Veterans' Advocate Jim Strickland answers questions from VA Watchdog dot Org readers.

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Veterans' Advocate Jim Strickland provides regular columns for VA Watchdog dot Org.  If you would like to contact Jim about his columns, you can email him here...  The archive of Jim's articles is here...  To find an answer to a specific VA benefits question, use the VA Watchdog search engine... click here...  And, be sure to use Jim's:  A Military Veterans Guide To Disability Compensation and Pension Benefits -- A Compendium of Resources and Knowledge For The Disabled Veteran -- click here...   JIm's series for new vets, "Welcome Home," is also featured on Military.com. And, you can follow Jim on TWITTER here ...

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by Jim Strickland

NOTE:  Letters in my Q&A columns are reprinted just as they come to me. Spelling and grammar are left as is and only small corrections are made to improve readability, ensure anonymity or delete expletives that may offend some readers. This is not legal advice. You should always seek the advice of an attorney who is qualified in Veterans' law before you make any decisions about your own benefits.

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Jim;

Thank you for previous help with my claims. Your wise counsel has made a huge impact on my family’s quality of life through the increased rating that you helped me obtain. I have been looking through my original C & P rating letter and noticed this entry;

“An evaluation of 10 percent is granted. An evaluation of 10 percent is assigned for evidence of at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas affected, or: intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period. A higher evaluation of 30 percent is not warranted unless the record shows 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period.” and in the actual Ch 38 says;

7816 Psoriasis:

More than 40 percent of the entire body or more than 40 percent
of exposed areas affected, or; constant or near-constant systemic
therapy such as corticosteroids or other immunosuppressive drugs
required during the past 12-month period.....60

This was for psoriasis.

I have indeed in fact been on Enbrel then followed by Humira along with Methotrexate (for a few months). All these drugs are classified as being immunosuppressive. I have been on Enbrel off and on for around 4 years and Humira for over a year straight. Although the above rating verbage falls under psoriasis, I have been treated for psoriatic arthritis with the above named drugs because of the shared efficacy.

My question is; should I submit an increase for compensation, which if assigned 60% should bring my rating to +95% thus rounding it off to 100% ? I don’t want to be greedy but at the same time I think my family deserves what is justified medically. At the same time also, I am leery of rocking the boat and potentially initiating an “audit” of some sorts and have them scrutinize the claim unnecessarily and rerate it. What do you think?

Reply;

You're correct in your assessment. A higher rating seems warranted. You're also correct to be concerned of "rocking the boat and potentially initiating an 'audit' of some sorts".

I caution veterans that any time they make any request for an increase or modification to their claim that their folder becomes vulnerable to scrutiny. As the process of adjudicating your request for an increased rating occurs, so does the process of looking for reasons to deny your request and to look for errors from previous decisions. The rater will also seek out any "improvements" in your condition that would lower your existing rating.

You should always calculate a risk/benefit outcome to help you decide what to do.

You've missed one important factor in your current analysis...that of the Combined Ratings Table.

http://frwebgate.access.gpo.gov/cgi-bin/get-cfr.cgi?TITLE=38&P
ART=4&SECTION=25&YEAR=2003&TYPE=TEXT

The CRT is what is often referred to as VA Math. This is that place in the bizarre Wonderland of your VBA where you can learn that, "...if there are three disabilities ratable at 60 percent, 40 percent, and 20 percent, respectively, the combined value for the first two will be found opposite 60 and under 40 and is 76 percent. This 76 will be combined with 20 and the combined value for the three is 81 percent. This combined value will be converted to the nearest degree divisible by 10 which is 80 percent."

So...using the CRT you can see that what you thought, that 60 + 40 +20 = 120, isn't true. Inside the well defended and secretive walls of the VBA the correct sum is 80. If you look over the CRT carefully you'll notice that a very small batch of numbers add up to 95% or greater.

Obviously, the thing to do is to read the complex instructions carefully and determine whether or not your math conclusion is factual. If it is, look at the values on the Rate Tables at http://www.vba.va.gov/bln/21/Rates/ 

As an example, if you're a veteran with a spouse and a child and you're rated at 30% ($453.00 monthly) and you believe that you may be able to increase your rating to 40% ($644.00 monthly) will the additional 10% ($191.00) justify the very real risk of your benefit being reduced to 10% ($123.00 monthly)?

