Source: http://vets.yuku.com/reply/234986/t/Permanent-Ratings.html
Timestamp: 2014-10-22 13:51:22
Document Index: 101562478

Matched Legal Cases: ['§\n3', '§ 4', '§ 4', '§4', '§3', '§ 4', '§ 3', '§ 1781', '§ 1781', '§ 4', '§ 3', '§ 3501', '§ 3', '§ 3', '§ 3', 'art 8', '§ 8', '§ 3', '§ 423', '§ 404', '§ 502', '§ 3', '§ 521', '§ 4', '§ 416', '§ 404', '§ 1502', '§ 1722']

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Apr 30 09 1:04 PM
Just read about P&T ratings. How would you know if a SC rating is permanent? Thanks All. Also any input from my previous post would be appreciated. Thanks
Apr 30 09 1:27 PM	legend in his own mind
lew2 wrote:
Just read about P&T ratings. How would you know if a SC rating is permanent? Thanks All. Also any input from my previous post would be appreciated.
Typically you would find a reference, often obscure, in your award letter that may or may not include the actual word "permanent", but
if a condition is determined as a total and permanent disability, your award letter should include a reference to Chapter 35 DEA benefits and(or) ChampVA
benefits being authorized. Permanence only has significant meaning within VA compensation when it is coupled with a total disability. 38 CFR §
3.340(b) "defines" it as "Permanence of total disability will be taken to exist when such impairment is reasonably certain to continue
throughout the life of the disabled person.".
Apr 30 09 1:37 PM	VBN recognizes, Cruiser, as a hero among us... Whenever a decision maker at VA grants a 100 percent evaluation or IU they are supposed to put a sentence in the Reasons and Bases part of the decision about
whether or not a future review examination is required.
In addition, they are supposed to put entitlement to Chapter 35 education benefits at issue in a totally separate issue in the Rating Decision and any future
review exams are also discussed here. The computer is even programed to prompt them to do this in the event they forget. Cruiser
Apr 30 09 1:44 PM	Thanks All, I don't see anything in my letters but appreciate the input
Apr 30 09 1:55 PM	VBN recognizes, Cruiser, as a hero among us... lew2 wrote:
Thanks All, I don't see anything in my letters but appreciate the input
We aren't talking about letters (plural), there should only be one. The award letter that initially assigned the 100 percent or IU is where
this would be. It wouldn't be repeated in subsequent letters.
Apr 30 09 2:26 PM	cruiser wrote:
We aren't talking about letters (plural), there should only be one. The award letter that initially assigned the 100 percent or IU is where this would
be. It wouldn't be repeated in subsequent letters.
What if you are not 100% or IU, im not. Its my understanding that a rating of 10% can be "permanent" based off if it is likely
to not get better over the lifetime of the veteran. Is this correct, thats what Im asking. Example: degenerative arthritis would be permanent condition
correct. I have my initial decision letter from 2002 and another from 2004 where I was increased. I was just wondering if there would be somewhere in
those decisions that would implicate permanent.
Apr 30 09 5:57 PM	My question was moved to IU forum.
bastards die for their country.- General George S. Patton Edited 2 times by 3ID tanker Apr 30 09 6:00 PM.
May 1 09 11:54 AM	legend in his own mind
What if you are not 100% or IU, im not. Its my understanding that a rating of 10% can be "permanent" based off if it is likely to not get better
over the lifetime of the veteran. Is this correct, thats what Im asking. Example: degenerative arthritis would be permanent condition correct. I have my
initial decision letter from 2002 and another from 2004 where I was increased. I was just wondering if there would be somewhere in those decisions that
would implicate permanent.
