VA trying to combine my TBI and PTSD ratings...

hey guys. first time posting. got a couple issues/questions im hoping that i can get some advice on. just finished up with the IDES and got medically retired with 30% PTSD. wasnt able to claim TBI because of no LOD even though my profile said traumatic brain injury with cognitive disorder and in parenthsis it stated from IED blast. first let me telll you what i am SC for through the VA.
100% TBi
migraines 30% (secondary to TBI)
30% ptsd
40% back
10% tinitus
SMC-S
everything is static but TBI and PTSD. been SC for 4 years now but my MEB lawyer sent me paperwork that says i am scheduled for a re-exam in feb 2019 to see if they can combine my PTSD and TBI ratings. i was just curious if this is common and if I should be worried about getting them combined or lowered. my TBI C&P exam in 2016 stated that i clearly have symptoms related to both PTSD and TBI and i suffer from both disablities so i am a little confused on why they would try and combine them now since the doctor clearly stated in his exam that he could differintiate the difference between the two based on my symptoms. also was curious on why my TBI wasnt considered P&T because it was linked to 4 IED blasts from 2004. i understand that they claim TBI can improve but after 15 years i would have thought that it would be considered permanant. i have had my private neurologist write me a letter that stated after this much time, her medical opinion is that my symptoms will never get any better. is there anything else that anyone can think of that would help me not get my ratings combined/changed and also that would help me get it switched to P&T because i have been a mess since i got word on a re-exam and would love to not have to go through this again. or if there is anthing i can file beforehand that would stop me from having to go through the exam at all?

ok on to my second issue/question. like i stated earlier i have just finished with the IDES and i get officially retired on 22 feb. i have done a lot of research on every step of the process because the individules that are supposed to help me through the initial process before i even started the IDES have no clue what they are talking about so i did all the research on my own. i learned about CRSC and CDRP as well. i tried to start an LOD for TBI but was told that i had to complete it with in 6 months of the incident unless it has to do with PTSD or MST so they refused to do one for me even though it stated on my permanant profile TBI (IED related) which made no sense. they told me that it would be considered going through the IDES process and not to worry about it which was totally false. no LOD then they dont even consider it. i felt totally betrayed considering all the evidence but at the time i knew that since my VA award was so high that finacially it wouldnt benifit me anyways because you arent aloud to collect both at the same time. my main concern was just getting medically retired in order to receive Tricare. my MEB lawyer stated that i should qualify for CRSC since there was certain codes marked on some of my paperwork. not sure which paperwork but she said it was a good sign and that it shouldnt be an issue qualifying for it. she calculated $575. i also know that you cant recieve CRSC and CRDP both but everything that i researched and my understanding is that CRDP only kicked in at retirement age (60) and seeing as i am only 38 i was more focused on CRSC. i got a call today from my retirement officer and she said i needed to come sign some paperwork because i qualified for CRDP and it started immediatly. well i ststed that i didnt believe that i qualified for it so young but she said i did. i guess the real question is that i was told that you can go back and appeal the IDES decision even after you have gotten out of the service. i was just wondering if anyone knew if that was true because i would like to go back and get the LOD for TBI so i recieve the full 75% retirement because if she is correct and i can receive both DOD and VA retirement the same time right now. there is a huge finacial diffence ($2,475 vs $976) between 30% and 75% and i feel i was short changed by the imcompetance of people not knowing every aspect of their job. i hope that this isnt to confusing and thanks for the help in advance.
 
Click to expand...
Here is the criteria from the CFR...

§4.126 Evaluation of disability from mental disorders.

(a) When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination.

(b) When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment.

(c) Neurocognitive disorders shall be evaluated under the general rating formula for mental disorders; neurologic deficits or other impairments stemming from the same etiology (e.g., a head injury) shall be evaluated separately and combined with the evaluation for neurocognitive disorders (see § 4.25).

