ptsd C&P Exam appeal

[ShawnRiggs]

I went through a C &P Exam in September for a re-evaluation of PTSD. The exam lasted less than 45 minutes and the Examiner did not ask but a handful of questions or even consider paperwork in my C-file from Voc. Rehab stating that my medical conditions prevent me from working. The first update to E-benefits stated the following provided in the screen shot. Before clicking on the action tab the claim type said INC. Today E-benefits shows that someone read my submitted evidence because now it says under review. Has anyone had this claim type of INC on a proposal to reduce before? If so, did you find out what INC meant? I know now that I am in an appeal status but none the less the whole thing is stressful and a continuous fight proving everything again to the VA. Considering that i just went througg all of this in 12. Plus, the VA dismissed the IDES amd MEB/PEB findings which was suppose to stream line the entire process. Any info or comments are helpful. Thanks. Riggs.

 

 

Edited November 9, 2015 by ShawnRiggs
Correct spelling and add additional info.

[Vync]

It is kind of odd that the Disabilities Claimed says "Proposal to reduce PTSD/mood disorder NOD (Increase)". That wording does seem to contradict itself. Maybe you filed for an increase in the past and they are proposing to roll back the increase. Not really certain about that.

 

Usually, when the VA makes a proposal to reduce, they either do it because the condition was considered temporary, expected to improve over time, or your medical records show marked improvement over prolonged time (not necessarily from a one-off good day).

Example 1: Veteran has surgery and is placed on temporary 100% for X months to recover. The VA requests a new C&P after X months to see if they can be reduced.

Example 2: Veteran has 3+ acute asthma attacks within a year and was treated with steroid pills or injections. Their asthma rating is temporarily increased to 60% because they are "expected to improve". 12+ months after evidence of the the last treatment, the VA requests a new C&P to see if they can be reduced.

The VA ignoring evidence and not following protocol happens to veterans a lot! The second example was from my own experience. When I got the proposal to reduce letter, I submitted continued evidence of steroid treatments going back 5+ years. The VA ignored it and reduced me. I appealed, the VA finally took the evidence into account, and reversed the rating reduction.

 

If you are 80% and unable to work, consider filing for IU or SSDI. If you can get your regular psych doctor (not an LCSW or NP) to state that your condition is not expected to improve, it can help a lot.

[ShawnRiggs]

Thanks for the info. I have been 70% since the Army and VA both agreed in 2012 on the IDES board. The Army placed me on PDRL with PTSD at 70% and said that it would not improve. The VA has me at 80%  overall combined with other disabilities. Go figure.

[Vync]

Wow, if they said it would not improve, then I'm at a loss as to why they would propose to reduce. Maybe someone at the VA missed that part. If it is on your award letter or you had a psych doc state it, I would advise you make the VA realize it. I really hope it works out for you.

[Navy04]

I just went thru this recently. Where the VA reviewed all of my conditions in Feb 15 but I was not up for Review until Feb 2016. Well went thru the initial exams and VA actually increased Migraines to 50% and continued the rest. Well in June 15 I saw a Claim on Ebenefits that stated the same statement. So the VA sent me to a Heart Doc at VES to Review my last 2 Original Conditions Scars and Tongue Damage.   Went thru the exam and then recently claim went to Complete, and I went from 100% T&P to 100% P&T, without asking for it. So it could be a good thing for you my friend. Good luck and keep us posted. God Bless

[ShawnRiggs]

Thanks everyone. I did highlight and make note of the board findings in my NOD to the VA letter. However, the VA did not move until I uploaded a NEXUM statement from my doctor in the civilian world: stating that my TBI and other secondary nurological issues from 97 are separate from my PTSD. Funny how fast they move when you interject new evidence to them about something that has been known to everyone including VA.  I do not trust them to do what is right...much less to take care of us. I will keep ya'll updated. Thanks for the feedback. God speed to you all, and never give up the fight.

Edited November 10, 2015 by ShawnRiggs
Fix typos and wording.

[Vync]

You are correct not to trust them to do what is right. I found that you often have to spell it out for them and connect the dots. Good luck on your claim!