ptsd Diagnosed housebound in 2008 by VA; is med diagnosis binding?

[Cannabis]

Hi everyone!

I started going to VA in 2008. I just discovered in my medical file that psychiatrist resident, as well as the head psychiatrist approved her diagnosis that I am housebound. That's 2 doctors. Then, over the next 2 years or so, many details in med record support housebound.

Sep 09, filed disability. 50% granted. (ptsd, depression, cannabis dependence)

Approx. May 2015, filed for increase. 100% granted, same as above.

I filed NOD.

My question regards this newly discovered evidence of record that shows since 2008, i was diagnosed housebound.  I also have current evidence of housebound, it's no mystery around here that I don't go anywhere. And haven't for years.

Is the disability examiner bound by this diagnosis in 2008?  If so, then

1. if I am housebound per physician diagnosis in VA medical notes, then how can I be 50%? Wouldn't that defacto be 100%

2. any ideas on approach for this?  NOD with SMC S claim to date back to Sep 09?  Or CUE?  Help!?

Thank you and bless.

 

Edited March 26, 2017 by Cannabis

[Berta]

"Did they have medical evidence at that time that your rating should have been 100%"

What I meant was, did they have medical evidence (such as a SSDI award solely for your SC issues and/or any documentation from VA Voc Rehab or any employment counselor that your SCs rendered you unable to be Vocationally rehabilitated, or any other documented medical evidence in VA's possession at time of the older rating decision that would fall into this criteria:

 

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.	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.	70
Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.	50
Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).	30
Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.	10
A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.	0

http://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&sid=c130ec487ea61b8a40ad0836188b94bc&rgn=div5&view=text&node=38:1.0.1.1.5&idno=38#se38.1.4_1130

I am assuming that the 50% was for PTSD and that the 100% you now have is also for PTSD which ,by medical evidence ,had put you into the 100% criteria when they awarded the 100% claim in 2015.

 

 

[Buck52]

I would call and open this back up  if they failed to give the SMC at the time he got the 100& but that was 2015..

The CUE would have been back in the original decision of 2009 is when the CUE was commited  in my opinion.

As  asknod had mention back in 2013  SMC is not a claim its a benefit based on your physical circumstances.  this veteran cannabis has his evidence based on that Dr' Opinion  he found in his records later.

Here is a post Ms Carlie posted back in 2013   for hedgey, that makes a lot of sense  she was very good with CUE'S and could very well shine a light for Cannabis

  On 3/15/2013 at 0:13 PM, hedgey said:

Hi again,

Thanks everyone for your replies and advice. As always, HadIt members are my best friends.

 

I read through his decision letter 3 times and there is no mention at all of SMC. It talks about additional benefits, but include only things like dental, dependent educational assistance, ID card access, voc rehab, etc. Not a word or line about SMC.

 

How can we get a list of his disabilities and percentages?

 

hedgey,

Since the decision makes no mention at all of SMC/S to include nothing in the narrative,

then SMC/S would not be an issue to file a NOD on, as VA has never made a decision on

SMC/S, there is no decision on this issue, to disagree with.

 

For clarity, was there anything in the decision regarding housebound in-fact ?

 

In the past I have actually had good luck (Sorry, I have to admit it when something works right)

with calling the 800 # to get an exact breakdown of my SC'd conditions to include

each separate Diagnostic Code (DC), effective date and percentage evaluation.

 

Since he has VSO representation, I would write something up on a 21-4138 requesting SMC/S

(with my question as to the procedural error of why SMC/S was not addressed on the most recent decision)

and also if one or more of his medical providers are willing to write something up stating in their opinion

he is housebound due solely to the SC'd disabilities , and support the opinion with full medical rationale

(this would surely be helpful too). This is what I would want my VSO to submit.

 

JMHO

 

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[Berta]

"The CUE would have been back in the original decision of 2009 is when the CUE was commited  in my opinion."

IF the VA had "prime facie" evidence that  was the SAME evidence that garnered the 2015 award yet the VA chose to ignore that same evidence in 2015  that would be a CUE under 38 CFR.4.6.

It is possible but what is missing here is the fact that a "housebound" designation is not part of the above MH criteria.

Prime Facie evidence of 100% SC due to an MH issue can also be in addition to a SSDI determination, that also holds employment info,and/or Voc Rehab determination, hospitalizations due to PTSD, increased PTSD meds or treatment, test results of the many multiphased PTSD tests the VA can administer........ 

I dont see any' prime facie' evidence here of 100% in the 2008 decision whether they said Housebound or not.

They might have meant a NSC condition caused the veteran to be housebound.

But the actual decisions will tell us more.

 

[Buck52]

Ms berta

what I don't understand is when they made the 2009 decision and in his records a Dr mention that this veteran was indeed ''Home Bound in fact'' in the 2009 decision & it as never mention.

and this veteran just recently found it in some of his records that date back to the 2009 decision...so by them not giving him the SMC-S1  wouldn't this be grounds for him to File the CUE? and if he wins they they pay him for the full SMC payment with spouse around 347/348.00  monthly for the SMC back to 2009 (correct)?

[Cannabis]

Thank you Berta and everyone else!

I didn't think I presented evidence here, only asking about how the raters/bva, etc., view the medical records. If there is any case law or decisions or handbook or manuals as to whether or not they are bound by what is directly said, and what is implied by the circumstances.  For example, MH rating does not require 'housebound' for 100%. But, if someone is housebound because they cannot leave due to anxiety, depression fear phobia ... and those things are admitted caused by SC disability, then housebound is an indication of P & T 100% ???  This is my theory I'm working on and so far, maybe. 

Back to research. Thank you.

[Cannabis]

1 minute ago, Buck52 said:

Ms berta

what I don't understand is when they made the 2009 decision and in his records a Dr mention that this veteran was indeed ''Home Bound in fact'' in the 2009 decision & it as never mention.

and this veteran just recently found it in some of his records that date back to the 2009 decision...so by them not giving him the SMC-S1  wouldn't this be grounds for him to File the CUE? and if he wins they they pay him for the full SMC payment with spouse around 347/348.00  monthly for the SMC back to 2009 (correct)?

Buck, homebound was not mentioned in the actual decision from the VA in 2009.  But homebound and criteria for 100% are clearly in my medical record from the VA. Which is really all I have from that time period.  Due to being homebound.  I used to go to VA for medical but I don't do that anymore.  And I recently stopped going out for food, found someone to deliver.  Mostly.  But i don't eat much anymore anyway.  I just have to get the decisions out and look at them and figure it out.  This all helps alot. Thank you.