ptsd Ptsd 70% Rating And Haven't Worked Since 2007? Help Please

[pushbroom]

I'm confused. I have DX from two VA PSY for PTSD, MDD, and GAD. All service connected. Just received initial 70% rating for PTSD. Interconnected symptoms.

I've also not really worked besides odd jobs here and there since 2007 where I had 6k in income. Had to file because I was in school in 2007 or I wouldn't have. Haven't made enough since then to need to file.

Was finally homeless last March when I finally went down to the VA for help. Because I had hit bottom and didn't bounce. Claim just finished. Also rated for tinnitius 10% and lower back 40%. Gives me 80% total.

I don't understand why I was rated 70% for PTSD instead of 100% when I haven't worked since 2007. Haven't been able to get a job. Wouldn't have been able to keep it. I'm a soup sandwich. The VA has a printout I got from the SSA showing my actual income for the last 20 yrs. They did not mention it in their decision but it is mentioned as part of one of the evaluations they mentioned in their decision.

So. What do I do next? Am I wrong in thinking the 8 years of unemployment should put me into the 100% rating even if I haven't forgotten my own name?

[Buck52]

File NOD on the decision that you disagree and should have been awarded TDIU,

Because your current SC disability keeps you from finding substantial gainful employment.

not sure failure to duty to assist applies for tdiu?

.....................Buck

Edited May 26, 2015 by Buck52

[Berta]

What was the exact date of the 70% PTSD decision?

I dont see in the scan, how they applied this Fast Letter:

http://www.scribd.com/doc/148923612/FL13-013-001

If they didnt apply it, they commited a CUE in my Opinion.

Did you ever raise PTSD in any past claim" If so did they rate it or did they deny it?

[pushbroom]

What was the exact date of the 70% PTSD decision?

May 21 2015 is the date of the letter. So I'm thinking it was that date. My effective date is 03/14.

I dont see in the scan, how they applied this Fast Letter:

My interpretation of the fast letter is the evidence and 70% rating should have caused them to consider TDIU without me having to file for it expressly. Which they did not.

http://www.scribd.com/doc/148923612/FL13-013-001

If they didnt apply it, they commited a CUE in my Opinion.

Did you ever raise PTSD in any past claim" If so did they rate it or did they deny it?

This was my first claim ever. I had 4 contentions. They decided 3 and deferred PTSD for two months which they just now decided.

By my own interpretation I meet 'total social and occupational impairment" because I am and have been totally occupationally impaired for quite a few years now. The socially impaired part doesn't seem to be consistently applied because married guys with families are getting it and I've never been married nor do I have a family. I'm just not capable of it. If I somehow woke up tomorrow and found myself with a wife and children I wouldn't still have them by the end of the week. This is obvious if you ever had to share an 8x12 exam room with me.

My confusion centers around if I have to have the exact symptoms listed for 100% or not instead of clearly complying with the spirit of the rules. I hope what I'm saying makes sense.

[Buck52]

Expressly and Reasonably Raised Claims

As a result of

Rice v. Shinseki

(2009), TDIU claims are no longer adjudicated asfreestanding claims. A TDIU claim may be expressly claimed in conjunction with anoriginal service-connection claim, or with a claim for increased evaluation. If, inconnection with a claim for increased compensation, the evidence of record showsevidence of unemployability, and the Veteran meets the schedular criteria for TDIU, thenthe evidence reasonably raises a TDIU claim.When a claim for TDIU is expressly or reasonably raised, VA will send the Veteran a VAForm 21-8940 for completion. If the Veteran has multiple service-connected disabilities,the Veteran must specify one or more disabilities that he or she believes precludeemployability. The Veteran’s specification of these disabilities will be treated as a claimfor increase for those conditions. If the Veteran only has one service-connected disability,VA will presume that disability to be the cause of the Veteran’s unemployability and willtreat the TDIU claim as a claim for increase for that disability.

Note

If the evidence reasonably raises the issue of TDIU, the Rating Veterans ServiceRepresentative (RVSR) will infer and defer the issue on the rating decision. In these cases,authorization must continue the end product (EP). The TDIU claim must be worked as partof the EP pending when the RVSR inferred the issue.

Section 5103 Notice

Send the Veteran a TDIU-specific Section 5103 notice for all TDIU claims. Include anydisability(ies) the Veteran specifies causes the unemployability in the notice as a claim for increase.

