ptsd Notified Of Rating

[RockyA1911]

I spoke with a VA service rep this am and was told my claim is in for authorization and rating was completed last Friday. I can't believe this crap. He told me that I have been increased from 10% to 60% with retro back to April 05. My effective date of my claim is 25 Mar 05.

The skull loss alone under diagnostic code 5296, inner and outer tables, for size exceeding 4.177cm or larger than a 50-cent piece at 50%. Both past and recent SMRs and VA medical records verified mine to be 4.5cm x 4.5cm. The skull loss was claimed in 1976 on the same claim form using the exact same medical evidence used when they awarded me 10% in 1976, for also claimed post concussion residuals the day after discharge from the Marine Corps. This is an open claim since Nov 1976 and I should get retro back to then according to the CFR. My entitlement arose in Nov 76 for the Skull Loss.

Since I was already getting 10% and if they awarded the 50% for skull loss but not retro, that is 60% combined right there.

That means they must have denied:

Post Traumatic Encephalopathy due to S/C TBI (C&P More likely than not)

Post Traumatic Stress Disorder (C&P More likely than not, IMO More likely than not, combat award)

Surgical Scar from TBI surgery and cranioplasty (C&P More likely than not)

Cognitive Disorder due to S/C TBI (C&P More likely than not)

Tinnitus (C&P more likely than not)

Skin Disorder (C&P more likely than not)

Unemployability (Psychiatrist and VA Neuropsychologist, both stated unemployable)

I guess I won't get the actual brown envelope to where I can figure out what they did wrong or what evidence they looked at. But, clearly they had to have not even looked or had a lot of it or were missing my claims.

Either way, after waiting almost two years this really sucks the big one.

I even made copies of the CFR reg on retro payments, the 1976 claim with their stamp on it, their 1977 VA

C&P and neurological exam report, and their 1977 rating decision rating decision form that even mentioned the skull defect and size in the narrative portion. At the bottom of the decision it had just "10% award for post concussion residuals due to head injury." I sent that two them almost two years ago with the statement in support of claim form and listed each document as an exhibit.

I just don't understand how they could have turned down seven of my claims as even just the Skull Loss and PTSD alone if at least 30% is 65 rounding to 70%.

I don't understand how the VA can service connect the TBI skull loss and the post concussion residuals due to TBI and deny service Encephalopathy, Surgical Scar, and cognitive disorder due to the same S/C TBI.

This IS FUBAR at it's best.

[RockyA1911]

The thing that I know is wrong and I am concerned is the claim for EED to 26Nov76 (day after discharge) claimed formally 15Nov76 (10 days prior to discharge).

What is the process to pursue when a valid claim is made back in 76 without a decision denying, deferring, or approving?

I can't appeal something that has not yet had a decision at all can I?

If the skull loss is not one of the listed claims included in the recent 60% decision, then am I back to it being an open claim? To re-open a claim would mean that there had been some kind of previous decision and in this case there hasn't.

How does one get a 30+ year open claim adjudicated by the VA?

I have read some CUE claims based on EED, but all of them that were denied was due to a long delay between the time they were denied without appealing the decision.

But again I only received a decision one of the conditions I claimed at the same time which there was an award of 10% and it specifically only addressed one of the two conditions I claimed while still in service.

The number two condition claimed was the Skull Loss, 4.5cm x4.5cm which is 50% per CFR diagnostic code 5296. This is an organic physical loss from an open not closed TBI of which that much skull was removed, brain debridement, and cranioplasty (plastic) formed to the skull where my own skull is missing.

The code they used to award the 10% for Residuals post concussion due to TBI is not to be combined with any other diagnostic code and will not exceed 10% when there is no objective finding.

So none of this washes and I'm really skewing now. Yes I have a cognitive disorder, memory loss, encephalapathy, and PTSD but I am not that dumb.

I think when I get the letter, I'm going to make an appointment and take all this crap and chat with Senator Barrack Obama and see what he thinks of this fiasco.

[marinejay]

Rocky a word of advice, so take it how you want, but others will agree with me.

When ever you open a claim with the va, always and i mean ALWAYS expect a low ball or better yet a denial, that way if it happens you wont be surprised. Now with that saying, you must always have a back up plan and try to anticipate what the va will do (very hard to do). With that you would begin to formulate a plan on how to attact the va from different angles.

Example: start seeing an out side doctor and getting an IMO that's in va standards, also start thinking on how you will appeal it, ie; by having a decision review officer or skip the process and go straight to the BVA as other have recommend.

I have about four claims going with the va right now, i am hoping for an increase, but at the sametime i am expecting them to deny or low ball my claims. So if that happens i won't be surprised. I have a draft NOD ready for their asses, only thing i will have to do is just formulate it to what i want to appeal and what i want to stay the same.

