Jump to content
  • Ads

  • Our picks

    • The 5, 10, 20 year rules...



      Five Year Rule) If you have had the same rating for five or more years, the VA cannot reduce your rating unless your condition has improved on a sustained basis. All the medical evidence, not just the reexamination report, must support the conclusion that your improvement is more than temporary.



      Ten Year Rule) The 10 year rule is after 10 years, the service connection is protected from being dropped.



      Twenty Year Rule) If your disability has been continuously rated at or above a certain rating level for 20 or more years, the VA cannot reduce your rating unless it finds the rating was based on fraud. This is a very high standard and it's unlikely the rating would get reduced.



      If you are 100% for 20 years (Either 100% schedular or 100% TDIU - Total Disability based on Individual Unemployability or IU), you are automatically Permanent & Total (P&T). And, that after 20 years the total disability (100% or IU) is protected from reduction for the remainder of the person's life. "M-21-1-IX.ii.2.1.j. When a P&T Disability Exists"



      At 55, P&T (Permanent & Total) or a few other reasons the VBA will not initiate a review. Here is the graphic below for that. However if the Veteran files a new compensation claim or files for an increase, then it is YOU that initiated to possible review.



      NOTE: Until a percentage is in place for 10 years, the service connection can be removed. After that, the service connection is protected.



      ------



      Example for 2020 using the same disability rating



      1998 - Initially Service Connected @ 10%



      RESULT: Service Connection Protected in 2008



      RESULT: 10% Protected from reduction in 2018 (20 years)



      2020 - Service Connection Increased @ 30%



      RESULT: 30% is Protected from reduction in 2040 (20 years)
        • Thanks
      • 4 replies
    • Wonderful news way to hang in. I hope this gives you some well deserved peace. 
    • If HadIt.com has helped you or you believe in it’s mission then please donate even $1 helps. I hope HadIt.com has provided $1’s worth of help to you. Imagine waking up and there is no HadIt.com it could happen and that is why I’m asking for your help now.



       



      Our traffic is going up and so are our expenses, however revenues have gone down and so I am reaching out to you to see if you can help me keep Hadit.com up and running.
      • 4 replies
    • https://community.hadit.com/searching-for-va-claims-information-on-hadit.com/

       

      Your question has probably been asked before so the fastest way to find the information you need is to search for it.
      • 3 replies
    • How to get your questions answered...


      All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

      Tips on posting on the forums.

      Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.


      Knowledgable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title. I don’t read all posts every login and will gravitate towards those I have more info on.


      Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.


      Leading to:

      Post clear questions and then give background info on them.

      Examples:

      A. I was previously denied for apnea – Should I refile a claim?


      I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?



      B. I may have PTSD- how can I be sure?

      I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?



      This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.

      Note:

      Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview.

      This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
      • 2 replies
  • Advertisemnt

  • 0
Narose

TDIU for PTSD denied... because I am a parent??

Question

Posted (edited)

Okay so this is my first post, but I have been a long time lurker and just want to say thanks for years of informative and helpful content!

I recently applied for TDIU due to my PTSD rated at 70% (90% overall rating) in April of this year, with an intent to file dated back to October 2019. I am honestly flabbergasted at what the rater used as the basis for their decision. I have never seen or even heard of something like this and am looking for input on how to proceed. I am definitely appealing but thats as far as I have gotten at this point. 

 

Here is a brief timeline for reference:

January 2019 - Started struggling at work (desk job, minimal interaction with people outside of email/calls) 6 months into my job due to issues related to my PTSD

June 2019 - My employer and I mutually decided that I should resign due to my ongoing PTSD related performance issues; this essentially was them saying they didn't want to fire me but I could not continue working there in my mental state at the time. They don't have to pay unemployment insurance, I get to keep them as a positive reference on my resume for when/if I am able to work again, win-win for everyone. 

August 2019 - My last day at work, the previous month was spent finding my replacement and using up sick/vacation days, etc. 

September 2019 - Former employer fills out VA 21-4192, everything about the statement is favorable to unemployability. 

January 2020 - I give birth to my 4th child. 

April 2020 - I submit the claim for TDIU; I waited until this point to file so that I did not go over the income requirement and get an automatic denial based on that.

April 2020 - C&P exam for PTSD, examiner opines favorably and conclusively that I am not employable due to PTSD.

