PTSD Claim Re-Assessment Question

[brokendude]

Well over year ago(May 2015), I submitted a claim for PTSD to VAC.  After quite some time(Dec 2015), & alot of bs and delays, I received a favorable decision at 5/5'ths for the claim.  I was mailed a decision letter that did not contain much of anything other than to say that I was granted a minimum initial assessment of 10% & would be re-assessed by VAC in 6 months.  That is pretty much all the information I received.  Fast forward to last week.  I received a phone call from VAC and told I would receive a letter in the mail shortly with a quality of life form to fill out.  The VAC representative told me that they are currently requesting and gathering all of my mental health files from my base and medical file to use in the reassessment and once I complete the QOL form to mail it to them so they can send it to head office and complete my reassessment.  What is the reassessment? What more are they doing? How valuable is the quality of life form in the bigger picture of the reassessment?  I have struggled immensely in the past 6 months to year since submitting the initial claim.  I do not understand the process of the claim reassessment.  Can anyone tell me....should I expect my percentage to increase from the "initial minimum assessment" of 10% they gave me on this PTSD claim?  Relatively speaking, do the percentages typically increase after a reassessment or stay the same as the initial minimum assessment?  VAC has been very cloudy and uninformative to me through this entire process, even after contacting the VA ombudsman's office.  Any information is and would be helpful amd appreciated.  Thank you in advance. 

 

[Fishbone Jones]

The initial award of 10% was to acknowledge your condition and get you treatment under a rehab program. This next one is just seeing what effect that treatment has had and how much more you'll receive as an award. It's SOP.

Awards can't be taken back.

It'll go two ways. You'll either be assessed at a higher percentage and receive a top up award, or they feel they've got it covered at 10% and nothing further will be forthcoming.

Either way, you won't lose anything.

 

[Staff Weenie]

If I can give you one piece of advice, it is to be as brutally honest in the Quality of Life assessment as possible. Detail every aspect of your life that has been impacted. If you have a spouse/partner, get them to give you feedback on changes they've noticed as well (we're not always aware of some of them, or we think it's not a big deal). Your spouse could say you're always very socially withdrawn, when you think you just need solitude. VAC will take this information in conjunction with the file from your clinicians, to come to a final assessment.

Many service personnel are embarrassed or unwilling, or even unable to address all of the impacts their OSI/PTSD has had on so many parts of their quality of life. Can't go to a kid's soccer game? Can't go shopping? Can't sleep? Can't have sex anymore? Put it all in there - they need to have this information to guide their decision.

And, don't be surprised if it takes VAC longer than six months to make their assessment. They need to see that you are clinically stable to properly assess the impact on your life. Getting to a point where your clinical team thinks you are clinically stable can take longer than six months.

As I don't know you, and have no legal right to your clinical info, I couldn't tell you if your assessment will increase. Recceguy is correct though - it will not decrease.

Good luck, and I hope all goes well for you in your recovery.

 

[Rifleman62]

Plus, do not confine your comments to the form. Take the time to consider everything as Staff Weenie stated, then add as many pages as you need to get your info on record with VAC. If it takes six pages, do it. It may take several days to do, but take the time. If you can refer to written specific medical professionals reports wrt your condition/disability and how that relates to QOL, do so.

Grocery shopping could be a simple example. If you are wary of large groups/crowds then you can't grocery shop, an everyday requirement.

My understanding is the QOL questionnaire is only a very small part of the assessment/decision on what you get, but is still vital. Someone from VAC here can tell us the exact %.

 

[brokendude]

Thanks for the input.  I will have the QOL form completed and submitted to VAC by 26 May 2016.  After that, I wait and see what happens.  Does the percentage calculated usually increase or stay the same ad the initial minimum number?

 

[blackberet17]

The initial 10% is just that. An initial assessment while you continue with treatment/rehab, etc. The entitlement (1/5th, 2/5ths, up to 5/5ths) is what opens the door to treatment.

The compare the initial 10% for your PTSD to an initial assessment for a physical wound. The physical wound required surgery, rehab, physio, etc. The initial assessment is "temporary" (without using the word "temporary" anymore) until such time as your mental/physical wound "stabilizes", IOT get a current "up-to-date" picture of your current limitations due to your medical condition.

