C&P review exam-potential confusion on my part -this is a long read

[GeekySquid]

Hi all.

I am new here and if i put this in the wrong section please help me get it to the right one.

My main question, and i have dozens on several topics, is about TDIU/IU and its effects after a review by C&P at 5 year mark.

Primarily do I have to accept an 'inferred" TDIU claim decision? As I understand it the RO can make this determination without my applying for TDIU, and there are some long term problems with being rated TDIU verses 100% Schedule.

Here are the salient details.

1) I am currently homeless, living in my car

2) I have advanced education some of which is paid by VR&E some by student loans.

3) The School and VR&E made decisions that denied me the most important classes in the degree I was seeking. I was forced to take second best or get kicked out of VR&E according to my case manager.  I took out 100K in student loans to offset the lack of those particular classes/certifications and got an MBA. It is not helping me re-enter the workforce.

4). I have a long gap in work because of my PTSD and then 5 years in school. Trying to get employment with that huge gap and the lack of the specifics classes I was denied, is proving to be a barrier I am unable to overcome.

5) Two days ago I had a C&P review at QTC (outside contractor) and Doc indicated that my condition and the current situation has me a millimeter from being, in his words "toast' in terms of being functional and able to work.

6) SSVF has made a similar determination to the above review.

7) VR&E has reopened my claim and is considering allowing me to get that additional training but I have to stabilize living situation first among several other requirements.

8 ) I am a vet who has fought the VA for 25 years just to get treatment, which finally started in 2013. They literally denied I was in the military, that the events actually took place, that I had applied, that I had a "real" problem, and a dozen other bogus statements over the years.

9)  I am currently rated as SC 70% PTSD, w/chronic anxiety, chronic depressive condition, and 3 or more other related things, 10% tinnitus,

10) I have never applied for ratings increase or attempted to challenge what the docs said to the ratings board.

11) I learned last year that my claim for bilateral hearing loss had been denied because they only looked at the records from one of my enlistments, but did say the tinnitus was SC.

12) I have sleep apnea with VA CPAP issued but cannot "document" it started around the same time as my other stuff.

13) The meds they gave me, a huge collection of dangerous drugs, caused excessive skin conditions that have not healed even though I stopped taking their meds (which were of no help anyway).

Now the complicated part to explain without going on for pages.

The doctor told me what he was going to write in his report to the raters. He claimed that I can expect to know in 5 weeks what the increase in my rating will become. I don't know how true that is but it is what he said is the "normal" time frame his company is experiencing for the vets they evaluate.

He informed me that the VA gives them a list of 7 sentences with which they must use to define each diagnosis and then provide their supporting narratives. These sentences are in the DBQ's.

Essentially he stated that for each of my conditions not specifically rated, i.e. chronic depression, chronic anxiety, etc. I am between 30% and 70% on each of them. AT a minimum my PTSD alone has worsened and should (his words) bump up significantly from 70%. To be clear he stated that they were NOT supposed to put out what they think the raters will decide but he said the way he was writing the report his patients usually fall in that category when they are like me.

Using the VA Disability Calculator, I end up at a minimum bump to 80%. All other scenarios take me to 96% or 97% with the exception of them just choosing to NOT increase my rating, which is always a possibility.

There is a significant likelihood that the VR&E will institute an "inferred TDUI" claim which seems to be in their purview. They do this by denying my VR&E and stating the reason as TDIU and the RO will process that whether I want it or not. 

The other way to get TDIU or IU is to apply for it, which I have not done and did not know before now that I could.

I also found out recently that a change in the Dept of Ed, originally started by the Obama administration but Congress would not vote on, has been now passed and the Trump administration is taking credit for the change. That change automates a process for Veterans who are 100% SC via Schedule or through TDIU or IU to get their student loans forgiven. The VA and the Dept of Ed and Social Security are sharing information and if you are rated at 100% they will actually notify you and you only have to sign a form, or you can start the process yourself.

There is a problem with this though. If you are 100% through Schedule, then you are good to go. You can make as much money as you want and your loans are still forgiven. IF however you get the forgiveness based on TDIU or IU then you can only earn Federal Level Poverty line income, no more. In this scenario the Dept of Ed says that if your TDIU resolves you will be on the hook for those loans again. If on TDIU you earn more than Fed Level Poverty line you have to pay back any income over the poverty level that you received as a benefit.

The change also makes it so the IRS does not treat the loan forgiveness as taxable income, which is a huge change.

Of course in both cases you can never get another Fed Student loan, without agreeing to paying back the old loans.

So my problem is understanding what I might do about avoiding getting an "inferred TDIU" rating if my latest evaluation does not get bumped to 100% Schedule. I plan on working and the idea of only being able to legally earn 13K a year poverty level income does not work for me. Until this exam I had not even considered asking for a review to increase my percentage, so getting 100% or any increase is pretty much a bonus that I had not looked for.

I just don't want to screw myself by not knowing how to avoid the VA doing what it wants instead of what is best for me in the long run

Thanks in advance for any help

 

 

 

 

 

[broncovet]

If you are living in your car, you have a lot more to worry about then concerning yourself with VA "inferring TDIU".    If you think you can work, dont even think about applying for TDIU.  

TDIU wont be inferred unless you go to VA and tell them you are not only not working, but your doctor says your sc conditions prevent you from working.  

Your doctor wont say that unless he has reason to believe you can, or are, working.  

If they do happen to "infer TDIU", simply do not send in the form they send you to fill out which is now required to file for TDIU.  Among other things, if you apply for TDIU you have to send a release form to your past employers, where they may tell VA why you are no longer working.  

In short, if you are working, even some, simply dont apply for TDIU, if you think you can/are working.  The VA does not "force" you to apply for benefits.  They are elective, and you can elect "not" to apply for one or more benefits for a reason or reasons which you may or may not disclose to them.