ptsd Unsure how to move forward

[M1A2Tanker]

Hello,

I could really use ya'lls help.  This is only second post and I'm reaching for help as I have a few questions I can't seem to find and when I call the VA no one knows how for me to proceed.  First, I am OEF veteran and rated 60% for my back (2 back surgeries after deployments) and 70% for PTSD, 10% tinnitus.  I am currently working full time and I'm struggling y'all.  I am having major insomnia and I'm dealing with chronic back pain from sciatic nerve throbbing down my left leg.  Most days, it's grit your teeth and soldier on.  I'm not getting any better over the last 15 years and I decided tonight I have to put in a new claim.  It's got to be done.

I don't know how to proceed with my claim with everything I have going on right now?  Currently, I'm seeing a psychiatrist at the VA for PTSD.  I don't know if I should file secondary claim to my back for chronic pain syndrome, or depression or insomnia?  How are these linked to PTSD, but they are also coming from my chronic condition with my back.  I can't get comfortable at night to even get to sleep, and no sleep/ work is building depression that I know is coming from pain and no sleep and not able to function.  I know I have chronic pain with my back but I don't know how to proceed with all these.  I'm supporting my family working I can't quit to do a TDIU claim?  How do I move forward?

I know you can only claim one MH but does that also include counting for a secondary for a chronic condition, as well?

THANK YOU all in advance.  I GENUINELY appreciate your thoughts.

[lotzaspotz]

Your profile says you're rated overall 60%, but if you have a 70% rating for PTSD, 60% for your back, and 10% for tinnitus, you're rated overall at 90%.  There's a big jump in compensation from 90% to 100% schedular (not TDIU), but to get there, it looks like you'd need additional ratings of 50%.  That would bring you to 95% rounded up to 100%, if I'm not mistaken.  That's a lot of ground to cover with additional claims.  I know you said you have to continue working, but it's feasible that if you did not, your PTSD could be the reason for TDIU paid as if it was 100%, plus you would have the ratings for SMC(s), for an additional $300+ per month (depending on the number of dependents), plus you could apply for SSDI.  You can't do any of that while you're working.  You're having trouble with physical symptoms that are interfering with your sleep, your mood, and your ability to continue working. If your goal is to reach 100% and then quit work, that's going to be a difficult road to travel on a schedular basis.  I'm also thinking that the fact that you're still working is possibly what is keeping you from being rated 100% schedular for PTSD (not TDIU).

Others will chime in here if I'm missing something, but unless you can get additional ratings of at least 50%, TDIU and SSDI would be the way to go.  Take a look at the rating criteria in 38 CFR for sciatica and insomnia, secondary to service connected back disability.  

Is there any chance your spouse could work outside the home and you could handle management of home and family while TDIU and SSDI applications are pending?  

[ArNG11]

lotzaspotz you are always tracking right on target. Could not have stated better. Very similar to what was my situation, however, my back ratings have not been correctly thus far.  BVA is where I am getting that straightened out.

Speaking from my experience in my claims, this is similar to the hurdle that I had to cross and decide on.  Schedular 100% is a difficult path to follow if you're wanting to continue to work.  Not impossible, however, not really a practical pursuit, at least this is my opinion.  

I wanted to continue to work, as I enjoyed my career, however, my disabilities where making working way too much of a stress both physically and mentally.  In the end, calling it quits was hard to accept, however, turned out to be the best decision I made, but it was difficult to come to terms with my predicament.

 Physically I was done, I could not perform my duties no where close to what was required and continuing to work made my physical and mental issues so much worse. My key obstacles were my back, PTSD, and lower extremity issues.  In my case once I lost control at work I knew I had to throw in the towel.

Your key issues, those you mentioned above are the most logical to pursue.  A medical opinion would be the most helpful here, coupled with perhaps a vocational experts opinion.  These two items will greatly support Lotzaspotz advice. I am in agreement with her suggestions.

JMO.  Good Luck, also don't dwell on having to stop working, you must do what is best for your health.

[broncovet]

Dont ask for an increase of PTSD secondary to something else.  Your service connection for PTSD is already established, so dont establish it again.  If your symptoms of PTSD worsened, then simply ask for an increase.  Ditto for other issues to which you are already SC.    Other than TDIU, which you wont get while working, the only other way to get to 100% is to get  an increase, or get rated for new conditions.  

My suggestion is to order a copy of your cfile, and ask for an increase.  Then, when your cfile arrives, compare the symptoms you had on your rating decsion which gave you benefits, with the symptoms the doctor says you have now.  

Its confusing what you are rated now, based on your post, because you stated that you were 60%, but had a 70 percent rating for PTSD, and then more, too.  Lets say you are 70%, and you were rated that in 2005.  In 2005, you went to the mental health doc twice a year, and now you are going once a month.  Lets further say you were on one med in 2005, and now you are also on lorazepam for panic attacks, and still more meds for more symptoms.  Then argue your condition got worse, because it did.  If you look at the criteria for mental health disorders, see how many of those symptoms you have in the 100% category vs the 70% category, especially related to social and occupational (work).  

General Rating Formula for Mental Disorders

	Rating
Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name.     70% criteria follows:	100
Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships.

[M1A2Tanker]

Thank you all for your thoughts.  To clearify I have 60% on my back, 70% PTSD, 10% tinnitus for a Total of 90%.  This definitely helps to understand my options better.

I have never heard of SMC(S)?  What exactly is that and how does that work?

[lotzaspotz]

If you have one disability rated 100% schedular or TDIU rated at the 100% level (even though your PTSD is rated at 70%), plus you have an additional rating of at least 60% single or combined for an unrelated disability(ies), in this case your back and tinnitus, you should qualify for special monthly compensation at the "s" level for housebound status based on statutory authority.  In other words, the statutes that guide the rating system state that these ratings in and of themselves qualify you for SMC(s).  You are not required to be literally housebound.  Alex Graham has a fantastic explanation of Special Monthly Compensation on his blog at www.asknod.org, and you can find discussion about it in the Forum here at hadit.

[M1A2Tanker]

Thank you for correspondence.  It's been most helpful.