Not sure why it would even be mentioned in your award letter IF you do not ALSO have a combined total rating of 100% either schedular or TDIU. It has no real
benefit associated just with it alone. Although your condition at whatever rating level given may be "permanent", i.e. not expected to improve within your lifetime, that doesn't mean that you will never receive another examination for it - the VA
can examine you at anytime for any of your SC conditions. A "permanent" condition may be indicated in the VA database as "no further exams
scheduled", BUT that is the VA "feeling" at the time you receive the award for that
"permanent" condition (that phrase is probably placed in the database only for VA workload mitigation). The VA has the right by regulation and law
to do an ad hoc examination of you at anytime for any of your SC conditions. Think of it as a "permanent until decided
otherwise" type of designation.
IF the underlying question you are really asking is "How do I determine if the VA has no further exams scheduled for my condition?", then contact
your VSO to find that out. If you don't have a VSO, this is probably one of the questions that the 800 number (1-800-827-1000) can answer.
Edited 8 times by Rougetet May 1 09 12:39 PM.
P&T, IU
May 1 09 2:47 PM	Here are some regs that lay out the prerequisites for P&T and IU. It comes out of the 38 CFR. Hopes this helps. You basically have to be rated at a 70%
or higher to be considered for the P&T and IU. Hope this explains better.
(a) Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment
of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities: Provided That, if
there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at
least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. For the above
purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) Disabilities of one
or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology
or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4)
multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. It is provided further that the existence or degree of
nonservice-connected disabilities or previous unemployability status will be disregarded where the percentages referred to in this paragraph for the
service-connected disability or disabilities are met and in the judgment of the rating agency such service-connected disabilities render the veteran
unemployable. Marginal employment shall not be considered substantially gainful employment. For purposes of this section, marginal employment generally shall
be deemed to exist when a veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census,
as the poverty threshold for one person. Marginal employment may also be held to exist, on a facts found basis (includes but is not limited to employment in a
protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. Consideration shall be given
in all claims to the nature of the employment and the reason for termination.
§ 4.15 Total disability ratings.
The ability to overcome the handicap of disability varies widely among individuals. The rating, however, is based primarily upon the average impairment in
earning capacity, that is, upon the economic or industrial handicap which must be overcome and not from individual success in overcoming it. However, full
consideration must be given to unusual physical or mental effects in individual cases, to peculiar effects of occupational activities, to defects in physical
or mental endowment preventing the usual amount of success in overcoming the handicap of disability and to the effect of combinations of disability. Total
disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person
to follow a substantially gainful occupation; Provided, That permanent total disability shall be taken to exist when the impairment is reasonably
certain to continue throughout the life of the disabled person. The following will be considered to be permanent total disability: the permanent loss of the
use of both hands, or of both feet, or of one hand and one foot, or of the sight of both eyes, or becoming permanently helpless or permanently bedridden. Other
total disability ratings are scheduled in the various bodily systems of this schedule.
§ 4.17 Total disability ratings for pension based on unemployability and age of the individual.
All veterans who are basically eligible and who are unable to secure and follow a substantially gainful occupation by reason of disabilities which are
likely to be permanent shall be rated as permanently and totally disabled. For the purpose of pension, the permanence of the percentage requirements of §4.16
is a requisite. When the percentage requirements are met, and the disabilities involved are of a permanent nature, a rating of permanent and total disability
will be assigned if the veteran is found to be unable to secure and follow substantially gainful employment by reason of such disability. Prior employment or
unemployment status is immaterial if in the judgment of the rating board the veteran's disabilities render him or her unemployable. In making such
determinations, the following guidelines will be used:
(a) Marginal employment, for example, as a self-employed farmer or other person, while employed in his or her own business, or at odd jobs or while employed
at less than half the usual remuneration will not be considered incompatible with a determination of unemployability, if the restriction, as to securing or
retaining better employment, is due to disability.
(b) Claims of all veterans who fail to meet the percentage standards but who meet the basic entitlement criteria and are unemployable, will be referred by
the rating board to the Veterans Service Center Manager under §3.321(b)(2) of this chapter.