IMPORTANT:

RVSRs must specifically address any identified disability(ies) as a claimfor increase in the rating decision, in addition to the issue of TDIU.

Requirement for VA Forms 21-8940 and 21-4192

If a claim for TDIU has been expressly or reasonably raised by the evidence of record, buta current VA Form 21-8940 is not on file, provide it to the Veteran for completion. BeforeVA will consider a claim for IU

•

the Veteran must complete a VA Form 21-8940, and

•

the Veteran with multiple service-connected disabilities must specify one or moreservice-connected disabilities that he or she believes cause the unemployability.

Handling Receipt/Non-Receipt of the VA Form 21-8940

Follow the guidance in the table below to determine appropriate action based on whether or

Page 3.Director (00/21)not the Veteran returns a completed VA Form 21-8940:

IfThen

the Veteran fails to complete and return theVA Form 21-8940

administratively deny the claim

(see below).the Veteran returns the VA Form 21-8940 send VA Form 21-4192,

Request for Employment Information in Connectionwith Claim for Disability Benefit

, to theformer employer(s) listed on the form for which the Veteran worked during his lastyear of employment.

Note

: Request VA Form(s) 21-4192 for theVeteran’s last year of employment

even if

the Veteran has not worked for five years or more.the Veteran with multiple service-connecteddisabilities returns the VA Form 21-8940 but does not identify which service-connected disability(ies) causesunemployabilitycontact the Veteran by telephone to gather that information.

•

Document the results of the call on VAForm 27-0820,

Report of General Information.

the Veteran with multiple service-connecteddisabilities returns the VA Form 21-8940 but does not identify which service-connected disability(ies) causesunemployability

AND

reasonable efforts to telephone the Veteranare not successfulsend the Veteran a letter requesting he or she identify which service-connecteddisability(ies) are believed to causeunemployability.

Important

: If the Veteran does not respondwithin 30 days from the date of the writtenrequest for clarification, or will not identifyone or more service-connected disabilitiesas the basis for the claim,

administrativelydeny the claim

(see below).

IMPORTANT:

Do not deny TDIU evaluations solely because an employer failed to returna completed VA Form 21-4192. SeeM21-1MR.IV.ii.2.F.25.e.

Administrative Denials

Follow the guidance in the table below to complete an administrative denial:

StepAction

1In VETSNET Awards, complete a Benefit Eligibility Decision using thereason “Failure to Furnish Requested Evidence.”2In PCGL (this letter is not currently available in VBMS), select the “Failureto Prosecute” template.

Page 4.Director (00/21)

•

When prompted for the date of the letter, enter the date of the Section5103 notice that initially requested completion of the VA Form 21-8940.

•

The evidence requested is the VA Form 21-8940.The template generates the following first paragraph:“On [date], we wrote and asked you to send us VA Form 21-8940,

Veteran’s Application for Increased Compensation Based on Unemployability

.Because we have not received it, we must deny your claim.

•

If the Veteran failed to complete and submit a VA Form 21-8940, leavethis language as-is.

•

If the Veteran returned the VA Form 21-8940 but did not identify whichservice-connected disability(ies) causes unemployability, change thesecond sentence above as follows:

o

“Because you did not provide all requested information on theform, we must deny your claim.”3Include paragraphs for:

•

“How Did We Make Our Decision”

o

In this section, describe the actions taken by VA to obtain therequested evidence and the Veteran’s response (if any).

•

Appeal information

•

How to contact us4Prior to authorization, add a note in MAP-D or VBMS (as applicable) tostate:

•

“FTP on IU claim. Failure to complete VA Form 21-8940. Admindecision completed [insert date].”

Note

This note is necessary in order to provide up-to-date information for national call center (NCC) representatives.5Clear the EP at authorization.The Veteran will still have one year from the original date of request to furnish theinformation necessary for VA to consider the claim. See 38 U.S.C. §5103(b)(1). Theadministrative denial will not be reflected on the rating codesheet; since the Veteran failedto submit sufficient information to adjudicate the claim, no rating action is needed. Thedecision notice should clearly indicate the reason for the administrative denial.

Updating the Rating Codesheet Following an Administrative Denial

If the RVSR inferred and deferred the issue of TDIU and the Veteran fails to complete andreturn the VA Form 21-8940, the claim is administratively denied (as described above).

