VA Ratings do not make sense...

#1
I got my rating from the VA on Tuesday. I was rated at 80% not P&T. I am not complaining at all, and I am extremely, extremely grateful. I just wish they did not give me a percentage breakdown because that frustrated me. I was a 12A who deployed 3 separate times, twice to AFG and once to IRQ. I performed Sapper roles in all three deployments (AKA losts of explosions, fighting).

On my third deployment I started sleep walking and having behavioral health issues. It was sleep and stress related. I was redeployed early from theater as a result. I was in a MEB for 6 months before the Army doctors decided against it and I ETS'd on July 8th 2018 (left the army on ETS leave May 16th), honorably, after 8 years of service. Hopefully my background can show why I am confused, so here are my questions.

1. Broken nose not service connected - I broke my nose boxing for the army. my medical records have the date of the injury, the date I saw the doctor, the doctors findings, and it was never corrected (set back in place)

2. Lost toenails not service connected - I lost my toenails at sapper school from having wet feet all the time. They never grew back correctly, fungus (gross I know). I went to the doctor at sapper school for the morning sick call and they removed them there and I went back out to finish the course. This is also in my Army medical records.

3. PTSD, generalized anxiety disorder, depression, sleep walking - 30% this is the one that has me confused the most. Why did they lump them all together? Aren't they separate issues? I didn't even know I had PTSD or agreed with the findings. I agreed with the sleepwalking and generalized anxiety disorder, but why weren't they rated higher or as separate issues?

Can I appeal for the first two to be service connected? Should I appeal the entire behavioral health rating of 30%? Do I need a lawyer to do this? Is it a difficult process or should I just count my blessings and be happy with what I have? Like I said I am extremely happy with it, but the rating break down has me confused.

Sorry for all the questions. I really appreciate any and all help. I am super grateful for the VA though. It was a quick and painless experience, and 80% rating and medical care is a nice safety net in case I ever have employment issues.
 
#2
First off, thank you for your service. I am active duty Navy and currently going through the MEB/PEB process and have been in 15 years. I will try to answer and help where I can, however, there are a lot of extremely sharp people on this forum that can offer sound advice.

On my third deployment I started sleep walking and having behavioral health issues. It was sleep and stress related. I was redeployed early from theater as a result. I was in a MEB for 6 months before the Army doctors decided against it and I ETS'd on July 8th 2018 (left the army on ETS leave May 16th), honorably, after 8 years of service.

I believe you could argue that your MEB should have been continued "if" your medical conditions made you unfit for continued military service. Since you have been separated the avenue for the Navy and Marines is to petition the Navy through a Board for Correction of Naval Records (BCNR). At first glance it doesn't appear that would be the best choice, but it's an option.

3. PTSD, generalized anxiety disorder, depression, sleep walking - 30% this is the one that has me confused the most. Why did they lump them all together? Aren't they separate issues? I didn't even know I had PTSD or agreed with the findings. I agreed with the sleepwalking and generalized anxiety disorder, but why weren't they rated higher or as separate issues?
Can I appeal for the first two to be service connected? Should I appeal the entire behavioral health rating of 30%? Do I need a lawyer to do this?
Another resource I would encourage you to review is militarydisabilitymadeeasy it has detailed explanations that break down how the whole process works in easier terms. All behavioral health conditions are rated on the same criteria. Even though you have multiple conditions they rate your disability based on how they effect you overall based on the following criteria (hyperlink has all of the details):

The majority of mental conditions are rated on the following schedule. Each rating has 5 main categories of symptoms/circumstances. Not every single symptom or circumstance has to be present in order to be assigned the rating, but the rating that most closely defines the condition should always be used.



