ptsd NOD / DRO or TARP?

[Billielea]

After almost a year of waiting on my C-File, I am starting my NOD without it. My question, which appeals method is better, DRO or TARP? Last year I was awarded 50% for PTSD reopened claim and had my 10% TBI rating decreased to 0% on an increase request. I originally filed in 2009 and was awarded the 10% TBI and denied PTSD. I filed a NOD at that time and wrongly assumed that they would call me in for another C&P and did not submit additional evidence. My appeal was closed in 2012 with no action. My last C&P notes on blue button state that I presented with same symptoms as 2009 C&P. Also, I realize the rules were different back then, but I had documented stressors (Combat Action Badge and serious incident reports). I plan on appealing the PTSD effective date and TBI rating. Please advise.

[Gastone]

Mrs B, I took the (5) Denial Discussion regarding "Personal Assault," as being related to the claimed PTSD Stressor.

If that's the case, I don't think the CIB or CAR come into play as far as a Stressor Concession by VA for a PTSD Claim, but then again, I've been wrong, at least once or twice, maybe 3 times.

It will be interesting to see how the Rating Dept handles a New PTSD Claim, where the Vet switches gears from a prior 09 Claim Denial, as to New Stressors for the New Claim. MH Clinician Notes and DX's are going to be crucial.

Sure would like to see a redacted copy of the 09 PTSD or other MH DBQ, would be very informative.

Semper Fi

[Berta]

"Personal Assault" issues need proof of the personal assault. We have info here on those types of PTSD claims.

Also don't forget, the VA requires a VA MH diagnosis of PTSD. However they would have to accept a diagnosis of any other MH issue from a private shrink.*

That is why I mention here from time to time that a vet should not lock themselves into PTSD when they might well have depression or a ratable

acquired adjustment disorder.

The amount of comp and they way they rate them is the same for all MH issues.

* I mean a diagnosis in an IMO/IME that follows the IMO criteria here at hadit, with a full medical rationale and the key lingo VA is familiar with...The topic here is searchable under Read First Before getting an IMO.

 

 

[Berta]

Buck said

"I wounder some times if them raters even know how to read & count"

For the past 2 days I have had to get together all of my VA denials and awards for a personal matter I may not even need them for.

I have a stack of proof of what you have said. They cant read and they definitely cant count.

They erred on $ 99,570 bucks they owed me and I already rattled off that info here before I think .They sure paid me when I raised Hell but when I see these decisions I have and a couple of audits they did , I just get pissed off again because I don't know

if it is incompetence or if they are ordered to try to screw us. or both.

[flores97]

Billielea, I noticed you have been waiting on your cfile for a year. I recommend you get in touch with your local congressman or senators office and ask for assistance in getting your cfile. I waited almost two years on mine, got fed up, contacted my congressman, and had it delivered on my doorstep by ups about a week later. I hope that helps and Good Luck to you on your claims.

[Billielea]

All,

Thank you for the response's. Due to me posting all of my documents intermittently, there seems to be some confusion with the timeline and issues. I will attempt to run thru this chronologically and repost all documents including my 2015 decision which I had not previously posted and answer all questions.

March 2009- Filed original Claim for the following issues and received results October 2009 (see 2009 - Rating Sheet below) I do not have the entire decision packet:

1. TBI - 10 % SC
2. Residuals, gallbladder removal - 0% SC
3. Back Condition - declined SC
4. Psoriasis - declined SC
5. PTSD - declined SC / Stressor conceded as combat action badge.

October 2010 - Filed NOD / DRO for PTSD

March - 2011 - Appeal decision received. I never stated that PTSD was due to MST. The paragraph on page 2 of 2011Appeal decision below is just the last part of 10 pages that I cut out covering rules and US code that they sent in the letter. The actual decision starts at the bottom of that page. Results:

1. PTSD declined - I did not submit any new evidence. Diagnosed as "adjustment disorder with mixed anxiety and depressed mood". Blamed on me worrying about my husband returning to Iraq, even though he had just returned???

