What Is The Effective Date For A Claim For Increase
Remember that the effective date general rule says that the effective date for your disability compensation rating is the later of the date the VA receives the claim or the date the entitlement arose.
And the VA often tries to apply this general effective date rule to VA increased rating claims.
But the VA is often wrong.
A veteran is entitled to an effective date equal to the date the Veteran establishes that the severity of his or her symptoms began to worsen, up to one year before the date the VA claim for increased disability rating is filed.
Of 10 Most Common Va Disability Claims: Migraines
Based on the latest 2018-2019 VA data, Migraines were the #9 most common VA disability claims for all Veterans, across all demographics.
Migraines are a high-value claim because there is a high likelihood of getting rated at 30 percent or higher.
Migraine headaches and tension headaches are two very different things.
Migraines are a serious neurological condition rated between 0 percent and 50 percent.
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Should Veterans Apply For Increased Ratings From The Department Of Veterans Affairs
This is a question best answered on a case-by-case basis. There are no guarantees that the VA will raise your disability rating, and your entire file may be subject to review not just the condition you want to have reviewed.
So the answer is not simple, but there are ways you can get closer to a decision. One of those is to examine the VA Schedule For Rating Disabilities, also known as 38 CFR Book C.
Reviewing this document can go a long way toward helping you understand what the VA is looking for, how the agency rates your specific condition, and what the compensation percentages are.
As mentioned above, the VA is willing to re-examine your medical claim, but if you dont understand how the VA does this, under what conditions additional compensation may be justified, and what the maximum compensation might be for your condition, you take a big risk in getting re-evaluated.
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Va Maximum Compensation Rules
There are some medical conditions that are assigned a specific percentage of disability. In many cases that percentage cannot be increased. If you are rated at a certain percentage for a given condition, you may not be eligible for more compensation even if the problem gets worse.
If you are already at the maximum amount of VA compensation for that medical issue, a review of the condition will not give you the opportunity for additional payment.
Of 10 Most Common Va Disability Claims: Post Traumatic Stress Disorder
The 2018-2019 secret VA data shows that PTSD was the #3 most common VA disability claims for all Veterans, across all demographics.
For example, 90.7% of Veterans were rated at 30% or higher for mental health, while 41.1% of Veterans were rated at 70% or higher.
Therefore, mental health conditions, including PTSD, major depressive disorder, generalized anxiety disorder, somatic symptom disorder, among others, are high-value claims.
We call mental health conditions high-value claims because they have a very high likelihood of getting rated at 30% or more.
Post-traumatic stress disorder is a mental health condition, which is triggered by a terrifying eventeither experiencing it or directly witnessing it.
Some mental health symptoms include flashbacks, nightmares, anxiety, depression, insomnia, suicidal thoughts, anger issues, work problems and relationship issues.
All VA mental health claims fall into one of three categories: 1) PTSD Combat, 2) PTSD Non-Combat / Military Sexual Trauma , and 3) All Other Mental Health Conditions.
PTSD always has in-service stressors, which cause or make the PTSD worse, such as exposure to death, threatened death , actual serious injury, threatened serious injury, actual sexual violence and threatened sexual violence.
Non-combat PTSD stressors include things such as PTSD MST, service-member suicide, serious car accidents, training accidents, victim of rape and witnessing a rape, among others.
PTSD first-time filer
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Know And Understand Your Current Va Rating
As mentioned above you will need to fully understand the VA disability rating for your existing condition and the VA justification for assigning that rating.
For example, tinnitus ratings are a maximum 10%. Do you know why this is? Or understand what VA policies dictate the cap on such ratings?
These are important things to understand going forward as these details can help you decide if you have a case the VA will take seriously or if you should leave well enough alone based on the risk of actually having the rating lowered based on current VA policies.
Scars And Va Disability Benefits
The VA assigns a disability rating for scars, from 10% up to 80%. While the scarring has to be quite significant in order to get rated for VA disability compensation, its usually a simple matter to get qualifying scars approved. Theres usually little doubt about a military service nexus. Injuries incurred on active duty that are significant enough to rate disability compensation are almost always documented in the military service record.
Additionally, scar tissue can occasionally result in reduced arm, leg, back, or neck mobility, resulting in a qualifying secondary condition under the musculoskeletal heading, above.
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Understanding The General Rating Formula For Mental Health Conditions
Before diving into the VAs rating system for PTSD, its important to understand their general rating formula for mental disorders. This is because VA determines rating levels by using the General Rating Formula. This is where VA takes the symptoms of any mental health condition and translates them into a rating.
The VA disability ratings for PTSD can be 10%, 30%, 50%, 70%, or 100%. Transparency about your worst symptoms is vital for your rating. VA often rates veterans by the average of their symptoms. So, if a veteran has such symptoms that fall in the 30, 50, and 70% ranges, they will often get a 50% rating. However, this is not the correct way to rate a mental health disorder.
