PTSD c&p what next

[Cole23]

I'm sorry this is so long. I just wanted to give all info:

My entire situation is my husbands ptsd back in 2016 he recieved a proposal to reduce on his ptsd from 70 to 50. I asked for a hearing and sent in a bunch of evidence with it including a letter from his va therapist. The case was closed within 1-2 months and he remained at 70.  He is 100 overall but going from 70-50ptsd takes him down to 90. 

Fast forward to April  2018 he receives a phone call from a hearing judge saying we missed his hearing can he do it right now over the phone (we NEVER got the letter I open everything from the VA immediately).  He tells the judge he thought the case was closed (which in ebennies it was) but goes on to answer the questions. About a week afterward he gets a call from the local VA saying he has an appt scheduled for May 1st (10 days from the date of call) for a c&p for PTSD but they had an opening that afternoon if he wanted to come in then, he declined and they kept the appt for May 1st.  Again we didn't get a letter from the VA for the c&p yet so I call the va benefits coordinator at our local va and he says the letters are showing in the system. After calling him I finally receive the c&p appt letter on APRIL 30TH and for the first time ever there is no post mark date on the outside of the envelope. Ok no problem he knew about the appt from the phone call. 

So he goes to the appt comes home and says he was with the examiner for 10-15 minutes. He said I just don't feel good about it he only asked me a few questions and kept asking "anything else?"  Part of my husband's issue is memory loss. He doesn't know what they're looking for if they're not asking specific questions. So anyway I tell him it's ok they don't go just based on the c&p they look at your therapy notes too (he's been in therapy at the VA for 3 years basically 2x a month).  

Well now on the 15th I go into ebennies and there is no open claims or open appeals or any notification letter sent but when I go to disabilities it's showing 90% overall and 50 ptsd date 8/1/2018. So I go look at the c&p and the examiner states this is not a mistake this is progression. I would be fine with that if it were true. However his therapist (that he sees twice a month) says his progress is poor.

So my questions are:

How do they give more weight to a single exam than 3+ years of therapy? I was under the impression that they weigh all factors?

I don't know if I should call them bc I haven't received the letter yet or wait another week? but I don't know how long ago they made this decision, I just happened to see it on the 15th and now we're at the 21st and haven't gotten anything. I just don't want it to cut into my 30 days to appeal. And should I appeal or is there something else I can do?

Thanks for any help

[Buck52]

Cole23 here is the rating formula for PTSD  FROM 0%   ALL THE WAY TO 100%

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

 

[Cole23]

Thanks,  I know that he meets the criteria for 70 at the least.  I have been reading this forum and I just wish that I knew before his appt that I could have gone with him or even to have given him notes on things that he doesn't even realize he's doing, he forgets things so easily.  He downplays some things that I think would be relevant like he said he has no violent outbursts but he recently had a road rage incident where his father was with him and since the other person backed down (which is usually what happens) he doesn't consider it a violent outburst because it wasn't physical. His father went home and was telling his mom how crazy it was, it literally scared him. 

[Cole23]

Ok so we recieved the letter from the va.  It says that they reviewed all of the evidence that I sent in in 2016 (statement from myself,  his therapist that he sees 2x month,  and his psychologist- they stated his ptsd remains severe).  I thought this proposal was done and over with considering ebenefits said that claim was closed after I sent in those statements. 

So the new letter says that after reviewing ALL  of this evidence the decision is final. I'm just in shock. His symptoms have not gotten any better and his progress reports show that. So my question is can I file an NOD? And if so will he be reduced in the meanwhile?  

I don't have a VSO bc the guy locally told me we should be happy with what we got because my husband is young,  and that was when the original c&p gave him 30% for an adjustment disorder. My husband is a combat veteran with a CAB.

[Gastone]

Of more concern right now, should be your preparation for the reduction in monthly SC Compensation and how the VA proposes to recoup the Overpayments made from the date of the original Intent to Reduce, that you Appealed.  The very last pages of the Reduction Letter will contain what Appeal Rights you have.

Is this Reduction Appealable, quite possibly? Your 1st stop should be getting with a POA-VSO, A Vet Claims Agent (VA Lists Claims Agents by States/Cities) or even possibly a LOCAL VA Appeals Lawyer. Any POA-Representative can directly access your C-File to see how things went South.

Hadit members generally need redacted copies of actual VA Rating Dept Decisions to determine a Vets actual problem and the best course of action. All the Vet's emotional thoughts and feelings have nothing to do with Claims/Appeals adjudication, it's all about the Facts and Evidence.

If you haven't already done so, File a VA C-File FOIA Request. You'll definitely need a Searchable CD Copy of your C-File for your future Appeal. Stop in at your VMC Med Record Dept and request a CD of his complete VMC Medical record.  Whoever assists you with your Appeal will need these.

[Cole23]

I don't think there is a recoup in payments. It says this rating reduction will take place in August 2018.  I'm going to assume that is because the 2016 case was closed (?) 

Ok so the c-file is different than the stuff I can download off ebenefits?

[Gastone]

Assuming is never wise. I could be wrong, your Decision Letter will certainly address the issue of a Clawback it required.  When a Vet receives a notification of Intent to Reduce and files a Timely NOD within the (60 days) Appeal Period, the Monthly Comp Amount continues until final Adjudication of the Appeal. You'll know for certain, soon enough.