Battling the va is not easy and its a process that take years to make it right, "only the strong survives" and you have to be strong which is easier said than done.

hope this helps

marinejay

[Vike17]

Rocky,

Just wait for the official rating decision. You've already waited almost two years, so an additional couple of weeks wont make much of a difference. I know this may sound cold, but it doesn't do you any good to get worked up over it until you have the decision in hand. Right now you don't have any idea what the VA decided except for the fact you now apperantly have a combined rating of 60%. Hell, the VA might have awarded everything at 0% and/or 10%, which would still be, according to your information, an incorrect rating. Just wait until the award letter comes and then you can share it here, and maybe I can shed some light on the subject to see what, why, and how things materialized as they did.

Marinejay,

Why on earth do you claim something with VA and expect it to get denied, and even have a draft NOD ready for their "asses." That tells me one of two things, 1) you may have submitted a bogus claim to start with that has absolutely no merit and you're trying to get one by VA, or 2) you submitted a claim that may have merit, but really doesn't have the evidence to back it up. The VA does not intentionally "low-ball" claims, they assign ratings to disabilities with the evidence in front of them. Having said that, almost all ratings involve a certain amount of judgement on the RVSR's part, and sometimes you'll get a RVSR that used extremely bad judgmrent on their part, or evidence to have a tendency to get lost or misplaced (VA is a the second largest agency). However, to say VA n general has some sort of secret policy to "low-ball" veterans to save the Government money simply isn't true. One must uderstand that not every veteran qailifies for a high rating percentage like 100%. Many veterans think "Well, I've got a bad back and can hardly move, I think I should be 100% disabled by VA." Then, when the veteran receives a 40% rating due to his rang of motion or incapacitating episodes documeted in their records, they piss and moan that they got "screwed" by VA. Now, have there been cases where VA employees have destroyed evidence or "lost" them intentionally, or intentionally denied a deserving veteran their benefit, sure there has, but they were individuals or small group acting on their own, and once they were caught they were fired. Just like the one case a few years back. There was RVSR in, I think Kanas, that routinely denied PTSD claims because he said the the benefits awarded would be more than his retirement pension or something to that affect. Well, he got caught and was immediately fired. There isn't a VA wide conspiracy to dely, deny and "low-ball" veterans and their disability claims.

1968,

See above post!

Vike 17

Edited January 9, 2007 by Vike17

[sixthscents]

I am going to choose to take exception to the following...

You said:

Why on earth do you claim something with VA and expect it to get denied, and even have a draft NOD ready for their "asses." That tells me one of two things, 1) you may have submitted a bogus claim to start with that has absolutely no merit and you're trying to get one by VA, or 2) you submitted a claim that may have merit, but really doesn't have the evidence to back it up. The VA does not intentionally "low-ball" claims, they assign ratings to disabilities with the evidence in front of them.

..............

I'm sorry but I think you are wrong. Personally my experience has been that the VA does in fact allow the LOWEST possible rating on an initial claim. Otherwise, how can a claim, which essentially remains the same, with the sane supporting evidence and diagnpstic tests evoke a higher (sometimes MUCH higher) rating after a NOD. I have seen this again and again. I think you will find that most of the advocates will NEVER accept the first rating given unless it is the magical silver bullet. I think again that you will find that most advocates agree with my position.

You said:

Having said that, almost all ratings involve a certain amount of judgement on the RVSR's part, and sometimes you'll get a RVSR that used extremely bad judgmrent on their part, or evidence to have a tendency to get lost or misplaced (VA is a the second largest agency). However, to say VA n general has some sort of secret policy to "low-ball" veterans to save the Government money simply isn't true.

...............

While I agree that the rater probably doesn't want to "save government money", the simple fact is that they exsist only to process claims and do upon occasion seem to treat veterans as people who are applying for welfare rather than compensation. I have sat down with raters one-to-one and find many of them to be decent people, but.. again this is my personal opinion... they are the minority. Most raters seem to start a claim with the assumption that it is false and try to skew the evidence to that end. The applicant of course takes exactly the opposite tack, and trys to skew the same data to support their claim. The big difference being that the rater should simply follow the guidlines established in CCFR 38, and M21-1 and applicable case law. Yet again, and again they simply DO NOT. I just had a claim for a heal spur on a soldier denied due to no service connection when we/he had a line of duty determination letter (yes) for the exact injury. The rater stated that the soldier was "inactive" duty, misunderstanding what IADT meant. Now if they cannot read their own regulation for something that simple what about a complex judgement?

We say that "they are trying to save money"... well explain to me why there is SUCH a drastic jump from 70% to 100% compensation. If the rate was say $2400 at 100%. One would expect the comp to increase by $240 per 10%, yet you and I know that is simply NOT the case. The VA has skewed the comp tables so that the majority of the veterans will not be able, or will have an extreamly difficult time ever getting to the higher paying brackets of 80, 90 and 100%.

You said:

One must uderstand that not every veteran qailifies for a high rating percentage like 100%. Many veterans think "Well, I've got a bad back and can hardly move, I think I should be 100% disabled by VA." Then, when the veteran receives a 40% rating due to his rang of motion or incapacitating episodes documeted in their records, they piss and moan that they got "screwed" by VA

...............