May 2020 - Denied. Copy of the basis for denial down below, with the only edits made for protection of privacy (names, dates, locations, etc.)

 

Entitlement to Individual Unemployability

Entitlement to individual unemployability is denied because you have not been found unable to secure or follow a substantially gainful occupation as a result of service connected disabilities. You are considered capable of gainful employment. {38 CFR 4.16, 38 CFR 4.18}

Although you and your previous employer noted issues with reporting late to work, missed days at work, and unsuccessful attempts at teleworking it should also be noted that during that time you appeared to be the primary caregiver to three young children and were approximately six months pregnant when you left their employment. During the examination conducted in April, the examiner noted: "Veteran is either in a panicked state or depressed, so could be emotionally unstable in a public environment. She has flashbacks and distressing memories daily, which could make it difficult for her to attend to tasks and support other staff. She has issues with mood and affect and cannot tolerate strangers or crowds, which could make it difficult to work customer facing or in a sheltered work environment. She does not get sleep, has poor concentration and memory, which would make it difficult for her to learn and retain as well as use new information." However the examiner did not address concerns related to non-service related post partum depression and possible thyroid issues, which can affect mood, concentration, and memory. Although you have had consistent issues with chronic sleep impairment, a newborn would also affect sleep which could also affect memory issues (which was also noted as a new symptom), however again this was not addressed by the examiner. The examiner also did not appear to consider the job that you do at home with regards to primary caregiving for four young children.

Evidence indicates that you completed four years of college and have not tried to obtain employment since you left your previous employer in August 2019. It's noted that you had your fourth child in January 2020, just prior to the COVID 19 outbreak and that unemployment rates are currently at an all time high due to pandemic restrictions. The SSA determination letter copy dated March 2013 noted that you were denied disability benefits as you are not considered disabled under their rules. 

While your service connected disabilities are substantial and may preclude you from doing certain types of work, the evidence does not show that you are prohibited from all forms of substantially gainful employment. Being unable to find a job, being unable to perform a particular job, the feasibility of working full time with four young children at home, or experiencing difficulties while being the primary caregiver to four children while trying to work are not sufficient reasons to find you unemployable due to your service connected disabilities. Recent VA Medical Center treatment records indicate that although you still struggle with your PTSD symptoms that you are able to appropriately care for yourself and serve as primary caregiver to your three children and newborn, even during current restrictions due to COVID 19. 

After carefully considering the available evidence, we cannot establish entitlement to IU. In order to establish entitlement, the evidence must show that your service connected disabilities by themselves prevent you from performing physical and mental acts required for any employment. 

 

A few important things to note:

I was service connected for PTSD in 2013, and have been rated 70% for the past 7 years, with one dip to 50% for a few months in 2017. My medical record shows a clear and consistent picture of my mental health, with most issues remaining the same or worse, and I have had the same VA Psychiatrist for the past 4 years. I have NEVER been diagnosed with  Post-partum Depression, nor has it ever even been suggested anywhere in my record. The "possible thyroid condition" mentioned was the result of an abnormal blood test done on the same day as my exam, so the examiner obviously would not have that information as they did not even have the results that same day; never had any abnormalities with thyroid hormones before, the most recent test prior to that was done in May 2019 and was normal.The "new" memory issues are not new and are documented in my medical record. The SSA denial mentioned was from SEVEN years ago for an unrelated neurological condition. I even included a statement with the claim to that effect just for clarification.

The fact that it feels like the rater essentially said that because I am a parent then I that means I am employable really bothers me at my core. I am not the primary or sole caregiver of my children; I have a spouse and a part time nanny who shoulder the majority of the burden. This really feels prejudiced because I am a woman who recently had a baby, so clearly that means that I am fine. The sleep issues I've had for over 7 years are apparently invalidated because I have a newborn who is the real reason my sleep is affected. Men who have children certainly are not denied IU because they are parents, so why is it that I was? It was the focus of the denial and it feels personal somehow. 

My VA psychiatrist was the one who recommended applying for TDIU and she will be writing a letter on my behalf refuting the statements made above, so that will be the new evidence used in the appeal. I am really trying to pinpoint what legal basis was used for this decision and how to move forward with my personal statement. 

There are a lot of little details missing but that is the gist of it, so sorry for the wall of text, and thank you all in advance for your input and help!

