ptsd Quite confused on the end result

[JBL]

Good day to everyone,

 

I have been approved 90% service connected 1 year ago, then I filed for the disability  that is denied from the 1st claim this year. I received a 100% rating 5 days ago but after the next day I checked ebenefits after it has been completed there is 2 pending disabilities on the bottom which was not there on the first day I fund out I have been approved, I have been backed  payed for 2 months after approval and decided to wait for the decision letter to come in the mail to clarify what i saw and today it came in that I was awarded 100% on  the first page and on the secondnce page they are reducing my rating to 80%. all this happened in not even 1 month after approval. The letter states that there is an improvement of the condition on my PTSD(previously depression) and TBI. Any members have this kind of situation? I am really leaning on getting a disability lawyer. Is this the right path to take? Any help would be greatly appreciated.

JBL  

[USMC_VET]

You can look at this website www.imenet.com , you can also call around to the local or near local specialists.  Call them up ask to see if they would be willing to perform an independent medical exam for a VA evaulation.  Or just ask to set up an appointment and then towards the end ask them if they would be willing to fill out a imo/ime report (ime is best for physical issues) and a DBQ. 

There is no VA form for a IME/IMO, its just a report on you. 

The 2 pending is probably TBI and PTSD, they are pending what is called "predetermination for reduction"

 

Ok I will try to write (and hopefully it works this time) what i wrote last time.

I just got through my Pre-determination for Reduction.  I kept my rating (they wanted to reduce PTSD from 50% to 30%). 

Your next move is this...

Fill out a VA form 3288 to request a copy of your c file (also included in a PDF i uploaded in above post).  You want to get your request for your C-FILE out now, today.  Often vets find very important pieces of evidence in their C-Files. 

next is to fill out a Sworn Declaration (in the PDF i uploaded earlier for submitting evidence) or Statement in Support of Claim.  Either will work. State the following in it.

"I officially request a DRO hearing on the Predeterminations for Reduction of my ratings for PTSD (70% to 30%) and TBI (70% to 10%), I also request that my disability be paid at the current rate of 100%.  (If you also want to challenge any of the SC ratings denials, such as gall bladder mention them as well).  I have also submitted a VA Form 3288 to the Claims Intake Center requesting a copy of my Claims file, commonly called a "C-File", on  ___Insert date you mailed it____, and request that the DRO hearing not be scheduled until such time that i have received my claims file and have proper time to review it in preparation to present my case to the DRO.  I request that the "proper time" be between 20 and 30 days upon receipt of my Claims File.  Given the fact that requests for claims files are considered a separate claim by the VA and in their tracking systems, it is possible for the VA to track its progress and know the date that the request is finalized and mailed out to me. "

Get the 3288 out today, and as i state in my submitting evidence PDF anything that is time sensitive such as evidence submissions, Notice of Disagreements, claims, etc. ALWAYS SEND IT THE FOLLOWING WAYS.

• USPS using CERTIFIED (which is evidence you sent it)  with RETURN RECEIPT (evidence they received it)
• FAX
• Ebenefits (if applicable)
• HAND DELIVER TO RO

Read over that PDF in full to know more, its important.

For the statement that requests a DRO hearing you have the following timetables running right now, rights and concerns.

30 days (From 8/10/2015 so you have until 9/9/2015)

You have in actuality 1 year to file a Notice of Disagremeent over anything in a decision, however the decision for TBI and PTSD reduction has not been finalized yet, but in a predetermination phase you dont need to file a NOD.  you have 30 days right now to request a hearing.  if you do so they will continue to pay you at the 100% level until after the hearing and the DRO makes his decision.  You can ask for a DRO hearing AFTER 30 days but if you do they said they "may continue with their proposed action", which means if you wait until day 31 they will take the action to reduce you. 