Nope not all vets even qualify for 10%. I handle claims all the time where honestly any service-connection at all is tenuous at best. If a vet really has not SC injury, and is destitute thats what the pension is for. However, I can speak from personal experience when I say that the VA C&P exams SELDOM follow even their own Physicians reference on exactly what and how to measure posture, range of motion, sensitivity, streangth, deep tendon reflexes, abduction, etc etc etc etc. I have found that the VA C&P physicians seldom if ever do a complete work-up, yet when the write up comes in 30 minutes later... magically plantar flexion, dorsi flexion and all the others appear, with no testing having been done. Thats why I push the EMG so hard. There is no real subjectivity to its diagnosis if properly administered.

I have handled DOZENS of claims where the vet received 40% for their lumbar spine and I was satisfied that was a fair rating, I have one on my desk now. Yet they rated the guy at 30% for his left leg, with an AFO and complete loss of dorsi-flexion and severly reduced plantar flexion.... thats loss of use all day long, I'll file for it, and win it one shot one kill and I'd be more than willing to bet serious money on it since we have an EMG showing paralysis of the anterior tibialis nerve and common peroneal. I'll win at 50% not 30%, but the VA didn't offer to tell the vet they could even file the loss of use. Then hell also qualify for the adaptive vehile grant, possibly the adaptive housing as well, but will the VA mention it? Maybe, and its a slim one, maybe in his rating there will be one small section that briefly and vauguely covers it.

I have personally handled and am currently handeling the claims for veterans who were shot in Vietnam, and received NO compensation for over 30 years. I'd have to talk to them, but if any one agrees than I'd be MORE than willing to let you verify this over the phone. No claim was ever filed for these guys and while they had received medical care from the VA for 30+ years, nobody ever told them they could file. They thought it was welfare.

So, while you may feel very good in what you said, I feel that your opinion does not present an accurate depcition of what is going on in the VA today. I think they are way understaffed with raters, and thats part of it. I think their raters are undertrained, and thats also part of it. I think the veterans are filing vague claims sometimes with tenuos service-connections, or not well founded proof that coorelates to the testing outlined in CFR 38 and M21-1. So while I agree that the veterans can and should do more to support their claims, I feel that the VA has a greater obligation as an institution to ensuring that every possible avenue of assistance is provided, and when the claim is weighed equally for and against the veteran, they should decide upon the veterans behalf. I just do not see that being done regularly. In fact the whole rating process is inconsistent, and almost totally dependent upon the rater who handles the claim, and how they decide to interpret the evidence. I EXPECT the raters to be more expert than I in determining the correct rating of a claim, or even the status i.e. service-connection and yet again and again that just is not the case.

So... theres MY opinion.... and on a personal note, if a vet wants to "whine" then in my book they probably have earned the right to a little b*tching and moaning...

[sixthscents]

Oh, I apologize for the spelling errors, I assure you all I use spell check on my claims I handle... or they'd really be guessing what I was trying to say huh? Further please substitue "piss and moan" for "whine" in my comment... I think the meaning was clear either way though.

[marinejay]

Rocky,

Marinejay,

Why on earth do you claim something with VA and expect it to get denied, and even have a draft NOD ready for their "asses." That tells me one of two things, 1) you may have submitted a bogus claim to start with that has absolutely no merit and you're trying to get one by VA, or 2) you submitted a claim that may have merit, but really doesn't have the evidence to back it up.

1968,

See above post!

Vike 17

Vike let me make this very clear, I HAVE NEVER submitted a bogus claim and I will NEVER, and i mean NEVER, EVER submit a bogus claim to the va. Second, When ever i submit a claim to the va, i make sure i have enough evidence to back it up. Let me remind you that what i think is a slam dunk, may be minimal evidence or nothing at all to the va.

When i first submitted my claims I was low balled at 20% rating, i know a few raters that work out of san diego office, so when my claim was in los angeles i had them looked over my claim with all my medical info copies and both said that my claim warrented a 40% rating based on my SMR.

i then submitted a notice of disagrement along with a DRO and what do you know, i was rated at 40% when the DRO looked at it. So based off that, i came up with the theory that the va low ball's vets many times. Again, this is not only from myself, they are from the many veterans that i have help with their claims which are in los angeles.(other areas may be different, but i beg to differ) Before i submit a claim, i normally have my RO friend take alook at it(if he fits me in his schedule) so i can get a general idea of what to expect. What he says i don't take it as gospel but it gives me a general idea.

Let me say this again, when ever i do something whether it be submitting a claim, looking at properties for my real estate investing or what ever i do, i always have my I's dotted and T's crossed, and i try to plan for every possible mishap that may occur. My philosphy (wng spelling i think) is hope for the best and expect the worse. With that thinking i am able to have back-up plans incase something happens and i am not worrying it too much because it was expected and planned for. Believe me this thinking has saved me lots of money, headaches and emotional stress which are priceless in the long run.

After dealing with the va for many years you tend to have a general idea of what to expect. Also if the va rated people fairly, i don't think the hadit board would be this successful and you and i won't be on this board.

p.s nothing personal taken from your comment, just letting you know the method to my madness.

marinejay

Edited January 9, 2007 by marinejay