Harm in calling the VA?

[drago]

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?

[drago]

PacmanX1: SInce hypersomnia is already claimed (but not decided) as secondary to TBI, would an alternative or better approach be to "amend" the claim, if that is even possible to be a stand alone claim?

Let me add, that I know no one can tell me exactly how to handle any of this, as there are too many details to fill in, and all cases are different. My VSO is pretty sharp, although WAAAYY busy. I would certainly discuss any ideas with him. I just kind of "don't know what I don't know", and so anything that helps me understand or talk to him better is greatly appreciated.

[pacmanx1]

Forgot to add that you can file for SSDI and get both most veterans do. The SSA may deny your claim but most claims are won on appeal at the ALJ Hearing.

We base our post on your post and really, we can only speculate (guess) based on our own experience with VA and how they may operate and make decisions. The more information you post the better response we can give.

Edited September 21, 2021 by pacmanx1

[El Train]

2 hours ago, pacmanx1 said:

It may be an off chance that you may have a nerve condition and or a spine condition due to your TBI and dropping things. I started this post not fully reading your entire post and prior to actually posting it I went back to make sure I tried to cover everything. I have a spinal cord injury, never thought of a TBI condition but I have problems holding things and there are times when my arms and hands feel like they are on fire or being stuck with really fine needles.

This is my case.  I suffered nerve damage to spine and neck when my TBI occurred.  Got TBI approved, but neck and spine issues denied.  Had more than enough evidence.  For some reason the VA was set on denying these conditions.  Like it was a small solitude of gratifications to deny me on somethings.  But hey, I did get max on Fibromyalgia, so in theory I did get rated for pain.

If I wasn't 100% P&T with smc-s, I would've appealed and won easily.

[drago]

 

10 minutes ago, El Train said:

For some reason the VA was set on denying these conditions.  Like it was a small solitude of gratifications to deny me on somethings.

I completely understand. I have tried to keep a positive attitude about what I call "VA rating side". I like to think of folks at the VA rating side as being there to help, but they are probably overworked government employees who simply need check boxes filled to move a file on, and that none of it is personal or mean spirited. MY VSO who has obviously much more experience rolls his eyes and says "if that helps you sleep at night...". Given this hadit.com, I'm guessing many folks have had less positive experiences also.

My back claim though seems to be the "set on denying" one, because they haven't taken my word into account for anything else, but "I hurt it carrying concrete" is the one they listen to. There has not been any movement on that claim since the PT letter was sent. There is also pain/numbness/weakness in my right leg which is waiting for the back to be rated, and then the plan is to add radiculopathy.

[brokensoldier244th]

19 minutes ago, drago said:

Lots of interesting information, so thank you all.

Folks keep mentioning not knowing about my situation. In a nutshell, 40ish years ago I was in an accident. Another soldier died. From the time of the accident I have only remembered fragments of what happened. I was locked up immediately following the accident until my 1st sargent came to get me. I don't remember receiving treatment except for someone in the few hours after the accident telling me I had a concussion. There is however documentation that I was treated at the ER at some point after the accident and I was released documenting head aches and back pain. I spent a few years in the bottle following discharge (honorable). Back pain and headaches never went away. I stopped drinking for a while, and during that period I ended up in the ER for severe back pain. I told the doc at the time that I was lifting bags of concrete when it hit me.

Back pain and head aches persisted over the years with periodic ER visits for the back. Briefly prescribed some meds for the headaches but many side-effects so just lived with it. Ironically, as I tried to put the accident behind me, I never attributed any symptoms to the accident. Thyroid went kaputs almost immediately from discharge also.

Fast forward to about three years ago, i was in PT for my back. PT was talking about what caused it, and I said lifting sacks of cement. He said wouldn't have happened that way, would have been from a trauma somewhere along the line. I described the accident, and he said that was almost definitely the cause.

Fast forward to last year, and in conversation with my father-in-law who is a Viet Nam vet, he showed his new VA hearing aids. I had recently bought my own, and he said I HAD to get hooked up with the VA, they're hearing aids are the best, yada yada. Ultimately, I went to my VSO fully expecting to hear "nice try but no, and thank you for your service". Instead, he talked me through hearing loss and tinnitus, PTSD, TBI, and back. Started with those, immediately rated at 70% for PTSD with alcohol, 10% tinnitus, 0% hearing, and denied on the back. Turns out the decision on the back was based on my statement of "hurt it lifting concrete"-of course THAT record still exists from all those years ago. My PT wrote a buddy letter (I think might be the nexus letter mentioned earlier). It is now sitting as "deferred" I think.

