Claim for increase time

[Rick33]

I currently have a claim for an increase in for PTSD PT. The claim is 5.5 months in and It is in the preparation for decision step almost 2 months now. I received my CP exam results a few weeks ago and the examiner marked: total occupational and social plus 5 of 7  of the criteria for 100. I do not get hopes up that this means automatic due to 3 horrendous experiences with the VA. I look at it like I have a possibility for the rating. 

Just curious if this is the norm on length now? Also , are only certain personnel allowed to review and rate increases for PTSD P&T? I have heard this. Just want to ask. 
 

 

Edited July 22, 2022 by Rick33
I made a mistake

[Dustoff1970]

Although decisions on claims for increase can often be very slow you appear to have solid evidence for your increase request and should hear something soon.  Maybe your VSO can keep track for you.

After 36 years of PTSD and dealing with the VA VBM adjudicators I have not heard of only certain raters being allowed to rate PTSD claims but may be something new.

Edited July 23, 2022 by Dustoff 11

[broncovet]

While I generally refrain from answering questions about "when will I get my benefits", I will add my 2 cents.  

The 100 percent PTSD/MDD criteria can be summed up:  "Total occupational and social impairment".  If you have "total occupational" impairment, then that means you are not working, else you would not have "TOTAL" occupational impairment.  

"Social Impairment" often involves things like marriage breakup (if married), or you are so socially impaired you can not snag a spouse.  Sometimes it also involves alientation of family and or friends.  

In other words, "your doctor checking total occupational and social impairment" is probably not accurate if you have a great job, and a great marriage along with many friends and a loving family.  

If you are divorced, you should tell the examiner, as well as other social problems such as, perhaps, a son who no longer speaks to you for 4 years.  

[Rick33]

2 hours ago, broncovet said:

your doctor checking total occupational and social impairment"

Thanks, the C&P examiner marked the “total” box and 100% criteria. 
 

[brokensoldier244th]

Rick- if your examiner checked Total social/Occupational Impairment that goes a long way. While its not a slam dunk (it never is, is it *sigh*) it helps a lot. Remember- Total and Social occupational impairment does not need to have ALL the things listed under it, a number of them in any combination will suffice. 100% doesn't mean we are vegetables, even with MH ratings. VA recognizes this, finally, and there is something working its way through the Federal Register that seeks to address this by changing some of the rating criteria for MH. Among the changes being proposed (NOT finalized yet) by McDonough are removing the 0% rating because what the hell is that, anyway, and removing the language about total occupational impairment from the 100% rating and not being able to work.

A 100% combined veteran can work (within their limitations, of course) there is no reason that a 100% mental rated veteran shouldn't be able to, either, especially since our economy has shifted pretty far away from manufacturing and agriculture, and being in an office 8 hours a day as a requirement. As an example, I'm 100% rated combined and heavily on both the mental and physical side, and I work from home 8 days out of every 10, and soon, hopefully, all the time. I can mitigate my 'low' days, migraine days, pain days at home in a comfortable, safe, quiet, and familiar environment with my kids and wife, and cat/dog around, and take as many breaks as I need to as long as I get my 8 hours in out of a 12 hour duty day period. My propensity for distrac ....SQUIRREL!!!....tions is reduced because I don't have Joe and Charlene discussing the Bachelor over there, and this dude over here humming off key to Broadway Favorites NOW Vol 12. McDonough (Sec VA Affairs) is on record agreeing that 100% doesn't mean useless, and Total Occupational and Social impairment doesn't mean the same thing in relation to the working and social world that it used to. 

How many of us on here have MH issues and PTSD, and manage to converse/relate to each other more or less daily IN THIS CONTEXT where, if we were in a coffee shop we'd be scanning for exits, or avoiding people in the corner so we don't get overwhelmed- and that's if our social anxiety or propensity for distractions let us get out the door of the house and safely drive somewhere in the first place? See what I mean? MS Teams, Skype, FB, VOIP, broadband, and email that allows really large attachments (for work) are pretty normal for a lot of people now. 

 

On to claims and who works them.

The short version- Claims have always been somewhat segmented between VSRs based on what the primary driver of the claim is. It just makes things easier and faster if the trained people or those with more time in do certain things

 

The longer version-

Claims have always been broken up into teams, at least in the last several years. Any RVSR 'can' rate most any type of claim and any VSR can work a claim- unless it is a Camp Lejeune, some kind of Radiation Exposure, AO, MST, Nehmer- those go to certain RO's designated as primary rating ROs for those types of claims- The RO I am in does 'normal claims', but is also a designated RO for Nehmer and MST. We have a large team that handles "VSC" claims (veterans service center- VA speak for an RO) that are general- hips, back, acne, optical, chronic pain, whatever. You know, 'normal' claims. But then we have a team specifically for MST, Navy Blue/Brown Water, Nehmer, and thats all they do.

