Should i cancel my claim?

jbugg

jbugg

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PEB Forum Veteran
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Hello everyone.i Have a situation I could use some guidance on. I am rated 100% for tbi with migraines as a secondary at 50%. I also have multiple non tbi related disabilities. I qualify SMC-S as well. I have been rated this way for 4 years now. Recently I went to a re-examination for my tbi, migraines and ptsd. Everything else is static. Well they recommended to combine my ptsd and TBI which I didn't agree with. I had multiple prior c&p doctors who plainly stated that they could separate the disabilities as well as civilian doctors who stated the same so I filed for a higher level review. Either way I got the decision letter back and they stated that they were going to keep the disabilities combined BUT they now rated me as P&T. Well at the same time as I submitted my NOD for the combined disabilities I also submitted an NOD for my psoriatic arthritis that was deemed not service connected. When i went through the IDES they stated that had it been service connected it would be rateable at 60%. So my question is since i am now 100% p&t with SMC-S should i just cancel my case for arthritis? My VSO said I should just let it play out but could this put my 100% p&t at risk?

Thanks in advance for your guidance.
 
You need to do some financial management here.... Anytime you add a claim, your P&T can be reevaulated, so your 100% could theoretically be at risk... if the arthritis is not service connected in anyway then you are ineligible for care for it correct?

Are you trying to claim it so you can establish treatment? Is this more valuable than if you possibly lost 100%

Also is the possible rating high enough to re-rate you back to 100% if you lose something else?

the value of treatment of compensation is a question that only you can answer. If the condition cause so much agony that you would pay anything to have it treated, then that may be worth $1000 a month to you... if it was a runny nose, then I personally would be able to fork up $20 in Kleenex a month to keep my 100% secure.
 
No I filed the notice of disagreements at the time. One just got done a lot quicker than the arthritis claim and that is where they found me p&t. And fyi at 100% everything is covered whether its service connected or not.
 
jbugg said:
No I filed the notice of disagreements at the time. One just got done a lot quicker than the arthritis claim and that is where they found me p&t. And fyi at 100% everything is covered whether its service connected or not.
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If the arthritis would be service connected at 60% it would have pushed my static disabilities to the 100% mark and made me p&t that way. That was what I was going for but they went ahead and rated my tbi as permanent.
 
P&T does not get changed unless there is fraud or a clear and unmistakable error in your prior rating decision. The arthritis would be treated a new claim and you would only be rated for it based upon the DBQ.
 
Ok so there is no risk to my P&T status and really no reason to cancel my arthritis claim then?
 
I agree with your VSO, but if you are going to keep pushing the combined issue you will lose the literature and the medical evidence is in contrary to what your doctors are saying and the VA has new guidelines in rating them just about all TBI's are getting combined. Why are you so up and over this if P&T and SMC-S already?
 
No sir im not pushing the combined ratings at all anymore. Im actually not pushing anything. Im truly grateful and relieved about the idea of no more exams. I filed the arthritis NOD at the same time as the NOD for combining the disabilities but the arthritis claim is still 12-26 months from completion according to va.gov. i called and asked if I should cancel it since I was just awarded permanent and my VSO said just let it play out. My concern is if I do let it play out could it possibly affect my p&t status somehow? Or should I just cancel it and be done with it? Just trying to get some expert opinions
 
Here’s the guidance on rating TBI in concert with BH conditions.

cognitive and/or behavioral/emotional residuals
the symptoms according to the table below.

If …Then …
the Veteran has subjective feelings of anxiety, depression, or other mental complaintsevaluate in the subjective symptoms facet under 38 CFR 4.124a, DC 8045.

Note: Subjective mental complaints are not a distinct comorbid diagnosis.
  • the Veteran has a comorbid mental disorder and/or neurocognitive disorder, and
  • the examiner is able to delineate both
    • symptoms, and
    • occupational and social impairment
assign separate evaluations for
  • the Veteran has a comorbid mental disorder or neurocognitive disorder, and
  • the examiner is unable to delineate both
    • symptoms, and
    • occupational and social impairment
assign a single evaluation under the DC (either under 38 CFR 4.124a, DC 8045 or the appropriate 38 CFR 4.130 DC) that provides the higher evaluation based on overall impaired functioning due to both conditions.

