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missunderstood

How Do I File for P&T

Question

I just got approved for PTSD as schedular 100% and have had it at 70% since 2012. Since they have increased me to 100% for the PTSD dated back to 2014 when I filed for TDIU, it now shows that my service connected PTSD is effective from 2014 although I have been getting paid for it since 2007. I have not improved and only now have gotten the 100 % that I should have been at from the beginning.  They also have approved me for SMC S1 since 2014 as well. My question is. how do I apply for P&T? My PTSD is not going to get any better as it has been increased steadily over time from 30% to now 100%. Should I file an NOD or should I appeal? Not sure what route to go. Please advise. Thank you in advance.

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VA is very reluctant to Award MH Conditions as  T & P. Probably 99.9% of MH Private & VA Clinicians believe with a great deal of certainty, ALL MH conditions can improve with a combination of Therapy & RX's.

Age doesn't come into play with IU, but it does as far a Scheduling future Exams if over 55. You maintain your SC % past 60/65, T & P is pretty much a lock.

If your under 55, getting the T & P on appeal is uphill, file the NOD, you got the time.

You got the SMC S (1) because a sharp eyed Rater realized your PTSD was now considered as 100% from the IU Award and your non-IU considered SC's totaled 60% Combined, making you Scheduler Eligible for SMC S, no Dr's Housebound Application necessary.

Semper Fi

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Thanks for your response Gastone. My PTSD is actually rated at 100% alone. My other ratings are....well i will post it so i don't have to write it out. I see a lot of people on here that have gotten 100% P&T for mental health. I just hate that it progressively has gotten worse yet they wont make it P&T.

 

Disabilities %

Total Combined Disability

You have a 100% final degree of disability. This percentage determines the amount of benefit pay you will receive.

How is this calculated

Rated Disabilities

Disability Rating Decision Related To Effective Date
         
         
tinnitus 10% Service Connected   05/13/2007
         
migraines 0% Service Connected   05/13/2007
         
post traumatic stress disorder (previously rated as anxiety disorder with depressive features under DC 9400) 100% Service Connected

Personal Trauma PTSD

08/13/2014
         
Thoracic spondylosis with chronic strain 40% Service Connected   10/16/2009

right lower extremity radiculopathy 

10% Service Connected   08/13/2014

left lower extremity radiculopathy 

10% Service Connected   08/13/2014
chronic urinary tract infections 40% Service Connected   05/13/2007
irritable bowel syndrome, claimed as gastroenteritis 10% Service Connected   05/13/2007
     
Edited by missunderstood
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Oh I have been receiving SSDI solely based of my PTSD since 2008. I guess I just don't understand why I am not P&T by now.

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A very helpful post, more info always make things much clearer. 2014 Bump in your PTSD to 100% SC triggered the SMC S (1) automatically, didn't take a sharp eyed Rater.

You made a statement that had (Emotion & Feelings) in it, regarding your PTSD Rating 2012 70%, "should have been getting paid for it since 2007." Were there prior Denials that were Appealed. No matter what you think or feel about anything related to your Initial PTSD VA DX, you didn't officially have PTSD until the C & P Psychiatrist made his DX, in 2012.

What Medical Evidence is in your C-File that makes you believe you should be Rated as T & P for your PTSD? How about posting a redacted copy of your 2012 & 2014 PTSD DBQ's and their respective Award Letters. Did the Rater address the T & P issue at all? Did you NOD the 14 Award in 2015?

Any discussion in either 12 or 14 Award Letter, regarding Future Exam Scheduling? If your not 55+ or North of mid 60's getting a New Award, or T & P, your C-File will be Diary Dated for a Scheduled Re-exam in 3 to 5 yrs.

If I'm recalling this accurately, Per VA Reg, your 70% PTSD Rating gets locked in, no possible reduction after 10Yrs, that's 2022, right. Same goes for your other 2012 SCs.

Semper Fi

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You made a statement that had (Emotion & Feelings) in it, regarding your PTSD Rating 2012 70%, "should have been getting paid for it since 2007." Were there prior Denials that were Appealed. No matter what you think or feel about anything related to your Initial PTSD VA DX, you didn't officially have PTSD until the C & P Psychiatrist made his DX, in 2012.

To answer this No. I got out of the military already diagnosed with PTSD in 2007. The VA had me rated at 30% for PTSD at that time. I filed an appeal for the rating and was BVA approved and bumped to 70% in 2012 with retro back dated to I believe 2007 or 08. I never received the BBE due to wrong address so I missed the deadline to appeal that and was stuck with the 70%. I only filed for TDIU and NOD at the same time in 2014 which both were stated to be invalid recently (September 24 2016) so I had them reopen my claim about a month ago and that is when they have just now awarded the 100% with SMC and backdated it to the original TDIU claim I filed in 2014.

What Medical Evidence is in your C-File that makes you believe you should be Rated as T & P for your PTSD? How about posting a redacted copy of your 2012 & 2014 PTSD DBQ's and their respective Award Letters. Did the Rater address the T & P issue at all? Did you NOD the 14 Award in 2015?

I would if I could but I wont receive my c file for at least another year. I never even knew what those were until I joined this forum and only recently requested it. I plan on NOD the 2014 award when I get the award letter in the mail (any day now) only to request the P&T rating. I was hospitalized twice during the appeal process for suicide attempts and was told by the VA doctor on the ward that I should be at 100% (I know that means nothing unless she puts it in writing which i do not think she did). I think that the reason they did not award P&T is because they think that PTSD will get better. Mine has not and will not. I have progressively gotten worse as my ratings increases indicate. I am going to try and get a IMO that states that it is permanent.

Any discussion in either 12 or 14 Award Letter, regarding Future Exam Scheduling? If your not 55+ or North of mid 60's getting a New Award, or T & P, your C-File will be Diary Dated for a Scheduled Re-exam in 3 to 5 yrs.

Don't have it yet but I am pretty sure they have addressed it and state that they have scheduled a future exam.

If I'm recalling this accurately, Per VA Reg, your 70% PTSD Rating gets locked in, no possible reduction after 10Yrs, that's 2022, right. Same goes for your other 2012 SCs.

Well they have now changed my PTSD date since they awarded it at 100% to 2014 so I think that bumps that to at least 2024.

**I should also add that I have an appointment with Voc Rehab on the 7th of Nov.  Will a denial from them help with my P&T claim?

Edited by missunderstood

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