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?

[brokensoldier244th]

0 is good- er, well, bad as in you don't get compensated for it, but good because now its acknowledged as an SC condition making it easier to raise. The hardest part (IMHO) is to GET condition X SC. After that, whether it gets worse or not is, based on whether it gets worse or not. But getting it on your list of conditions is the hard part. If you haven't (and if your symptomatology warrants it) I would have them look at the headaches, too. 

The chronic sleep impairment looks like its encompassed with the PTSD. Im rated for hypsomnolence in part because of MDD and in part due to my OSA, so that condition is encompassed under both. I've seen it also classified under Narcolepsey and also circadian rhythm disorder, since its more of a symptom than a condition in and of itself. It's commonly rated under OSA at 30% if you don't have to use a CPAP or Bipap.

[drago]

brokensoldier244th: Thanks for the reply... since headaches are their own condition, they probably can't just do a re-look with this set of re-evals since this set is for PTSD and TBI?

Also, is it possible (not necessarily likely), that the hypersomnia could increase the overall PTSD/TBI rating? The original rating letter for PTSD describes what would have to happen for PTSD to go from 70 to 100, and it is pretty substantial. Would the same rules apply now that TBI is in with PTSD? I guess I'm thinking along the lines of "we didn't realize the sleep disorder (now we know it's hypersomnia) was this bad" so PTSD won't go up, but TBI will?

Sorry to belabor this, but if I have an inkling of what *could* be the outcome, it's generally easier to deal with. As opposed to getting a letter saying "yup, you've got it, but we kind of took that into account, so no change". Hopefully that makes sense...

Headaches, ironically, they aren't' worse, they were just never properly acknowledged in the first place LOL

EDIT**-also, is there a place on the va.gov website to see everything a person is rated for? I've not found the website to be especially helpful so far.

Edited September 22, 2021 by drago
added another question

[drago]

Hi Everybody,

Please tell me if I should start this as a new thread, and I will, but it does pertain to the stuff already typed, so I'll keep it with this thread for now. I now other forums get very particular about what is in one thread and what should be a different thread.

So, I've been looking around on Hadit and carumba... doesn't give one a reassuring feeling about the VA and their processes. Anyway, three main things I wanted to bring up...

1. I read a post titled "requested increase, and they removed my service connection" which has some similarities to my situation, but not necessarily a ton. One thing stuck out from poster 63charlie about being sent to a general C&P physical exam (sorry I haven't mastered the art of quoting between threads yet). I thought this exam overall was for the ischemia., but now it sounds like maybe I would be well served to be prepared to talk about everything? I tend to be a "minimizer", so if I think I'm in a heart exam and someone asks about PTSD, I would be likely to say something like "well, I'm managing it" or "you know, some days good, some days bad, today is good" etc ESPECIALLY if they make it sound like an off the cuff comment/conversation. That makes me think maybe I would be well served to be prepared to talk about everything?
2. Degen Disc Dis Issue-someone also mentioned in that thread (I think), about a first examiner from VA denying a claim, then the veteran getting a positive opinion. The overall take was it was 1:1 tie with opinions, and a tie goes to the veteran. After reading the letters I've been sent and seeing the reports on my back, the initial VA examiner said due to concrete lifting. We asked for another review, and a person I've not met did some sort of remote review, and confirmed that opinion and threw in some of the other facts listed above, including the erroneous or misinterpreted ones about treatment. I then submitted a buddy letter from my PT WHO HAS TREATED me, that said undoubtedly from service accident. Does that basically boil down to 2:1, I lose? I mean, that's kind of like a 3 Stooges "you lie and I'll swear to it" kind of thing, since the second remote reviewer had no new info!
3.  Does anyone know a good place to gain more than a basic bit of knowledge in all this? For instance, in the above referenced post, there are acronyms that I don't know the meaning of such as "CUE" and "NOD". I'm thinking like almost a playbook of what the VA does? For instance, I never thought about a general exam being a booby-trap, and maybe it's not. It certainly was explained to me that the "VA just likes to get a sense of how you are doing, make sure nothing is being missed". Which, I interpretted as "the caring folks at the VA, maybe they do have my back". I did have a moment of "but they could just check my VA medical to see that?"  NOW, I think that "nothing is being missed" can equally mean not being missed in terms of you are being over-rated and over-compensated!

Thanks everyone for all the help and support

[brokensoldier244th]

On 9/21/2021 at 12:49 PM, drago said:

 

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.

 

There m21-1 manual we use is online at the VA website. It won’t define terms because it already assumed we know them but it, and the 38cfr for disabilities are both freely available. You can google terms, and honestly, google your condition or question and add M21-1 to it and google will (usually) take you there faster. I use it more than the official version at work. 
 

https://benefits.va.gov/WARMS/bookc.asp

 

https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018

 

 it’s under compensation. 
 

 

On 9/21/2021 at 12:49 PM, drago said:

 

Edited September 24, 2021 by brokensoldier244th

[drago]

Good info, thanks brokensoldier244th.

I just had a moment of enlightenment, and thought I need to toughen up, stand tall, and prepare for these exams like I would anything else. Not "study" per se, because I think that could imply embellishment.  But be prepared, so I called my VSO and asked for a few things. That way I can be prepared for when they ask a question, I can have examples and such ready as opposed to "oh, I don't know, let me think...". Because thinking in the moment like that is not my strong suit.

[brokensoldier244th]

No, its not embellishing to study what the exam will be for- otherwise you are caught unawares by the questions. DBQ's for the exams are online, too. NVSLP has them on their website, VA does too but they are moving things around internally on the site so the link doesn't always work, so NVSLP is your best bet. You can look at the questionnaire and see exactly what they are evaluating. Take notes on things and take your notebook with you if you need to, to remember things. I journal in MS One Note and I have a desktop 'virtual' sticky note that I use during my video calls for MH. If I forget something, I secure message my provider- those secure messages show up when we pull Capri (VAMC) records, and it gives you the opportunity to rebut, clarify, thank, whatever, your provider(s).