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Filed For P & T And Now I Have A Predetermination Letter For Reduction


EthanAllen

Question

I am 100% SC PTSD, Panic Disorder with Agoraphobia. Effective date is 02/16/2009. Had my third C & P in December 2014. I have the copy and it is not good again. My VSO told me to file for P & T now since it has been six years with no improvement.

My claim for P & T was opened on 12/02/2014 and my C & P was on 10/08/2014. Wife attended with me because of the process plus I do not like crowds.

I waited for answer. On 02/09/2015 on E benefits in my open file it said pending decision approval.

On 02/10/2015 another claim was opened that said 'Gathering Evidence and Predetermination letter sent".

On 02/14/2015 my original claim was closed with appropriate words decision letter sent etc.

The 02/10/2015 claim remained opened. On 02/17/2015 the second claim vanished into thin air.

I waited til yesterday for the mail to arrive. After two weeks I called 800 number and was told that a Predetermination Letter was being sent. I asked about the details and they would only tell me it was for a reduction and it was mailed out on 02/23/2015. I do not have the letter yet telling me the details.

I have SSDI and 100% SC for six years and I get this from the VA. I am messed up and see my Psych 2X a month and group therapy. I have been an in house patient five times. The last less than a year ago for an attempted suicide. Where is the problem because I do not see it. I also had a C & P in 10/2013 and continued with the original 100% SC award of benefits. A year later I am better off. This a joke I hope.

Does anyone know what is going on?

To say the least I am baffled

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Sorry to hear of your issues bud. I am in the same boat, I put an FDC in back in Nov, well from Dec-Jan it was Prep for Decision, and then a few weeks ago that claim went back to Gathering of Evidence. All of a sudden the VA calls me a schedules a C&P for every condition I claimed, which went well and looks to be granted SC. Then out of nowhere the VA reviewed most of my conditions to include a PTSD Review which just went up from 30% to 70% last year after a C&P exam like yours. Now the PTSD review which sucks, looks it will either stay at 70% or go up to 100%, and hopefully I will finally be permanent. I too spent 3 months in a Civilian Hospital and was retired for Navy for PTSD and Crohns, yet I am Temporary. The VA screwed with me too, as they thought I was rocking the boat or ungrateful for the 100%. I was awarded SSDI for PTSD and Bone issues, in less than 10 weeks which is unheard of. Sorry that the VA is trying to lowball you bud. I don't get it too, I was always told that the 5 year mark was a safe blanket for a condition, I guess I was wrong. Good luck, God Bless and keep us posted.

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Got my letter today. VA proposing reduction from 100% to 70%. Completely flabbergasted. They said I have shown improvement. Since last year. Thats funny. I tried to hang myself. Did three days in patient hold. Held a knife to my throat another time this year and all the police showed up. Boy I sure have improved. I will fight this crap. Right when I applied for Permanent and total these guys pull this stunt.

What next?

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This is BS, plain and simple!

Can you scan and attach here the proposed reduction ? (cover c file #, name, address etc.)

We need to see the exact words VA based this crap on.

As to the Reasons and Basis and also their evidence list.

"My claim for P & T was opened on 12/02/2014 and my C & P was on 10/08/2014."

So the C & P had nothing to do with the P & T claim?

" am 100% SC PTSD, Panic Disorder with Agoraphobia. Effective date is 02/16/2009. Had my third C & P in December 2014. I have...

What did that older 100% award decision say regarding SMC consideration? There might be a CUE in that decision regarding SMC and possibly a CUE

in the proposed reduction decision

We got a proposed reduction letter once, Christmas eve 1988, The fully decorated tree went flying out the front door.

The VA dropped the idea a few months later when I prepared the NOD for my husband.

I realize now I could have also called a CUE on that decision.

Agoraphobia can make a veteran Housebound.(SMC S award)

Can you also attach here the last C & P results?

"The 02/10/2015 claim remained opened. On 02/17/2015 the second claim vanished into thin air."

what was the second claim for...P & T ?

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This BVA award shows what I mean:

In part:

"2. The veteran filed a claim on February 27, 1996, for SMC
based on being HB, and medical evidence since obtained,
particularly the results of a March 2000 VA psychiatric
evaluation, confirmed that the severity of his service-
connected psychiatric impairment precludes him from leaving
his home and the immediate premises surrounding it-primarily
due to recurring acute anxiety reactions and a panic disorder
with agoraphobia, both associated with his PTSD."

