Outpatient Mental Health Benefits expanded via TriCare

eps17

PEB Forum Veteran
#2
ChaplainCharlie, just a question only somewhat related.

If someone has a mental health rating of 70% from the military and they are PDRL; is it possible that the VA could rate that same exact condition less than 70%, say 50%, or even 30%? Or does it stay at the very minimum at the military percentage?
 

Sgt zo

PEB Forum Veteran
Registered Member
#3
My understanding is that, The military gets their ratings from the VA. So I don't think that can happen.
My ratings with the military are the same as my VA ratings for those particular conditions. Combined VA ratings are overall higher because they are all combined. Military/DOD rating are only for Unfitting conditions.
 

jahlon

PEB Forum Veteran
Registered Member
#4
ChaplainCharlie, just a question only somewhat related.

If someone has a mental health rating of 70% from the military and they are PDRL; is it possible that the VA could rate that same exact condition less than 70%, say 50%, or even 30%? Or does it stay at the very minimum at the military percentage?
No.

I am rated at 70% for a mental health condition, but when you say you are rated, you aren't "rated" by the military.

The military decides which of your conditions are unfitting for continued service. The VA rates you, and the military is required to accept the VA rating.

I am 70/90. I am 70% disabled according to the DOD because my only unfitting condition was 70%. I have an additional 20% from the VA because I have sleep apnea (50%) migraines (30%) my shoulder (20%) and tinnitus (10%)

Yes, 50/30/20/10 after starting at 70 doesn't get you to 100. I get to 92.44 with all of my conditions, and since I max all of them, I shall never get to 100%
 

eps17

PEB Forum Veteran
#6
I am PDRL at 70% for one unfitting condition. That can never change.

I guess the VA has to honor the DoD permanent rating for the single condition when it comes to VA compensation so I must assume it can never go down either.

I'm not talking about IDES. I've been out for six years now.
 

Sgt zo

PEB Forum Veteran
Registered Member
#7
I am PDRL at 70% for one unfitting condition. That can never change.

I guess the VA has to honor the DoD permanent rating for the single condition when it comes to VA compensation so I must assume it can never go down either.

I'm not talking about IDES. I've been out for six years now.
What is your va rating now. I'm assuming its 70% or better.
 

eps17

PEB Forum Veteran
#8
90% with TDIU so technically 100%.

I was just asking the question generally to better understand the relationship between VA ratings and DoD ratings.

I was retired after the fact, like four years later, and I was just wondering if the VA had to honor my DoD rating percentage is all.
 

chaplaincharlie

PEB Forum Veteran
Registered Member
#9
@jahlon

VA
The VA has both temporary and permanent ratings. Temporary VA ratings are subject to change. You have to know if your VA ratings are permanent, temporary, or a mix of the two. Permanent ratings can also be changed, in extreme circumstance (fraud....)


DoD
If you are PDRL then your DoD rating is fixed. If your are TDRL the rating can change.
 

eps17

PEB Forum Veteran
#10
I'm tracking 100%. So I guess the VA is not obligated to honor a permanent DoD rating and can lower the same exact condition lower at the VA lower than what the DoD permanently rated.
 

Sgt zo

PEB Forum Veteran
Registered Member
#11
I'm tracking 100%. So I guess the VA is not obligated to honor a permanent DoD rating and can lower the same exact condition lower at the VA lower than what the DoD permanently rated.
Technically, I guess it could. Say for instance you are rated 70% dod and VA, then the VA re-evaluates you and lowers the rating. That's the only scenario that i can think of
 

chaplaincharlie

PEB Forum Veteran
Registered Member
#12
Temporary VA ratings can and sometimes do change. DoD should have placed a member with an unstable condition on TDRL. Once on PRDL it is a done deal.

In my case my unfitting condition was considered temporary by the VA, but DoD placed me on PDRL for that condition using the VA's temporary rating. Once retired, I filed an appeal with the VA and the temporary rating was made permanent.
 

islandboy25

PEB Forum Veteran
Registered Member
#13
Temporary VA ratings can and sometimes do change. DoD should have placed a member with an unstable condition on TDRL. Once on PRDL it is a done deal.

In my case my unfitting condition was considered temporary by the VA, but DoD placed me on PDRL for that condition using the VA's temporary rating. Once retired, I filed an appeal with the VA and the temporary rating was made permanent.

