PTSD Denied with a Not Service Connected but PTSD - Combat related description

[SHef]

I am currently at a 90% rating and have been fighting the appeal status for a PTSD rating for the last few years.  I just saw that my Higher Level Review was closed yesterday with no change to my E-Benefits.  What I am struggling with is that they have PTSD described in my disabilities and classify it as "Not service Related" but the "Related to" section it shows PTSD-Combat.  How can I have PTSD from COMBAT that came from incidents that happened while I was in COMBAT but its NOT service related!!!!  I have over 500 pages from my VA Psychologist showing that I have PTSD and they still denied it.  I haven't received my letter from the HLR to see what the appeal has stated but I don't see a change in EBenefits.  

Has anyone else had this issue?  If so, what have you done to prove your case?  

[SHef]

I just got the letter from the VA.  Here is what they said:

A duty to assist error has been identified during the Higher Level review for posttraumatic stress disorder.

Reasons for decision:

1.  Higher level Review for posttraumatic stress disorder.

The issue of posttraumatic stress disorder was returned for correction of a duty to assist error in the prior decision.  We failed to get an examination and/or medical opinion.  We will develop for examination with medical opinion:

Favorable findings identified in this decision:

You have been diagnosed with a disability, Gainesville VA Medical Center treatment Center reports to include Jacksonville VA Clinic confirm a diagnosis of posttraumatic stress disorder based on DSM-5 on June 25, 2019.  

Evidence shows that you performed service in Iraq from Februray 11, 2005 to September 8, 2005 and Afghanistan from November 1, 2002 to October 6, 2003 which are conceded as hostile territories during these time periods.

The evidence shows that a qualfiying event, injury, or disease had its onset during your service.

Separation exam dated October 29, 2014 notes examiner comments of anxiety and depression recently started and amitriptyline.

It did not give a rating decision and nothing has changed in EBenefits.  Does this mean that they are still trying to figure out the percentage to give for this diagnosis?

Edited June 21, 2020 by SHef

[GBArmy]

SHef You are correct. The VA has to develop your claim, including a further eval to determine the extent of your disabilities. That is they need to figure out an appropriate rate for your disability by a thorough eval of all your symptoms. Thtt' how it works. They don't have that detail in your file, so the reason for another C&P. If you have more than one separate MH issue, they have to include that as part of your ratings. You're going to be ok; just go to the eval and be honest and open about all your symptoms. Keep us informed on progress so we can advise as things develop for you.

[SHef]

Next C&P is on Friday for PTSD and Depression.  I just found the news article that backs up the account of an incident that occurred when I was in Afghanistan and our base was under attack.  I also printed out when our convoy struck an anti tank mine.  I printed out all the records of the VA Psychologists and their diagnosis of PTSD notes from the last 6 years.  Is there anything else I can do to prepare?

[Marineleo]

It looks like from the letter you shared that they have already agreed that 1- You have PTSD and 2- That it's related to a qualifying event that occurred in service.  Those are the two biggest hurdles and the C & P exam at this point is just to establish the severity for the rating %.  

[GBArmy]

If you downloaded all your VA records then they should also be available for the C&P examiner. That doesn't necessarily mean that he will see and actually read them prior to the exam. So I would put them in order and understand what you have so if they ask you a question that is in them, you should tell them the answer but also state that the info is available in so-and-so file/document. Be polite but if they just "first page" your evidence, they can miss some important stuff. Now, this is me: if it is at HLR but returned for correcting a VA error, I believe they say in your decision letter that you can submit additional info. If you can, I would down load thru VA.gov the newspaper articles, etc. if it is new evidence before your exam. The problem is if they correctly, or incorrectly say that constitutes new evidence, so it will be redirected to a Supplemental Claim, it's going to delay.Your option is to just  bring a copy of the new evidence and see if they will look at it. If they don't, and later deny your claim, you just resubmit as a supplemental claim anyway. Check the wording on your decision letter. This is new AMA stuff and there isn't a lot of advise on something like your situation. Maybe Brokensoldier may chime in on what their procedural manual says.

[ShuMan]

My option, You will need an IMO to fight this. Once you have that and a personal statement (outlining where the rating decision was not correct) file a supplemental claim. Should side in your favor at that point.