Tricare New Changes cost WAY MORE!!

[Grumpbox]

Hey folks...I wasn’t sure where to put this, so here goes.

I guess this year, Tricare made some changes. My total pay out is now $3,000.00 before Tricare Insurance starts to kick in.

 I am 100% P&T but don’t live close to a VA facility; plus, I have my daughter (16) and wife on my insurance. These amounts are piling up!!!  I called Tricare and they said it doesn’t matter if I am 100% P&T.

 

Can anyone provide me with some advice.  I’ve got all the Tricare numbers/website, but is there something I am missing being 100% P&T that I am overlooking that could offset these mounting bills???

 

Many thanks!!

Grumpbox

[Gastone]

A redacted copy of the TBI/PTSD Award would be a great Read.

[Grumpbox]

4 hours ago, Buck52 said:

Roger That!

Grumpbox  I notice you have TBI/PTSD Listed as 100% and all your other ratings follow.

Question...How did the VA Rate your TBI/PTSD Together? or did they seperate the two? for 50% rating each? or total 100% for both? 

I understand the PTSD Ratings  but I do not understand TBI & just how they rate these two together being both fall under MH Disabling Criteria?

and also the Post Concussion Headaches 50% as separate rating? It seems that would fall under the TBI Rating Criteria.

It would help some of us learn just how they rate the TBI/PTSD?

Thanks in Advance.

@Buck52 First I had my 5 year C&P for PTSD this past fall.  Well, the examiner never listed other conditions, despite it saying right there: TBI.  You see, I was NEVER rated for TBI since retirement. The TBI was lumped into my PTSD rating. I never thought anything about it or knew it was a separate condition. 

Ok, moving forward now with the results of my recent PTSD review.  I guess the man upstairs was looking in on me, because whoever was my reviewer at the VA saw the word TBI.  And, since I had never, ever been screened for TBI, this reviewer scheduled me for a TBI C&P!!!  It all makes sense now actually with my vertigo, headaches, and loss of both short/long term memory, and difficulties with concentration.

You see, I never put in a claim for TBI.  Remember, I was medically retired and the army did all my claims through the VA.

Ok, back to the TBI C&P.  So I went to the TBI C&P and a very nice lady neurologist asked me questions and performed a bunch of tests on me.  In short, she ruled in favor for my TBI while the Army in the past just pushed it off.  Remember, when I retired, I knew nothing about claims, or how a doctor's note can hurt or help you, because I believed what any doctor would tell me.

After my TBI C&P, the VA immediately scheduled me for another C&P for PTSD.  Yep two C&Ps for PTSD within a 4 month period.  I was so nervous, confused, and feared the worst.  So when I arrived for this 2nd C&P for PTSD, the first thing this female doctor did was apologize to me, and I could see her frustration with how the VA handles PTSD/TBI patients.  

She basically told me that the VA is unable to differentiate PTSD sysmptoms from TBI symptoms, so in short, the VA lumps them together.  Mind you, I specifically asked her: But aren't PTSD and TBI separate injures? Meaning, isn't PTSD a mental condition and TBI an injury? She said yes, you are right, followed by (as she said), and this is what really concerns me about how the VA treats Vets.  The whole C&P with her was brief...maybe 20-25mins.

With regards to the headaches, the Neurologist asked me several questions about that, also.  If I am right, I do believe in the CFC that headaches/migraines are a separate condition.  While they are connected in one sense, for VA rating purposes, it is a different rating.  At least it was for me.  

Again, all this time since my medical retirement, I never filed for a claim nor sought treatment for my TBI, headaches, or vertigo.  I basically just thought I was just getting older and slowing down.  I know - this is stupid, but I can't help but think that my absence of filing for increased award caused these doctors to shed some empathy on me and demonstrate further the frustration how the VA (and for me) how the DOD handled my medical retirement.   

Hope I answered your question, Buck!!

[Grumpbox]

@Gastone Got the letter right here, but unsure how to make changes once I snap a shot of it with my phone...

Advice???

[Buck52]

Roger that Gumpbox,  I understand what they did, they have a duty to assist the veteran and look at all his disabilities and check the severity of the symptoms  and give the appropriate ratings to the highest rating allowed in conjunction with the CFR's and the criteria for each condition  TBI/PTSD so they were unable to differentiate the two like they said  so when this happens they have a lump gap to to invite the two separate conditions as a mental condition and also an injury  this is what makes it hard for them to know what to do?.so they give a rating for both,.

what is even harder to understand  you didn't have  a Diagnosis for TBI did you?

