In the case of an award of 50, or 70 percent, while you want 100 percent then you:

Show how your conditions (give examples from your medical records) on how you meet the criteria for a higher rating by doing as the blogger did below. REMEMBER your 5 P's Proper Preperation Prevents Poor Performance.

his is what I did, and I took (3) copies with me to my C&P Examination.

I copied and pasted the "General Rating Formula for Mental Disorders" into a Word Document.

I then separated the conditions...or whatever they are...within each of the categories...from 30% on up through 100%.

(All anyone has to do NOW...is copy and paste into their own Word Document what I have already separated.)

Then I used THREE different colors to represent how often a particular condition occurred...using GREEN for SOME OF THE TIME...BLUE forMOST OF THE TIME...and RED for ALL OF THE TIME.

I then colored the appropriate condition with the COLOR that it would represent...so the appropriate condition was color-matched.

If something did not apply...I just left it as it is...with NO COLORS.

Then I started at the 30% and highlighted the appropriate condition...and clicked on the matching color in the top-right corner of my Word Document to change the highlighted area to the chosen color. Then I clicked on the BOLD function.

Then I went to the 50% level, and did the same...and then the next level, and so on.

I have done the 30% as an example to show how it looks.

Make sure you remove (MY) colored 30% exampleand replace it with your own colors.

Across the top of the page, I equally separated the COLORED words...SOME OF THE TIME...MOST OF THE TIME...and ALL OF THE TIME

I also UNDERLINED and made BOLD the "SOME OF THE TIME, MOST OF THE TIME, and ALL OF THE TIME...and each of the PERCENTAGES, too.

Now this should give you a better picture of what your rating should be.




********************************************************************************************

CFR 4.130 Schedule of ratingsmental disorders

9440 Chronic adjustment Disorders

General Rating Formula for Mental Disorders:


SOME OF THE TIME....................MOST OF THE TIME....................ALL OF THE TIME


0%
A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication

10%
Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or;
symptoms controlled by continuous medication

30%
Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as:
depressed mood
anxiety
suspiciousness
panic attacks (weekly or less often)
chronic sleep impairment
mild memory loss (such as forgetting names, directions, recent events)

50%
Occupational and social impairment with reduced reliability and productivity due to such symptoms as:
flattened affect
circumstantial, circumlocutory, or stereotyped speech
panic attacks more than once a week
difficulty in understanding complex commands
impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks)
impaired judgment
impaired abstract thinking
disturbances of motivation and mood
difficulty in establishing and maintaining effective work and social relationships

70%
Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as:
suicidal ideation
obsessional rituals, which interfere with routine activities
speech intermittently illogical, obscure, or irrelevant
near-continuous panic or depression affecting the ability to function independently, appropriately and effectively
impaired impulse control (such as unprovoked irritability with periods of violence)
spatial disorientation
neglect of personal appearance and hygiene
difficulty in adapting to stressful circumstances (including work or a worklike setting)
inability to establish and maintain effective relationships


100%
Total occupational and social impairment, due to such symptoms as:
gross impairment in thought processes or communication
persistent delusions or hallucinations
grossly inappropriate behavior
persistent danger of hurting self or others
intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene)
disorientation to time or place
memory loss for names of close relatives, own occupation, or own name

[Plinky]

Wow! Thanks for all the replies folks. It's a bit dizzying.

Broncovet - Yes, my SSDI is for PTSD, well they say anxiety disorder.

Navywife - Since I haven't received the BBE yet I'm not sure if they flat out denied TDIU or what...

Berta and Navywife - That's what I was trying to find. Thanks

John999 - Fellow Tampa vet....Thanks for the info. What is Voc Rehab like over here? It makes me nervous to think about.

Relax guys! I'm not filing an appeal like tomorrow or anything.....just trying to get my mind on track for what I have to do next.

With the holidays coming up I plan to TRY and enjoy them and start the battle after the New Year. I will need time to wrap my head around all the great info you all gave me. Thanks so much.