Appeal ? - need help

[Cavman]

I was rated 50% PTSD SC in September and was also sent an IU form. I sent back the IU form because I haven`t worked since 2004. I also sent a letter from my mother, wife & sister describing my life with PTSD since Vietnam/Cambodia. I sent back with that my NOD letter, a current doctors diagnosis giving me a gaf of 40 and stating I am total & permanently disabled and unemployable and copy of prescriptions taken daily with their side effects.

My question is being rated at 50%, can I be given 100% with this appeal? If so, what are your ballpark opinions? Thanks for any answers. I do appreciate them.

Cavman

[Cavman]

I forgot to mention I had filed other claims with the PTSD claim and was rated SC 0% for 2 purple hearts, SC 0% for 3 malaria cases and denied Agent Orange for recent stage 4 tonsil cancer.

Cavman

[TinCanMan]

cavman:

Generally you are not eligible for IU based on a total rating of 50%. The requirement is 60% from a single etiology or a rating of 40% from a single etiology with an overall rating of 70%. There is a provision for an extra schedular IU rating but it must be approved by the Director of the C&P service in DC. It happens almost never.

There are no ratings for Purple Hearts, not even if you have a hundred of them. Compensation is awarded based on disabling conditions or diseases. What you think you may have gotten for your PH was probably awarded for scar or GSW. Not sure how malaria is compensated. I'll have to go look it up but I'd suspect it's something to do with number of disabling incidents in some periodicy. Your tonsil cancer isn't compensable as presumptive of AO exposure as it is a digestive system cancer which don't qualify. If you think it was caused by AO exposure then it will be up to you to prove exposure to AO caused your tonsil cancer since the IOM doesn't currently find that it is so. You can do that by finding a doctor willing to state your tonsil cancer is "as likely as not" caused by AO exposure .AND. providing a scientifically sound rationale supporting his conclusion.

OK Looked up malaria and it is based on frequency and severity of recurrences, and the necessity for and the reaction to medication rather than the presence or absence of parasites.

Look it up in the VA Schedule for Rating Disabilities (VASRD) 38 CFR 4.88b. Scroll down to Diagnostic Code 6304 and see where you fit. Looks to me like you get 100% for an active disease but nothing for one in remission unless there are residuals that might be compensated separately.

[Cavman]

Thanks TinCanMan so much for the help.

My original PTSD c & p stated serious impairment to social and emloyment functioning. Suicidal ideation, mood disorder etc etc. He gave me a gaf of 48. As stated I was awarded 50% disability and have not worked since 2004.

I appealed for a higher rating and IU. I understand what you told me in previous answer about the 60/40 or 70 rating needed. If you feel I can`t be awarded 100%, what procedure should I have followed in my NOD I did immediately after receiving this rating?

I also just read a message from back awhile ago from I believe a Babyduck, stateing he appealed a 30% PTSD rating and was awarded 100% p & t.

Cavman

[Cavman]

Should I immediately send a letter asking for 100% p & t regarding my appeal and not mention the IU form I sent back?

Cavman

[TinCanMan]

Cavman:

Have to let you know I don't have much experience with mental disorders so I'm probably not real qualified to provide advice on such claims. You might want to try the "Ask a VSO" link at the top of this page. I can tell you this though: Asking for IU on the basis of your existing 50% isn't likely to happen. Chances are slim and none. You can certainly ask for an increase and IU if awarded. Understand, P&T isn't compensation and isn't a rating. Nor does it come with a 100% rating. It's a status. Generally the RO will grant P&T status when they've determined a condition to be static and will never improve. That doesn't usually happen out of the gate except for obvious physical loss. Usually, you're subject to re-examination for 5 years before being evaluated as permanent but understand, anyone can be re-evaluated, even if P&T. I don't know if you're eligible for 100% or not. That's something only your doctors and the C&P examiner can determine. Ask your doctor what he thinks. Take him a copy of the VASRD for mental conditions and ask him where he thinks you fit. I believe PTSD is evaluated under 38 CFR § 4.130.

OK, now the GAF. While there are charts proclaiming this GAF is equal to this percentage, it is mostly wishful thinking because the decision makers don't rely on GAF as a determinant. GAF is simply an estimate of your ability to function at a particular moment. A simple snapshot in time. It can and does change widely in a short time. A GAF of 48 isn't indicative of being all that dysfunctional.

I remember babyduck having some success at an appeal a while back but don't remember the details. I'd doubt p&t was part of it but I could be wrong, anything is possible.

I just noticed you said you received a rating of 50% in Sept. Is that Sept 06? If that's so, you would submit an NOD and state what it is you disagree with and why. I'd ask for a DeNovo review at the local RO. If it doesn't go your way you can still ask for the traditional appeal. Understand, this isn't bidding for ratings. If you are going to appeal, you need evidence to support your assertations. IOW, why do you think you should be rated higher. Your doctors evaluation needs to support that. You have a year from Sept to appeal. I'd get a copy of the C&P and see what the examiner said. His examination may not support a larger award. In that case, you'll need an IMO to state othherwise.

[jimmymac2]

Originally Posted by TinCanMan

Cavman:

His examination may not support a larger award. In that case, you'll need an IMO to state otherwise.

Forgive my ignorance for acronyms. What is an IMO?

[sooner1938]

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[Cavman]

Yes, I received the 50% in September 06 and filed the NOD a few days later for a DeNovo hearing at the RO by a DRO.

As I said the VA sent me an IU form with the rating. I returned the IU form, letters from my mother, wife, sister & myself (nod letter) along with a new diagnosis from the doctor I`m seeing for treatment stating I am totally/permanently disabled with no chance of being employed now or in the future with a gaf of 40.

Cavman

[TinCanMan]

Cavman:

They sent you the IU form because a successful claim would put you in range of IU. It doesn't mean you will be successful, just that if you were, you'd be in range. Fill it out and send it in. Understand, any consideration for IU will be based on your SC conditions. If non-SC conditions contribute to your inability to hold a job, they can't be considered.

[TacomaSmoke]

Originally Posted by Cavman

I was rated 50% PTSD SC in September and was also sent an IU form. I sent back the IU form because I haven`t worked since 2004. I also sent a letter from my mother, wife & sister describing my life with PTSD since Vietnam/Cambodia. I sent back with that my NOD letter, a current doctors diagnosis giving me a gaf of 40 and stating I am total & permanently disabled and unemployable and copy of prescriptions taken daily with their side effects.

My question is being rated at 50%, can I be given 100% with this appeal? If so, what are your ballpark opinions? Thanks for any answers. I do appreciate them.

Cavman

appeal with a VA attorney- man you deserve a 100%. Contact Halpren@Oliver,PLLC Ask for Mark Bean excellant VA attorney he fights for all vets. Their phone number is 360-753-8055 FAX 360-753-8584 tell him Jim Bryan refer you.