100 Percent , Does My Family Rate Champus

[CHARLES]

I have been rated 100 percent for about 3 years. I had a re evaluation about 6 months ago and the rating remaigned the same. However, they did not make it permament, they feel that thier is a chance that I can get better since it is a mental illness (anxiety and depression). They also say I am currently unemployable. The doctor said I could eventually apply for permament. My questions is

1. Because I am not permament they say my family does not rated champus medical benefits. Is that true and are there any suggestions to get my dependents medical coverage?

2. When will they make it permament and is thier anything I can do to initiate it, or to quicken the descion.

Not having medical coverage for my dependents is tuff. I just dont understand (if it is true) why one person who is 100 percent rates medical coverage for his family thru champus becuase that person is permaament but another percent who is 100 percent doesnt because tier is a possibility he could get better. Shoudnt they rate it until that time comes, if it even does?

[sixthscents]

OK, I'm going to chime in here:

Schedular refers to the VA schedule for rating disabilities, also known as the VASRD... if someone has a schedular rating, it siply means that they have a rating based upon the schedular requirements set out in Chapter 4 of CFR 38.

So, if vet A is rated a 40% for loss of a limb, he has a schedular raing of 40%. Now schedular ratings may, OR MAY NOT be permanent. More and more frequently I am seeing th VA rate someone for PTSD, and saying that improvement is possible, so they set some distant re-evaluation date.... say 3 years, whatever...

Sometimes the VA conceeds permanancy... that is, as in our example vet A had loss of a limb, well the VA will conceed permanancy, and they will have a 40% schedular permanent rating.

OK, so hopefully we understand what the VA and we mean when we say "schedular" and "permanent"....

Now... to get a SCHEDULAR rating of 100% is ... hard. I actually am rated above that, but I have 1 rating of 100%. Normally it is hard for a vteran to get 100%, because as they move up the rating table, their next rated injurycounts for less and less... to understand this, you have to understand VA Math, and I am going to do a post today JUST on VA math... but accept for now please that it is hard to get rated 100% schedular unless you have some BIG disabilties.

Many vets do not reach 100% schedular... but they get paid 100% because of a part of CFR 38 called TDIU... or sometimes referred to simly as IU... - Total Disability Due to Individual Unmployability... TDIU... OK? With me so far? How that works is, say vet A's total combined scedular ratings are 80%... well can someone who is 80% disabled have "gainful" employment? Can they even get a job? The VA often conceeds that since a veteran is so disabled, they probably will not be able to have "gainful" emplyment in their current physical state. If so, they can and often do grant TDIU, which is that a veteran is paid at te 100% schedular rate, even though they are really schedular rated 80% or whatever.

Again the VA can say that the TDIU is "permanent", or not...

So, there you have it... a quiz will be given at the end of class....

HeHe.... this is a question that pops up again and again, so if I failed to make something clear, or confused anyone, please feel free to ask... and like I said, I am going to post a description and explanation of VA math tonight...

[sixthscents]

I'm sorry, I realized I failed to actually ANSWER the question asked...

If a veteran is awarded 100% permanent scedular disability, OR is awarded 100% TDIU (with the VA conceeding permanency) then a veterans spouse and children become eligable for ChampVa...(regurdless of the ACTUAL schedular rating of the veteran, if 100% TDIU is awarded)

The VA MUST admit permanancy though, so if they say that there is no further exams scheduled, or simply state that the award is permanent and total... then all the benefits apply... these include:

Chapter 35

ChampVa

Free life insurance (20K I believe)

and some other benefits...

BUT AGAIN... it doesnt matter if someone is schedular or TDIU... permanency must be awarded or conceeded... you'll see this described as "Permanent and Total", or P&T...

Hopefully that clarifys the point.

[Testvet]

Bob I perfectly understand your explanation, but then again I have been fighting with them for almost 5 years, now as soon as they admit my heart disease is SC I will quit, but it appears that they aren't and so I have appealed all the issues to the BVA, I should be rated for COPD 100%, heart disease heart ejection fraction less than 25%, 100%, PTSD 100% but since I know they don't rate that way, but start doing SMC tables, I have made the concession if they would SC the heart disease and PTSD I would agree to dropping the other open issues, as they are not going to be my cause of death, but they can't find it in their STAMP box to do the right thing, they have chosen to attempt to lie about the situation, when the BVA sees this file, someone is going to have some explaining to do. Senator Craig caught them lying last year, and so they played another game and lied again and then "closed" my file, not so fast my original claim for heart disease was filed in Dec 2002, my PTSD was granted as of Dec 2003, they owe me a years back pay, and the SC for heart disease, and then all the other benies that will become due. waiver for life insurance etc. I was issued a power chair by them in Sept 2003. Due to ejection fraction and bad back I can't walk more than 100 ft at a time. I have to hire the yard done, since I am not capable so I don't know if I should file for A&A or Housebound, my wife wants me to wait until this heart mess gets decided one way or another before I open any more cans of worms.

[sixthscents]

but since I know they don't rate that way, but start doing SMC tables

Well I know what you are saying but to be clear, no they do actually rate that way.... SMC as guided by CFR 38 S 3.350 only comes into play when there is loss of use, or the schedular criteria exceeds certain points, or there is a clear need for aid and attendance.

You state you are rated 100% for PTSD, well if you get a further 100% rating that is covered under 3.350, as well as a 50% rating... and these schedular ratings can be single injuries, or combined...

So when the schedular rating EXCEEDS 100%, they still use it, they just do not grant normal compensation for it... reserving special monthly compensation instead. Housebound SMC at 160% is paid at an o rate, loss of use k, for 1 limb, L for 2.. etc again as outlined in 3.350

but the schedular combination is still important, since it does effect SMC... and the VA Math rules still apply.... hence I am rated at 100% for general compensation, but actually have a scedular rating of 170% for special monthly compensation.

If you are tired of fighting, I can understand that, but personally I wouldnt stop until I was satisfied that just compensation was being paid... and thats a personal choice...

[Testvet]

Bob, the local VARO has taken it out of our hands it is on appeal to BVA once they get into my file I get the feeling they will have wished the VARO had settled it, because I have the doctor statements showing the links to COPD, heart disease, ED and nuerological and LSD exposures while in service courtesy of the Army test center at Edgewood Arsenal so the BVA won't play lets make a deal like the VARO could have either in 2004, 2005, 2006 let someone esle sort this mess out, I am just hoping they don't renege on the lawyer rule before July I will have an attorney on record on July 2nd,

[sixthscents]

Yeah, I'm hoping for a lot of vets that they dont go back on allowing laywers..... imagine being allowed the same rights as in a civil court... or, if we want to compare.... the criminal court and we'd be allowed the same rights that Ted Bundy had.... they allow a mass murderer legal representation but not a veteran.... something seems wrong there, but maybe its just my cynical nature...

Well see... I am betting on another illegal stay of some kind, or a rewrite allowing a laywer to only represent one client at a time... etc. They'll try and hamstring it, I'll just bet.

All the while the DAV is helping them.