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Question About PTSD Re-Eval

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USAF K9

Question

I'm sorry if I am posting in the wrong place.  I wasn't sure where this should go.  

I am prior Air Force, combat action medal from Iraq, blah, blah.  Lots of issues from Iraq and base football, and other stuff.

I am 100% SC schedular, non P&T.  I am 70% PTSD, 40% back, 20% for each leg bilateral radiculopathy, and a bunch of 10% ratings on my feet, knees, hands, etc.

I went to my first and only C&P for PTSD back in March 2019, so I have only been SC for PTSD for 4 months or so.  

I recently filed claims for several other conditions (Sleep Apnea secondary to wt gain from PTSD and other disabilities, Fibromyalgia for Gulf War, Migraines from Gulf War, ED secondary to PTSD meds).  I also provided a letter from a doctor saying I should be P&T.  I would have left well enough alone after getting 100%, but the rating said I would be re-evaluated for my PTSD and my back, so I figured I may as well go for the jugular and overwhelm them with the rest of my issues, so maybe they give me P&T.  I also THOUGHT I was safe from a re-eval since I had been rated so recently. 

Anyway, despite me providing  them records to fulfill all the necessary elements (favorable DBQs and nexus letters from Dr. Ellis, and diagnoses/sleep studies, etc. from my personal doctor) for all the new claims, they still sent me to a C&P for all the newly claimed conditions. Fine, I will play the game even though I sent you everything wrapped in a nice bow. But, then comes the part that threw me for a loop, and is my actual question:

I looked in ebenefits and see a request for a PTSD increase showing in the system, which I absolutely never asked for.  I didn't even think I could go for an increase since I had only been rated like 4 months ago at that time.  I also didn't think I rated 100%, based on the description in the CFR.  Anyway, I call a bunch of people to ask what is going on and nobody has an answer.  The VA acknowledged that they asked for the re-evaluation.  I understand the VA can and will re-evaluate anytime, but it is a bit ridiculous, even for the VA, to do another PTSD exam 4 months after the first one.  I would certainly understand if they re-evaluated my physical issues since I was seeing a primary care type C&P examiner for my new claims.  But, it doesn't make sense to generate a request to have PTSD added to the mix after only 4 months.  

Does anybody have any thoughts?  Some have told me that this may be part of their process to determine if I should get P&T, but I had a VA phone rep read me the correspondence between the VA and the Psych, and nothing was mentioned about "find out if this dude is going to be messed up for the rest of his life," and I know the C&P psych certainly didn't ask any questions about permanency, and she actually seemed mildly annoyed that they sent me again so soon, especially when I told her I never requested an increase.  BTW, the C&P seemed to go really well, so I am not super stressed about the outcome, but you never know.  Actually, scratch that.  I am pretty much constantly anxious about everything.  But, the exam did seem to go well.

Anyway, if anyone has any thoughts about why they sent me for another C&P exam for PTSD so soon, I am all ears.

Thanks everyone!

P.S.  This forum has been EXTREMELY helpful to me as I took myself from 20% up to 100% (and maybe back down again depending on what the VA says about my PTSD C&P exam).  So, I thank you all for that.

Edited by USAF K9
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So there are a few issues here.  That is pretty fast for a reevaluation, but not unheard of.  So P&T you need your doctor to state this condition is a progressive or will never get better!  You need this ammo to make sure they understand the severity of the condition. 

I recently filed claims for several other conditions (Sleep Apnea secondary to wt gain from PTSD and other disabilities, Fibromyalgia for Gulf War, Migraines from Gulf War, ED secondary to PTSD meds)

These conditions you stated here would all put you in the way of a permanent disability.  The reason I say this is I have heard doctors at the VA talk about curing PTSD.  For me there is now way to CURE it, what happened never goes away.  You learn how to deal with it so you can function.  

I would load up with am IMO and also keep fighting these other conditions.  As they could be what leads you to P&T.

