ptsd Rating Reduction After Reconsideration Hearing

[Desiretofish'swife]

Hi,

This is my first post to this forum and any help that anyone can provide would be greatly appreciated. Sorry this is so long, but I felt I needed to explain, to the best of my ability, of what happended.

A little background:

My husband was rated at 70% PTSD and 10% knee injury for a total of 70%. When he originally applied for compensation benefits he included both military and post military trauma (which was in his C-file) prior to his first C&P exam in May of 2005. At the C&P examination in May of 2005 the examiner stated that she reviewed his C-file and after the exam her opinion was sent to the rater. He was then given a rating of 70%. Ok, this is where it gets a little complicated:

My husband was then invited to apply for IU because of his 70% rating. After applying for the IU (we moved from one state to another before filing for this IU) he was then sent for a second C&P. We included his SSDI award. This SSDI was given to him after a post military trauma occured and he had to retire. The SSDI was based on his PTSD from this trauma. Now, when he was sent for the second C&P exam the rater asked the examiner to seperate the symptoms (military and post military traumas,) and he was also ask to state (in his opinion) what percentage could be attributed to military and to post military traumas.

The rater then sent a proposal to reduce his rating for PTSD from 70% to 30% and keep his rating the same for his knee injury at 10% for a total of 40%. My husband then filed for a reconsideration hearing and was given one in November. We just recieved notice in today's mail reducing his rating to the 30% + 10%. So, now he has to file an NOD on this rating.

My question:

How can a doctor and rater seperate traumas from the military and post military to get a percentage for each? My husband's stressor and military nexus was proven in the first rating, but now they want to say that his military trauma only rates at 30% and his post military is 40%? so he will only recieve the percentage attributed to his military and they will discount his post military from the overall rating. This is no joke, this actually happened. They stated that the first C&P examiner was not FULLY aware of his post military trauma when he/she rated him at 70%. But the fact is that when my husband first applied for compensation the only records that were in his C-file where from the post military trauma, until he was able to provide the stressor and diagnosis, at which time they were then able to rate him at the 70%.

We are both very confused as to how they can seperate symptoms from military and post military traumas for rating percentage purposes. What can we do? Is there any cases that anyone can think of that deal with this type of way to rate? We don't know where to go from here. We are going to file an NOD on Monday, but need help. Stressed on this one, but we just cannot follow this type of logic.

Keep in mind that they did not take away his rating for PTSD, only reduced it because of his post military trauma. I thought that in order to get a rating all that you needed to do was prove the stressor occurred, that you had a diagnosis, and that it was an ongoing problem. We did that. Now they are reducing him because of his post military trauma, which the rater said the first C&P examiner was not fully informed about when giving him his original rating. Remember that all of his post military trauma records were in his C-file PRIOR to his first examination, and the C&P doctor even stated that she reviewed that C-file prior to his exam. The problem was that she only mentioned the post military accident in her report, and the second rater made quite a big deal about this fact.

HELP would be welcomed.

Best regards,

Desiretofish'swife

Edited February 10, 2007 by Desiretofish'swife

[robert51]

I am facing the same thing i am 70%PTSD and IU and PT and will be going to another CP which the letter states to see if my PTSD has gotten better and the rating is still at 70% of should be at another rate... Any way you spin it i think its part of a money saving thing...

[Vike17]

Desiretofish's wife,

This is probably one of the most bizare cases I've heard of. Simply there isn't any way a Shrink could seperate the two and determine what symptoms are due to what stressor. Furthermore, the PTSD is PTSD and I suspect that the first inservice stressor probably would have played a big role in the stressor after the service. You should file a NOD ASAP and ask for a DRO reiew. Any DRO worth anything knows this decision holds no water and will reinstate the 70% evaluation.

Vike 17

[Berta]

I would imagine many many PTSD vets have experienced post service stressors unrelated to their service.

Did the SSA make any findngs at all on his inservice PTSD or did they just focus on the post service event?

A Notice of Disagreement- in my opinion- should be reasonably brief but completely disagree with the VA's statements and- anything at all that you can attach as evidence- could help-

NVLSP suggests asking for DRO review right in the NOD.

You might have to consider the expense of a Independent Medical Opinion-does your husband get any private care for PTSD? maybe he could get a free IMO from a private doctor-

"How can a doctor and rater seperate traumas from the military and post military to get a percentage for each" a real psychiatric doctor probably could-another reason for an IMO-then again SSA already did!

The service PTSD rating would depend solely on the medical evidence that warranted the 70% in the first place-based on the stressor and med recs-

also it would depend on the level and beginning of service PTSD PRIOR to the post service event-and you have a date for that- the SSA award date-

that date is in granite as a date that a different stressor disabled your husband-

this sure is nothing regarding his service PTSD.

This is as Vike said- Bizarre to say the least and it raises a serious question-

if a PTSD vet in later years experiences lets say-the loss of his family in a fire, or is assaulted or raped as a civilian , or has a horrific auto accident,

does this give VA any right to question their initial PTSD rating and lower it?

NO- dont allow them to get away with this-

we are only hearing the basic problem here- is there any way you can scan the denial particularily as to the actual wording of it?

Put a post up or black out over the c file number etc-

Was the evidence properly listed and was it all refered to in the decision?

Your husband's present VA treatment records -and those prior to the second traumatic event-

do these records focus on his initial cause of PTSD or do they contain additional but more recent records as to the second non-service stressor?

Since the VA DID award the 70% initially- what Medical Rationale did the VA provide -in the denial-that proves that the second traumatic event CURED 40 % of his initial 70%?

