100 Disabled Vet Forgot to Go Ta a Scheduled Appt for Evaluation to Continue Benefits

To be 100 percent disabled by VA standards means that you are totally disabled.  Veterans awarded disability at this level receive the maximum in schedular monthly compensation.  VA has stringent criteria veterans must meet in order to receive this rating.  Continue reading to learn more about what the 100 percent rating means and what rights veterans with a 100 percent rating have.

What Are VA Disability Ratings?

A VA disability rating is a percentage assigned to a service-connected disability based on the severity of the condition.  Disability ratings are meant to compensate veterans for the average impairment in earning capacity caused by their service-connected condition(s).

VA uses the VA Schedule for Rating Disabilities (VASRD) to assign diagnostic codes and disability ratings for service-connected condition(s).  Each rating criteria describe symptoms and/or treatment for a specific condition.  VA can issue ratings ranging from 0 to 100 percent.  Generally, the more severe a disability is, the higher the disability rating will be.

A 0 percent rating offers no monthly monetary compensation, but it may make some veterans eligible for ancillary benefits, such as health care.  A 100 percent rating provides the maximum schedular benefit in monthly compensation. For ratings between 0 and 100 percent, the monthly benefit increases incrementally with each higher rating.

As of December 1st, 2021 the VA disability rate benefit amounts are as follows:

• 0 percent disability rating: $0.00 per month
• 10 percent disability rating: $152.64 per month
• 20 percent disability rating: $301.74 per month
• 30 percent disability rating: $467.39 per month
• 40 percent disability rating: $673.28 per month
• 50 percent disability rating: $958.44 per month
• 60 percent disability rating: $1,214.03 per month
• 70 percent disability rating: $1,529.95 per month
• 80 percent disability rating: $1,778.43 per month
• 90 percent disability rating: $1,998.52 per month
• 100 percent disability rating: $3,332.06 per month

Who Assigns VA Disability Ratings?

Typically, VA disability ratings are assigned by Rating Officers, such as Decision Review or Higher-Level Review Officers, at the Regional Office level, or by the Board of Veterans' Appeals.  The type of rating official issuing a disability evaluation depends on the level at which your case resides (i.e., the Regional Office or the Board).  To rate each service-connected condition, adjudicators use the VA Schedule for Rating Disabilities (VASRD).  Under that schedule, each disability is assigned to a specific diagnostic code and rated in increments of 10 percent.

Disabilities Without Diagnostic Codes

There are countless conditions from which a veteran might suffer and not all of them are included in the VASRD.  If you are service connected for a condition that is not listed in the rating schedule, VA will rate it by analogy.  That is, VA will look for a condition that produces similar symptoms and levels of impairment and assign a disability rating based on the criteria for that condition.

Symptoms Not Accounted for in the Rating Schedule

If you have symptoms that are not necessarily contemplated by the rating schedule, it means that the condition is causing problems that VA does not recognize as typically being part of the disability.  However, that does not mean that you are not entitled to a separate rating for those symptoms.  In that case, you might look for a separate rating under a different diagnostic code.

What Are 100% Ratings and How Can I Qualify?

A 100 percent disability rating, or total disability rating, is the highest percentage that can be given for service-connected compensation purposes.  This rating is reserved for veterans with extremely debilitating service-connected conditions that typically make them unable to work and mostly unable to care for themselves. As mentioned above, 100 percent ratings also provide the highest amount of disability compensation. Some veterans can get additional compensation if their disabilities are especially severe.

Types of 100% VA Disability Ratings

100 Percent Schedular VA Ratings

There are two ways in which you can receive a schedular 100 percent disability rating:

1. You have a 100 percent rating based on one disability alone; OR
2. You receive a combined disability rating of 100 percent, meaning the combination of all of your disability ratings for each service-connected condition is 100 percent.

However, it is important to note that disability ratings are not added together in the traditional way.  Instead, VA uses its own form of math when combining disability ratings.  To avoid doing VA math by hand, use the VA math calculator found on ourwebsite.

Importantly, VA does round up.  Therefore, if the VA math calculator produces an outcome of 75 percent, it means you are likely entitled to an 80 percent combined disability rating.  On the other hand, if the VA math calculator produces an outcome of 73 percent, then you are only entitled to a 70 percent combined disability rating.