100% rating: This rating will have the majority of the following circumstances and symptoms:
The Ability to Care for Yourself: This individual cannot take care of himself at all. Constant or near-constant hospitalization and one-on-one supervision is required.
Medications: This individual requires psychiatric medication at all times.
Symptoms: Some or all of the following symptoms will be present.
– Regular or constant delusions or hallucinations and the inability to tell fact from fiction
– Completely inappropriate behavior (like drooling, mumbling, shouting, etc.)
– There is constant danger of hurting self or others (including suicidal tendencies)
– Significant memory loss, including not being able to remember names of close friends, family, or self, and other important information
– The individual cannot understand the idea of time or place
– The individual cannot properly reason, think or communicate logically
– Constant anxiety, fear, suspicion​
The Ability to Work: This individual cannot work at all.
Social Relationships: This individual cannot participate in any relationships. In other words, they cannot interact or build a relationship with another person. Family members may care for them, but it is only a one-way relationship. They cannot seek, invite, or encourage any relationships.
70% rating: This rating will have the majority of the following circumstances and symptoms:
The Ability to Care for Yourself: This individual cannot take care of himself most of the time. He is in the hospital or a care facility or is being taken care of by family members all of the time, and requires one-on-one supervision 50% of the time. This person cannot take care of his own personal hygiene.
Medications: This individual requires psychiatric medication at all times.
Symptoms: Some or all of the following symptoms will be present.
– There is the regular possibility of hurting self or others (including suicidal tendencies)
– This individual often cannot communicate logically
– This individual is actively psychotic, but may have intermittent contact with reality
– Obssessive-compulsive behavior that causes repetitive physical actions that interfere completely with daily necessary activities
– Severe, constant anxiety
– Mood often changes radically, without warning.
– Almost constant severe depression or panic, with the inability to function at all in stressful situations
– This individual cannot control impulsive actions like anger, violence, etc.
– Often disoriented to time and place​
The Ability to Work: This individual may not be able to work at all or may be severely under-employed (such as a former intelligence analyst now working part time as a custodian).
Social Relationships: This individual cannot participate in any relationships most of the time. In other words, they cannot interact or build a relationship with another person. Family members may care for them, but it is normally only a one-way relationship. They cannot seek, invite, or encourage any relationships the majority of the time.
50% rating: This rating will have the majority of the following circumstances and symptoms:
The Ability to Care for Yourself: This individual is occasionally hospitalized, but can mostly take care of the basic personal needs like bathing or going to the bathroom, although their personal hygiene may not be kept up regularly. They may also be able to function in areas like shopping, driving, cleaning, etc.
Medications: This individual requires psychiatric medication at all times.
Symptoms: Some or all of the following symptoms will be present.
– Trouble expressing or showing emotions (This doesn’t mean that they are just reserved. It basically means that they are completely blank the majority of the time), or shows the wrong or inappropriate emotion for the situation
– Always shows significant signs of anxiety
– Regularly gives unnecessary or unrelated details when communicating
– Two or more panic attacks a week
– Trouble understanding complex directions
– Trouble remembering things (forgetting to complete tasks, etc.)
– Trouble thinking logically and often has poor judgment
– A serious lack of, or a seriously increased, mood or motivation
– Occasional delusions or hallucinations
– Regular to nightly trouble sleeping (nightmares, insomnia, anxiety, etc.)
– Complaints of physical symptoms, like pain, that do not have a physical cause
– Suicidal thoughts, but no definite plan to hurt himself​
The Ability to Work: This individual may try to work, but will not be able to hold a job for more than 3 or 4 months because of their inability to remember or follow all directions or other similar reasons based on the symptoms or circumstances described under this rating. (In other words, they wouldn’t lose their job simply because they have anger issues and would regularly get in fights. A person like that could also not hold a job more than 3 or 4 months, but they would still be considered able to work). This individual would only be hired for jobs like cleaning, picking up trash, or other simple-task jobs.
Social Relationships: Like his ability to work, this individual may try to build and engage in relationships, but these relationships would not last long in most situations. Divorce or other breaks in relationships and friendships could occur due to his inability to properly participate in a relationship.
30% rating: This rating will have the majority of the following circumstances and symptoms:
The Ability to Care for Yourself: This individual may have occasional, short hospitalizations, but can entirely take care of himself most of the time.
Medications: This individual usually requires medication to function normally.
Symptoms: Some or all of the following symptoms will be present.
– Spikes or drops in mood, like depression
– Often anxious or becomes easily stressed
– Panic attacks occur, but no more than once a week
– Difficulty sleeping (nightmares, insomnia, anxiety, etc.)
– Mild memory loss could include regularly forgetting names or directions
– Often suspicious of other people, particularly ones he does not know​
The Ability to Work: This individual will be able to work and will usually function normally. There may, however, be occasional times where he is unable to properly fulfill all job requirements. This could result in occasionally losing his job.
Social Relationships: Like his ability to work, this individual will normally have fairly stable relationships. These relationships, however, will not be great and will often be strained by the symptoms of his condition. Divorce or breakups could occur, but not in every case.
10% rating: This rating will have the majority of the following circumstances and symptoms:
The Ability to Care for Yourself: This individual will always be able to take care of himself and will very rarely, if ever, be hospitalized.
Medications: This individual may or may not be taking medication. Meds may be taken all the time, or only during stressful times. They satisfactorily keep all symptoms under control.
Symptoms: Some or all of the following symptoms will be present, but only during times of significant stress. The majority of the time there are no symptoms.
– Mild depression or other mood changes
– Mild to moderate anxiety
– Mild panic attacks may occur, but very rarely
– Occasional difficulty sleeping (nightmares, insomnia, anxiety, etc.)
– A range of other, very mild symptoms, which could include suspiciousness of strangers and hyperarousal​
The Ability to Work: This individual will be fully employable and will very rarely have any problems at work that are caused by the mental condition.
Social Relationships: This individual will have full, functional relationships with only occasional, mild stresses that are caused by the condition.
0% rating: If a mental condition has been diagnosed but there are no symptoms that impair social or occupational functioning or require medication, then it is rated 0%.​