What VAC will do is take all of the reports from your psychologists/psychiatrists/treating physicians and look at the medical date. From there, they will take YOUR input from the Quality of Life Questionnaire, and assess all of it to have a global picture of how your PTSD is affection you.

The medical reports help assess your condition against the four tables in Chapter 21 of the 2006 Edition of the Table of Disabilities.

The QoL Questionnaire helps then take everything from Chapter 21 and compare it all to the two tables in Chapter 2, to arrive at a percentage. It is rare to see someone with an initial 10% for PTSD stay at the 10% for PTSD. Typically, the individual with PTSD will see a higher percentage. I don't want to elevate hopes, but it is what I have seen.

As everyone above has statement, be honest. Provide all the details of how your PTSD is affection your QoL, and that of your family and friends. Nothing to lose and everything to gain (as terrible as it may sound) by telling it like it is.

The tables can be found here: http://www.veterans.gc.ca/eng/services/after-injury/disability-benefits/benefits-determined/table-of-disabilities

 

[brokendude]

Well...I completed and submitted my QOL questionnaire last week.  I took the advice of many people, and included an additional 3 "typed" full pages of additional comments and a synopsis of my life.  The VAC paramedical assistant looked somewhat displeased or surprised that I handed it in to her with 3 + pages of comments and remarks.  I wonder now, how long this reassessment will take to complete and give me an answer or final assessment and percentage?  I'm sick of dealing with VAC, and just want this to be over.  Spending 2 weeks picking my brain and writing out how my life has changed and been affected by my incident in a negative way has been hard for me, and challenging to remain in the moment, as well as cope with the memories of what happened while bringing it back up to myself.  Hopefully VAC comes to a decision on my claim sooner than later.

 

[blackberet17]

I hate to be the bearer of bad news, but...if VAC has all of the information they need, you "should" receive a decision in 16 weeks - that is the advertised turnaround time for a decision.

Psychological assessments do take longer, they are rather complicated and intricate. Just look at how it is assessed according to the four tables (two of which have two and three columns to further assess the condition). Just...put an 'X' on the date roughly 16 weeks from now, and put it out of your mind for a while.

 

[brokendude]

So after submitting my QOL questionnaire and supporting "statement" (additional 3 pages of how my life has been affected in a deteriorating manner), this morning I checked MY VAC ACCOUNT.  My re-assessment on this PTSD claim has moved from step 2 to step 3, & says they have received all supporting documentation regarding the re-assessment dated 12/May/2016.  That was the day I submitted the QOL questionnaire & statement.  It goes on to also say that I should expect a decision 16 weeks from that date of 12/May/2016.  Is this somewhat quick or on par with the "normal" turnaround on re-assessments? (To go from step1 on 26/April/2016 to step 3 on 30/May/2016).  How much of the information I answered in the QOL questionnaire and my additional comments/3 page statement is considered and utilized in determining the final decision and percentage?  I think I stated it earlier, but was originally assessed the initial PTSD "standard" of 10%.  Additionally, this is regarding an incident that occurred back in 2010, and after years of on again/off again treatment and therapies, I eventually landed on my feet with a very good and understanding psycologist.  I have not been able to jump into trauma therapy yet with the psycologist due to other life issues, so how DO or WILL VAC make a final decision if Im still undergoing therapy?  I have been seeing the psycologist every other week for over a year and half now.  Hoping to push myself safely towards understanding my life better.  But I would not say I am stable at this point.  If VAC uses  (and I assumer they will and should) my psycologist's reports, they will likely know this too.  Does that change their final decision by them saying I am again still not stable and unable to proceed with the decision & figure?  So many questions and very difficult to navigate a department that has no standard really.  Thank you to those of you whom have replied previously also.

 

[blackberet17]

Continued professional care is expected with a number of medical conditions, including (and especially) psychological conditions.