In order to be entitled to SMC based on being HB, the veteran
not only must have at least one service-connected disability
that is rated as 100 percent disabling, but he also must have
either (1) an additional disability or disabilities
independently ratable at 60 percent or more-separate and
distinct from the disability rated as 100 percent disabling
and involving different anatomical segments/bodily systems,
or (2) be permanently housebound by reason of his disability
or disabilities. And to satisfy this latter requirement, it
is especially important to point out that he must be
substantially confined to his dwelling and the immediate
premises surrounding it or, if institutionalized, to the ward
or clinical area, and it must be reasonably certain that the
disability or disabilities and resultant confinement will
continue throughout his lifetime. 38 U.S.C.A. § 1114(s); 38
C.F.R. § 3.350(i).

ORDER

An earlier effective date of February 27, 1996, is granted
for SMC based on being housebound,, subject to the laws and
regulations governing the payment of VA compensation.

http://www.va.gov/vetapp01/files03/0118462.txt

Sometimes when VA proposes to reduce erroneously, it is a good time to ask them for more comp!

When I mentioned their proposal to reduce my husband, in 1988 , three years later they rendered him an EED of 100% P & T for his PTSD back to 1991....but that was in an accrued award I got in 1997, as he had been dead by then for 3 years.

Figure that. One does not jump from 30 to 100 in 3 years but Fenderson didnt play in because of the accrued regs at that time.

Edited by Berta (see edit history)
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SO SO SORRY to hear of the crap the VA is putting you thru. Please listen to Berta's advice, and I wish you the best. Please try to stay strong and we will be here for you. God Bless!!!

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Mike you are exactly right bud. I mean look what happened to me, I just put in an FDC in Nov 14 so that I get SC for all the other issues, which looks good and will probably be granted SC. Then the VA decides, "Hay lets just review all of his SC big %s, which they did" Very painful process, but it backfired on the VA, it looks like a few of those Reviewed %s just might increase. Just try to stay calm and we will figure out your next plan of attack.

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Update to all and love all the support,

Filed for 30 day hearing an hour ago with long narrative as to why I oppose. Stated documented facts as well as difference in opinion.

Prepared for this just in case by notifying Senator's Office. I have their form to release my records. I will fill this out. I am also sending certified mail to Senator including decision letter and VA form 21-4138 explaining why I want the office to look into this. In addition I will attach corresponding C.F.R. regarding the reduction of five year static rating with 3 C & P's all saying the same and also send regulation relating to reduction of 100% total. I will also ask about SMC-S as Berta mentioned. I will also write a personal note to the Senator respectfully. This cannot happen to other veterans.

VSO and I have requested full medical file today also.

I do not have a scanner nor do I know how to upload at this moment. But I will give brief synopsis.

Based on my third C & P 12/08/1014 for PTSD (Chronic), Panic Disorder with agoraphobia, alcohol abuse "we are proposing to reduce your prior evaluation of its overall disabling effect. The combined evaluation for all of your service connected disabilities will drop from 100% to 70%. This does not affect you entitlement to treatment for service connected conditions. We propose to reduce your monthly rate of compersation from $3068.90 to $1447.71".

"We have reviewed medical records concerning your service connected disabilities and noted some improvement".

Some improvement?

The decision shows 20 different problems more associated with 70 percent rather than 100 percent. Their words not mine.

They left out that I have "persistent dangerof hurting self or others". I was on high risk suicide list for 120 days last year ending in August. The examiner states in my last exam that I was disorientated during some of the questioning. They left out that I had three panic attacks at the CBOC requiring nurses and my Psych. July of 2014 I got so upset that they summoned five local policeman to the VA but my doctor talked me down. "Grossly inappropriate behavior".

Bottom line. They have messed up bad. I will let the Senator know about why this all happened during a request for P & T and why I have not received my decision letter on that which was closed on E Benefits 02/14/2015. Basically as the letter says "some improvement". God forbid.

The VA does not scare me. They could call tomorrow and I would still send this case to the Senator. Yes I will find out Sec Bob email and send it to him. I was in 1st Special Forces Group (2nd Bn, B Co, ODA 156 as a 18E myself maybe he can give me a little help. I still have some humor left.

I may be home bound with some serious problems but I do remember how to fight back. Being from Vermont I will wear my Ethan Allen and the Green Mountain Boys shirt to the hearing.

Thank you very much to all. I will keep everyone updated. God Bless

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