Unless the C&P Examiner was qualified to give the TBI Diagnosis?

 ''You Quoted''  ''And, since I had never, ever been screened for TBI, this reviewer scheduled me for a TBI C&P!!!  It all makes sense now actually with my vertigo, headaches, and loss of both short/long term memory, and difficulties with concentration.''

I've never seen the special rating table for the TBI?  Or Rating sheet criteria for it , like they have for the PTSD

The old TBI  Back in War War II was called  shell-shock or bipolar PTSD Same with the Vietnam era Veterans   except now they do have the PTSD/TBI   for Nam Veterans  CFR  38 3.310   But if they don't have it their STS's OR some record  medical notes or morning reports of the event from combat to report the injury its hard to win the claim  b/c/ back then most of us never reported the 2:00am party of Mortars hitting outside the Hooch  we just jumped in the Bunkers and played cards.& let charlie have his fun, now if one was hurt pretty bad  we haul him in for the medics to look at and I'm sure this was reported for that soldier at that time...but most of us never went in to get medical attention to be looked at...Hell at the time I never knew we could be compensated for our injuries or mental health problems after we return home.  lots of things I witness over there went unreported or it didn't happen.(according to higher command) we all just did what we were ordered to do and never thought twice about it.

https://www.law.cornell.edu/cfr/text/38/3.310

 I would say you did get a fair rating  as most veterans with TBI/PTSD just get one rating or the other.(the older ways of rating the PTSD/TBI)..probably whichever is more severe (is my guess) in this case you got both...just hope they don't do an administrative review  or they may change it. (what is your age?)

Not sure if your retirement had anything to do with them rating this the way they did   but to me it seems to be a fair rating...you do get the SMC's  correct? if you didn't  you may want to check the criteria out b/c at the time they rated you for the TBI/PTSD 100% together  and all your other combined ratings  them should qualify you for the SMC's and inferred  them to you if the injury is was severe or cause you severe health problems and at 100% it  is pretty severe and that's what they look at to invite the SMC,  in my opinion you should qualify.

  Also if you have not yet filed?   file for SSD...get all you can coming in as for as InCome.

Thanks for the clarity of this TBI/PTSD Rating.

I appreciate it.  and thank you for your service and sacrifices. 

Edited April 29, 2018 by Buck52

[Grumpbox]

@Buck52 

12 hours ago, Buck52 said:

what is even harder to understand  you didn't have  a Diagnosis for TBI did you?

Unless the C&P Examiner was qualified to give the TBI Diagnosis?

The following is what Ebenefits had for me I was medically retired:

"Posttraumatic stress disorder and anxiety disorder, NOS (claimed with insomnia) with traumatic brain injury and vertigo (claimed with memory loss)"

Upon my retirement, this rating was for only 50%.

One year following my retirement, VA requested a C&P for this condition.  Mind you, I knew ZERO about a C&P or the impacts it can have on one's entitlements. Within this first year after retirement, I had lost my marriage of 14 years and lived on $400.00 a month. 

After this C&P, the VA increased me to 100%.

NOTE: At the time, the VA never scheduled me for any type of screening for TBI, nor did I have an independent award for TBI.  It was my fault...knowledge is power and considering all that happened to me losing my marriage, I really didn't care. 

Now we move forward five years later - the fall of 2017, whereby the VA contacted me requesting my Five Year C&P for PTSD.  It came as a shocker, and I was terrified, because I was living on sufficient income to get by.  This prompted me to join Hadit.com and so starts my legacy gleaning knowledge from you folks!!

Since last fall, I've had three C&P apts, in this order: One for PTSD, one for TBI, and one for PTSD.

The first C&P for PTSD was imo done wrongly and not in accordance with VA regulations. I say this, because the doctor didn't use my records.  In fact, he couldn't have, because he never listed or looked at my current PTSD rating/history.  IT SAYS IT RIGHT THERE: posttraumatic stress disorder and anxiety disorder, NOS (claimed with insomnia) with "traumatic brain injury and vertigo" (claimed with memory loss). TRAUMATIC BRAIN INJURY!!!