So what does this all mean.  If you request a dro hearing now, within the 30 days, they will continue to pay you at the 100% level, however if you do this and 1 year from now you lose at the DRO hearing (we will do our best to help you here and not let this happen) you will be on the hook to pay the difference between 100% and 80% which after 12 months will be around 16k.  You can either pay them back out of your bank or they will just garnish your regular VA payments until the debt is paid.  Personally to protect yourself I would start living on 80% right now, stick the difference between 100% and 80% (roughly 1300) in a seperate bank account so if you lose and go to appeals with the BVA etc, you wont be hit hard.  if you win at the BVA or higher at the CVAC you will get all of it back anyways.

So If i were you (sorry to go over the same things multiple times...) I would in this order

• Fill out form 3288 (according to how i say to do it i nmy PDF) and send it out today Certified Mail with Return Receipt
• Fill out a Statement in Support of Claim or Sworn Declaration and mail it out in the next few days Certified Mail with Return Receipt stating what i wrote above.
• If you want to challenge any of the denials of SC you received in that letter (e.g. challenge anything other than TBI and PTSD such as gall bladder, etc.) then also fill out a NOTICE OF DISAGREEMENT.  In that State that you have sent the RO a request for a DRO hearing for a reduction of your TBI and PTSD and wish to include in that hearing your disagreement over the SC denials of _____,_____, etc.
• Go and get IMO/IME for your TBI, PTSD and any other issues that you are challenging (Private message me on Hadit for a good IME person for PTSD, her report accounted for 75% of the reason i wont my case)

If you can afford it start seeing a Primary Care Provider outside the VA, ask for consults for neurology and any other specialists (other than mental health) that pertain to the claims you are challenging.

If you havent already start seeing a psychologist whether in or out of the VA.  The VA puts weight for mental helath claims on whether or not you are seeing someone and receiving treatment and/or medications for treatment.  If you havent been its very likely the rater took the opinion that you must be better if you havent needed treatment.  A rater friend of mine told me when they reviewed my predetermination for reduction that they "had never seen anyone at 50%+ that wasnt in treatment" which basically means that the way they see it if you are 50% or more and not in treatment you must be getting better.  They dont realize that not taking meds or seeing someone doesnt mean we are better, in fact isolation is part of our problem.

 

If you could also upload...

• the letter you received a year ago granting you 90%
• the C&P exam for PTSD and TBI from that 90% rating a year ago
• the C&P exams for PTSD and TBI from this last round

I want to see how they rated you last year as well as compare the C&P exams from last year to these last ones so that i can see where they noted "improvement".  You will also need this because you will want to note where they saw "improvement" and in your IMO/IME make sure the doctor specifically hits on those areas, basically a rebuttal of the C&P findings from this last go around.  I also want to see if the last person who did the C&P for TBI was one of the "holy trinity" of three specialists who are, according to VA regs, allowed to actually determine TBI residuals.

 

 

 

 

[USMC_VET]

I want to help, i know how shitty going through a reduction can be.  I was nerve wracked, anxiety ridden, a mess.  if it wasnt for hadit, i would have lost.  you hav emade a great choice coming here.

[JBL]

Thank you USMC Vet.. I already started the process on requesting my C File. Thank you very much for the detailed instructions too.. Very helpful.. How do you do a PM?

[k5one]

Something I saw on another post; 

 

A vet got a proposal to reduce and he immediately submitted a claim for an increase.  He had the evidence that he needed and they cancelled the reduction pretty quickly.  

There has to be an improvement for them to reduce, so they must have some evidence that you improved to reduce you.  

Did they notify you that they were going to reduce you, or just notified you that you were already reduced?  I thought they had to notify you and give you time to respond, before they could reduce you.

[Navy04]

Sorry to hear of your issues bud. Are you seeking treatment at VA for the condition that was reduced. Remember that the VA can review a SC condition at any time and increase or decrease the condition. All of my high %s were reviewed a few months ago, Even though I was not up for Review until Feb 2016, including PTSD and my TBI/Migraines. Those exams were very brutal especially the PTSD review, which was over 2 hours long. Well it back fired in the VA's face, most conditions were continued at their current %s, and my TBI was increased from 30 to 50%. I make sure and go to all of my VA Docs and seek treatment, even though I live over 200-300 miles away from all three VAs. Good luck, God Bless and keep us posted