Page 5.Director (00/21)Although the administrative decision sufficiently handles the denial of TDIU in thesecases, a deferred issue remains on the rating codesheet which must be removed. Followingcompletion of the administrative denial, the RVSR must take action to remove the issue.RVSRs should follow the guidance in the table below for removing the deferred issue:

StepAction

1In RBA2000 or VBMS-R, enter the file number and select “Pull for Backfill.”

Note

:

A backfill does not require a pending EP, so this action should take place following authorization.2Remove the deferred TDIU issue from the Master Record.3Return the case to files.

Note

This action removes the deferred issue from the data in RBA2000 and VBMS-R;however, it does not update Share. The deferred issue will still be visible in a Master Record inquiry under “Additional Rating Decisions” in Share. Share will continue toreflect the deferred issue until a subsequent rating is completed and promulgated on theclaim. For this reason, the MAP-D or VBMS note regarding the administrative denial, asspecified above, is required. If there has been an administrative denial on TDIU previouslyand TDIU has not been removed from VBMS-R, then delete the issue.

Examinations

VA is not required to provide a general medical examination in connection with everyTDIU claim. The decision to request a medical examination or opinion is contingent uponVA’s duty to assist as part of an original disability compensation claim (38 CFR §3.159©(4)), or as part of a claim for increased evaluation (38 CFR §3.326). These regulationsrequire VA to provide an examination to a claimant “if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim.”When developing a claim involving a request for TDIU, normally request condition-specific DBQs for the issue(s) alleged to cause unemployability (e.g., joints, mental, peripheral nerves, etc.). These DBQs should generally be sufficient to fairly and fullyadjudicate TDIU claims. Do not order examinations for disabilities not alleged to cause or contribute to unemployability.Schedule a general medical examination only if the rating activity determines that it isneeded to fairly and fully adjudicate the TDIU claim, such as original claims for disabilitycompensation or TDIU claims involving the impact of multiple service-connected and/or nonservice-connected disabilities upon employability.

Page 6.Director (00/21)If the facts of the case require VA to examine the Veteran, do not ask the examiner to opineas to whether or not the Veteran is unemployable due to his or her service-connecteddisabilities. SeeM21-1MR, III.iv.3.A.9.f.The responsibility for this decision rests solelywith the rating activity (see 38 CFR § 4.16(a)). VA should request that the examiner comment instead on the functional impairment caused solely by the service-connecteddisabilities.

TDIU Schedular Requirements

38 C.F.R. 4.16(a) provides the schedular requirements for TDIU as follows: “if there isonly one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percentor more, and sufficient additional disability to bring the combined rating to 70 percent or more.” However, in some cases, a Veteran will have one disability ratable at 60 percentwith an additional disability rated at 0 or 10 percent, and the combined rating will stillequal 60 percent. In these cases, consider the schedular requirements to be met. Thereference in 4.16(a) to two or more disabilities should be interpreted as applying to caseswhere no single disability is sufficient to meet the 60 percent criterion.

Appeals Involving TDIU

The table below provides guidance on properly considering an appeal that involves TDIU:

IfAndThen

the Veteran has filed a Noticeof Disagreement (NOD)regarding an increasedevaluation for a service-connected disabilitywhile the appeal is pending, the Veteranclaims TDIU due, at leastin part, to the disability onappeal

AND

the rating decision deniesthe TDIU claimthe TDIU claim is now partof the pending appeal. VAshould send the Veteran aStatement of the Case(SOC) or SupplementalStatement of the Case(SSOC) regarding theTDIU.the Veteran filed a NOD on aTDIU evaluationthe Veteran subsequentlyclaims that a service-connected disability noton appeal causesunemployability

AND

the rating decision fails toincrease the evaluation tothe schedular maximumthat disability will also beconsidered in appellatestatus. VA should send theVeteran a SOC or SSOCregarding the evaluation of that disability.

.............................Buck

[Navy04]

Sorry to hear of your issues bud. You should file for IU immediately. In my case I have not worked in 2 years and was medically retired from the Navy at 30, I am 33 now. I have a ton of health issues yet 100% Temporary, and I easily met the 100% for PTSD alone. Spent 3 months in Civilian Mental Hospital while active and had to resign from Law Enforcement position in 2013 after 9 months. If I had filed for IU in the first place, instead of submitting a ton of claims, even though the conditions have been granted, I would have been better off with the IU route, Instead I am Temporary 100% Schedular. No you want lose your retro, and file IU asap. Good luck, keep us posted and God Bless