100% p&t exam

[SPO]

Starting a new thread to avoid confusion.  I was awarded 100% p&t on 12/1/2020, effective 7/7/2020 (date of last c&p).  However, in the decision letter it says they are scheduling exams to evaluate my current severity.   What is the point if I’m already 100% p&t. Are they just looking to take away what they just gave me?

[broncovet]

I agree this is confusing.  Can you post the letter (but not personal information)?  

"Future scheduled exams" and "P and T" are in conflict with each other.  

Its POSSIBLE, that you could actually be eligible for additional benefits, in other words, SMC S.  

Remember, Statuatory SMC S means 100 percent (sounds like you got that covered) plus an additional combined 60 percent, separate and distinct.  The additional combined 60 percent, for smc s, may be what this is about.  

This said, "confusing Veterans" is what the VA does.  Confused Vets are usually not able to easily maximize their benefits, and often settle for much less.  

As an example, instead of using the term "Permanent and Total", (as many state and county governments require for many additional benefits, such as property tax reductions), the VA often says, "no future exams are scheduled".  So, an auditor at the county government has to "know" that means P and T, in VA code.  Another way, is to say, "eligibility for Chapter 35 DEA benefits is established." 

    Usually only people who deal with VA on nearly a daily basis are able to decode VA's confusing decisions.  

[pacmanx1]

16 minutes ago, broncovet said:

I agree this is confusing.  Can you post the letter (but not personal information)?  

"Future scheduled exams" and "P and T" are in conflict with each other.  

Its POSSIBLE, that you could actually be eligible for additional benefits, in other words, SMC S.  

Remember, Statuatory SMC S means 100 percent (sounds like you got that covered) plus an additional combined 60 percent, separate and distinct.  The additional combined 60 percent, for smc s, may be what this is about.  

This said, "confusing Veterans" is what the VA does.  Confused Vets are usually not able to easily maximize their benefits, and often settle for much less.  

As an example, instead of using the term "Permanent and Total", (as many state and county governments require for many additional benefits, such as property tax reductions), the VA often says, "no future exams are scheduled".  So, an auditor at the county government has to "know" that means P and T, in VA code.  Another way, is to say, "eligibility for Chapter 35 DEA benefits is established." 

    Usually only people who deal with VA on nearly a daily basis are able to decode VA's confusing decisions.  

Bronco, yes there is the SMC factor, but this veteran was granted 100% P & T but was also deferred multiple ratings for more C & P exams. Even though I used the word speculate, I do believe it is a clear answer. These new C & P exams can possibly warrant an earlier 100% rating effective date.

 

Quote

 

Ok.  So some new, somewhat confusing info.  The VA rated me 100% p&t on 12/1/2021, effective 7/7/2020 and I received retro last week. However, they have not issued a decision letter for it from the RO.  Dav says that everything is listed as deferred and the are scheduling exams.   He said it looks like they are scheduling record review exams to evaluate if I rated more than 0% between 11/2018 to 7/7/2020.  Which would change my effective date and fix the issue, if they decide in my favor. He said he’s pretty sure, but not 100% that’s what they are doing.  Has anyone ever heard of this? 

Based on your post it appears that the VA granted you 100% P & T with an effective date of July 2020, but you have deferred claims pending for exams that could possibly push your 100% P & T rating closer to the November 2018 effective date. This is pure speculating, but it is very possible, and you will not know until after the VA makes their decision. Each rating if rated separately could get you closer and closer to the 2018 effective date but keep in mind that even if the VA grants you a rating higher than 10% it may not result in a combined rating change and may not hit the 100% rating. With a combined rating change it should generate a retro payment. These are just examples but depending on when you filed your claims, no one knows. Example: 80 + 10% = 80% round down to 80% no change in rating no retro payment due, or 80% + 30 = 86% round up to 90% change in rating and retro payment due but not a 100% rating. Too many variables to try to figure out.

 

 

 

Edited December 7, 2021 by pacmanx1 (see edit history)

[SPO]

Sorry. Couldn’t get a redacted copy so here is a copy and paste.  All the various joints read about the same.  
I am positive that I’m 100%p&t , it’s in my letter generator and the DEA info is in this decisions.

I noticed the didn’t  list the evidence I submitted as part of the appeal in the evidence reviewed.
 