 

chaplaincharlie

PEB Forum Veteran
Registered Member
#3
You can appeal the first two. Most MH conditions are rated as one number. The VA prevents pyramiding of illness/injury. A bad example of pyramiding would be claiming "I lost my left leg" and claiming "I lost my left foot." The VA compensate for loss earning capacity. So If you have three MH illness they evaluate the cumulative effect on future lost earnings rather than trying to figure out which illness is causing which symptom. Appealing for three separate MH ratings is a non-starter. You could appeal the total rating if you have evidence that you were not properly rated cumulatively.
 
#4
Well damn...30% rating description hits the nail on the head for me. That rating describes me almost exactly. That makes sense why its 30% and why everything is put together!! Thanks a lot! That saves me some time.

But for the broken nose and the toe issue should I appeal that? I mean it happened in the army, during army events, and was taken care of by army doctors. What do I have to do for an appeal? I looked on ebenefits and theres nowhere to start an appeal. Also, if you guys think the best route is for me to just shut up and be grateful, please tell me that too. I have thick skin! :)

Should I apply for permanent and total as well? A VA rep on the phone said its in my best interest to do that. I do not understand why though. Isnt the only difference just going to annual VA appointments to see if my conditions improved?
 

Warrior644

PEB Forum Veteran
Registered Member
#5
I got my rating from the VA on Tuesday. I was rated at 80% not P&T. I am not complaining at all, and I am extremely, extremely grateful. I just wish they did not give me a percentage breakdown because that frustrated me. I was a 12A who deployed 3 separate times, twice to AFG and once to IRQ. I performed Sapper roles in all three deployments (AKA losts of explosions, fighting).

On my third deployment I started sleep walking and having behavioral health issues. It was sleep and stress related. I was redeployed early from theater as a result. I was in a MEB for 6 months before the Army doctors decided against it and I ETS'd on July 8th 2018 (left the army on ETS leave May 16th), honorably, after 8 years of service. Hopefully my background can show why I am confused, so here are my questions.

1. Broken nose not service connected - I broke my nose boxing for the army. my medical records have the date of the injury, the date I saw the doctor, the doctors findings, and it was never corrected (set back in place)

2. Lost toenails not service connected - I lost my toenails at sapper school from having wet feet all the time. They never grew back correctly, fungus (gross I know). I went to the doctor at sapper school for the morning sick call and they removed them there and I went back out to finish the course. This is also in my Army medical records.

3. PTSD, generalized anxiety disorder, depression, sleep walking - 30% this is the one that has me confused the most. Why did they lump them all together? Aren't they separate issues? I didn't even know I had PTSD or agreed with the findings. I agreed with the sleepwalking and generalized anxiety disorder, but why weren't they rated higher or as separate issues?

Can I appeal for the first two to be service connected? Should I appeal the entire behavioral health rating of 30%? Do I need a lawyer to do this? Is it a difficult process or should I just count my blessings and be happy with what I have? Like I said I am extremely happy with it, but the rating break down has me confused.

Sorry for all the questions. I really appreciate any and all help. I am super grateful for the VA though. It was a quick and painless experience, and 80% rating and medical care is a nice safety net in case I ever have employment issues.
Well damn...30% rating description hits the nail on the head for me. That rating describes me almost exactly. That makes sense why its 30% and why everything is put together!! Thanks a lot! That saves me some time.

But for the broken nose and the toe issue should I appeal that? I mean it happened in the army, during army events, and was taken care of by army doctors. What do I have to do for an appeal? I looked on ebenefits and theres nowhere to start an appeal. Also, if you guys think the best route is for me to just shut up and be grateful, please tell me that too. I have thick skin! :)

Should I apply for permanent and total as well? A VA rep on the phone said its in my best interest to do that. I do not understand why though. Isnt the only difference just going to annual VA appointments to see if my conditions improved?
Welcome to the PEB Forum! :)

First, congratulations on the receipt of your DoVA disability ratings! :D

In reference to your first two medical issues/conditions, you can indeed submit a DoVA Notice of Disagreement (NOD) appeal if you believe the DoVA Rating Agency didn't make a correct decision. Within your DoVA ratings decision documentation, you should have received a VA Form 21-0958 (as attached) to include the mailing address where to forward the completed NOD appeal. In short, I submitted a DoVA NOD appeal in 2015 and it was approved (e.g., granted full benefits sought) after 2+ years. So, yes! Indeed, submit the DoVA NOD appeal immediately at least in my opinion.

