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Should I Post This As A Success Story? Advice Needed...

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NJ_Devil_Dog

Question

I just received my rating for SC PTSD, they rated me 30%, stating that I had a GAF score of 50, with 55-60 assigned for the last twelve months. Shouldn't the rater have considered the lower GAF score as well? I've only recently started seeing a VA psychologist in the past five months and I obtained a copy of my first progress note from our first session and he rated me with a GAF of 41. During my next appointment with him he told me that he gave me the GAF of 41 because he was worried that if he had rated me any lower his supervisor would've questioned him why I wasn't admitted for care at the facility.

I am a full time student, however in the past year since returning from Afghanistan I have not been able to complete not even one semester at school, I've had to withdraw because of attendance and an inability to finish assignments. The university has been incredibly helpful by allowing me to withdraw from classes after the drop date as well as refunding my tuition in both instances. To make a long story short, I believe that I meet the qualifications for a higher rating. My question is: How typical is it for the VA raters to 'low-ball' awards decisions?

Here's the second part of my story. I am a 're-tread', having served in the Marine Corps from '87-'92, and then reenlisting in 2001 with the National Guard. I was awarded the CAR during the Gulf War, and had already been denied my original claim from '95. The claims award I just received was from that re-opened claim for which I had to submit new and material evidence.

In my original denial letter dated May 03, 1995, the evidence they reviewed making the original decision was only my SMRs and they stated that I failed to report for a C&P exam (which I clearly remember reporting for!) However in the recent decision the evidence they reviewed included my recent C&P exam, my stressor letter, current treatment records, my DD214 & 215, and 'mysteriously' my VA treatment records for the time period between July '92-June '96!!!!!

I realize that I was pretty naive back then, after I had seperated from active duty, but I was diagnosed with PTSD well within a year of my release date (more like less than 6 months of my release date!) I guess that my original denial in '95 more or less gave me a false reassurance that there was nothing wrong with me, in retrospect I know better. I've never held a job for longer than 18 months, I bounced around from at least ten jobs in the eight years following my seperation from the Marines and I've even been fired from three of those jobs for incidents that could be directly related to my PTSD/stress!

I'm doing a little bit better now, but I can tell when I miss taking my medication, even if it's only one day! I have sleep onset problems even when I take the meds, I'm always tired, never feel rested, nightmares, intrusive thoughts, anxiety attacks several times a week, I feel isolated from my colleagues at school, have no friends or any professional/social relations, and I have CRS (Can't Remember S***). When I don't take my meds I don't sleep at all! I'm currently attending school now, but there has been a considerable drop in my performance (I used to be a solid B student, but I'm hoping to be able to get through my last two semesters with just passing grades.... and hopefullly this drop in my GPA won't affect my chances for future employment in my field of study - I'm studying Aerospace Engineering and with such a highly technical field grades mean EVERYTHING!)

I feel like the 30% rating is an insult!!!! I intend to file an NOD to have it adjusted, I also intend to file a CUE for the original denial! I would appreciate anyones input on how I should proceed... should I file for the increase first? The CUE first? Or can I do them at the same time? Also, could my PTSD diagnosis in '92 constitute an informal claim? What or where can I find any information about that?

I appreciate the time you've all spent reading this rather lengthly post, and I especially appreciate any information you can offer me.

Thank you all,

Gerald

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I just received my rating for SC PTSD, they rated me 30%, stating that I had a GAF score of 50, with 55-60 assigned for the last twelve months. Shouldn't the rater have considered the lower GAF score as well? I've only recently started seeing a VA psychologist in the past five months and I obtained a copy of my first progress note from our first session and he rated me with a GAF of 41. During my next appointment with him he told me that he gave me the GAF of 41 because he was worried that if he had rated me any lower his supervisor would've questioned him why I wasn't admitted for care at the facility.

I am a full time student, however in the past year since returning from Afghanistan I have not been able to complete not even one semester at school, I've had to withdraw because of attendance and an inability to finish assignments. The university has been incredibly helpful by allowing me to withdraw from classes after the drop date as well as refunding my tuition in both instances. To make a long story short, I believe that I meet the qualifications for a higher rating. My question is: How typical is it for the VA raters to 'low-ball' awards decisions?

Here's the second part of my story. I am a 're-tread', having served in the Marine Corps from '87-'92, and then reenlisting in 2001 with the National Guard. I was awarded the CAR during the Gulf War, and had already been denied my original claim from '95. The claims award I just received was from that re-opened claim for which I had to submit new and material evidence.

In my original denial letter dated May 03, 1995, the evidence they reviewed making the original decision was only my SMRs and they stated that I failed to report for a C&P exam (which I clearly remember reporting for!) However in the recent decision the evidence they reviewed included my recent C&P exam, my stressor letter, current treatment records, my DD214 & 215, and 'mysteriously' my VA treatment records for the time period between July '92-June '96!!!!!

I realize that I was pretty naive back then, after I had seperated from active duty, but I was diagnosed with PTSD well within a year of my release date (more like less than 6 months of my release date!) I guess that my original denial in '95 more or less gave me a false reassurance that there was nothing wrong with me, in retrospect I know better. I've never held a job for longer than 18 months, I bounced around from at least ten jobs in the eight years following my seperation from the Marines and I've even been fired from three of those jobs for incidents that could be directly related to my PTSD/stress!