This need for continued care is also taken into consideration in the assessment of your PTSD. For reference, have a look at Table 21.4, which is fully titled as "Table 21.4 - Other Impairment - Treatment Needs". (http://www.veterans.gc.ca/eng/services/after-injury/disability-benefits/benefits-determined/table-of-disabilities/ch-21-2006#t04)

As you can see, the criteria include the need for ongoing therapy, whether it be "infrequent" (rating of 5), monthly (rating of 7), "intensive" (rating of 10), etc.

Without knowing exactly what you wrote in the additional statement, and connecting it to the rest of your file, none of us can say how much of it will be considered/used in arriving at a decision. The information you provided will be used to assess the impacts on your quality of life, as indicated in Table 2.1 (http://www.veterans.gc.ca/eng/services/after-injury/disability-benefits/benefits-determined/table-of-disabilities/ch-02-2006#t01), the Quality of Life Level Determination Table. You can see for yourself at the link the criteria used to determine a Level 1, 2, or 3 for QoL.

I learned a few weeks ago there are "teams" of adjudicators who work on certain medical conditions, i.e.: a team for hearing loss and tinnitus; a team for back conditions; etc. I don't know for certain about psychological conditions, but it is possible there is such a team, and you're in luck turnaround which seems faster than usual...although the 16-wk is the standard, so who knows.

Understand, too, the huge importance placed throughout government on mental health and wellness, so maybe psychological claims are treated as a priority. I couldn't say for sure, though.

 

[brokendude]

Thank you.  So then, initially, what then would have been utilized for the 10%?  If that initial  10% was simply a minimum assessment? How do they calculate and come up with that 10% and based on what?  There is zero explanation, & from whatI read of others, no explanation to their initial minimum assesent of 10% either.  Doesn't make sense to me at all.

 

[blackberet17]

The initial or interim 10% is based on the clinical picture of your medical condition at the time of your application and, as always, is based on all of the information you and your health care providers submitted with your original application.

Note the 10% is an INTERIM assessment - this is usually clearly stated in the letter you would/should have received saying you were granted an award for your medical condition. It is a "temporary" assessment while VAC waits for your condition to stabilize to a point where you can be further assessed and be given a "permanent" assessment (while keeping the door open for future, higher assessments, of course). The interim 10% basically allows you to receive a quick award of XX amount of dollars, while ensuring your treatment costs are covered, and while you continue to receive the help you need IOT reach a stable point, which is typically expected by six months.

After the six months, the condition is reassessed, using again all of the information in your file, plus current/up-to-date information you and your health professionals are providing (i.e., your new QoL questionnaire, any new reports, etc.). Following the review, a "permanent" assessment is awarded...which 99.9% of the time is higher than the original INTERIM 10%.

While it may appear to someone as though there is no reason or basis for the 10%, it's always based on some piece of medical documentation in your file (listed in bullet points in the decision letter, i.e. Dr. Smith's report dated 30 February 2103), which is cross-referenced against the applicable criteria and tables in the Table of Disabilities.

 

[brokendude]

So a question I have now is....my reassessment claim is now currently sitting at step 3.  Waiting on a decision.  Does VAC ever NOT make a final decision on reassessments?  Do they ever make reassessment decisions and say that they cannot make a percentage decision becausr they (VAC) still dont see your condition as stable and make you wait longer and again for another reassessment down the road to complete the claim?

 

[Fishbone Jones]

Dude,

You have to relax.:chill: You're dealing with VAC :deadhorse: A decision is forthcoming. You'll either like and accept it or disagree and appeal it. As previously stated, more than once, nobody can even begin to guess what is going to happen with your file. Quit panicking anic: and wait for the results, like everyone else does.

 

[brokendude]

I'm not panicking whatsoever.  I'm simply looking for replies of people who MAY have been in a similar situation as this one.  I asked a question to which you did not answer.  And that's fine.  But if you have nothing positive or an actual answer, to please kindly keep it to yourself.  I am interested to know if a reassessment decision has ever been deferred due to instability of a claimed condition even though it is still a REASSESSMENT 1 year from the initial claim and decision.   

 

[brokendude]

It's difficult enough to get answers and communication from VAC, so alot of people come here looking for individuals that can offer help, experience in similar situations and a general feel that VAC does not give.  We don't come here to essentially be told to shut up about things.  If someone else has been in the same spot as me, I would love to hear their reply and situation.  Thanks for coming out, but your services are not required here. 

