I have been on the Dept. of the Navy TDRL since Jan 2012 and rated at 70%.
1: 50% Major Depressive Disorder D-codes 9394-9411
1.1 Hx of PTSD (related Cat 2 diagnosis)
1.2 Anxiety Disorder not otherwise specified. (related Cat 2 diagnosis) ,
2: 20% (bilateral factor applied) D-codes 5099-5024
Right Shoulder Painful Limitation of motion status post superior labrum anterior and posterior repair ,
3: 10% Vertigo D-codes 6299-6204, peripheral, episodic & motion sickness associated with pressure changes to ear.
4: 10% (bilateral factor applied) D-Codes 5299-5201.
L Shoulder pain w/ decreased range of motion and recurrent instability status post 3 surgical stabilization repair & revisions to L shoulder
4.1 Hx of L subscapular nerve injections w/ L thumb/Volar pad numbness. (related Cat 2 Diagnosis).
I recently had my first Re-eval for the 4 unfitting conditions only. These tardy evals occurred from November 2012-February 2013 (long story) and my board apparently convened 28 Feb. Yesterday, (March 15th) I received my results which read that "After a thorough review" I have been rated at 60% and will be removed from the TDRL and placed on the PDRL.
Good news after initially waiting so long and then not having to spend 5 years on TDRL right? Well, this is what I am not so sure of.
Herein lies some recent history and my dilemma.
Sept. 21, 2013 I received notice from the VA that I had been rated at 100% due to IU retroactive to the day I was released from active duty. It was then modified retro to July 2012 as 100% scheduled (read: not total and permanent).
This was merely days prior to the PEB requesting that I start my TDRL re-eval. The VA continued my R shoulder @ 20% and obviously raised several others as well as adding one to reach 100%. None have to do with my dilemma except the R shoulder hence my inclusion here.
Along with my Jan 2012-Present medical records, I sent the VA findings and rating documentation. They contacted me requesting a mental health, ENT, and Ortho re-eval anyway. I returned with a "Why? since I just sent you everything that was recent including my rating decision taken directly from the VASRD which you will be using anyway?" They stated to do it anyway or else... So, being far from the hospital they ordered me to and Sequestration just having shut down travel re-imbursement, I asked who else could perform the ortho and mental health portion. The board secretary told me and my wife twice via phone call that I could have the "nearest MTF, civilian through Tricare, or "THE ORTHO DR. AT THE LOCAL VA"" perform the exams. What the hell?
So I stated, that my MTF was Air Force and does most things differently, a civilian will be about as worthless as a medicine man writing this up, and they (PEB Board) just told me a few days before that the Local VA decision dated 21 Sep 2013 wasn't good enough for them. Pure confusion.
Anyway, I schedule the exams at the local Air Force MTF and actually found assistance from a PEBLO just assigned there. My Mental Health exam obviously went well went, My Ortho measurements however were take by a physical therapist (which is authorized in black & white as they are quite capable but probably not preferred over an ortho Doc.) on forms they use for their TDRL cases which look no where similiar to the DON or VA. They actually take averages. Regardless, my averages and writeups regarding ROM and pain all qualified for the 20% level according to the VASRD.
Hence my confusion about the downgrade discrepancy in their board finding for that shoulder.
I have been told and have read on this very forum that my TDRL should be a Head-to-Toe evaluation of all service connected conditions. Even after raising this question with the PEB they emphatically said "No!".
My other issue with their documentation is that in the findings block 6, they continue to credit me with 11 years 7 months of service when I have just under 18 years day for day active duty service and nearly 22 years overall.
In their findings they also state that it did not result from a combat related injury when in fact 2 (plus a back injury that happened the same moment my L shoulder injury occurred but was curiously not found to be unfitting by DoN but was 20% by VA) of my 3 unfitting conditions occurred in a combat related scenario.
I have mentioned these two discrepancies in IPEB appeals before but it has not been corrected. Am I missing something here as to what LOS actually is? This is obviously affecting me by having to physically apply for CRSC, but would the LOS affect any pay due me past, present, or future?
I am also curious that if in the future since I am not "permanent and total", the VA downgrades my PTSD from 50% to 0%, this would assumingly affect my DoD % resulting in possibly dropping below 30% and a theoretical end to DoD retirement benefits and pay if/when both drop down.
I have waited so long for the TDRL/PDRL results, and now that I have them, I had an overwhelming relief, only to again pop out of bed in the middle of the night frantically considering that this mere 10% drop could negatively affect future DoD percentages since a loss of 50% would put me below 30% for the DoD.
Does anyone have any thoughts on
1. My need to appeal 10% while staying on the TDRL (which I am not currently receiving any monetary benefit anyway due to the VA 100% mark) or just accept the findings?
2. Appeal due to wording in block 6 for my LOS and additional findings that it was not combat related?
3. Appeal due to Orthopedic measurement oddities which obviously confused the board members as well?
4. Appeal due to wording of finding # 1 being classified as a "Major Depressive Disorder" vice simply PTSD which the code already identifies (9411)?
and:
5. Should I just be happy I obtained PDRL status, be done with the fight and move on hoping the VA keeps all of my unfitting conditions the same for 20+ years?
