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Permanent and Total (P & T) rating

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Posted on: Wednesday, May 16, 2012

Jim,

I am receiving ssdi and tdui 100% p&t no future exams schedulded. It will be 2 years in January 2013. They are for multi skeletal problems an secondary depression. Should I relax and send in my yearly report and feel safe that I will not lose my ratings in the near future.

Reply:

Yes, you should relax and enjoy the benefits that you earned with your honorable military service.

However, although your benefits are rated as "permanent" (we know this as you say that there are no future exams scheduled), there is no guarantee that VA won't try to review your file with the express purpose of lowering your rating. This can happen at any time. The phrase "no future exams scheduled" does not say that there will neve be a future exam...it only says that as of the writing of that letter nothing is scheduled.

At the time that you've held a Permanent and Total (P & T) rating for 10 years, the benefit changes a bit. If you die of any illness or injury after you've been P & T for ten consecutive years, your surviving dependents are eligible to apply for certain benefits. Prior to the 10 year period, your death must be from a service connected condition for dependents to be eligible. We may safely assume that you won't suddenly die of your currently rated conditions. Until you reach the 10 year goal, your survivors will not receive any benefits.

VA has been known to wait until you are at or just past the 9 year mark and suddenly require that you be subjected to a C & P exam. This often results in a proposal to lower the 100% rating and if that is allowed to happen, it effectively takes those potential benefits away from your dependents.

This isn't something that you should spend an inordinate time thinking about. You should know that it can happen and you should prepare for it just as if it were going to happen.

To be prepared, you must participate in pursuing health care, both for your physical health conditions and your mental health conditions. Many veterans will receive a 100% rating and a large retroactive payment and they think they're done. The veteran will stop going to see the mental health care team and he/she won't press on VA to continue the pattern of appointments to care for those physical ailments. The veteran will drop off the radar and there may not be any record of a continuing problem over the following years.

That gives VA reason to believe that your rated conditions have improved. After all, if you don't need the health care you're eligible for, why should you be rated at 100%?

As you are rated TDIU, you can't seek or hold gainful employment. You must continue to complete and return the VA Form 21-4140 once each year to verify that you aren't working. The form is usually mailed to you on or about the anniversary of your award. The VA Regional Office that has your C-File is notorious for not sending the form to you. If you don't get the form, you can't return it. If you don't return it, you will probably get a letter that proposes to lower your benefit because you didn't send in the form that VA didn't mail to you. I recommend that every TDIU vet should mark his or her calendar and as the date approaches, the veteran should download and print a copy of the form and mail it in. As always, any such communication to VA must be by certified mail, return receipt requested. Once you have the returned receipt, it goes into your files to prove that you sent in your 4140 form.

Any time a TDIU veteran gets a letter that proposes to lower the 100% benefit, it's relatively easy to appeal. For example, if you didn't return the 4140, you can quickly complete and return one and that should solve the problem. If there is a notice of a C & P exam at about the 9 year mark, you will have kept up your records to demonstrate that your condition is not improved, that you have not held gainful employment and that your rating must remain the same.

Once we veterans are involved with the VA, it is for life. We can never forget that VA is on a constant quest to discover ways to lower our benefits. If we move, we must take steps to ensure that VA is properly notified of our new address. If we have changes in the number of dependents, change a checking account or anything else, veterans have to take extra steps to be sure that the ever-inefficient and dysfunctional VA gets the record correct.

To do this we have to accept responsibility for keeping our health care records updated. I recommend that every veteran have a complete copy of the entire C-File in good order at their home. It is important that you get a copy of your current health care records to keep with your C-File. This means that you must visit your VA medical facility and talk to the people in the Release of Information (ROI) department. This process should be done again each year to update the records that you have in your own files. The ROI department is rarely easy to negotiate and veterans must be persistent and firm. It is your right to have complete and updated copies of your health care records.

Mental health records will take some special work to obtain. Unlike physical health records, mental health records are restricted from the patient. The patient must get an authorization from the treating health care provider or the department head to release those records to the patient. If you receive civilian health care of any sort, those records can also be difficult to obtain. Many civilian providers today don't maintain your records on site. They use contractors who may be located across the country in another state. You will have to deal with that contractor and you'll probably have to pay a fee for copying and delivery.

Although this sounds like quite a burden, it really isn't once you're into the routine. The routine is the very best insurance that you won't have any future problems with your VA. Knowing that you've done your part to protect yourself will help you to do what you want...relax and enjoy the benefits you've earned by serving your country.

You may learn much more by visiting http://www.vawatchdog.org/tdiu-unemployability.html

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