It can be confusing sometimes, if anymore questions, be sure to ask away. That's what the forum is for and there is a lot of knowledgable people
May 1 09 5:46 PM	legend in his own mind
Here are some regs that lay out the prerequisites for P&T and IU. It comes out of the 38 CFR. Hopes this helps. You basically have to be rated at a 70%
I would suggest that all veterans with a total and permanent disability designation (often referred to as P&T on this board) read critically and carefully those provisions in the 38 CFR § 4.15 - 4.17 sections Baghdaddy has provided in his post # 8. If you do, you will note that when you obtain that
P&T designation, these sections state very clearly that unemployability (i.e. inability to secure or follow a substantially gainful occupation) is one of
the prerequisites for that designation. This is also supported in other 38 CFR sections as well as CAVC decisions.
Does that mean if you have that designation of P&T (as abbreviated on this board) and you are currently working ("gainfully employed" as defined
by VA) that you can then expect the VA to cancel your (or your "eligible" kin) Chapter 35 DEA and ChampVA benefits if you receive them that such a
designation allows? Maybe. Does that mean that VA can come back sometime in the future and request recoupment of the overpayment you (or your
"eligible" kin) received for those Chapter 35 DEA and ChampVA benefits for the periods you were working ("gainfully employed" as defined by
the VA) while having that P&T designation and received those benefits? Maybe.
Although VA seems to have been showing by their actions that they have not followed or enforced this "P&T" unemployability requirement, that
certainly isn't worth squat if they do decide to start enforcing it in the future, perhaps in a misguided effort to save taxpayer money now that all
government budgets are under scrutiny.
Although many members on this board has been reluctant to admit that such actions are available to the VA, this appears to be due to the misunderstanding of
the definitions as used by reg and law of a total rating versus a total disability - they are not exactly the same in 38 CFR and the law. A "total
rating" has to do with having a 100% rating either through a single rating of 100% for a disability, or a combined total rating of 100% for the
combination of all your disabilities. It determines that YOU will be paid at the 100% compensation rate directly by the VA. It is
determined by your actual SC disabilities. A "total disability" (as shown by the reg excerpts Baghdaddy posted et al.) is when your combination of
disabilities PREVENTS YOU from pursuing a substantially gainful occupation. In certain cases, such as NSC Pension, you can actually have less than a 100%
SC rating and still be determined to have "total disability" (see 38 CFR § 3.3(a)(2)(iv)). Your "P&T" benefit that allows your eligible kin to receive Chapter 35 DEA benefits require a "total disability permanent in nature" as
defined in Title 38 USC Chapter 35 subsection 3501(a)(1)(A)(ii). Although subsection 3501(a)(8 ) may provide some tenuous ambiguity for a case to be made that
unemployability is not a factor by not explicitly mentioning unemployability like it does in 38 CFR, since it does refer back to provisions only applicable in
38 CFR, AND since regulations are designed to be implementing guidelines for the law as supported by the CAVC, the 38 CFR "definitions"/terms must
control and they do clearly support that a "total disability" requires unemployment. Of course, anyone is welcome to take a case to the CAVC or
other qualifying/appropriate jurisdictions based upon that Chapter 35 tenuous ambiguity should they ever have the VA attempt to stop or recoup Chapter 35 DEA
benefits based upon the veteran working while under a "P&T" designation.
Your "P&T" benefit that allows your eligible kin to receive ChampVA benefits are covered by Title 38 USC § 1781. Subsection (a)(1) indicates the
eligibility requirement to be "total disability, permanent in nature, resulting from a service-connected disability" and since there is no other
provisions in § 1781 that provide any ambiguity to that requirement, again the 38 CFR more defining terms must control which require unemployability. It would
probably require a massive amount of effort for the VA to attempt to recoup any payments for services under ChampVA ("payments" individually variable
based upon services performed) so I would think that the outcome in any budget reduction or VA procedure change would simply be to stop current kin eligibility
if you were working while carrying the "P&T" designation.