Thank any and all who make it through my post and can provide meaningful and experiential advice.
1: 50% Major Depressive Disorder D-codes 9394-9411
1.1 Hx of PTSD (related Cat 2 diagnosis)
1.2 Anxiety Disorder not otherwise specified. (related Cat 2 diagnosis) ,
2: 20% (bilateral factor applied) D-codes 5099-5024
Right Shoulder Painful Limitation of motion status post superior labrum anterior and posterior repair ,
3: 10% Vertigo D-codes 6299-6204, peripheral, episodic & motion sickness associated with pressure changes to ear.
4: 10% (bilateral factor applied) D-Codes 5299-5201.
L Shoulder pain w/ decreased range of motion and recurrent instability status post 3 surgical stabilization repair & revisions to L shoulder
4.1 Hx of L subscapular nerve injections w/ L thumb/Volar pad numbness. (related Cat 2 Diagnosis).
I recently had my first Re-eval for the 4 unfitting conditions only. These tardy evals occurred from November 2012-February 2013 (long story) and my board apparently convened 28 Feb. Yesterday, (March 15th) I received my results which read that "After a thorough review" I have been rated at 60% and will be removed from the TDRL and placed on the PDRL.
Good news after initially waiting so long and then not having to spend 5 years on TDRL right? Well, this is what I am not so sure of.
Herein lies some recent history and my dilemma.
Sept. 21, 2013 I received notice from the VA that I had been rated at 100% due to IU retroactive to the day I was released from active duty. It was then modified retro to July 2012 as 100% scheduled (read: not total and permanent).
This was merely days prior to the PEB requesting that I start my TDRL re-eval. The VA continued my R shoulder @ 20% and obviously raised several others as well as adding one to reach 100%. None have to do with my dilemma except the R shoulder hence my inclusion here.
Along with my Jan 2012-Present medical records, I sent the VA findings and rating documentation. They contacted me requesting a mental health, ENT, and Ortho re-eval anyway. I returned with a "Why? since I just sent you everything that was recent including my rating decision taken directly from the VASRD which you will be using anyway?" They stated to do it anyway or else... So, being far from the hospital they ordered me to and Sequestration just having shut down travel re-imbursement, I asked who else could perform the ortho and mental health portion. The board secretary told me and my wife twice via phone call that I could have the "nearest MTF, civilian through Tricare, or "THE ORTHO DR. AT THE LOCAL VA"" perform the exams. What the hell?
So I stated, that my MTF was Air Force and does most things differently, a civilian will be about as worthless as a medicine man writing this up, and they (PEB Board) just told me a few days before that the Local VA decision dated 21 Sep 2013 wasn't good enough for them. Pure confusion.
Anyway, I schedule the exams at the local Air Force MTF and actually found assistance from a PEBLO just assigned there. My Mental Health exam obviously went well went, My Ortho measurements however were take by a physical therapist (which is authorized in black & white as they are quite capable but probably not preferred over an ortho Doc.) on forms they use for their TDRL cases which look no where similiar to the DON or VA. They actually take averages. Regardless, my averages and writeups regarding ROM and pain all qualified for the 20% level according to the VASRD.
Hence my confusion about the downgrade discrepancy in their board finding for that shoulder.
I have been told and have read on this very forum that my TDRL should be a Head-to-Toe evaluation of all service connected conditions. Even after raising this question with the PEB they emphatically said "No!".
My other issue with their documentation is that in the findings block 6, they continue to credit me with 11 years 7 months of service when I have just under 18 years day for day active duty service and nearly 22 years overall.
In their findings they also state that it did not result from a combat related injury when in fact 2 (plus a back injury that happened the same moment my L shoulder injury occurred but was curiously not found to be unfitting by DoN but was 20% by VA) of my 3 unfitting conditions occurred in a combat related scenario.
I have mentioned these two discrepancies in IPEB appeals before but it has not been corrected. Am I missing something here as to what LOS actually is? This is obviously affecting me by having to physically apply for CRSC, but would the LOS affect any pay due me past, present, or future?
I am also curious that if in the future since I am not "permanent and total", the VA downgrades my PTSD from 50% to 0%, this would assumingly affect my DoD % resulting in possibly dropping below 30% and a theoretical end to DoD retirement benefits and pay if/when both drop down.
I have waited so long for the TDRL/PDRL results, and now that I have them, I had an overwhelming relief, only to again pop out of bed in the middle of the night frantically considering that this mere 10% drop could negatively affect future DoD percentages since a loss of 50% would put me below 30% for the DoD.
Does anyone have any thoughts on
1. My need to appeal 10% while staying on the TDRL (which I am not currently receiving any monetary benefit anyway due to the VA 100% mark) or just accept the findings?
2. Appeal due to wording in block 6 for my LOS and additional findings that it was not combat related?
3. Appeal due to Orthopedic measurement oddities which obviously confused the board members as well?
4. Appeal due to wording of finding # 1 being classified as a "Major Depressive Disorder" vice simply PTSD which the code already identifies (9411)?
and:
5. Should I just be happy I obtained PDRL status, be done with the fight and move on hoping the VA keeps all of my unfitting conditions the same for 20+ years?
Thank any and all who make it through my post and can provide meaningful and experiential advice.