Here we get into where imo the reviewer at the VA saved me.  He or she noticed the TBI comments and put me in for TBI C&P.  

SO, TO ANSWER YOUR QUESTION, NO - I was never rated/screened for TBI.  All this time, Buck, I've never been screened or received care for TBI.  

TO ANSWER YOUR SECOND QUESTION, YES - the doctor was a Neurologist that conducted my C&P for TBI. She was very knowledge in her field and asked many question about my symptoms, events while deployed, types/magnitude of explosions, and she conducted some tests on me that day.  PLUS!!!  Check this out! She reviewed all my past records and saw where I had complained about headaches, dizziness, vertigo, loss of memory, etc. I had multiple listing where I had visits doctors at Fort Sam Houston, TX. 

After these results and her comments hit the desk of my reviewer....well, you know the rest, I was set up for another (and my last) C&P for PTSD.  This is the one where I mentioned earlier that the doctor was apologetic about how the VA has handled my situation and she disagreed with the first doctor that evaluate me for PTSD, because he never used my past records or listed other injuries/illnesses. 

And for your last question: Yes, I receive both SMC S&K.

With regard to SSD.  This is a sticky subject for me. I know I am eligible, but my conscience has issues with applying.  Plus, considering my wife's income, to be honest, I am not even sure if SSA will allow me draw SSD?????

I really wish I knew someone that was an expert in this field.  Within Hadit under Social Security Forum, I've posted some questions about SSD.  But one can only learn so much typing back and forth - so many other questions arise outside a forum.  Maybe its me...I do overthink things way too much. Still, I like to know as much as I can about something before I commit. I want to know the pros and cons, because SSD is a major decision imo. 

Services and Sacrifices??  Honestly, I don't feel like I made much of an impact or did that much.  I simply did my job.  I even had an opportunity to get a Purple Heart while deployed, but I turned it down and told my Company Commander not to put me in for it.  We hit a very bad IED...the largest in the Battalion, and I was knocked out and went to the medics.  But they were handing out Purple Hearts like bottles of water.  I told the medics I was fine and to look after my Soldiers.  I was an E&/SFC(P) at the time serving as a Platoon Leader, so those young medics did what I told them. 

I guess I look at the Purple Heart and the SSD in similar ways now. Don't get me wrong, I'd love to be a recipient of the Purple Heart, but I want to earn it, not have it given to me.  There are some things that gnaw at a man, I guess at the time when this happened, I didn't want this gnawing at me when I was old and decrepit.

Its you that need thanking Buck.  You boys over in that God-forsaken county had to endure more than our generation did.  Well, at least I feel that way...just imo.

  

[Buck52]

Roger that,

My feelings about the P.H. are same as yours.

   My Borther-law recieved his P.H. but was not around to accept it at 23 years of age he lost his life at Quang Tri Province Vietnam July 27th 1968.

 I've always felt the medals are for the badly injured soldiers/and the ones that lost their life in the duty protecting our country.    just because some of us were in combat and never was hurt physically and can go on about our business every day  don't truly Deserve a P.H.  ...>The ones that do Earn it.

http://www.virtualwall.org/df/FoleyWL01a.htm

We did have a elder hadit member that understood the SSA pretty good and was very knowledgeable '' Phillip Rogers'' Which spent countless hours of his time here on Hadit helping veterans like you and I get their benefits to include the SSD  but he as went on to enjoy his life and see the world as he was just burned out here at hadit...which I don't blame him,  we all wish him Well  he is a great Veteran Advocate and good friend to all of us here at hadit.

I never had enough work credits to recieve the SSDI as this is what SSA mention to me and denied me twice  ..looking back and doing research they were wrong  but since the laws have changed since I filed for SSD the time limits for filing run out as I've age over the age 65..so I took the SSA Retirement instead   I took the loss from what SSDI PAYS vs Retirement   the SSDI PAID ABOUT 300.00 MORE PER MONTH but it is what it is

but with my 100% COMP AND 2 SMC's  its a farily modest income  plus my spouse became totally disabled at age 60 And currently drawing her SSDI..so every little bit helps.

If you can get it and get it....its there for you  so file for it and just let them SSA clerks figure it out  I think you will get at least the minimum ....around 900.00 a month or more...so add that to your VA Comp and it will help you out ,  if you don't need the $$ just put it in a savings account for your family.

Edited April 29, 2018 by Buck52