If this applies to you and worries you, I suggest that you obtain the services of an attorney cognizant of government law to validate what I have indicated
above. After that you can make a decision on whether to continue your benefits OR instead continue working (if you are risk averse) if this attorney does
validate what I have said. Of course if this applies to you, you can elect to ignore this post and do nothing. If you do that I would suggest you at least
solicit an opinion on the best course of action from someone who has been in a somewhat similar situation of dealing with the government such as been required
to pay back taxes, penalties and interest on their SSDI payments because they didn't bother to do the due diligence to determine whether their SSDI
payments were taxable.
Just trying to make the VBN reader aware of potential pitfalls should they work while carrying a "P&T" designation.
If you disagree with what is outlined here and do decide to place that disagreement in a reply, please be kind and provide links to the regulations and/or laws
that you believe refute what I have said in order to provide a "fair" reply. I find it hard to respond in a thoughtful or logical manner to
"Hogwash" or like terms if they are not supported by facts and logic.
May 2 09 12:14 AM	VBN recognizes, Cruiser, as a hero among us... Rougetet wrote:
I would suggest that all veterans with a total and permanent disability designation (often referred to as P&T on this board) read critically and
carefully those provisions in the 38 CFR § 4.15 - 4.17 sections Baghdaddy has provided in his post # 8. If you do, you will note that when you obtain that
P&T designation, these sections state very clearly that unemployability (i.e. inability to secure or follow a substantially gainful occupation) is one
of the prerequisites for that designation. This is also supported in other 38 CFR sections as well as CAVC decisions.
Only if the P&T is based on Individual Unemployability. Please stop misleading folks on this matter. Please understand that I realize that
you are trying to help and your intentions are good, but it is clear that you are confused about "permanent and total" disability and employability. If you have a 100 percent schedular evaluation (ie. not based on IU) there is no prohibition against working. Many people who are 100 percent and P&T
work at VA. One of my best friends at VA, a Rating Specialist, has been 100 percent P&T for almost 40 years now from wounds he received in Vietnam that
includes the loss of one leg above the knee. For the record, he does not have PTSD.
Having said that, one should not have a 100 percent evaluation for a mental disorder if he/she is capable of working because a total vocational impairment is a
requirement for a 100 percent evaluation for a mental disorder, but not for any other disability.
May 3 09 5:57 AM	legend in his own mind
I still contend that having a "P&T" designation (as that term is used on this board) requires unemployability (as defined by the VA). I guess
that is only "misleading" if it is not true. So far the only arguments advanced to refute my contention have been that there are people working at
the VA who are 100% schedular and have a "P&T" designation. My response to that is "So?" Where are the regulations and laws that
support that? If I happen to be caught breaking the law by performing a "rolling 'California' stop" at a stop sign, the judge in my case
will certainly not accept my assertion "Well, everyone else is doing it." We have a case here if it ever comes to appeal or trial for a
"P&T" veteran seeking to keep benefits or avoid recoupment as I outlined in my previous post of "Do as I say, not as I
do". The "say" is what is defined by regulation and law, the "do" is what the VA just happens to have allowed and not enforced
in the past - that doesn't mean they can't "crack down" in the future. My contention hinges on that there is a difference in VA definition
of "total rating" vs. "total disability. One pertains to compensation, the other pertains to employment requirements.
Since I evidently have not provided enough documentation yet to "prove" my contention, consider this:
BVA CASES:
BVA citation # 0904608 (http://www.va.gov/vetapp09/files1/0904608.txt Summary: Veteran currently had at time of decision 100% PTSD schedular rating attempting to also get "P&T" through the BVA:
Excerpt: "Total disability is considered to exist when there is any
impairment which is sufficient to render it impossible for
the average person to follow a substantially gainful
occupation. 38 C.F.R. § 3.340(a)(1)."