In accordance with Board of Veterans Appeals decision, dated November 23, 2021, service connection for psoriatic arthritis of the left shoulder has been established as related to the service-connected disability of psoriasis (previous rated as minimal erythematous slightly scaly patches). (38 CFR 3.303, 38 CFR 3.310)
The effective date of this grant is November 16, 2018, the date we received your intent to file, because we received your formal claim within one year of the date of the intent to file. When a claim of service connection is received more than one year after discharge from active duty, the effective date is the date VA received the claim (38 CFR 3.155).
A noncompensable evaluation is assigned from November 16, 2018.
We have assigned a noncompensable evaluation for your psoriatic arthritis of the left shoulder based on:
• Objective evidence of rheumatoid arthritis without evidence of limited or painful motion (38 CFR 4.31)
Note: In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. {38 CFR §4.31}
The provisions of 38 CFR §4.40 and §4.45 concerning functional loss due to pain, fatigue, weakness, or lack of endurance, incoordination, and flare-ups, as cited in DeLuca v. Brown and Mitchell v. Shinseki, have been considered and are not warranted.
A higher evaluation of 10 percent is not warranted for arthritis, rheumatoid (atrophic) unless the evidence shows:
• Objective evidence of arthritis along with any limitation of motion of the joint. (38 CFR 4.69, 38 CFR 4.71a, Historical 38 CFR 4.71a effective April 1, 1946)
Additionally, a higher evaluation of 20 percent is not warranted for limitation of motion of the arm unless the evidence shows:
• Limited motion of the arm at shoulder level; or,
• Limited motion of the arm midway between side and shoulder level; or,
• Painful motion of the shoulder. (38 CFR 4.69, 38 CFR 4.71a, Historical 38 CFR 4.71a effective April 1, 1946)
An evaluation of 20 percent is assigned from July 7, 2020, the date of medical evidence which shows increased severity in your service connected condition.
An evaluation of 20 percent is assigned for limitation of arm motion midway between side and shoulder level or for limitation of arm motion at shoulder level. A higher evaluation of 30 percent is not warranted unless arm motion is limited to 25 degrees from the side. (38 CFR 4.69, Historical 38 CFR 4.71a effective April 1, 1946)
 
A higher evaluation of 40 percent is not warranted unless there is evidence of symptom combinations productive of impaired health objectively supported by examination findings or incapacitating exacerbations occurring three or more times a year. (38 CFR 4.45, 38 CFR 4.71a)
A VA examination will be schedule to assist us in obtaining an accurate assessment regarding the current severity of your service connected condition.
Laws and Regulations applicable to this issue:
38 CFR §3.1 Definitions.
38 CFR §3.155 How to file a claim.
38 CFR §3.159 Department of Veterans Affairs assistance in developing claims.
38 CFR §3.303 Principles relating to service connection.
38 CFR §3.310 Disabilities that are proximately due to, or aggravated by, service-connected disease or injury.
38 CFR §3.400 Effective Dates - General.
38 CFR §3.2500 Review of decisions.
38 CFR §3.2502 Return by higher-level adjudicator or remand by the Board of Veterans' Appeals.
38 CFR §4.10 Functional impairment.
38 CFR §4.40 Functional loss.
38 CFR §4.45 The joints.
38 CFR §4.59 Painful motion.
38 CFR §4.71a Schedule of ratings-musculoskeletal system.

[broncovet]

You posted:

Quote

veteran was granted 100% P & T but was also deferred multiple ratings for more C & P exams. Even though I used the word speculate, I do believe it is a clear answer. These new C & P exams can possibly warrant an earlier 100% rating effective date.

There is your answer.  You may get an eed, or maybe smc.  My advice is to attend C and P exams, as applicable, and wait for the results of the deferred issues.  

[SPO]

They already issued a decision on the 12 items that are also deferred.   I feel like it’s an attempt to justify reducing me since the appeal hasn’t been fully closed.

[pacmanx1]

6 minutes ago, SPO said:

They already issued a decision on the 12 items that are also deferred.   I feel like it’s an attempt to justify reducing me since the appeal hasn’t been fully closed.

SPO, the VA just granted you 100% P & T minus the deferred issues. Even if the VA rated some or all of these deferred issues, the VA is trying to make sure they are paying you, your correct compensation rate. They are not trying to reduce your rating. It is normal for some ratings to be deferred for a final C & P exam to be rated.  

[SPO]

No,  I was granted 12 issues by the board, the RO then gave me ratings which then pushed me to 100% p&t for all 12 issues. Those same 12 ratings are still deferred with in person exams requested.   

[pacmanx1]

Best thing to do is wait for your decision and if VA contacts you about exams, just go. Your decision letter will explain a lot more than the generated letter from VA.gov. You can also try to ask your VSO for a preliminary letter.

[Carl the Engineer]

I believe when you get to 100%, and or, TDIU, they do a full look at your VA record and poke around to see if they owe you something more, or you owe them something more, to finalize it, etc.   