(d) When a single disability has been diagnosed both as a physical condition and as a mental disorder, the rating agency shall evaluate it using a diagnostic code which represents the dominant (more disabling) aspect of the condition (see §4.14). (Authority: 38 U.S.C. 1155)


[53 FR 22, Jan. 4, 1988, as amended at 61 FR 52700, Oct. 8, 1996; 79 FR 45099, Aug. 4, 2014]


Supplement Highlights references: 19(1), 54(1).
 
thanks for replying but i'm not picking up what your putting down. im a little confused
 
The long and short is that many of the symptoms of PTSD and TBI overlap and it is difficult to delineate between the two. TBI can manifest as a neuro-cognitive disorder, therefore it can be rated under the mental disorders criteria.

Here is some guidance that Jason Perry had posted some time back.

New VASRD Criteria for Rating Residuals of TBI (Traumatic Brain Injury)

This was just posted on the VA Press Release website: VA Announces Changes to the Disability Rating Schedule for Traumatic Brain Injuries and Burn Scars - Public and Intergovernmental Affairs Note that those evaluated under the old criteria may request a re-evaluation of their rating from the...
www.pebforum.com www.pebforum.com

Here is the CFR on the rating of TBI

 
yes i understand that the 2 can have overlapping symptoms but the doctor anotated that he clearly could differentiate my symptoms between the 2. thats coming stright from a VA doctors notes so why would they try and combine them now after almost 4 years? is there anything i can do to prevent this from happening and get it marked permanant because i cant keep going through all this uncertainty?
 
The doctor doesn't make this legal decision the rater does and they can disagree with the doctor if they believe the opinion deviates from standard medical facts. I only know of one guy now that has survived the VA not combining of TBI/PTSD most eventually got put under the same umbrella. I do believe you can prevail here but most likely on appeals at the BVA or higher level.
 
jbugg,

Apparently, you posted the same info in two different threads.

My reply to your initial post (CRDP & CRSC portion) follows:

Comments:
1. You must be eligible for retired pay to qualify for CRDP; the age requirement applies only to qualification for reserve retirement. If you were placed on a disability retirement, but would be eligible for military retired pay in the absence of the disability, you may be entitled to receive CRDP.
Under these rules, you may be entitled to CRDP if…

  • you are a regular retiree [20 years AD] with a VA disability rating of 50 percent or greater.
  • you are a reserve retiree with 20 qualifying years of service, who has a VA disability rating of 50 percent or greater and who has reached retirement age. (In most cases the retirement age for reservists is 60, but certain reserve retirees may be eligible before they turn 60. If you are a member of the Ready Reserve, your retirement age can be reduced below age 60 by three months for each 90 days of active service you have performed during a fiscal year.)
  • you are retired under Temporary Early Retirement Act (TERA) and have a VA disability rating of 50 percent or greater.
  • you are a disability retiree who earned entitlement to retired pay under any provision of law other than solely by disability, and you have a VA disability rating of 50 percent or greater. You might become eligible for CRDP at the time you would have become eligible for retired pay.[age 60 for those qualified for reserve retirement]
2. CRSC
The CRSC for a CH 61 retiree with less than 20 years service is the lesser of
—dollar amount of the longevity portion of retirement pay
OR
—the amount associated with the approved combat related disabilities by the service concerned.
Note: Most receive the longevity portion.
A collection of CRSC info is at LINK <——

3. General.
—CH 61 retirees waive retired pay dollar for dollar in the amount of VA compensation received.
—CRDP restores waived retired pay in the amount of longevity portion of retirement pay (residual retired pay + CRDP cannot exceed longevity).
—CRSC replaces some or all of waived retired pay. See collection of CRSC info link at paragraph 2.
—One cannot receive CRDP and CRSC at the same time.

Ron
 
You can file a NOD to request P&T. I would attached your neurologist's opinion.
 
Thank you for your responses. Can i do that before going through the exams?
 
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