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Many VA disability ratings aren't!
The 100% P & T designation is seen as important because of the additional dependents benefits of Chapter 35 educational benefits or the CHAMPVA health insurance. There are other benefits associated with a permanent rating; for example, a veteran must be rated as permanently disabled for an uninterrupted 10 year period for his spouse to be eligible for DIC should the vet die of anything that isn't rated as service connected.
P & T may be associated with either a 100% schedular rating or a 100% TDIU rating.
Whether or not a veteran receives a "permanent and total" (P & T) rating depends on a wide variety of factors. There are generally 2 classes of 100% ratings that aren't rated as P & T. Service connected cancer ratings are always rated as temporary 100% because it's assumed the veteran will get treatment and the cancer will go to remission or a cure. The other class of ratings that are always temporary are mental health related. VA assumes that with time and treatment, almost all mental health ratings will show measurable, sustained improvement.
Mental health 100% ratings may convert to P & T after the veterans 55th birthday. The 55th birthday is generally viewed as the point that a person can't effectively be retrained in any field that would allow him or her to reenter the workforce. This standard isn't unique to veterans or the VA, the SSA and other similar agencies use the 55 year old standard too.
We recommend that veterans do not try to appeal their temporary 100% rating to achieve a permanent rating. The first reason to avoid seeking an appeal is that VA will tell you there's nothing to appeal, you haven't been denied anything. Then you must consider that any time we ask VA to review anything in our file, they will review everything. During these reviews they look for areas of improvement in your rated conditions and will often seek to lower an existing benefit. Advocates have many horror stories of veterans who "appeal" or otherwise ask for P & T and end up with a 30% rating after VA opens the file.
As time passes and you attend those future exams, it becomes very difficult for VA to show sustained and measurable improvement. We agree that in broad terms, when 5 years passes between exams it becomes almost impossible to show sustained improvement.
Waiting it out also gets you closer to the 55 year old point and a better chance of a permanent rating after that.
While we understand that to not be rated as P & T may cause you to miss out on some dependents benefits, we believe the risks of seeking the permanent rating status outweighs any perceived potential benefits.
Our recommendation is to wait it out and not seek a P & T status. You should attend any and all future exams that VA schedules for you. Never miss or try to reschedule C & P exams. Be prepared for each C & p exam to show the examiner that there has been no change to the condition being examined.