 

Edited by Narose
Changed examiner to rater in one section

Share this post


Link to post
Share on other sites

Recommended Posts

  • 0

Two new updates, I did in fact find out that they assigned my effective date correctly, so there will be no more fighting them on this claim! Retro-pay already showing through the DAV so it should be hitting my account next week sometime.

AND the best news of all, my rating is not actually TDIU, they assigned a scheduler 100% P&T so I am truly DONE with all of it for good! I am incredibly thankful to all of you here for your support and encouragement on this one; I felt so defeated and you all really made me feel like I could get through it, so thank you!!

  • Like 1

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.

Guest
Answer this question...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


  • Ads

  • Our picks

    • The 5, 10, 20 year rules...



      Five Year Rule) If you have had the same rating for five or more years, the VA cannot reduce your rating unless your condition has improved on a sustained basis. All the medical evidence, not just the reexamination report, must support the conclusion that your improvement is more than temporary.



      Ten Year Rule) The 10 year rule is after 10 years, the service connection is protected from being dropped.



      Twenty Year Rule) If your disability has been continuously rated at or above a certain rating level for 20 or more years, the VA cannot reduce your rating unless it finds the rating was based on fraud. This is a very high standard and it's unlikely the rating would get reduced.



      If you are 100% for 20 years (Either 100% schedular or 100% TDIU - Total Disability based on Individual Unemployability or IU), you are automatically Permanent & Total (P&T). And, that after 20 years the total disability (100% or IU) is protected from reduction for the remainder of the person's life. "M-21-1-IX.ii.2.1.j. When a P&T Disability Exists"



      At 55, P&T (Permanent & Total) or a few other reasons the VBA will not initiate a review. Here is the graphic below for that. However if the Veteran files a new compensation claim or files for an increase, then it is YOU that initiated to possible review.



      NOTE: Until a percentage is in place for 10 years, the service connection can be removed. After that, the service connection is protected.



      ------



      Example for 2020 using the same disability rating



      1998 - Initially Service Connected @ 10%



      RESULT: Service Connection Protected in 2008



      RESULT: 10% Protected from reduction in 2018 (20 years)



      2020 - Service Connection Increased @ 30%



      RESULT: 30% is Protected from reduction in 2040 (20 years)
        • Like
      • 4 replies
    • Wonderful news way to hang in. I hope this gives you some well deserved peace. 
    • If HadIt.com has helped you or you believe in it’s mission then please donate even $1 helps. I hope HadIt.com has provided $1’s worth of help to you. Imagine waking up and there is no HadIt.com it could happen and that is why I’m asking for your help now.



       



      Our traffic is going up and so are our expenses, however revenues have gone down and so I am reaching out to you to see if you can help me keep Hadit.com up and running.
      • 4 replies
    • https://community.hadit.com/searching-for-va-claims-information-on-hadit.com/

       

      Your question has probably been asked before so the fastest way to find the information you need is to search for it.
      • 3 replies
    • How to get your questions answered...


      All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

      Tips on posting on the forums.

      Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.


      Knowledgable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title. I don’t read all posts every login and will gravitate towards those I have more info on.


      Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.


      Leading to:

      Post clear questions and then give background info on them.

      Examples:

      A. I was previously denied for apnea – Should I refile a claim?


      I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?



      B. I may have PTSD- how can I be sure?

      I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?



      This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.

      Note:

      Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview.

      This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
      • 2 replies
  • Ads

  • Popular Contributors

  • Ad

  • Latest News

Announcements

  • veteranscrisisline-badge-chat-1.gif

  • Donation Box

    Please donate to support the community.
    We appreciate all donations!
  • Advertisemnt

  • 14 Questions about VA Disability Compensation Benefits Claims

    questions-001@3x.png

    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 ...
    Continue Reading
     
  • Ads

  • Most Common VA Disabilities Claimed for Compensation:   

    tinnitus-005.pngptsd-005.pnglumbosacral-005.pngscars-005.pnglimitation-flexion-knee-005.pngdiabetes-005.pnglimitation-motion-ankle-005.pngparalysis-005.pngdegenerative-arthitis-spine-005.pngtbi-traumatic-brain-injury-005.png

  • Advertisemnt

  • VA Watchdog

  • Advertisemnt

  • Ads

  • Can a 100 percent Disabled Veteran Work and Earn an Income?

    employment 2.jpeg

    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

×
×
  • Create New...

Important Information

{terms] and Guidelines