 

[brokendude]

And lastly to RecceGuy....I'm not 10, please don't feel that you need to sicken me with your child's emojis during your little rant.  Try adulting and speaking with the English language when communicating with me.  I'm more than happy to discuss things, but when insulting my intelligence, you are actually only insulting your own.  Cheers

 

[blackberet17]

So a question I have now is....my reassessment claim is now currently sitting at step 3.  Waiting on a decision.  Does VAC ever NOT make a final decision on reassessments?  Do they ever make reassessment decisions and say that they cannot make a percentage decision becausr they (VAC) still dont see your condition as stable and make you wait longer and again for another reassessment down the road to complete the claim?

No, they do not NOT make a "final decision" on reassessments. As noted by recceguy, you will receive a decision in due course. Positive or negative, you will receive a decision.

Should it be a negative decision, you will be informed of your rights to appeal the decision. Let's not cross that bridge until we get to it.

 

[Fishbone Jones]

I'm not panicking whatsoever.  I'm simply looking for replies of people who MAY have been in a similar situation as this one.  I asked a question to which you did not answer.  And that's fine.  But if you have nothing positive or an actual answer, to please kindly keep it to yourself.  I am interested to know if a reassessment decision has ever been deferred due to instability of a claimed condition even though it is still a REASSESSMENT 1 year from the initial claim and decision. 

It's difficult enough to get answers and communication from VAC, so alot of people come here looking for individuals that can offer help, experience in similar situations and a general feel that VAC does not give.  We don't come here to essentially be told to shut up about things.  If someone else has been in the same spot as me, I would love to hear their reply and situation.  Thanks for coming out, but your services are not required here. 

And lastly to RecceGuy....I'm not 10, please don't feel that you need to sicken me with your child's emojis during your little rant.  Try adulting and speaking with the English language when communicating with me.  I'm more than happy to discuss things, but when insulting my intelligence, you are actually only insulting your own.  Cheers

I was attempting to keep the post light with the emoticons. Sorry. As for my answer, see:

No, they do not NOT make a "final decision" on reassessments. As noted by recceguy, you will receive a decision in due course. Positive or negative, you will receive a decision.

Should it be a negative decision, you will be informed of your rights to appeal the decision. Let's not cross that bridge until we get to it.

Gee, same answer. Guess I wasn't being childish or condescending after all. Nor was I insulting your (or mine) intelligence. Fortunately, I was born many decades ago and know that not everything involves instant gratification, or happens I WANT IT RIGHT NOW!! I know how to be patient.

For future reference, I know exactly what you are going through. You're not alone in your dealings with VAC. I've had better than 15 years dealing with them for various problems, including the same as yours. I am not a neophyte, but it's your choice whether to accept my 'frank' response or not. Each case is unique

You'll have to depend on others from here on in. However, that's my decision, not yours. You don't get to decide who responds to your posts...... or how they do it.

Enough time responding to you, I have to go cash a cheque I got from VAC today.

Hope things work out the best for you.

 

[the 48th regulator]

I was attempting to keep the post light with the emoticons. Sorry. As for my answer, see:

Gee, same answer. Guess I wasn't being childish or condescending after all. Nor was I insulting your (or mine) intelligence. Fortunately, I was born many decades ago and know that not everything involves instant gratification, or happens I WANT IT RIGHT NOW!! I know how to be patient.

For future reference, I know exactly what you are going through. You're not alone in your dealings with VAC. I've had better than 15 years dealing with them for various problems, including the same as yours. I am not a neophyte, but it's your choice whether to accept my 'frank' response or not. Each case is unique

You'll have to depend on others from here on in. However, that's my decision, not yours. You don't get to decide who responds to your posts...... or how they do it.

Enough time responding to you, I have to go cash a cheque I got from VAC today.

Hope things work out the best for you.

Brokendue,

Recceguy gave you two posts, of the best advice anyone can give you.

Trust me, I leanred to be patient with VAC, and I am one of the most anxious guys that you can meet.

Tess