VA Individual Unemployability (TDIU)

Total disability based on individual unemployment, or TDIU, is a benefit that allows veterans to be compensated at the 100 percent level, even if their combined rating does not equal a schedular 100 percent.

TDIU is awarded when veterans are unable to secure and follow substantially gainful employment as a result of their service-connected conditions.

Permanent & Total VA Ratings

Total disability is synonymous with a 100 percent rating.  Permanent disability means the severity of the disability is expected to continue for the remainder of the veteran's life, with no improvement.  Permanent & Total ratings cannot be reduced.

Temporary Total VA Ratings

Veterans who are rendered temporarily incapacitated due to a service-connected condition may be entitled to receive a temporary 100 percent disability rating.

VA Ratings for Cancer

Veterans service-connected for active cancer should automatically receive a 100 percent disability rating.  This rating continues for as long as your cancer is active, and then for another six months following the successful completion of a treatment program, such as chemotherapy, radiation, or surgery.  VA will then reevaluate based on residuals.

Are 100% VA Ratings Permanent?

VA disability ratings at 100 percent are not automatically permanent; however, they can be granted permanent status in certain situations.

For example, if a 100 percent rating is in place for 20 years or more, VA is not going to reduce that rating unless there is evidence of fraud in the initial rating assignment.

If it is less than 20 years, VA can pursue a rating reduction, but there needs to be both material improvement and improvement under ordinary conditions.  Importantly, VA cannot rely on a simple examination showing improvement when issuing a rating reduction.

Having a rating for 20 years does not mean it automatically becomes permanent; but, if VA determines your rating cannot be subject to reduction after 20 years, your 100 percent rating will remain the same (i.e., become permanent).

Are There Other Benefits Available for Veterans with 100% Ratings?

Yes, there are a variety of benefits available to veterans rated at 100 percent, aside from disability compensation.  These may include:

Priority Group 1 for Healthcare

When veterans apply for VA health care, VA will assign you to 1 of 8 priority groups based on:

• Your military service history;
• Your VA disability rating;
• Your income level;
• Whether you qualify for Medicaid; and
• Other benefits you may be receiving (e.g., VA pension benefits)

Veterans with a 100 percent VA disability rating meet the eligibility requirements for Health Care Priority Group 1, the highest priority.  This group includes benefits such as:

• Dental care (e.g., regular cleanings, restorative care such as fillings and crowns, x-rays, etc.)
• Hospitalizations, some inpatient services, and preventative care
• Medical or automotive adaptive equipment
• Medically related travel benefits
• Dependent health care
• Vision care and hearing aids

CHAMPVA

The Civilian Health and Medical Programs of the Department of Veterans Affairs (CHAMPVA) is a health care program in which VA shares the cost of certain covered healthcare services that exist for the spouses and children of disabled veterans with 100 percent disability ratings.

Dependents Education Assistance Program

The Survivors' and Dependents' Educational Assistance (DEA) program offers education and training opportunities to eligible dependents of veterans who are permanently and totally (i.e., 100 percent) disabled due to a service-connected condition, currently receiving TDIU benefits, or who died while on active duty, or as a result of a service-connected condition.

DEA benefits may be used for degree and certificate programs, apprenticeship, and on-the-job training.

Commissary and Exchange Benefits for 100 Percent Disabled Veterans

Veterans with a 100 percent rating can present their Veteran Health Identification Card to gain entry to Department of Defense (DoD) and Coast Guard installations, some commissary stores/commissaries, exchanges, and Morale, Welfare, and Recreation (MWR) retail activities where they can shop at discounted rates.

Additional VA Ratings Above 100 Percent

Under the traditional rating scale for compensation, 100 percent is the highest rating you will receive for either an individual service-connected condition or combined service-connected conditions.  However, there are certain circumstances in which veterans can receive additional forms of compensation due to particularly severe conditions.  For example,special monthly compensation (SMC) is awarded to veterans who have severe disabilities that bring them above and beyond the schedular rating criteria.