As an MST team/Blue/Brownwater person I work MST claims, though they often come in combined with other issues, so I work the whole claim, since we were all trained originally to work regular claims. The MST portion is a separate bit of training that I had specific to those types of issues and I also can work regular PTSD claims and stressor research as well since, at the end of the day, PTSD is PTSD. The process for researching the stressors isn't all that different for one or the other. I may spend a few hours pouring over deck logs, newspaper searches, obituaries, personnel/STR for a combat PTSD claim, whereas, for MST I will do the same but also be privy to police reports, CID, NCIS, shore patrol, whatever. The repositories of information I look through are somewhat different but the process is the same. I put on my glasses, grab caffeine, put on my headphones, and dive in. When I was hired it was for Blue/Brownwater claims and I did those for about 8 months on my own before transitioning to where I am now.

Originally (like, prior to 2 or so years ago) MST claims could be worked by anyone, but a rather damning OIG report (justifiably so, Ive read it) showed that they were being mishandled. Information was being missed for behavioral markers and stressors, VSRs were missing variations of  'medical speak' for certain issues that might present themselves in a sexual trauma claim where the doctor weren't using 'standard medical speak, VSRs weren't developing completely for stressors to civilian or federal law enforcement for investigative reports, they weren't noticing behavioral shifts in STR and Personnel records. Thats when VA National chose 5 RO's to work them specifically, based on a multiyear average of accuracy and output of completed claims. Soon MST claims will be consolidated again down to 1 RO where that RO will pretty much only work those claims. A recent OIG report showed that there were still errors being made on MST claims, but a sizeable fraction fewer than what was happening before since the shift to specifically trained people. Other reports that I have read about Nehmer/AO, etc. say similar.

Our RO has authorized several hundred thousand dollars worth of Nehmer and MST claims just in the last few months that I can remember off the top of my head- to veterans, not just survivors, because we caught a lot of errors or found evidence buried in some PDF from NPRC, deck logs, day logs, mission AARs, NCIS, Mayberry PD, that was missed before. That comes from training, familiarity, and a general sense of personal pride at our overall national ranking. Some other RO's hate mine because we overturn errors that they make and send the claims back to them to get fixed, or overturn their errors on US because they weren't actually errors in the first place). We work really hard to maintain that.

 

Ok- Ill shut up now. 

 

Edited July 23, 2022 by brokensoldier244th

[Rattler]

On 7/23/2022 at 9:46 AM, brokensoldier244th said:

How many of us on here have MH issues and PTSD, and manage to converse/relate to each other more or less daily IN THIS CONTEXT where, if we were in a coffee shop we'd be scanning for exits, or avoiding people in the corner so we don't get overwhelmed- and that's if our social anxiety or propensity for distractions let us get out the door of the house and safely drive somewhere in the first place? See what I mean? MS Teams, Skype, FB, VOIP, broadband, and email that allows really large attachments (for work) are pretty normal for a lot of people now. 

I am still this way. (sigh) I some times think it will never go away.... If you are a PTSD / MST Vet you can only learn to manage you symptoms. My wife of 18 years doesn't understand and I don't expect her to. I have been lucky in that I have had some great MH works over 5 years who have helped me through it. 

If no one has said it thanks brokensoldier244th for educating us on how it works in the real VA world. No VSO or barracks lawyer fancy land. 

[brokensoldier244th]

No worries. Sometimes I get thanks on the down low- sometimes I don't. It's okay, for the most part. I started out as a vet on the outside for many more years than I've been at VA. In fact, ive only filed one claim for a minor increase since I started working there (other than dependent stuff with my kids aging out or going to college, etc) that ended with a denial- but I understand why now, after several years of wondering why my sleep apnea rating was only 20% and not 50%*. I try to pass that same 'lightbulb moment' stuff on to you all. I learn stuff every week that I didn't know, because even with 4-5 months of training to start there is no way in HELL you can learn everything. There is a very large component of 'don't know until you run across the scenario....'. They told me when I got hired that it can take 2-3 years after training to start feeling comfortable doing the job. I about freaked at the time when I asked about that in my interview. Now I understand why. 

You all, many of you, are piecing it together in snippets just like I was doing, and I know how frustrating that is, so I try to help out with information when I can. I never get to see the end result of the claims I work on unless I go look them up again several months later to see what has 'closed out'. At least in here there is more direct feedback- and some of you know way more than I do just from your own experience, or from having worked at VA also, so I learn stuff here too.  

 

* its convoluted, but I can explain it if someone is interested- you can DM me