Added in chronic kidney failure which was rated at 60% due to alcohol. Also added in overactive bladder at 10%. I urinate 19 times a day. Currently "out there" as claimed is hypertension related to PTSD, Ischemic heart disease which we claimed as chemical exposure, hypertension secondary to PTSD, and hypersomnia claimed as secondary to TBI. Chemical exposure is due to a range I was assigned to, so its a long shot, but I have no family history of ischemia and it is an effect of some of the chemicals that were there.

Hope that is not too much personal info.

brokensoldier: So, if the hypersomnia as secondary to TBI is "substantiated" (my word) meaning the VA says yes I have it and it's related to the accident, the VA could then say the hypersomnia is not in addition to TBI, but is incorporated in TBI? As in  PTSD/TBI/hypersomnia and still be 70%?

And I've always thought of VA medical benefits as separate and distinct from VA claims/rating (mostly because it was explained to me that way). Does that mean the VA claims can pull info directly from my records with VA medical? If so, that is probably a good thing as they could see my therapy notes regarding the PTSD, and also my blood pressure readings from various appointments.

We are legally required to pull VAMC, Vet center, OMPF, STR, and PMR (if its indicated and the 4142/4142a releases are filled out and sent to us telling us who to request from). The systems are not in 'sync' with each other, or with private doctors, so just because you go to a VAMC for something next week isn't going to automatically update your file on the VBA (benefits) side. However, if we DON'T request one of those prior things, its a pretty hard full stop on your claim (for us, the VSR) and it gets kicked back to us with a pretty substantial error that we need to correct. We are 'graded' for lack of a better term not only on production (how many claims we work/what we do to them) but also accuracy on those claims. There are 11 categories of things that we have to be aware of, though they don't all apply to each claim. 

If the hypersomnia is rolled into TBI (if the medical opinion says that its manifesting because of TBI) it may or may not affect your rating. It could still increase you. Depending on your total rating now, or if you consider yourself employable, you *could* claim unemployability by sending in a 21-8940 that describes your disabilities that most affect your ability to be employed. Your claim hasn't been rated yet (Im assuming, since you are posting here) so that contention would be added to the current claim- there may or may not be an 'exam', though your records would be reviewed holistically alongside your 21-8940 to see if it is enough to consider you unemployable. IF that happens you would be rated 70% (example) but be paid at the 100% rate. 

Upsides of this- you are paid at 100%. Downsides of this- you don't get many of the benefits that may be extended in your state to 100% veterans. It depends on how strict they are (DMV, County/State Treasurer, etc). You also don't get educational benefits for your dependents. You also can't make money over the poverty level of 1 person, as calculated by SSA in a year. So there is the constant nagging in the back of your head feeling (if you are working, or hobby working) that you might make too much. If you were to be rated 100% schedular (just based on your ratings alone) then there is no such restriction and you can work as much as you want. 

I am a 100% rated veteran since 2015. Was a basket case for a few years in there prior to (when I was working) and after (when I was not). After I was rated 100% I still didnt work for a few years, getting my shit together. In 2018 I started working part time for a local library in the stacks for about 10-15 hours a week. Eventually I got better around patrons on the floor and ventured out more out of the back to interact with them. After 1.5 yrs I applied to an open VSR position with the VA and after about 9 months of back and forth I interviewed and got the job. I currently work from home right now due to Covid in the area, and have since March of 2020. Once that finally goes away enough to open back up to employees Ill probably file a request for accommodation to continue to do so. I already qualify to work from home based on time in grade and performance, but I still have that other feather in my back pocket if I need it. Working even in an office environment is too distracting to me, and my irritability and people skills very quickly diminish in an 'open office' environment with noise, sounds, and people all over. 

You CAN work at 100%, but you really have to find a niche that might allow you to. I could fall back onto computer programming or remote Info Technology if I wanted to as well, but I like what I do and after several years of my own claims and volunteering online (mostly) helping others, I like seeing the other side of things. It makes me better when I assist with claims outside of work while not wearing my 'official' VA hat (/*disclaimer- I don't speak for the VA, and nothing I say should be construed as official policy - unless I post a direct link to something *\end disclaimer). And the volunteering is partly what helped me get the job that I have because I had an idea of the layout of the M21-1 claims manual and some of how it is applied.

[drago]

As additional detail, I would also add that I retired early from work. Full pension would have been 35 years, but I retired at 31 years and took a penalty on pension.  I retired due to attention issues (not getting things done and things that were done and had mistakes), memory issues, and poor judgement (as my boss stated).  I thought it best to retire, as I was beginning to have meetings with my boss and HR. At the time of retirement (before VA was even on my radar), I attributed it all to the stress of the job. After retirement, those things have not improved, and a civilian doctor recently asked me if I had ever had a TBI.