Total Disability Based on Individual Unemployability (TDIU): Compensated at 100% Rate

By demonstratingTDIU, you can receive monthly disability compensation at the 100 percent rate, even if your combined disability rating is less than 100 percent.  TDIU is awarded when veterans are unable to obtain and maintain substantially gainful employment due to their service-connected conditions.  Importantly, TDIU can be due to any service-connected conditions that contribute to their unemployability (i.e., physical or mental).

Furthermore, such service-connected conditions can be taken in combination when considering TDIU.  That is, veterans do not have to show that their depression alone prevents them from working.  Instead, veterans can argue that their depression combined with their knee and back conditions make them unable to work.  In order to qualify for TDIU on a schedular basis, veterans must demonstrate the following:

• They have one service-connected condition rated at 60 percent or higher;or
• They have multiple service-connected conditions, one of which is rated at least 40 percent disabling, with a combined disability rating of at least 70 percent

Extraschedular TDIU

Veterans who do not meet the rating requirements for schedular TDIU outlined above may still qualify for extraschedular consideration, or extraschedular TDIU.  Essentially, if you do not meet the rating criteria listed above, but you are ultimately still unable to work due to your service-connected conditions and there is evidence to prove that in the record, then you can still be granted TDIU.

Can Veterans Work While Receiving TDIU?

There are certain situations in which VA can still consider and grant TDIU when a veteran is working.  Again, the regulation requires that you are unable to secure and followsubstantially gainful employment.  VA considers jobs that result in annual income less than that of the federal poverty threshold to be marginal employment.  Importantly, veterans who are only engaging in marginal employment are still eligible for TDIU.

There are additional circumstances where veterans who earn above the federal poverty threshold may still receive TDIU benefits.  Here, veterans must be receiving extensive and unreasonable accommodations from their employer, resulting in a protective work environment.  If the accommodations are afforded due to the veteran's service-connected conditions, and without such accommodations the veteran would not be employed, TDIU should be considered.

Can Veterans with Schedular 100% VA Disability Ratings Work?

If a veteran has a schedular 100 percent disability rating for one or more service-connected conditions, they are fully entitled to continue working.  However, veterans should keep in mind that the VASRD is based on average impairment to earning capacity.  This means that a veteran's ability to work is one of the factors VA considers when trying to determine whether there has been an actual material improvement to a service-connected condition.

Is TDIU Permanent?

Similar to schedular 100 percent disability ratings, TDIU is not automatically permanent but it can be granted permanent status.  Oftentimes, the veteran must apply for permanent status and demonstrate to VA that their service-connected conditions are not going to improve over time, thereby rendering them permanently unemployable.

100% Permanent and Total VA Disability Ratings

Permanent and total disability ratings mean that VA has determined the veteran is both permanently and totally disabled.  It is a classification that means veterans no longer need to attend Compensation & Pension exams.  In addition, veterans with permanent and total disability ratings are typically no longer subject to rating reductions.  If you believe you are entitled to a permanent and total disability rating, you should apply through VA.

How Do You Know if Your Rating is Permanent?

If a veteran is rated permanent and total for a service-connected condition, there are a number of ways in which they will be notified.  In most cases, it will be indicated in the decision letter.  On some Rating Decisions, there is a Permanent and Total box that will be checked.  On others, there may be language like "eligibility to Dependents Chapter 35 DEA/CHAMPVA are established" or "no future exams are scheduled" – both of which indicate permanence.  The exact language may vary between different VA Regional Offices.

100% Temporary Total Disability Ratings

Veterans who are rendered temporarily incapacitated due to a service-connected condition may be entitled to receive temporary and total disability compensation equivalent to a 100 percent VA rating.  VA offers three forms of temporary 100 percent disability ratings:

Prestabilization

A prestabilization rating is a temporary, immediate disability rating assigned to veterans who have recently been discharged from military service with a severely disabling and unstable condition that is expected to continue for an indefinite period of time.  These veterans are considered to be "most likely in need and least likely to be self-sufficient."

Prestabilization ratings are assigned in increments of 50 and 100 percent over a period of 12 months following the veteran's discharge date. Veterans who receive a 100 percent prestabilization rating are suffering from an unstable condition incurred in service that will result in a severe disability. According to38 CFR 4.28, a 100 percent prestabilization rating is only assigned if "substantially gainful employment is not feasible or advisable."