ChaplainCharlie,

Can you provide some guidance on how you went about filing a appeal with the VA to change your temporary rating to permanent with the VA. I was place on TDRL via the Army, my back condition is rated as permanent DoD, but VA has it temporary with a reevaluation date for 2021.TIA
 

wyldth1ng

Registered Member
#15
The problem is not the VA it's DoD in this scenario. TDRL can only last 5 years maximum after your discharge date. If you don't get an appointment with your closest military facility that can handle your non fitting conditions in that time frame then you are automatically transferred to PDRL at that time you can update your ID card to reflect your change and you will be issued an updated DD215. (Not a typo.)
If you want to end it early then you should contact your closest MTF regardless of branch of service, explain what you're asking to their PEBLO, then attempt an earlier appointment to evaluate your non fitting conditions. The key to this is "non fitting conditions", things that prevented you from being a Marine, soldier, airman, sailor, or gaurdsman. Even if only one of those were considered temporary all non fitting conditions will be evaluated. Most people just have one, I have 8 so it sucks for me since only one was considered temporary/unstable. It was PTSD, the reason for this is after so many faked it in 2006 all personnel with PTSD conditions were listed as temporary requiring revaluation.
At 18 months after discharge you will receive your letter about your evaluation automatically to your home of record at time of discharge. If you don't respond in 30 days, the government has the right to stop all payments. Thats any government payment, VA, DoD, SS, whatever. So it's smart to follow the rules on this. If your MTF can't get you in, that's not your fault so you are basically in limbo until you have your appointment. Then the 5 year rule could apply to you. I've heard of people that have ignored their letter and nothing happened to them financially and then transferred to PDRL at 5 years, but why take that chance.
 

wyldth1ng

Registered Member
#16
As far as ratings in general, yes the DoD does not rate anything. Only the VA assigns percentages using 38 CFR part 4. An easier link to use is this https://www.law.cornell.edu/cfr/text/38/part-4 . You can use the VA version but Cornell link is easier to navigate through.
What the DoD does is state how your condition is then the VA uses the words listed on the evaluation and matches them to the charts and paragraphs in the 38 CFR part 4. So if the wording grants or warrants 60 percent but you thought it should have been 70 really the only person you can blame is yourself. Read up on your condition and ask your evaluator use the wording you want. Now if your problem is something like movement like your range of motion of your right shoulder is at 50 degrees and at your evaluation you squeezed out 75 degrees then your rating with be downgraded. This not verbatim just an example.
Some parts of the body and mind are not listed or are blank for percentages, then the percentage is based on ADLs, assisted daily living. If for example you are unable to feed your self half the time then it warrants a 50 percent rating.
It's kind of like GI Joe, "Knowing is half the battle."
 

eps17

PEB Forum Veteran
#17
As far as ratings in general, yes the DoD does not rate anything. Only the VA assigns percentages using 38 CFR part 4. An easier link to use is this https://www.law.cornell.edu/cfr/text/38/part-4 . You can use the VA version but Cornell link is easier to navigate through.
What the DoD does is state how your condition is then the VA uses the words listed on the evaluation and matches them to the charts and paragraphs in the 38 CFR part 4. So if the wording grants or warrants 60 percent but you thought it should have been 70 really the only person you can blame is yourself. Read up on your condition and ask your evaluator use the wording you want. Now if your problem is something like movement like your range of motion of your right shoulder is at 50 degrees and at your evaluation you squeezed out 75 degrees then your rating with be downgraded. This not verbatim just an example.
Some parts of the body and mind are not listed or are blank for percentages, then the percentage is based on ADLs, assisted daily living. If for example you are unable to feed your self half the time then it warrants a 50 percent rating.
It's kind of like GI Joe, "Knowing is half the battle."
I wasn't ware so many people "faked it" in 2006.

To what are you referring? Most of these changes you speak of were driven by the NDAA as a result of the Sabo case. It was the military low balling people on PTSD and assigning them 10% and the boot out the door.
 

wyldth1ng

Registered Member
#18
We're talking about 2 different things. I'm aware of the low balling cases but the retracted cases was listed in a ALMAR, I don't remember the number. It was something I, at the time, was required to diseminate to all the Marines under my charge. That's why I remember it so well. Plus it was right before I flew out to Al Asad. But the message came out in 2006, so I have to assume the cases were leading up to that time. If I can find it I'll list it here.
I wasn't ware so many people "faked it" in 2006.

To what are you referring? Most of these changes you speak of were driven by the NDAA as a result of the Sabo case. It was the military low balling people on PTSD and assigning them 10% and the boot out the door.
 

eps17

PEB Forum Veteran
#19
Knowledge is power; but "faking" PTSD and such a classification by the DoD or VA is something I haven't ever read or seen to date. Lots of fraud cases though.
 

wyldth1ng

Registered Member
#20
Here is some information.
https://www.google.com/url?sa=t&source=web&rc
http://prhome.defense.gov/Portals/5...gg6MAI&usg=AFQjCNE0j6t4trj9rbpIOXXxv1rxBmoBJw
The Temporary Disability Retired List (TDRL):
An Assessment of its Continuing Utility and Future Role
--------------------
https://www.google.com/url?sa=t&sou...gglMAA&usg=AFQjCNGOw3sCg_idWL49ixTSsJ2J9WzZ4A
VA/DoD CLINICAL PRACTICE GUIDELINE FOR
MANAGEMENT OF POST-TRAUMATIC STRESS

I'm still looking for the original messages. This stuff solves some of the questions that was asked and in similar posts.