The basis of a rating is the highest level of symptoms, not an average. So, if a veteran has six symptoms at 30%, three at 50%, and two at 70%, a 70% rating is proper. Also, the VA cannot downplay symptoms and give the veteran a lower rating.
For example, if a veteran has suicidal ideations, that is a 70% rating. However, VA doctors sometimes state that the veteran does not have intent or that the ideations are fleeting. The VA will sometimes grant a lower rating by minimizing the symptom altogether. It is, nevertheless, a 70% rating if a veteran has suicidal ideationsno matter the frequency or intent.
Recent Department Of Veterans Affairs Administrative Trends Regarding Posttraumatic Stress Disorder Disability
From 1999 to 2004, the number of veterans receiving VA disability payments for PTSD increased 79.5% , whereas those receiving payments for other disabilities increased only 12.2%.
From 1999 to 2004, total PTSD disability payments rose 148.8% , whereas payments in other disability categories increased by only 41.7%.
Most veterans self-reported symptoms of PTSD become worse over time until they reach 100% disability, at which point an 82% decline in use of VA mental health services occurs no change in use of VA medical health service occurs.
In a recent review of disability award files, 25% of files were found lacking compelling evidence of combat exposure, putting the monetary risk of potential fraud at $19.8 billion.
Among veterans seeking mental health treatment in VA clinics, most concurrently apply for PTSD disability benefits.
Only about half of those veterans who apply for PTSD disability are seeking psychiatric care at the time of their disability application submission.
A nearly 2-times regional difference in the rate of approved PTSD disability claims is found across the nation this variation is not explained by differences in PTSD symptom severity or psychiatric comorbidity, suggesting inconsistent evaluation standards or procedures.,,
In 2006, the VA took an average of 657 days for appeals resolution of disability claims.
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How Va Disability Pay Affects Your Total Va Compensation
If you receive VA disability for erectile dysfunction, this will increase your overall monthly compensation. If you have been assigned a VA disability rating for ED, this will increase your overall rating.
However, it wont simply be added to your existing rating . The VA uses its rating system to estimate the total disability of a person. Therefore, once your ratings are combined, they will make a higher total rating, but they arent added together directly.
For example, if you already have a 20% disability rating and are assigned another disability rating of 30% for ED, your total VA rating will not be 50%. Instead, it will be somewhat lower.
To work out your total VA rating accurately, we recommend that you use our online VA rating calculator. There you will also be able to see your rates of compensation based on personal circumstances, such as number of dependants.
If you have been assigned a 0% disability rating and are receiving the Special Monthly Compensation, this is a stand-alone amount. It will not influence your other ratings or compensation amount.
Combined Rating System For Veterans With Multiple Disabilities
Veterans with multiple disabilities use the combined rating system.
To use the combined rating system, arrange the disabilities in order by severity and locate the intersect of the two numbers on the table below.
The VA rounds the final figure to the nearest to 10 percent.
If the Veteran has more than two disabilities, find the combined value for the first two, without rounding, and repeat with the third disability. Once you have a final number, round to the nearest 10%.
For example, if disability 1’s rating is 40% and disability 2’s is 20%, the combined rating is 52%. That figure gets rounded to the nearest 10%, making the disability rating 50%.
For a three-disability example, if disability 1’s rating is 60%, disability 2’s rating is 30%, and disability 3’s rating is 20%, we first find the rating of 1 and 2. The rating of 1 and 2 comes out to be 72. We then take the first combined rating and find the intersect with disability 3. The final number comes out at an even 80% rating.
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Unhappy With Your Ptsd Rating Lets Do Something About It
If you believe your current VA rating is unfair or inadequate, please contact us.
Helping veterans get full and fair percentage ratings is an important and rewarding part of our case work. We will present your case so that the VA is compelled to look at how post-traumatic stress genuinely impacts your life.
When you hire Marc Whitehead & Associates, youll have an experienced VA disability attorney to help you through every aspect of your case. We will review your C-file, clarify the issues and help you develop the competent evidence it takes to ensure your case is supported appropriately.
About Marc Whitehead
Va Disability Ratings Are Not Always Permanent
Many disability ratings are temporary and the VA retains the right to reexamine the disability rating at any time. If they wish to reexamine you, you will receive a Notice of Reexamination letter in the mail which will include a scheduled appointment date.
Make sure you attend this appointment or reschedule, as the VA can reduce or terminate your benefits rating if you fail to attend this scheduled appointment. After the VA reexamines your condition, they will make a recommendation to increase, decrease, or leave your benefit at its current rating.
There are times when your ratings may be protected, based on the type of disability, how long you have held the rating, your age, or other factors. Here is more information about VA Disability Reexaminations and Benefits Reductions.
Present A Current Diagnosis Of Ptsd
The first step to receiving VA benefits for PTSD disability requires the veteran to have a current diagnosis. A psychiatrist, psychologist, licensed social worker, or other mental health care practitioner must diagnosis the veteran with PTSD. Additionally, the diagnosis must conform to specific criteria.
