My Take On Claims

My Take On Claims

(This is what the VA calls a fully developed claim.)

  The Fully Developed Claims (FDC) program is an optional new initiative that offers Service members, Veterans, and survivors faster decisions from VA on compensation, pension, and survivor benefit claims.

  Veterans, Service members, and survivors simply submit all relevant records in their possession, and those records which are easily obtainable, such as private medical records, at the time they make their claim and certify that they have no further evidence to submit. VA can then review and process the claim more quickly.

(This is what I think about the Fully Developed Claim Process.)

  Over the years I’ve helped many veterans with claim advice, and not one has been turned down following my advice. This comes from working experience at the VA Veterans Outreach Program and from my own research and extreme sense of obtaining justice and benefits or disabled veterans. I’ve never helped people who I believe have phony claims, and there have been a few I’ve encountered.

  The Fully Developed Claims program sounds good, but in my experience, probably 90% of claims are turned down the first time through. This is an automatic process. The VA says it isn’t, but I believe it is. I doubt if they even read half of the first time claims and send them back for more evidence without seeing what has been submitted. No claim is ever fully developed the first time through, and if it is, the VA will tell you it isn’t, and you will need more evidence.

  That’s why I always say to never submit all your evidence upfront.
  No matter what you submit, the VA will always ask for more evidence. If you don't have any additional evidence to submit, this stalls your claim until you have more evidence, or until you give up and go away.

  (I always suggest holding back stressor letters and buddy statements until the VA requests them.)

  With the new wars, buddy and family statements will carry more weight because the PTSD criteria have been softened. This is good for Nam vets because buddy and family statements never meant much for Vietnam PTSD veterans. They were passed off as non-medical opinion unless they favored the VA.

  If you file for PTSD, and have a report from a civilian doctor saying you have PTSD, hold on to that report. File the claim, see the VA shrink, and then if they say they need additional evidence, or if they turn you down, then submit the civilian doctor report.

  Never give them everything upfront. It is hard to do at times because you want the claim resolved quickly, but it will help you if you keep some additional evidence back.

  If you submit paper evidence versus online, make copies and send it certified mail so somewhere there has to sign for it. If you don’t, chances are they will say they didn’t get it and you will have to submit it again.

  Also, don’t listen to any service officer who says you must have a fully developed claim to file. That’s a lie. You can file at any time, if you feel the disability was caused by the military.

  If you are already service-connected and you are told the VA will cut your current disability if you apply for another one and you should be happy with what you have...report that service officer to the National Office and demand another service officer. If they don’t want to do their job, someone can replace them.

  Always use a national service officer, once you find one you think you can trust. Never go it alone or through a VA Hospital Rep. The Rep is a VA employee and can only do so much for you because it would be like they are suing their own boss.

  They announced this morning that the backlog has stalled at 400,000 claims. I would take that figure as something that may look good on the news but is hardly realistic. A lot of those other claims have moved to an appeals board or have been denied in the fist step and will be back. If a claim is out of the system, it doesn’t mean it’s been settled, but could be pushed somewhere else. So backlog figures cannot be trusted.

  In summary, the fully developed claim is somewhat of a myth. The VA is adversarial, meaning, they will turn you down if they can. It’s not something they do on purpose. It’s just the nature of the claim process. You will still have to do everything right to make it through the system with the least hassle.

Reducing Compensation For PTSD: Can It Happen?



 

You’ve been fighting a long time with symptoms of PTSD, and after the VA grants your claim, you are told that your compensation may be cut in the near future due to a temporary improvement or even just an improvement.

I tell veterans not to worry about this. PTSD is a lot different than a physical disability. Certain physical conditions do show improvement, and the rating percentage can be reduced at some point. But with PTSD, any long term improvement is not likely to happen (at least improvement that would deserve a rating cut).

When you are first service-connected for PTSD, you may be called in for the first couple of years for a Comp Exam, but this doesn’t mean you are going to lose your percentage.

The VA is so swamped with claims right now from the Middle East Wars that an easily settled PTSD claim is not going to be called back in any time in the near future. That would just add another claim to the already full docket.

Also, the VA cannot cut a veteran with PTSD for any short term improvement without considering the entire claim history.

One veteran who is currently 100% for Individual Unemployability was told that he would be called in for a future exam because ‘improvement was anticipated with continued therapy’.

 

Just because a veteran improves on a temporary basis (there is no permanent long-term improvement of PTSD) does not mean the veteran is all of a sudden capable of holding a permanent full time job, or spending months or years in some Voc Rehab training program. Still, it would be best for the veteran to continue therapy, or start therapy again until the condition is made permanent.

The VA must follow regulations in the CFR (Code of Federal Regulations) before reducing the percentages of any disabled veteran.

Veterans who have held a rating for less than five years are protected under several rules. According to the CFR, the VA must find that there has been an improvement in the level of disability before reducing the percentage rating. The entire history of the disability must be reviewed. The evidence must show that there has been some positive improvement in the veteran’s ability to live and work. (Improvement does not mean such silly things as your ability to walk your dog down a public street or playing cards once a year...such excuses have been used to cut veterans by saying their social interaction skills have improved).

Any attempt at reduction must also include a current Compensation Exam covering the issue of the disability. A Comp Exam for PTSD which does not include the issues bothering the veteran is not valid.

Veterans with PTSD can expect to keep their percentage without fear of reduction.

The GAF Scale

Camp Books North of Danang during TET 1968
2 KIA at this location from a 122 rocket

THE GAF SCALE

(I get so many questions about the GAF scale, I have to include it every so often to make everyone aware of it. They use it to determine your daily level of PTSD.)

91-100 Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. No symptoms.
 
81-90 Absent or minimal symptoms (e.g., mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns (e.g., an occasional argument with family members)
 
71-80 if symptoms are present, they are transient and expectable reactions to psychosocial. stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social occupational, or school functioning (e.g., temporarily falling behind in schoolwork).
 
61-70 Some mild symptoms (e.g., depressed mood and mild insomnia) or some difficulty in social occupational, or school functioning (e.g., occasional truancy or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.
 
51-60 Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (few friends, conflicts with peers or co-workers).
 
41-50 Severe symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational or school functioning (no friends, unable to keep a job for any length of time ).
 
31-40 Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school).

21-30 Behavior is considerably influenced by delusions or hallucinations or serious impairment in judgment (sometimes incoherent, acts inappropriately, suicidal preoccupation) or inability to function in all areas (stays in bed all day, no job, home).
 
11-20 Some danger of hurting self or others (suicidal attempts without clear expectation of death; frequently violent; manic excitement) or occasionally fails to maintain minimal personal hygiene (smears feces) or gross impairment in communication (e.g., largely incoherent or mute).
 
1-10 Persistent danger of severely hurting self or others or persistent inability to maintain minimal personal hygiene or serious suicidal acts which would result in death to veteran or others.
 

  Most combat veterans with PTSD are probably between 50 and 30 on the GAF Scale. Anything below 45 should be a 50 to 70 percent rating, with possibility for unemployability. Anything below 40 should be a definite case for unemployability status.
   But just because your GAF is rated higher on any given visit is not a valid reason for the VA to cut your percentage without taking the entire claim history into consideration. Some days you may feel better than other days, and this is no grounds for a reduction.

Dennis Latham's PTSD thriller MICHAEL IN HELL