I'm doing a little bit better now, but I can tell when I miss taking my medication, even if it's only one day! I have sleep onset problems even when I take the meds, I'm always tired, never feel rested, nightmares, intrusive thoughts, anxiety attacks several times a week, I feel isolated from my colleagues at school, have no friends or any professional/social relations, and I have CRS (Can't Remember S***). When I don't take my meds I don't sleep at all! I'm currently attending school now, but there has been a considerable drop in my performance (I used to be a solid B student, but I'm hoping to be able to get through my last two semesters with just passing grades.... and hopefullly this drop in my GPA won't affect my chances for future employment in my field of study - I'm studying Aerospace Engineering and with such a highly technical field grades mean EVERYTHING!)

I feel like the 30% rating is an insult!!!! I intend to file an NOD to have it adjusted, I also intend to file a CUE for the original denial! I would appreciate anyones input on how I should proceed... should I file for the increase first? The CUE first? Or can I do them at the same time? Also, could my PTSD diagnosis in '92 constitute an informal claim? What or where can I find any information about that?

I appreciate the time you've all spent reading this rather lengthly post, and I especially appreciate any information you can offer me.

Thank you all,

Gerald

Gerald, I would file a Notice of Disagreement ASAP. I would pursue an increase on your claim that has been approved and handle the CUE seperately. CUE is a tough nut to crack because you will have to have new and material evidence in order for the VA to look at it. It is important to pursue the CUE because if it is granted, you will be awarded back pay to the earliest effective date the claim was first opened. Many of us have had a service officer from one of the veterans organization represent us, however, it would be in your best interest to work your claim and be sure your service officer communicates with you. I had a service officer from an organization who never followed through with my wishes and I revoked the power of attorney. I found a good service officer and my claim went through. If any of this information is questionable I am confident that someone else will correct it. I am speaking from personal experience as I have dealt with the VA since 1967 when I was seperated from the Army after a 1 year tour in Vietnam.
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Thanks for the insight Jim, I do intend to pursue both the NOD as well as the CUE. You mentioned that I had to present new and material evidence to pursure the CUE, I have already presented the VA with new and material evidence in order to reopen my previously denied claim for PTSD in '95. Does this mean that I will also have to present even more evidence to the VA to follow up on the CUE?

As I mentioned in my previous post, during the original '95 claim my denial letter stated that the only evidence they reviewed was my service medical records, but I had been diagnosed and was being treated by the VA for PTSD since '92! The evidence they had in their possession at the time of the adjudication should have at least warranted that the case be remanded for further development. Now, 10 years later they're stating that the '92-'96 VA treatment records were evidence for this decision?!?! Wouldn't the omission of these records during the '95 adjudication process alone be grounds for the CUE?

Also they stated that I never reported for the '95 C&P exam, but I clearly remember reporting and spending about 3 hours with several different doctors. I have requested all my VA medical records from that time period but all I've received was inpatient records for a non-SC knee operation I had in'92. I'm guessing that my c-file might contain the records that I'm looking for and I'm still waiting for the requsted copy of those records.

Thanks for the heads up about the SOs, I'm fairly confident that I have a very competent SO helping me with my case, I haven't had any problems with him yet.

Sincerely,

Gerald

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NJ_Devil_Dog: I believe that jimlane is incorrect when he states you need new and material evidence to open a CUE claim.

A CUE claim is based on the evidence of record at the time the CUE is predicated to have occured. New and material evidence can not be use to support the claim for CUE.

I'm not sure if you can base a claim for CUE because of records that may not have been before the VARO at the time of their decision.

Jim S. B)

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Thanks JIM C, for clarifying that for me, I certainly hope they don't ask me for new evidence simply because I believe I have provided them with all the evidence there is in the matter regarding my PTSD.

I'm not too sure about not being able to base the CUE claim on evidence that was not before them at the time of the decision, that just goes to reason.... how can they make a well based decision on the claim if they don't consider all the evidence available at the time??? And especially if it was outpatient records that the originated at the VA?? That would be like me saying that I didn't have to pay (whatever) bill only because I neglected to check the mailbox!!! Perhaps that's a vague analogy, but you get my meaning.... I can't simply disregard my responsibility to pay my bills simply because I don't go to the mailbox to get them! It would not be as if they weren't there when I did go to check it! It's the same for the VA, they based their decision on the records before them, without considering all the records that were in their possession! They have the resposibilty to go 'check their mailbox' as well!

I believe that now, in the recent decision, the inclusion of the previously omitted records from '92-'96 form a perfect basis for pursuing a CUE on the original claim! They're saying now that the evidence is good enough to consider in deciding the claim, but back then it wasn't considered?!?!

Gerald

Edited by NJ_Devil_Dog
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DevilDog

With a GAF of 50 I think you should have gotten at least 70% on the PTSD. Appeal this and get an IMO to back it up.

Thanks John,

I was expecting about 70% myself, I was absolutely floored when I saw that I had only received 30%! My SO even told me that in his experience a GAF of 41 would warrant 70%! And I believe that he is very competent (I think I really lucked out getting him to represent me).

Should I file the NOD to get the rating increased first and then file a CUE?

Based on what rating would they make retroactive payment? For example, if I filed the CUE at the same time as the NOD, and received the increase to 70%, and then also won the CUE, would they base the retro-pay on the 30 or 70%?

Forgive my ignorance, but what exactly is an IMO? I'm not too sure about all the acronyms...

Edited by NJ_Devil_Dog
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