In reference to submitting a new DoVA disability claim for an increased P&T rating, do you believe any of your medical conditions will improve over the next couple of years or so? Do any of your medical conditions prevent you from obtaining/sustaining/maintaining employment at this point in time? An important note to remember is that the DoVA Rating Agency shall review all military service-connected medical conditions prior to making it's decision. Meaning, your current DoVA disability ratings are subject to either an increase, a decrease, or remain the same as based upon all available medical evidence and/or medical documentation.

Regardless of your response, maybe you should also consider talking with a Veterans Service Organization (VSO) for additional feedback to include assistance with filing new DoVA disability claims and DoVA NOD appeals. As such, please reference this URL https://www.va.gov/vso/ which gives an online directory of VSOs for 2017 in PDF format. Take care!

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer!"

Best Wishes!
 

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#6
So my medical conditions will not improve. I will eventually need surgery for joint issues, my neurologist and pulmonary doctors said adult sleep walking never goes away, and I got rated for sleep apnea. My pulmonary doctor said that never goes away, as well, if its not weight related (I'm tall and thin). But I know for a fact I will always be able to work regardless of my military disabilities. I just didn't understand what permanent and total would do for me and the VA rep on the phone just said well you'll have your benefits for life. I thought if you have a disability you would get them for life regardless? I cant see things improving the older I get.

I know these are all newb questions. Thanks for all the help. You guys are great.
 

Warrior644

PEB Forum Veteran
Registered Member
#7
So my medical conditions will not improve. I will eventually need surgery for joint issues, my neurologist and pulmonary doctors said adult sleep walking never goes away, and I got rated for sleep apnea. My pulmonary doctor said that never goes away, as well, if its not weight related (I'm tall and thin). But I know for a fact I will always be able to work regardless of my military disabilities. I just didn't understand what permanent and total would do for me and the VA rep on the phone just said well you'll have your benefits for life. I thought if you have a disability you would get them for life regardless? I cant see things improving the older I get.

I know these are all newb questions. Thanks for all the help. You guys are great.
Indeed, you are welcome!

No worries, ask away; that's how you become "well-informed" for sure!

Well, one highly useful benefit of being awarded a DoVA P&T rating is that you will no longer be scheduled (via the DoVA VBA) for any future DoVA C&P examinations on the military service-connected medical conditions. Some medical conditions do have a tendency to improve and if an improvement is documented on a C&P examination, then the DoVA Rating Agency shall recommend an adjustment (e.g., decrease) of the disability rating in accordance with the criteria as annotated in 38 CFR VASRD.

To any extent without an updated DoVA C&P examination, the DoVA Rating Agency is not likely to recommend a change (e.g., a decrease) in your DoVA disability rating(s) unless fraud is subjected and eventually proven. So, maybe that's what the VA rep was trying to say; no future C&P examination may result in "well you'll have your benefits for life" at the current disability rating(s). Take care!

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer!"

Best Wishes!
 
#8
Ok great thank you. This is what I gathered from your help, So pursue the service connected disagreement for toenails and nose, do not purpsue the P&T since it will not most likely get apporved, and do not pursue the mental health one since the 30% rating now makes sense. Thanks for all the info!!
 
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Warrior644

PEB Forum Veteran
Registered Member
#9
Ok great thank you. This is what I gathered from your help, So pursue the service connected disagreement for toenails and nose, do not purpsue the P&T since it will not most likely get apporved, and do not pursue the mental health one since the 30% rating now makes sense. Thanks for all the info!!
Again, no worries and you are quite welcome!

In my experienced opinion, the sound insightful feedback provided is to assist with your own decision-making process for seeking DoVA disability compensation benefits.

Indeed, by all means, will I ever recommend not to apply or appeal for any disability compensation benefits (e.g., DoVA, DoD, SSA, etc.); that's ultimately your decision naturally.

To that extent, my stance is to apply for any/all disability compensation benefits for which an individual potentially meets the established criteria then allow that organization to officially inform the individual applicant of an unfavorable decision. If the individual applicant don't agree due to the preponderance of medical evidence and/or medical documentation, then submit a formal appeal and continue the fight until the very end.

Nonetheless, sometimes maybe an individual truly doesn't meet the specific qualification for a certain disability benefit, but speculation ever time will definitely hinder the award of any potential future disability compensation benefits at least in my opinion.

Bottom line, historically, I had to fight (e.g., appeal) for numerous years with several federal disability processes (e.g., DoD IDES, TDRL via DoD LDES PEB, and DoVA VBA) in order to receive my well-earned and rightfully due disability compensation benefits. Fortunately, in my specific situations, justice was eventually served at the appeal's conclusion due to the preponderance of the medical evidence/documentation, and maintaining a positively proactive approach throughout those previously very unsettling years. Take care!

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer!"

Best Wishes!
 
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