In order for VA to reduce your prestabilization rating, a reevaluation must be conducted to assess your condition's status. These examinations are scheduled between 6 and 12 months following separation from service. VA will reduce your prestabilization rating if the evidence following a reexamination warrants a reduction.

A prestabilization rating is not assigned if the veteran is immediately eligible for a 100 percent schedular rating "under the regular provisions of the rating schedule," or a 100 percent rating due tototal disability based on individual unemployability (TDIU). To the same effect, a 50 percent prestabilization rating will not be assigned to those who would otherwise qualify for a schedular rating of 50 percent or higher "under the regular provisions of the rating schedule."

Hospitalization

Temporary hospitalization ratings are assigned to veterans who have been hospitalized for over 21 days as a result of a service-connected condition.  This rating is also assigned to those who remain under hospital observation for more than 21 days at the expense of VA.  In order to qualify for a temporary hospitalization rating, you must be receiving treatment at a VA medical center or other VA-approved hospital.

If a veteran is assigned a temporary hospitalization rating, their effective date will be that of when continuous hospitalization began.  Benefits will continue until the last day of the month in which the veteran stopped receiving treatment for their service-connected condition.38 CFR 4.29 states that if a veteran is hospitalized for more than six months, their "claims folder will be referred to the rating activity for consideration of a schedular 100-percent rating."

Convalescence

Convalescence is the third and final form of temporary total compensation assigned to veterans by VA.  In the case Felden v. West, theUnited States Court of Appeals for Veterans Claims (CAVC)  hasdefined convalescence as "the stage of recovery following an attack of disease, a surgical operation, or an injury" and recovery as "the act of regaining or returning toward a normal or healthy state." Felden v. West, 11 Vet. App. 427, 430 (1998.)

Temporary 100 percent convalescence ratings are assigned to veterans who underwent treatment or surgery for a service-connected disability at a VA medical center or VA-approved facility. In order toqualify for a temporary and total convalescence rating, the veteran must have:

• Undergone treatment or surgery with a convalescence time of at least one month; or
• Experienced severe postoperative residuals that resulted from surgery (e.g., surgical wounds are not completely healed, the veteran is rendered housebound, there is a need for continuous use of crutches or wheelchair); or
• Experienced the immobilization of one or more major joints "by a cast without surgery."

According to38 CFR 4.30, entitlement to a convalescence rating can be corroborated by a work excuse provided by a medical professional if there is a "clear connection between the claimant's inability to return to previous employment and surgery or cast immobilization," and if there is no evidence of record to the contrary.

VA Ratings for Cancer: Temporary Total

If you are service-connected for an active cancer, VA should automatically assign a 100 percent disability rating.  This rating continues for as long as your cancer is active, and then for anothersix months following the successful completion of a treatment program, such as chemotherapy, radiation, or surgery.  Six months after your cancer treatment ends, VA will schedule you for a Compensation & Pension examination to evaluate the current status of your condition.

If the examination shows that your cancer is no longer active and is in remission, VA will evaluate the cancer based on its residuals.  For example, erectile dysfunction and urinary incontinence are common residual symptoms of prostate cancer.  If prostate cancer is no longer active, VA will likely reduce the disability rating for that condition and assign new ratings based on the severity of the veteran's erectile dysfunction and urinary incontinence if present.

Get Help Winning a 100% Disability Rating

As you can see, the criteria to receive a 100% disability rating from the VA is complex and confusing. Even if you think you have a strong case, the VA might argue otherwise. Once the VA makes a decision, it is tough to appeal and get a reversal.

That is why you need a top VA disability lawyer to fight for your benefits. The attorneys at Chisholm Chisholm & Kilpatrick LTD have a strong track record getting our clients VA disability. We know how to fight cases the VA, and we can put our tools and resources to work for you.

We offer a free consultation during which you can speak to someone in our office about your situation. We may be able to help.  Ready to get started? Call our office today: 401-331-6300.

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Source: https://cck-law.com/types-of-va-disabilities/what-does-it-mean-to-be-100-percent-disabled-by-the-va/

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