Note: This guidance applies to all cognitive and behavioral/emotional TBI residuals as defined in M21-1, Part III, Subpart iv, 4.N.2.d. If separate and distinct physical symptoms due to TBI are present, evaluate them in the subjective or other applicable facet under 38 CFR 4.124a, DC 8045, as long as the physical symptoms are not the basis of an evaluation for another condition.

 
Yes sir like I said I had 1 MD and 2 PHDs say that they could clearly separate the symptoms. Panic attacks, extreme paranoia, flashbacks, nightmares are all clearly related to my ptsd and dizziness, confusion, slow and slurred speech, tinitus(rated at 10%) are clearly related to my tbi. Of the migraines are the biggest symptom. I know that my extreme memory loss can be attributed to both but I my mind it is caused from my tbi as well. And the fact that the mri showed a small bleed as well.
 
jbugg said:
Yes sir like I said I had 1 MD and 2 PHDs say that they could clearly separate the symptoms. Panic attacks, extreme paranoia, flashbacks, nightmares are all clearly related to my ptsd and dizziness, confusion, slow and slurred speech, tinitus(rated at 10%) are clearly related to my tbi. Of the migraines are the biggest symptom. I know that my extreme memory loss can be attributed to both but I my mind it is caused from my tbi as well. And the fact that the mri showed a small bleed as well.
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Either way it doesn't matter at this point. I just don't agree with it.
 
Just canceled my claim. I feel a lot better now. Why risk the VA looking at anything anymore.
Thank you everyone for all your valuable input. It is exactly why this site is so valuable to soldiers and veterans like me who are lost in the sauce. Thanks again
 
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heathro1281 said:
if the arthritis is not service connected in anyway then you are ineligible for care for it correct?

Are you trying to claim it so you can establish treatment? Is this more valuable than if you possibly lost 100%
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Just to clarify, once you're at or above the 50% threshold, you'll receive care at a VA Facility for any/all aliments; service connected or not.
 

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That's my understanding buddy. Not sure if there are some fine print that I don't know about but as far as I know that's correct.
 
I qualified for it because my TBI is rated at 100% and I have other disabilities that are not related to my TBI that are rated more than 60%. So I qualified for SMC-S1. SMC-S2 is given if you are house bound.
 
So basically SMC-S1/S2 are given to veterans who are housebound due to their SC disabilities?
 
S2 is. S1 is given if you have a disability rated total(100%) and separate disabilities rated at least 60% that are not related to the total disability.
 
It all depends on how you feel. I always say, 100% formula today may not be the same process for tomorrow. A lot of people will beg to differ, I just don't see it that way and I hate the thought of everyone saying "your going to risk it", to me, if its legitimate medical illness then you should file for it IF you feel you should be eligible for this. In my case, I got screwed big time by the military. I'm not just about to give up and then three years for now instead of P&T 100% that become s 70 or 80% because of re-math formulas. Again, not sure if its ever going to happen but so much is done in error on claims that nothing surprises me anymore. I'll settle in CAVC or Federal District Court in the end if I have to because as messed up as my health is and how screwed I was as stated I'll never give up fighting and no veteran should.
 
GUNS'N'STUFF said:
It all depends on how you feel. I always say, 100% formula today may not be the same process for tomorrow. A lot of people will beg to differ, I just don't see it that way and I hate the thought of everyone saying "your going to risk it", to me, if its legitimate medical illness then you should file for it IF you feel you should be eligible for this. In my case, I got screwed big time by the military. I'm not just about to give up and then three years for now instead of P&T 100% that become s 70 or 80% because of re-math formulas. Again, not sure if its ever going to happen but so much is done in error on claims that nothing surprises me anymore. I'll settle in CAVC or Federal District Court in the end if I have to because as messed up as my health is and how screwed I was as stated I'll never give up fighting and no veteran should.
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I do agree with you about claiming any and all disabilities that you feel are service connected. We have earned that right but in the end my piece of mind is more important than getting every single disability service connected. I can now officially relax knowing that there is no claim hanging out there and that there is no reason to go back and look at anything. Thanks for your input though. I really appreciate it.
 
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