Information on VA benefits, Social Security benefits, how to files claims, and how to appeal denials.
Is it possible to receive P&T with a combined service connected evaluation/rating of/at 60%?
P & T stands for Permanent and total...as in Permanently & Totally disabled. Since a totally disabled rating is 100% it becomes apparent that a 60% rating isn't total. Ratings of less than 100% are generally considered to be permanent unless there's some specific reason for a future exam. In other words, if it's P & T you're seeking, you're a ways off from that.
I was recently awarded a 100% percent benefit for Prostate Cancer (April 2020). I am on a watch and wait and seen every 6 months by my private physician, not the VA. I was just notified I must take an exam with the VA to review my situation. I certainly do not have any issue with that. Just have a few questions regarding possible outcomes of exam. My Doctor says if I do have it removed I could be faced with other issues such as incontinence, etc. Guess you take your chances either way (watch and wait or removal).
My question(s) are, do my benefits get reduced because of my choice to watch and wait? What would cause the VA to do a benefit reduction? If they do reduce, what is the typical percentage reduce to? If they do reduce and I appeal, what documentation would be required from me? Thanks for any information you can provide.
Watchful waiting in reference to prostate cancer means that you won't treat your low grade, less aggressive cancer but you will monitor it for any change. The Vietnam veteran who is diagnosed with prostate cancer is entitled to a 100% rating while the cancer is active. The rating will drop after the cancer is treated.
Watchful waiting is a very popular option these days since most men will get prostate cancer in their lives but most will die with the cancer, not of it.
VA doesn't grasp this. VA thinks every veteran will aggressively treat every cancer and every cancer will be cured. You will likely encounter many C & P exams where you'll later get a notice that since your cancer is treated now, your benefit will be lowered. You'll need to appeal that if and when it happens to keep the 100% benefit. If you are not treated with surgery, radiation or chemo, your benefit will remain at 100%.
Treatment is a complex discussion. Removal of the prostate leaves most men incontinent to a degree and with erectile dysfunction.
Personally I'm a fan of watchful waiting. Prostatectomy often leaves the patient worse off than he was before. Quality of life diminishes and statistically speaking, overall life expectancy isn't increased by much. Watchful waiting is a good option if you can deal with the inefficiencies at VA.
I am a Vietnam veteran and have been denied VA health care benefits for excessive income. I thought we were not required to meet the income test.
I'm going to assume that you applied for VA health care some time after 2006-2007.
Prior to that time all honorably discharged veterans were entitled to free or very low cost health care. Anyone with a DD 214 could walk in, register and get care. The wars of the period brought home many new veterans who were in immediate need of care and overwhelmed the VA system. Rules were changed during the 2006-2007 period and different tiers of care, time periods for care and other eligibility factors came into play. POWs, Purple heart and MOH recipients and some others get varying levels of care at no cost.
If you weren't previously registered for VA health care, you now must have certain qualifying conditions to get in the door. You need a service connected disability rating or you must be a recently returning soldier who will be given free care for a given time period post separation...2 to 5 years as a rule.
The other category that may be eligible for VA care is the indigent veteran who has non-service connected conditions and is of a certain age group. This is the VA pension benefit and it comes with a stipend and free health care from VA. I'll assume you were means tested for the benefit and your relatively high income excluded you.
This isn't an unusual problem for veterans who may be retiring or aging and losing their health insurance. Many veterans will find a disability to file for just for the sake of getting in the door to low cost health care.
Good luck.
Why do I need an evaluation for prostate cancer if it's already in my VA medical files that I was diagnosed with it?
In reality, you don't. Way back in the olden days...2013...VA started the ACE Program so that folks like you wouldn't have to endure the waste of time that is a C & P exam and also to save the taxpayer some money. Those examiners don't come cheap.
But the contract companies that provide C & P exams are mostly owned and invested in by former VA officials. Since the companies are paid by each exam...piecemeal if you will...the more exams conducted the more the former VA executives earn. So everybody gets a C & P, often more than one.
This costs you, the taxpayer, for this enormous waste.
But there is nothing you can do about it but follow orders and go to the exam. If you miss it, VA will default to denying your claim no matter how much evidence is in your file.
Welcome to your VA.
I am currently at 90%, but I have about 6 different claims I have in that I am fighting. My question is, if I go up to 100%, and at least one of my disabilities are permanent, will that qualify me as P&T?
No, not necessarily. A 100% rating can be comprised of numerous individual ratings, any one or more of which may have a future exam scheduled. Even though other individual ratings may be permanent in nature, if a rating that carries a lot of weight is scheduled for a future exam, the 100% rating would be temporary.