Its important that the diagnosing doctor provides a report that fully describes why they feel that the veteran has PTSD and how the veterans symptoms meet the specific criteria. All of this medical evidence must show that it is as likely as not that the veteran currently has disabling PTSD.
Common Stressors For Veterans With Ptsd
A stressor is another word for the trauma which can cause post-traumatic stress disorder or PTSD. For veterans, stressors could relate to exposure to danger, an injury, or an assault. Generally, VA categorizes stressors as combat-related or non-combat-related. Below are some examples of both types of PTSD stressors.
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Of 10 Common Va Disability Claims: Paralysis Of The Sciatic Nerve
Based on the latest 2018-2019 VA data, Paralysis of the Sciatic Nerve, also known as Sciatica, was the #7 most common VA disability claims for all Veterans, across all demographics.
92.2% of Veterans are rated between 0% and 20%.
Musculoskeletal system conditions include issues with joints and muscles and must involve limitation of range of motion and/or painful motion.
Back injuries and various musculoskeletal injuries, which can lead to Sciatica, or severe radiating pain, are quite common for veterans.
Sciatica is the pain that one experiences when the sciatic nerve is irritated.
Sciatica is not an actual diagnosis of a problem, but rather, an accurate way of describing the location of the pain.
What is Sciatica?
The sciatic nerve is the largest nerve in the body.
This nerve runs from the lower back through the hips and buttocks all the way down to the leg.
Sciatica is extreme pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg.
According to the Mayo Clinic, Sciatica most commonly occurs when a herniated disk, bone spur on the spine or narrowing of the spine compresses part of the nerve. This causes inflammation, pain and often some numbness in the affected leg.
Sciatica develops when the pressure on the spinal nerve causes pain to develop on the lower back, buttocks, and legs.
Getting Tdiu For Ptsd Rating
If posttraumatic stress keeps you from being able to obtain or maintain employment, you may be able to get Total Disability based on Individual Unemployability, or TDIU.
TDIU pays at the 100% rate when the VA finds that the veteran is not capable of working because of a service-connected condition.
Eligibility for TDIU may be schedular or extraschedular:
- Schedular TDIU: You cannot work, and you meet the 60-percent or combined 70-percent criteria.
- Extraschedular TDIU: You cannot work, and you do not meet the above 60-percent or combined 70-percent criteria.
TDIU is another path to 100% for veterans who do not qualify for the 100 percent schedular rating. However, many veterans are not aware that they may be entitled to these higher-paying benefits.
Rather than assume the VA will hand it to you, you must ask for TDIU benefits and thoroughly support your claim for it. By using VA form 21-8940, Veterans Application for Increased Compensation Based on Unemployability, you can file a VA Individual Unemployability claim.
It is important that you fill out and submit this form without it, VA will view a TDIU claim as incomplete and will not decide the claim. This in effect results in VA administratively denying your claim.
We help veterans seek TDIU benefits by showing the VA how posttraumatic stress affects their ability to work, in the following ways:
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Evaluating Post Traumatic Stress Disorder
Mental health disabilities typically require C& P exams because of the subjectivity of medical diagnoses. Even if a veteran has a current diagnosis from a medical professional, the VA will typically still require a C& P exam for conditions like anxiety, depression, and PTSD.
Post-traumatic stress disorder is a mental health disorder that involves flashbacks, nightmares, or intense episodes that are related to and/or caused by a traumatic event. Due to the high number of possibly traumatic events that occur around active military members, a disproportionate number of veterans suffer from this condition. The VA rating for PTSD can range from 0% to 100%, but typically lands around 30%.
PTSD can be especially difficult for the VA to assess. When filing a disability claim for PTSD, its important to be as honest and forthright as possible about symptoms. Providing a clear picture of how the condition is affecting ones life can influence the VAs decisions about compensation.
Va Disability Rating For Ptsd: Criteria Eligibility And Making A Strong Disability Claim
There are many different events that cause PTSD . Some examples are personal trauma, sexual trauma, combat , and reactions to training. This condition is the 6th most-rated disability among veterans. There were over 63,000 new claims in 2015, and the VA compensates more than 800,000 veterans for symptoms of PTSD at some level.
When a veteran can show that their PTSD is service connected, the VA will assign a disability rating. A disability rating is based on the earnings lost due to the PTSD. The VA will use medical evidence to determine the severity of the disability.
The VA will nearly always require a C& P exam. It is important to note that C& P examiners do not rate claims. Exam results go to a VA adjudicator to apply the rating formula and provide a rating for the veterans PTSD.
When the VA is evaluating a PTSD claim, it looks to both the rating formula and the DSM-V. In evaluating ratings, the VA can consider factors outside of the rating schedule. However, the DSM-V symptoms are not meant to replace, but supplement, the rating formula scale for PTSD. Additionally, the rating formula factors for PTSD are examples of severity of the condition, not an exhaustive list.
This guide will break down the general rating formula for mental health conditions, the rating formula for PTSD specifically, and how veterans can best make a claim for VA disability benefits.
Below is our Ultimate Video Guide for PTSD.
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