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

[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.