Appeal 50% Dro Rating Or Apply For Increase In Rating?

[tssnave]

After a long, 3 year process and one really cruddy C&P exam, I have been granted 50% sc disability for mental illness through the DRO process. The check has arrived (and been cashed) and I’m in the process of sending in the other paperwork (marriage license which I sent with my original claim, insurance, trying to figure out how to set up direct deposit – again, this info went in with the original packet but I’ll spare you that rant and try to stay on topic).

However, after reading the rating decision and talking with my DAV rep I see very clearly that I fall in the 70% rating. Even though there were notes from a couple of the 70% factors, most of what was in the C&P report fell out at 50%. My GAF was 49 (which I read somewhere, maybe on this board, that a 49 GAF would correlate to 70% but apparently the VA can use the GAF as they see fit).

I believe I got 50% because I was so depressed during the C&P exam that I couldn’t think straight, didn’t answer the questions fully, and didn’t expound on closed ended questions that I should have (who knew?) so the 50% rating is in part the fault of my sc disability (what a round robin this whole system is).

The other side of that coin is that there were several areas of the rating that weren’t even addressed in the C&P exam. How can they evaluate me on that which they do not ask?!? Since I am uninsured and have only been going to my civilian primary care doc, I don’t have treatment notes and they won’t accept the ones from several years ago when I was seeing a shrink when I had insurance.

So, I didn’t perform well on the C&P exam and the C&P exam didn’t cover all of the topics used to rate mental illness and I wound up at 50% instead of 70% where my symptoms fall out.

My DAV rep has advised me to go to a shrink and talk it all out. Tell him everything that goes on with my sc mental illness and get clinical notes to give to the VA. I have that appointment set up next week. The shrink said we’d talk for 2-3 hours (much longer than the half hour C&P exam), he’d talk to my spouse for symptoms I am not clued into, and he’d write up clinical notes, though he won’t make any disability determination. That along with my most recent clinical notes from my visit to my primary doc should, according to the DAV rep, be enough to get the VA to reopen my claim and hopefully go to 70%.

I have a couple of questions about this route:

1. In my situation, is it better to appeal the 50% and provide additional independent clinical notes to show them I am really at 70% or is it better to take the 50% and try to get an increase to 70%? Please tell me why you believe either choice is best. If there’s not a clear best way to go on this please list the pros and cons of both routes (appeal the 50% vs go for an increase).

2. If I go for an increase can they back date it to the original date of the 50% rating? Does the VA recognize just how hard it is to work your psych claim when you’re a psych patient??!!??

3. If you go for an appeal do you have to go through another C&P exam or will the clinical notes suffice?

4. If you go for an increase do you have to go through another C&P exam or will the clinical notes suffice?

5. If I do have to do another C&P exam will they still consider the clinical notes from the independent shrink?

Thanks in advance for the replies.

ts

Edited March 15, 2007 by tssnave

[sixthscents]

They say..... "little effort, little results"..... thats why...

First to properly prepare a NOD takes great deal of effort, and the results, well I have handled hundreds of claims to this point, and I have almost always been satisfied with the results... my own 170% schedular rating for example...

or a DRO Review. A written NOD is good, but not as good as a DRO Review and the DRO Review should be faster?

A DRO review is a NOD, a NOD is a DRO review, it's the same thing, what you are talking about is a face-to-face review, but there is no difference in any case as to how the review is handled except for the fact that you get to present your claim verbally, with your argument... the same argument that you would use for a NOD...

Further, not only do you get the chance of presenting your case, face-to-face, but you give the DRO Official an written outline of your brief, DETAILED, with your argument/justification.

Thats exactly what a NOD is... a detailed written outline of your argument with factual supporting evidence to support your supposition...

Its more powerful and dynamic. Will it work? Well........

Maybe, I would say that in a VERY limited number of claims it may be of some benefit, maybe it would help clarify a point that the veteran attempted to address in their NOD, but were unclear on and thus a DRO came to the same conclusion as the original rater etc... but it'd be a VERY limited number of claims...

The fact is that a clearly written, well documented, and well evidenced NOD will achieve the same results without the delay in waiting for the face-to-face in most claims...