BVA citation # 0740068 (http://www.va.gov/vetapp07/files5/0740068.txt
Summary: Veteran currently had at time of decision 100% schedular rating for adenocarcinoma of the prostate, status post radiation therapy that was
"total, permanent, and static in nature" Excerpt: "Total disability is considered to exist when there is any
BVA citation # 0300974 (http://www.va.gov/vetapp03/files/0300974.txt) Summary: Veteran had at time of decision 100% PTSD schedular rating
Excerpt: "Legal Criteria. The term "total disability permanent in
nature" means any disability rated total for the purposes
of disability compensation which is based upon an
impairment reasonably certain to continue throughout the
life of the disabled person. 38 U.S.C.A. § 3501(a)(8 ). Permanent and total disability will be held to exist when
an individual is unemployable as a result of disabilities
that are reasonably certain to last throughout the
remainder of that person's life. See Talley v. Derwinski,
2 Vet. App. 282, 285 (1992); 38 C.F.R. §§ 3.340(b), 4.15.
Total disability exists when there is present any
impairment of mind or body which is sufficient to render
substantially gainful occupation. 38 C.F.R. § 3.340(a)"
BVA citation # 9917095 (http://www.va.gov/vetapp99/files2/9917095.txt)
Summary: Veteran was seeking a 100% schedular rating for myocarditis. The remand had the following excerpt:
Excerpt: "38 C.F.R. § 3.340 (1998) provides that total disability will
be considered to exist when there is present any impairment
of mind or body which is sufficient to render it impossible
for the average person to follow a substantially gainful
BVA citation # 9718109 (http://www.va.gov/vetapp97/files2/9718109.txt)
Summary: Veteran attempting to obtain waiver of NSLI premiums based upon total and permanent disability
Excerpt: "The definition of "total disability," other than that for
speech, was removed from 38 C.F.R. § Part 8 effective June
10, 1996. 61 Fed. Reg. 29290. See 38 C.F.R. § 8.21, as
amended. Generally, however, total disability has been
defined for VA adjudication purposes, and is considered to
exist when there is present any impairment of mind or body
which is sufficient to render it impossible for the average
person to follow a substantially gainful occupation. 38 C.F.R. § 3.340(a)(1)."
Examples of VA "total disability" for a non-TDIU reason defined within the law:
1) Talley v. Derwinski, CAVC case # 90-419, April 6, 1992:
"…Pursuant to a provision of Public Law 101-508, applicable to
claims filed after October 31, 1990, the preambulatory clause was
chapter, a person shall be considered to be permanently and totally disabled if such person is unemployable as a result of disability reasonably certain to
continue throughout the life of the disabled person …".
Although this CAVC case was put forth to resolve an NSC pension issue, there are many other parts of this case that relate this "total disability"
definition used to all the other non-NSC pension 38 CFR parts where "total disability" is discussed - also note that a reference to this case was
cited in one of my BVA examples above that relates this case to a 100% schedular evaluation.