October 2014  - Initiated following claims: (I had transferred to the North Texas VA and had finally began receiving treatment after being fed up with OKC VA. I live in southern Oklahoma, so its a drive for me to go to either one)

1. PTSD - Re-open Claim.
2. TBI - Request for increase.

May 2015 -  I reported for C&P exams at the Dallas VA clinic for PTSD and TBI. I'm not sure if this is relevant, but I received a call while my husband and I were driving there stating that the TBI examiner had to leave early and they would have to re-schedule that exam. I protested because it is a 3 hour drive. They called me back 10 minutes later stating that he would conduct the exam. He seemed pissed the whole time. His notes stated that No TBI residuals were present.  This is also the exam where the PTSD screener stated "However, it should be pointed out that most of the symptoms the veteran described during today's MH examination certainly those common to a PTSD diagnosis- she also described during her 7/8/09 Initial PTSD examination, in Oklahoma City, three years PRIOR to her son's illness."  ( see 2015 C&P exam notes below)

June 2015 - Latest decision received. Results (see 2015 - decision part 1 &2 below):

1. TBI - Decreased to 0% SC
2. PTSD - 50% SC

May 2016 - Wondering what my best next COA should be? Would like to get PTSD effective date back to 2009 and get TBI increased to at least percentage it was before. I have about 50 days to file my NOD.

Q&A:

• Berta: What did the C & P doc diagnose you with?
  • 2009 - TBI (SC) and adjustment disorder with mixed anxiety and depressed mood (not SC)
  • 2015 - No TBI residuals and PTSD w/ major depressive disorder.
•  
• Berta: Have you googled the doctor who did the C & P?
  • I do not know the Doctor's name from 2009. But I have found several articles referring to a Dr. Gail Poyner who was conducting PTSD exams at OKC VA at the time. She was fired from the VA in 2010 for applying test to Veterans to see if they were malingering or faking. Her research paper can be found here: http://link.springer.com/article/10.1007%2Fs12207-010-9076-x?LI=true I would like to have my C-File to see if she conducted the evaluation.
•  
• Gastone: What did you claim as the PTSD Stressors in your 09 app for PTSD?
  • Combat Action Badge
•  
• Gastone: The 1st Denial, discussed "No Evidence of Personal Assault," MST?
  • No MST ever claimed. The paragraph that covers PTSD due to MST was just the last paragraph of 10 pages of regulations that they sent with the decision. Actual decision starts at the bottom of that page.
•  
• Gastone: Did you know anything about the DRO Process Requirement, for the N & M Evidence?
  • I did. My fault I didn't send any. I was fed up with OKC VA and assumed they would send me for a new C&P exam. Stupid on my part.
•  
• Gastone: Did you ever get a copy of your 09 PTSD C & P DBQ?
  • No, I did not. Blue button records do not go back that far. I have requested a copy of my C-File. EBenefits states that I will get it between NOV 2017 and NOV 2018.
•  
• Gastone:  Do you currently have a VA MH Psychiatrist/Psychologist that treats you on a regular basis?
  • I was being seen at Bohnam, TX VA. After they kept switching Dr's a few times, I now just get my meds re-filled thru my family physician. My husband is active duty, so we are on tri-care prime remote. I also qualify for VA choice, but have not used it.
•  
• Gastone: Have they given you an official PTSD DX?
  • I have a PTSD diagnosis and receive 50% SC in 2015.
•  
• Berta: Did they have the incident reports?
  • I faxed in two incident reports. They do not show on the evidence list, but stressor was conceded with CAB.
•  
• Flores97: Email congressman for C-File.
  • Thank You for the advice. I emailed my congressman today and reiterated the time crunch I am under.

 

 

2011 - Appeal decision.pdf

2015 - C&P exam Notes.pdf

2015 - decision part 1.pdf

2015 - decision part 2.pdf

2009 - Rating Sheet.pdf

Edited May 6, 2016 by Billielea