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  • 14 Questions about VA Disability Compensation Benefits Claims

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    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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Amazing Becky

FDC 4 TDIU is C&P exam necessary

Question

The Baltimore RO received my IU claim on 04/30/2019. It’s is an FDC and includes a DBQ from my therapist. Will I still need a c&p exam?The last one was done in 2016 and it was brutal. I’m hoping to avoid a repeat. Right now my claim is in Initial review. Has anyone had a claim that jumped from the Initial Review to Prep for Decision approval and how long did the whole process take?

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The standard answer is they certainly can and probably will. Your last exam was 3 years ago. I would be surprised if you don't. With a favorable dbq it is most likely you won't be decreased and it could go the other way. Be positive and above all, be sure to go to the scheduled exam. Don't put any faith in the status on ebenifits; it moves all over the place.

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C and P exams are discretionary.  They are not supposed to "develop to deny".  This means if there is already evidence in your file that "you are unable to maintain SGE due to SC conditions" you should not need more MEDICAL evidence.  

However, I have seen the VA does not like to take the doc's word on this.  Doctors are not experts in employability.  Voc Rehab specialists, however, should be able to opine pretty much the same thing, but you often need BOTH a doc and a voc rehab specialist opinion.

You may be able to get away with "just" a medical opinion, but VA sometimes wants you to be able to do "sedentary" work if you, for example, have bad knees.  This should not apply to PTSD or Depression, however, it did in my case.  

If you have the evidence you need, documented in your file, then a C and P exam should not be necessary.  

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Posted (edited)
5 hours ago, Amazing Becky said:

received my IU claim on 04/30/2019.

@Amazing Becky

As  @broncovetsaid C&P's are almost always discretionary. but PTSD is one of the few that are not.

You list you are SC for PTSD, the C&P, if ordered, would be for PTSD. I don't see your listing for % but if you are 70%  the C&P might bump you to 100% Schedular which is actually better for you, if you can get it.

How long ago were you rated for PTSD? If you don't have your award letter handy, look under Ebennies Documents and you will find your review date in one of them.

There is a specific Review DBQ that is different than the initial one, not much different just a specific form is used for the review.

The VA kinda hates TDIU and if you are showing signs of not getting better or even worse then bumping you is the path they will take over TDIU.

IU (for many things, just not PTSD) can be done just from the record but the record and documents have to be very complete.

These two links are to the M21-1 about TDIU

https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000014564/M21-1,-Part-IV,-Subpart-ii,-Chapter-2,-Section-F---Compensation-Based-on-Individual-Unemployability-(IU)

https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000014389/M21-1,-Part-V,-Subpart-ii,-Chapter-1,-Section-B---Determining-Disability,-Unemployability,-and-Marginal-Employment#2c

Having things like a Voc Rehab letter saying you are unemployable is strong evidence as in an IMO from a Shrink.

Make sure that they get your Social Security files about your work history and even your IRS taxpayer sheet showing taxable income over the years and it's sources. you may have to get that yourself.

Consider looking at Veterans Law Blog by Chris Attig. You may want to even invest in his TDIU field manual.

as others have said, they may fight you so you need to be prepared for that. may be lots of hoops and a C&P. and even a denial that you should NOD. Again look at Veterans Law Blog for more info on this issue.

Good luck and let us know what happens

 

Edited by GeekySquid

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I agree with Geekysquid, however, I wasnt aware that c and p exams are ever mandantory, even for PTSD.  I do know, however, VA "does not accept" a PTSD diagnosis from a private care doc.  VA thinks "only their doctors" can diagnose PTSD, and private docs have no clue.  That is an interesting position, especially since many doctors receive their internship training at VA OR in private practice and they are pretty much the same as far as education, so why would VA insist on THEIR Doc's diagnosis?  

    Yes, its another method to deny PTSD Vets.  Many people have PTSD diagnosis from stuff "other than" war, or war related.  People can be kidnapped, family members or friends can be murdered, or many other things, other than "at war" can cause PTSD.  

     Also agree Veterans law Blog by Chris Attig is a great source.  In fact, I looked on Chris Attig's site in regard to fighting VA on the effective date, and located something that I thought applied to me.  I contacted Chris Attig, and hired him as my attorney on the issue.  Just recently, he "won" a remand on the issue.  

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19 minutes ago, broncovet said:

wasnt aware that c and p exams are ever mandantory, even for PTSD.

 

Many conditions can be rated based on paperwork alone. PTSD is one of the very few that (mst is another) that must have an exam. Think about it. Vet from Vietnam era says I was shot at, killed people, messed me up. Then says I have been messed up for years, see I am rated for depression or knee, or agent orange, etc.

They would fail the claim. They would need the Caluza and a C&P to say it happened and is affecting them today.

As always the VA language can be tortured for real people. Someone needs to publish a VA-to-Human dictionary.

This is from the M21-1, Part IV, Subpart ii, Chapter 1, Section D - Claims for Service Connection (SC) for Post-Traumatic Stress Disorder (PTSD)

IV.ii.1.D.6.b.  Requesting Initial PTSD Examinations Other Than Personal Trauma

 
When evidence of exposure to stressors related to combat, experience as an FPOW, fear of hostile military or terrorist activity, or drone aircraft crew member duties is established by a Veteran’s individual decoration(s) or other military records, include a statement to that effect in the Remarks section of the examination request.  This evidence allows VA (including the examiner) to accept the Veteran’s own description of the specific events without further corroboration.
 
Important:  Evidence of experience as an FPOW, exposure to combat, fear of hostile military or terrorist activity, or drone aircraft crew member duties, in itself, does not satisfy the diagnostic criteria for PTSD.
 
Note:  When requesting a PTSD examination, specify that, if possible, the Veteran’s treating mental health professional should not perform the examination.
 
Reference:  For more information on evidence of stressors related to combat, experience as an FPOW, a fear of hostile military or terrorist activity, or drone aircraft crew member duties, see

IV.ii.1.D.6.c.  Requesting Examinations for PTSD Claims Based on Personal Trauma

 
In compliance with 38 CFR 3.159(c)(4), an examination will always be needed when a thorough review shows
  • a current medical diagnosis of PTSD or the Veteran’s lay statements describing PTSD symptoms
  • credible supporting evidence of the personal trauma incident or evidence of a marker in the in-service or post-service records
  • indication that the PTSD symptoms may be associated with the claimed MST stressor (established by applying a low threshold and liberal approach satisfied by virtue of a current diagnosis or symptoms and the presence of a marker), and
  • medical evidence adequate for rating purposes is not already of record.  
In cases where the only evidence of the personal trauma stressor are behavioral changes that may be markers of the claimed trauma, an examination is almost always needed because the marker itself does not establish the occurrence of the stressor, but the opinion of the qualified examiner can provide credible and probative evidence to make that determination.  The examination is needed specifically to determine 
  • whether a medical opinion can provide evidence for occurrence of the claimed in-service personal trauma stressor based on the marker and the Veteran’s lay statement, and
  • whether that claimed stressor is related to current PTSD symptoms. 
Important:  In order to ensure the examination request language is adequate, use the Exam Request Builder (ERB) or Simplified ERB (ERB-S) tool, as appropriate, and select either the PTSD MST or PTSD personal trauma (non-MST) medical opinion template based on the nature of the claimed stressor.
  
References:  For more information on

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