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Harm in calling the VA?



Hi All,

I’m new to the VA system and new to the forum so please accept an apology in advance if I’m doing this wrong.

In a nutshell, I’m 57 years old, and received a VA rating of 70% for PTSD, and a subsequent rating for TBI for injuries that happened in the Army 35 years ago. The TBI is lumped in with the PTSD because they say it is hard to say what is PTSD and what is TBI. The rating was given just over a year ago when I was 56.

I was under the impression that since I was over 55 years old, the rating would be “locked”, and would not be revisited/re-examined/re-evaluated unless I asked for an increase. 

I have a claim that is progressing for hypersonia that a civilian doctor diagnosed and said is “definitely” related to the TBI. QTC robo called and said to get in touch with them to schedule an appointment. When I called them back, they said the appointment is for a re-eval for the PTSD and TBI, and did not mention hypersomnia. 

I can’t find anything that says that PTSD/TBI is an exception to the age 55 rule, but perhaps I misunderstand that rule. So two questions I’m hoping someone can help with: 1. Does the re-eval seem correct? I read somewhere in my research that upwards of 35% of VA re-evals are not required and are actually mistakes. And 2. Would there be any harm in calling the VA to talk it through? I also read that the VA “writes EVERYTHING down” and I don’t want to create extra problems for myself with a phone call.

Ultimately, I’m not opposed to a re-eval, as overall I’m in worse shape than I was a year ago, but going through the process of recounting things led to a bad few days, and I simply don’t want to do it again if not necessary. Also, I had a bad experience with the TBI evaluator not reflecting what I actually said, and that’s concerning for this re-eval.

Thoughts from the group?

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Hi Drago, welcome to Hadit. PTSD is a MH condition. Some of TBI symptoms can also be the same as MH., so the VA has a hard time spliting them off. You did not say when you got your 70% rating, but I would bet that yotr rating sheet has rse, routine scheduled exam, against your disability. Since you are claiming a new disability that could be linked to an existing MH disability, the VA is going to do a re-do. If your symptoms for MH and your doctor treatment records have been submitted to the VA, you should  be all set. Keep in mind if you can't separate the sleep disorder by way of a good nexus letter, you will be rated at the MH diagnostic code. The rate of 70% is about as high as you can go; the next is 100% which is pretty hard to achieve. On top of that , if the diagnostic code for hypersomnia is low, like 10% rating, you could possibly be not even raising your overall combined rating . (see VA-Math.) Be sure you weigh all the facts; risk vs. reward is not in your favor IMHO.

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  • HadIt.com Elder

Hypersomnia and sleep disorders fall under mh unless it's sleep apnea,  and since your tbi is intertwined they will be looked at as a whole. 

Basically you did ask for an increase because likely sleep issues were already consideted under your MH, and even if it wasn't at the time it still falls under it. You can only be rated for onebody condition at a time with a few exceptions, and we go with whatever generally rates higher and that's what umbrellas any other related contentions you have. 


We go through revals before they are sent out and we pull your VAMC medical. If it's enough to go on you usually won't get a notice. If there has been a major sustained change based on the information we have then you get an exam. We can't go back and just pull private records again so if you are getting other treatment and we didn't know about it, and your VA medical is thin, then an exam is usually done. 


Generally over 55 is when we don't automatically request a reval every few years. Static conditions are another. Google 'protected ratings'.


Where did you get that 35% figure from? Some sources are better than others, and some like to post non contextual statistics to rile people up to appeal, bruiser itt makes them money. 

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Thank you for the replies. So it seems then it is according to Hoyle, and I’ll simply plan on going. I ended up calling the VA directly before either reply, and the person on the phone said generally what GBArmy had said. I must say that my experience with the VA folks has been positive, but it’s about 3/5 on the third party evaluators. I think that is partly where my angst comes from. I still seem to be very symptomatic of the PTSD, and I would also say symptomatic of a TBI. The first third party evaluator for TBI told me when I first sat down he could tell I didn’t have a TBI because of how I walked and my speech, “but we’ll do the form anyway because that’s what they want”. Someone at the VA actually sent his report back asking for more info on headaches and a couple other things, and he did the same thing again, not using my statements and minimizing my symptoms. I wanted to complain and file an appeal, but my VSO said something similar to the your replies, that 70% PTSD and TBI was about as high it would reasonably go and there wasn’t a point in going further when I had other claims that were clear.

GBArmy: Thanks for your reply. I think if I get impartial evaluators it should be fine. With the PTSD I continue to have ideations, as recently as this past weekend. As far as TBI goes, I have symptoms of that as well, although some are a little less clear, and some don’t have supporting documentation. For instance, headaches have been a problem since the incident and I was treated at various times for them. BUT, in both cases, it was a while ago, and the doctors are retired and the records are long gone. Also have some problems with dropping things etc for which I was evaluated for MS with a nerve test, but those records also long gone. There are other symptoms as well that indicate TBI in the civilian world, but not sure how an evaluator and the VA will see them.  Things like teeth grinding and significant memory issues (which the initial evaluator were probably related to “OAD”, “old as dirt”). But enough sour grapes… is it possible to roll back a claim once it is made? I can’t imagine it would be viewed favorably if I cancelled the claim out to avoid a re-eval?

broken soldier: Thanks for your reply as well. You both spent some time on your answers and I appreciate that.  When you say VAMC and VA Medical file, do you mean records that I’ve had sent in, or records pulled from VA treatment? The 35% figure came from a website, maybe one of the attorney websites, and was supposed to be from an OIG report in 2017 or 18.

14 hours ago, brokensoldier244th said:

You can only be rated for onebody condition at a time with a few exceptions, and we go with whatever generally rates higher and that's what umbrellas any other related contentions you have. 

Does that mean that PTSD/TBI would most likely be lumped together (as they are at 70% right now) and even if hypersomnia is added (attorney websites say it usually 30 or 50) they will all still stay at 70%? Meaning it would then become something like PTSD/TBI/hypersomnia =70%? Or would it be PTSD/TBI=70% and hypersomnia=30% so 70%+30%=(VA math) so like 79%?

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  • HadIt.com Elder

*Bottom line up front- Im not a rater, im a VSR that builds your claim based on what you send in, your STR/OMPF, VAMC records, records research for stressors/units/actions,  awards, MST behavioral markers, yadda yadda, and then I send it to the raters. 


That said, VAMC and VA medical file are what we can pull directly from whatever VAMC/VAMC's you have ever been to. STR's are your service records, we request those but we don't have a direct conduit to NPRC- we request, then they find and scan and send to us. 

Without seeing your DBQ from your TBI exam and the rating decision I can't say how it will be/was rated. Generally when I see TBI claims things like motor difficulties, speech impediments, sleep-wake disorders, etc are put in with it as ancillary symptoms caused by the TBI so its rated as 1 thing due to avoidance of pyramiding (assigning separate ratings for all facets of a contention where, taken together, they are still all 1 thing). There are a few ratings where those are separated, like knees that can have separate ratings for different parts of them, but MH issues are usually pretty encompassing, TBI especially. 


Edited by brokensoldier244th
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