In the last year or two I've worked with veterans who have requested increases (none of which I recommended) and I've seen a veteran rated at 50% with spouse and child ($899.00 monthly) aiming for 70% ($1,409.00 monthly) and who received notice of a proposal to reduce his existing 50% benefit to 30% ($453.00) because of the "improvements" to his conditions.

In the example above we filed a standard Notice of Disagreement (NOD) to the proposal to reduce and after a year or so of wrestling with the VBA the veteran was able to maintain the 50% rating he'd started with. His request for increase was denied and he chose not to appeal.

Needless to say it was a year of worry for the veteran that had he done a risk/benefit analysis he probably wouldn't have had to face.

I do believe that at any time you deserve an award because of your condition(s) that you should have the maximum benefit allowed by law. Having said that I urge veterans to be very sure that their case is as rock solid as can be. If a condition has truly become worse over time and that progression is fully documented in irrefutable medical records and there is no evidence of any other condition improving, by all means...file for an increase.

In another example, if the veteran (with spouse and child) rated at 70% who has multiple conditions with at least one rated at 40% (or a single rating of at least 60%) becomes unemployed, that veteran should consider applying for the 100% Individual Unemployability (IU) rating.

In that case if there is little or no question that the unemployment is due to service connected conditions, the monetary benefit will rise from $1,409.00 monthly to $2,932.00 monthly. That represents an increase of some $1523.00 per month (and other non-monetary benefits) and is such a significant increase that the work and waiting is almost always worth a calculated risk.

In your case, it's now up to you to do the VA math.

Keep in mind that I estimate that about 70% or more of all applications for benefits are denied today and require an appeal. Another factor to consider is how long it's been that you've had the current condition. If you received a rating a year or two ago and you're seeking an increase now, you aren't as likely to see a favorable outcome as you might had the rating been in place 5 or more years.

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Jim;

I thank you for your kind assistance several weeks ago.

Here's one for you, but I'm sure that you have heard this many times before. I called the VA 800 national number on Wednesday, July 22 and talked with a VA benefits counselor and she said that my claim was completed and signed on July 21 and that it had to be entered into the computer and that I could call back Friday, July 24 to get my rating increase percentage as it would take 24 hours or so for the computer to be updated. She also said that I should receive my award letter within 10-20 days.

So, today, Friday morning, I call back and get a different VA benefits counselor and she said that my claim was "pending" for authorization, in other words, needed to be signed. Also, this counselor said that they can't give out time frames, as each claim is taken in order as it is received. Then she said that it may be another 30-60 days before I get a letter from the VARO but couldn't narrow down a specific date (which I was already aware of this).

Guess I'll just continue to wait. I am inclined though, to believe the first counselor, as she seemed to have a more direct answer to my question than the one I talked with today.

My question is: I wonder why the answer to my question was so varied greatly by the benefits counselors? I thought about calling my VSO, but he will probably have a third answer...........oh, well.......

Any comments? Again, keep up the good work!

Reply;

If you keep up with my stuff you'll learn that there are 3 great lies.

(1) Darling, of course I'll respect you in the morning.

(2) The check is in the mail.

(3) If you need the correct answer about your benefits it's as easy as calling the VA toll free number.

The toll free number routes to a call center, not to your VA Regional Office. The people at the call center don't have access to your record. They have access to a program that shows some fuzzy data about where the computer thinks your folder is and they then sort of guess at the rest.

Like so much of the rest of the VA, the people answering the phone have quotas. Management tracks those quotas but they don't track the accuracy of the answers given to you.

This is much the same work process as the person who does your rating. He or she is tracked for their raw productivity but not the quality of their work. If they can close the required numbers of claims each day they get their bonus whether or not each decision is wrong.

It's quantity v. quality at the VBA and quantity always wins.

The person you speak to is given about 3 minutes per call to give you the data you want. Anything longer and their job performance is questioned...they may be chatting with a friend or listening to some tale of woe for which there is no answer.

This results in the bottom line that they will tell you anything that makes you happy if you'll please shut up and get the hell off of their telephone.

I recommend that veterans only call the toll free number to check on the weather forecast and to ask for tomorrow's winning Lotto numbers.

You'll probably get the wrong information then too but at least there'll be some small chance that they may get it right.

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TOPICS: veterans, veterans' benefits, VA, Department of Veterans' Affairs, Jim Strickland, Veterans' Advocate,