I went 100% back in June, I believe, and they poked around and found that I had been paid seperation pay in 2008 and the they (VA) had recouped it, before they started actual payments to me, back in 2011.  This spring, after I got my backpay (retro), they withheld about 900 bucks from my VA comp and started, not one, but two new claims, regards my sep pay.  I requested a hearing and went to the hearing in MIlwaukee a long time ago.  It hasn't gone in front of the judge yet is what the "VFW" is telling me, but it looks good for me to get my 900 bucks, but it's been since June.

However, the most important part is I am still 100 P&T and I am getting my comp deposit every month. 

LOL,

Hamslice

I wouldn't worry too much, and I surely would not miss a C&P exam.  Even if I had a 300% rating.  Just sayin..

 

[pacmanx1]

In my case when the VA granted me 100% scheduler P & T, I had several claims on appeal not deferred but the BVA just recently granted me a separate effective date going back to 1998. When I say separate rating, this particular rating in not included in my 100% combined rating so the VA had to retro pay this award back to my original claim prior to my 100% rating decision.

[pwrslm]

You have been given a lot of good info here. 

Regarding the 0% rating up until 07/20, scour your medical records on this to see if you ever reported painful motion in this condition.  If there is notation of pain that was not addressed, that date should be your effective date. Psoriatic arthritis causes swollen, stiff, and painful joints.

Painful Motion (§4.59): This is the most commonly used principle. Basically, regardless of how much the service member can move their knee (or any joint), if it hurts when they move it, then they will get at least the lowest Compensable rating for the knee–for example, 10% (money) instead of 0% (no money).

You would need to request a HLR on this because if it were already in your records you would not consider that new evidence that is required for a supplemental claim. Alternatively, you could also present them with a lay statement making the claim on painful motion and point out that they ignored evidence on this issue in you medical file. That may work for a supplemental claim.

 

Edited December 8, 2021 by pwrslm (see edit history)

[pacmanx1]

2 hours ago, pwrslm said:

You would need to request a HLR on this because if it were already in your records you would not consider that new evidence that is required for a supplemental claim. Alternatively, you could also present them with a lay statement making the claim on painful motion and point out that they ignored evidence on this issue in you medical file. That may work for a supplemental claim.

In this particular case the veteran's claims/ratings are deferred still pending/open and there is no need to request an HLR or supplemental. The VA is already in the process of determining the veteran's decision by requesting new medical exams/opinions.

[Mr cue]

Ok are they ordering exam for the condition they was granted the pt 100.

Or are they ordering exam for the deferr issues.

That is the?

If they are ordering exams for something that was just grant there a problem.

My opinion

[SPO]

It is exams for the ones that were just grnated

[pacmanx1]

Let's not confuse the veteran any more the thread states that the veteran is still waiting on his official decision letter. Any speculation outside of him receiving that would just confuse him even more.

[Mr cue]

Well to me it seem to be a problem.

What does a letter have to do with getting a exam for a condition that was just granted.

And he ain't even get the award letter yet

Make no sense.

Now there is a thread going where ppl are give advice on get a comp exam cancel.

If it were me I am call the 1800 and ask for a supviser and have them put something in the system about it.

I am uploading something in the record about it.

I am sending something to everbody.

Then I would go to exam if it not cancel.

But I would have something in my record stating I feel this is no a legal exam.

I am not from the school of just waiting and  see what happen.

 

 

[pacmanx1]

The official letter explains what the VA is looking for, some C & P exams will state that the veteran has to appear and some state that the VA is looking for more details and the veteran does not have to appear. The exams are to determine if the veteran would get an EED (EARLIER EFFECTIVE DATE). There is no problem until an actual decision is made. For a decision to be made, it has to be in writing. Calling the VA at this particular time would not do anything. 

[Mr cue]

Well I feel you got good advice now Its up to you to use the advice the way you want.

Good luck

 

 

 

 

 

[SPO]

I have it in writing.  It says they want exams to evaluate currEnt severity.

[Mr cue]

I understand what u are saying.

And it's an error 

How do a veteran get granted a issue  not even 8 days ago.

And now they want a exam to see how the condition is doing. Smh

Did u get a copy of the notification letter or the award letter for the granted.

If not it not process. Yet

call 1800 and get all letters fax over. You don't have to wait 7 10 business day anymore.

See if they did the letters for the grant.

I would not just sit back and let them do it.

My advice is get stuff In the record and you have to go to the exam.

Don't give them that ammo 

But I would put thing in the record before the exam.

Good luck