2) Collier v. Derwinski, CAVC case # 90-839, August 9, 1991:
"…With respect to what bearing the A.L.J.'s decision rendered under the Social Security Act is to have on the
VA's determination of total and permanent disability, the Court notes that while there are significant differences in the definition of disability under
the Social Security and VA systems (e.g., under Social Security, 42 U.S.C. § 423(d) (1988) and 20 C.F.R § 404.1509 (1990), the disability need not be reasonably likely to last for the
claimant's lifetime as is required for VA purposes under 38 U.S.C. § 502(a)(1) and 38 C.F.R. § 3.340(b)), there are also significant similarities (e.g.,
both statutes include within their respective definitions, the terms "substantial[ly]" and "gainful" when describing the form of employment
in which the claimant is unable to engage). Compare generally 38 U.S.C. §§ 521, 502 [and] 38 C.F.R. §§ 4.17,
3.321(b)(2), 3.340, 3.342 with 42 U.S.C. §§ 416, 423 (1988 & Supp. I 1989) [and] 20 C.F.R. §§ 404.1505-1576 (1990). …" This CAVC case by the excerpt above indicates that VA's "total and permanent disability" requires unemployment, i.e. "…both statutes include within their respective definitions, the terms "substantial[ly]" and "gainful" when
describing the form of employment in which the claimant is unable to engage…". It, at the least, indicates
that such definition applies in whatever situation the term "total disability" is used by VA since it does include the 38 CFR references for both
3) Title 38 U.S.C. § 1502 (formerly 38 USC 502) titled 'Determinations with respect to disability' (http://vlex.com/vid/determinations-with-respect-disability-19234801) states in part (1502 falls under Chapter 15 which generally refers to
pensions): "…(a) For the purposes of this chapter, a person shall be considered to be permanently and totally disabled if
such person is any of the following: (1) A patient in a nursing home for long-term care because of disability. (2) Disabled, as determined by the Commissioner
of Social Security for purposes of any benefits administered by the Commissioner. (3) Unemployable as a result of disability reasonably certain to continue
throughout the life of the person. (4) Suffering from - (A) any disability which is sufficient to render it impossible for the average person to follow a
substantially gainful occupation, but only if it is reasonably certain that such disability will continue throughout the life of the person; or (B) any disease
or disorder determined by the Secretary to be of such a nature or extent as to justify a determination that persons suffering therefrom are permanently and
totally disabled. …" In the case of (1), being in a VA nursing home by its eligibility requirements requires a low income but can be slightly above the poverty threshold (see
38 USC § 1722). In the case of (2) both SSI and SSDI require unemployability (inability to do any substantial gainful activity). In the case of (4)(B) first consider that (4)(A) implicitly discusses the context of "disability" associated with NSC
while (4)(B) implicitly discusses the context of "disease or disorder" associated with SC AND secondly in order for (4)(B) to even be considered as
an argument that "permanent and total disability" or "P&T" as it is referred to on this board does not require unemployability as
defined by the VA, THEN such argument would have to show where the Secretary has determined that unemployability is not a requirement in SC cases. The 38 CFR regulations, BVA/CAVC decisions and the law do not support that argument EXCEPT in some very limited and income-defined
cases where the "P&T" veteran is in a VA nursing home. Although a tenuous argument (tenuous because in
order to pass the "totally disabled gate" to get "P&T", you already had to be unemployable as required by 38 CFR and the law - so a
"Catch 22") could probably be made that a non-VA nursing home veteran with a "P&T" designation may be able to work without restriction,
that certainly doesn't help all the other "P&T" designated veterans who do not reside in such a non-VA nursing home. Those non-nursing home veterans with a "P&T" designation are still required to be unemployable (VA definition) by 38
CFR, BVA, CAVC and the law.
CAVC decisions can be reviewed here: http://www.vetapp.uscourts.gov/ So I will continue to put forth my contention as necessary that "P&T" requires unemployability (as defined by the VA) UNLESS AND UNTIL someone
can show me in regulation and/or law where that contention is not correct. If that is done, I will be more than happy to "eat crow" on my contention
because I certainly don't like the fact that "P&T" requires unemployability. I searched very hard to try to refute that contention before I
gave it but was not able to do so by law or regulation found.
Again, we should probably just agree to disagree if you are not yet convinced.
May 3 09 8:02 AM	VBN recognizes, MiltStar, as a hero among us... Rougetet wrote:
You sir may argue until the cows come home, but the fact, plain and simple is a person who is 100% perminant and total schedular can work all
he/she wants, unless he/she is 100% for a mental condition (and I am sure there are even rare exceptions to this, if that persons work for wich he/she is being
paid to do is medically determined to be therapy for his/hers SC mental condition). I do not present this as an argument, but a simple fact I know and enjoy.
May 3 09 8:27 AM	Question asked and answered.
Rouge, you stand corrected whether you want to believe it or not. You are misreading things badly.
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