For the veteran who is at 90% and "fighting" with 6 different claims in a struggle to get to 100%, I'd advise that the path you've taken is the most difficult way ever to reach a 100% rating. In most instances it can't be done because of VA Math.
Many 90% rated veterans are unable to work and hold onto gainful employment because of their service connected disabling conditions. The TDIU (unemployability) rating was made just for circumstances like yours and the TDIU rating is exactly the same benefit as the one you're struggling to reach.
Were I you, I'd have a long look at TDIU. Good luck.
I filled a claim years ago for hypertension and was denied. If VA put hypertension on the agent oranges list would I be able to use that as a start date or would I have to start a new claim?
Maybe. In Nehmer it was ruled that many veterans who had filed claims for heart disease caused by agent orange were awarded significant retroactive benefits.
However, I have to comment that although there may be some small chance of retroactive benefits, I personally believe that VA won't be awarding any more agent orange benefits. If hypertension were awarded it would be interesting to see what happened since many hypertension claims are service connected but rated at 0% since hypertension isn't in and of itself a disabling condition. Because of a familial pattern I've been hypertensive for most of my life, I take a couple of pills, I'm not at all disabled by it.
To get a rating for a disabling condition the condition actually has to be disabling in some way. Unless your hypertension is wildly out of control you could get 25 years of retro at 0% service connected and that would net you...$00.00.
Hi Jim, I am a disabled veteran and I am receiving TDIU. I wanted to get a part time job but I know I will most likely go over the poverty threshold for one person. I have 3 children that are my dependents so will the VA go by my household size poverty threshold or just one person?
TDIU veterans are encouraged to return to work if they're able to. Work is good and healthy for us. You are able to work and earn up to the amount of the federal poverty threshold for your household in your region. That's explained in more detail here https://www.payingforseniorcare.com/federal-poverty-level
If you return to work you don't have to notify VA or anyone else. VA will track your earnings at the SSA and IRS and if you go above the threshold, you'll receive a letter from VA proposing that you have a chat.
Many TDIU vets who want to return to work discover they aren't able to so this approach ensures you don't lose your benefits because you wanted to try. If you're able, go for it.
Good luck!
I am 70% but 100% TDIU, how do I find out if it's permanent or not. The packet I received doesn't say but where it says about family education benefits it does say permanent in nature, so does that mean it is. Thanks.
VA loves obscure, obtuse, mysterious verbiage. Rather than just coming out and saying that your benefit is permanent with no future exams scheduled, they will codify that to say that your dependents are eligible to apply for Chapter 35 educational benefits and/or CHAMPVA health insurance. If you see either of those, your benefit is permanent.
Interestingly, the word permanent at VA doesn't mean permanent. VA can and often does investigate any benefit for the quality of the adjudication or fraud and if any problems are found the benefit may be modified. When your 100% benefit is coded as permanent it only means that you have no further scheduled exams to review the conditions status and it opens doors to those extra family benefits.
Hi Jim, Just heard that Hypothyroidism was added to the Agent Orange presumptive list. I will now file a claim. My VA health file in 2015 reflects Hypothyroidism. Will I receive retroactive pay back to that date? Thanks.
That's not quite correct. Hypothyroidism hasn't yet been added to the list.
What you're reading is about the legislation occurring that has the potential to add 3 presumptive conditions to the list. At this stage of the legislative game it will be a long way into the future before this is approved, if ever. Then it has to pass over many other hurdles before it's a reality.
Personally, I believe that Congress and VA are done with adding any more conditions to the AO presumptive list. The debate rages on in DC because that's what politicians do and that confuses a lot of vets who think a benefit is coming when it's only politics as usual.
To specifically answer your question: No, retroactive pay is only available to the date you file a claim, not the date of the onset of an illness or condition.
There is an option. I believe that there is a significant link or nexus between diabetes and hypothyroidism. Diabetes is a presumptive condition to the Vietnam veteran and a link is easy to establish between the two. In other words, you may be able to claim hypothyroidism as a secondary condition to a service connected diabetes.
To do this requires a review of your complete medical records by an expert disability physician who may then write an IMO...an Independent Medical Opinion...that supports the idea that the two are linked.
You can learn more about how an IMO works here.
You can better prepare yourself for dealing with this particular issue at VA by searching BVA decisions that are similar in kind to your situation. Click here and enter key words <hypothyroidism diabetes> and search those decisions by year.
The results that are returned to you will give you an idea of how to go about your own claim. BVA decisions are not precedential, you will still have to follow every step of the process to win the claim.
Finally, a cautionary tale. I've recently managed a similar claim and learned just how devastating the combo platter of diabetes and hypothyroidism can be. Please ensure that your health care providers are aware of both conditions and look for any signs or symptoms of one or the other getting worse. Good luck!