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Thanks, Shrek for the response. I did provide a letter from a doctor saying my issues are not expected to get better. I can see the VA saying, since the bulk of my 100% rating is PTSD, maybe the physician isnt reliable to say the PTSD is not going to get better. It just threw me off when there was no request from the VA to the psych C&P examiner for any kind of opinion on how permanent the PTSD is. At least the VA operator reading the request over the phone said there wasn't. 

It is good to hear that a super quick re eval is not unheard of. I thought it was a clear sign the VA rater was trying to bump me down.

I am definitely fighting for those other conditions as well. I am hoping that, if some or all of them get approved, the VA will see that, even if a bunch of stuff gets reduced, I will still be at 100%. Maybe a fool's hope...

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Not a fool's hope, a good move.  I would not worry about the PTSD re-evaluation.  I got SC and rated for neuropathy and now have a re-evaluation pending.  The good news is that some disabilities do not get better, we learn to live with them but that does not make the disability go away.  If on the off chance that you do get reduced, fight it to the BVA if you have to.

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21 hours ago, USAF K9 said:

I recently filed claims for several other conditions

any time you file new claims or a claim for increase the VA has to review your entire claim file, including for TDIU though that is not relevant to your situation as 100% schedular.

21 hours ago, USAF K9 said:

I also provided a letter from a doctor saying I should be P&T.

This likely to have been the cause of ordering a new C&P for PTSD. Not that that is bad or anything, just that it is likely the cause. Their rationale would be to document if you are decompensating mentally.  In fact if they didn't send you to one after getting that type of letter, there is good likelihood you might call CUE based on them not doing a thorough review of available medical records in your c-file.

21 hours ago, USAF K9 said:

I am 100% SC schedular,

there is more to compensation then just 100% schedular. There is SMC(k) for things like ED, as well as Statutory Home bound (smc(s)) or even Aid and Attendance.

The VA has a legal requirement to maximize your benefits. If you have provided them with the documentation of those other claims (their caluzza elements) then there is a potential for SMC(s) or greater compensation.

21 hours ago, USAF K9 said:

I am 70% PTSD, 40% back, 20% for each leg bilateral radiculopathy, and a bunch of 10% ratings on my feet, knees, hands, etc.

playing what if with VA math,

if your PTSD bumps to 100% that gives you 40, 20 and a bunch of 10's as you put it, that could be the 60 for  SMC(s). Also remember that having two 0%'s equals or can equal 10%. Plus add the new claims assuming they are granted and you could be 200% (but easily 160%)

in order to maximize your benefit the VA would need a VA shrink to agree with that letter saying you are P&T and that your PTSD is getting worse. Or they would need those new claims to tally up to enough to reach the SMC(s).

 

I am not saying that is the reason or those are the ratings you will end up with, they are just potentials. I suspect in your case the VA is actually doing what it is supposed to do... go figure, you may be get to be the lucky one!

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GeekySquid,

I really appreciate the feedback.  That is reassuring to hear. 

You know, I was heavily involved in filing claims up until about 2009, and then I just quit once I hit 60%.  Anyway, I was pretty much disgusted with the VA back then.  Well, after my 10 year hiatus, I have to say some things have really changed.  I am certainly not saying VA is perfect or even good, but they are light years beyond where they were when I stopped messing with claims 10 years ago.  Maybe I should give them more benefit of the doubt since they have made some improvements. 

Thanks again.

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3 minutes ago, USAF K9 said:

anyway, I was pretty much disgusted with the VA

we have all been in that same boat at one time or another.. hell some have taken up residence on that boat.

i really hope it is what I suspect. Since the Legacy and RAMP processes closed to new claims, things have changed under AMA with the new National Work Queue. At times it seems like just a faster way to deny initial claims, at other times it looks like the system is trying to improve.

who the hell knows?

If you feel compelled to, copy your award letters and black out the identifying data and upload, along with a copy of your 526 application for the new stuff. Also maybe maybe screen cap the Ebenefits Disability Link Display, as it shows what the VA considers secondary to what other condition.

That can give a potentially clearer idea if they are looking for a route to SMC's of some sort.

Keep strong, keep fighting. Remember that in the event you become too ill to fight you want your heirs or caretakers to be in the best possible position to deal with the VA.

 

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