You might have gotten some gung ho VA rater trying to make points-

then again the TDIU triggered a new look at all this- and there could well be good reason for VA to question the initial rating-

still-

it doesn't make sense to me----

I have a friend who just got 50 %SC PTSD last year -his wife and me are the only people he has any contact with at all socially-

if something terrible happened to her -he would certainly experience severe additional trauma-

if VA tried to take away any of his PTSD due to something like that-I would try to give the VA PTSD!

We would NOD and then ask for secondary award for the additional PTSD trauma- as his service PTSD (I know his whole story) is so severe that ANY additional stress is compounded by it.

I would think also that your husband's former employers and anyone -neighbors, family and friends could help support the 70% by giving statements to the VA-

there was a medical criteria for the 70% and-yet then again- as long as the evidence for that award is in the c file- I dont see how the VA can say something that happned after the fact warrants a reduction.

Can't stress this enough-the medical evidence of the 70% criteria-must be still in the c file and has nothing to do with anything else but his inservice PTSD trauma.

Does he have a complete copy of his VA med records and also his c file?

We do need more info- this is an awful decision-

do you have a vet rep supporting your husband's claim?

If we know more about that decision maybe we could help more-

what medical background did the C & P doctor have?

Are they psychiatrist or psychologist?

I suggest strongly that if you consider getting an independent medical opinion (and Please read all the info here on that) that you get the best psychiatrist you can find- try Med Opinions link here-they can assess the fee and tell you what they need if you send them brief email questions at their site.

I am outraged at this- they pulled something like this on my husband many years ago.

Then they reversed on the NOD I prepared.It only took a few months.

I didnt quote a lot of regs- I was so mad that I stated the common sense facts that they disregarded.

Actually the NOD I prepared was kind of comical-because their attempt to lower his comp and their Reasons and Bases was literally a joke and a travesty and I knew it held no water.

He was so afraid of the VA he thought maybe they were right by the proposed reduction-

the medical evidence showed they were wrong.

Within 3 years after that he was declared 100% PTSD by SSA and also by VA posthumously-so obviously his stress disorder was higher than they ever thought.

Fight this crap with medical evidence-of the 70% award.

Edited February 10, 2007 by Berta

[Guest jangrin]

I agree with Vike 17, it would be totally impossible to apportion the symtoms between the two stressors. However, doctors do it all the time with physical ailments and (some mental as well). For example:

A person gets in an auto accident on January 1st, they go the the doc with neck pain headaches and low back pain. They recieve treatment four or five times and continue to have problems. Then they are in another accident on February 5th with the same syptoms neck pain, low back, headaches,and they get treatment for the second accident. But they wern't healed from the first accident.

The doctor is then asked to apportion what symptoms were atributable to the first accident and what symtoms to the second, (the symptoms were the same). Then they are asked to give a percentage based on the history of the accident and the patients symtoms. The ratings can be anything such as... 50/ 50, 40/60, 30/70, 90/10???? Doctors are asked to do this all the time. Including PTSD from an auto accident which could be inclusive in the treatment records for the accidents.

I think this is what they are trying to do. Generally, a first injury is more harmful than a subsequent injury. As the first injury predisposes the patient to be more easily injured if an additional similar injury occurs in the same area. I would bet that this holds true for psychological issues as well. The first traumatic stressor predisposing the person to be more easily affected by another traumatic insult. All of this apportionment is JUST A DOCTORS OPINION AS TO THE DAMMAGE. You need a doctor with some very strong credentials to go against the VA C&P shrinks.

I think this is were they are trying to go with this. I would diffinately get an IMO from a very qualified doctor.

[Berta]

This 2006 BVA case shows that a vet should fight these proposed reductions:

http://www.va.gov/vetapp06/files4/0621922.txt

Different situation but it might help- and it shows these decisions can be changed.

Also last year I posted a PTSD vets claim that-not only did they try to lower his comp-

he claimed a CUE had occurred and he won the CUE-and he also was awarded TDIU.

On the TDIU form (21-8940) that seemed to cause this whole brooha ha- did your husband tell them of the side affects of his SC meds that would cause him to be unemployable-

like dont take and drive, can cause confusion, drowsiness etc.

Does he receive additional NSC meds for the second trauma?

I dont think he would- that doesn't make sense-

Was he given the Combat related MMPI?

I asume he was combat but he did not have to be combat-

I mention this only because the combat related PTSD tests show levels of stress-that- I cannot imagine- even additional civilian stressors would Lower-

My point is to focus on the 70% criteria for service connected PTSD when you prepare the NOD and how his medical evidence at that time and since continues to support the 70% rating.

I think perhaps -just guessing- that when the more recent stressor occurred perhaps he focused on this in treatment sessions with the VA doc-and this was documented a lot-thus the VA C & P revealed maybe more current stuff about this then what the initial stressor was all about-

as this abstract on this MMPI states- this test can predict lifetime symptoms of PTSD:

http://ajp.psychiatryonline.org/cgi/conten...tract/150/3/479

Based on what you have told us- the VA appears to claim his PTSD was partially altered or cured by an additional stressor-

that is NOT what they are saying- but this is how I learned to manipulate what VA says into what will set up a medical and/or legal challenge to their decision.

You have to look at this type of claim in many ways.

Can you tell us what VARO rendered this decision?

[Guest fla_viking]

Dear Fellow Veterans & Friends

Rember 1 1/2 years ago the phoney PTSD reviews and congress passed laws telling the VA to stop PTSD reivews.

This looks to me like they are ignoring the law. Veit Nam Vets of America wants veterans who have PTSD and the VA reviewing them to contact them so they can file a law suit.

USeing veterans real life experances post PTSD grants sure seems chicken shit to me and a violaton of the law.

Terry Higgins