When can the VA reduce my rating "again" after reduction?

[jayodizzle]

Good morning my fellow veterans, I hope that you may answer this humble request for advice with my particular reduction of rate.

You see, I have been diagnosed with Asthma induced from my OIF/OEF deployments before which included backpains, eczema, fatigue. etc... well, they gave me 100% (though it says P&T also) but now reduced my rating upon seeing improvement of my asthma. Technically, they terminated my whole asthma rating which  now I could only receive an overall 40% from my other symptoms which where before "does not need further evaluation" I held the 100% for 4 years but this last one the 3rd examination, my asthma was deemed improved- so called for the reduction of my rate which was kind of sad because from 2900$ now I receive 587$. So if I may ask,

If I was reduced from my 100% rating to 40%... When can they reduce my rating AGAIN? or would they reduce my rating again in the future time after they gave me this 40%?

 

Thank you very much.

Edited May 30, 2016 by jayodizzle

[Cobra4v]

I'm happy you're better, sorry for the decrease though. I think on the issues which aren't temporary and are chronic they are less likely to reduce. Raises the question though.

How often do they try to reduce ratings? If you are constantly at VA about you SC disability getting treatment does that keep them off your back?

[jayodizzle]

12 hours ago, Vync said:

I'll try to help as I have had an asthma rating for 20+ years and also have been victim of an improper reduction.

Broncovet is right that they can pretty much attempt to reduce at any time.

Keep in mind that here are the way the protections work (not counting fraud or jail). Basically, there are three thresholds which help define "protection from reduction":

5 years = Rating is stabilized, must show sustained improvement to attempt reduction
10 years = SC status is protected
20 years = Percentage protected if held continuously for 20 years
 

I have already been through the ringer with the VA about reducing my asthma rating. I had a 60% rating and the VA sent me a "proposal to reduce" letter in the mail stating my 60% asthma rating was only temporary. This is your alert that it is time to fight the reduction, in most cases. I submitted medical evidence along with justification for continuance and figured that would be no problem. I got a letter in the mail stating that it was reduced to 30%. I filed a NOD and eventually saw a DRO for this and other issues. Everything was reversed because they didn't read the rating table correctly and most importantly they ignored the evidence I submitted.

 

I recommend you take a deeper look at what makes the asthma rating special. It contains different criteria for each rating level:

6602   Asthma, bronchial:
FEV-1 less than 40-percent predicted, or; FEV-1/FVC less than 40 percent, or; more than one attack per week with episodes of respiratory failure, or; requires daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications	100
FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids	60
FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication	30
FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy	10
Note: In the absence of clinical findings of asthma at time of examination, a verified history of asthmatic attacks must be of record.

The VA loves to look only at the FEV-1/FVC values from spirometry and overlook all the other possible ways to be rated for asthma.

Take a look at the 100% criteria:
- FEV-1 less than 40-percent predicted, or;
- FEV-1/FVC less than 40 percent, or;
- more than one attack per week with episodes of respiratory failure, or;
- requires daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications

That's 4 different ways to qualify for 100%. You don't have to qualify under all four conditions. You need only qualify under one of those conditions. The same goes for the rest of the rating percentage levels. If you qualify under different percentage levels, then they are supposed to grant you the highest percentage.

Additionally, for FEV-1/FVC ratings, they are supposed to take a baseline reading first, have you inhale your rescue medication (i.e. albuterol), and then take another reading. Whichever is lower is what the FEV-1/FVC component that should be used.

Also, keep in mind that when they state "systemic (oral or parenteral) corticosteroids), that means things like prednisone, medrol, solumedrol taken orally in pill or injected form -- not inhaled corticosteroids like Intal. This is important because the 60% and 100% rating levels can be met with just being treated with these medications over time. In my case, I have consistently been prescribed 3-6 courses of these meds every year. The VA totally missed this because I also am treated by a private doctor and they did not have access to the records. Yes, I sent form authorizing release and copies of the form. Once verified, they backed off and reinstated the rating. If you got lots of meds like this over the years, dig up the records, prescription history, etc... and show the VA.

You mentioned they completely erased your asthma rating. If your breathing is better than "FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent" and you do not use any rescue inhalers, then that would be the only way they could do that. If you still use an albuterol inhaler "intermittently", they screwed up and you should have at least a 10% rating. If you take inhaled anti-inflammatory inhalers daily, like Asmanex, mometasone furoate, Advair, etc..., then they screwed up and you should have at least a 30% rating.

Check your original award letter and C&P exam. It will specifically tell you exactly why you were given a 100% rating. Then look at your reduction letter and C&P exam and compare them.

 

 

 

 

 

 

 

Thank you Vync,

Yes I looked at my award letter but it says that I got reduction from 100% to 40%. It is not actually permanent but total is what the medical officer at VA said. Asthma can be controlled they said and this time I have shown improvement (I have to or I will fail any acceptance to EMT jobs because they require proper pulmonary functions at a certain level). The reason they also can monitor my status is that albuterol cannot be procured anywhere without prescription of the VA. So I have to go to VA to get mine, which ofcourse they monitor to know if I improve or not. This is in Tennessee by the way. 

The VA here is quite on the spot with their care, and I even received my ID card too. Sad part is... well, no more 100% but 40% now. Quite a big reduction. I went to VRO yesterday, he himself told me that my case may be hard to disprove because I got good medical results- kind of saddening that when you receive good results, you will receive less money. 

 

Anyways, I have moved on... I got a job and a life. Nothing could replace that. Now my question is.... 

Would they also lower my 40% from my other ratings any time in the future?

Thank you again you answer helped me so much. 

[jayodizzle]

5 hours ago, Cobra4v said:

I'm happy you're better, sorry for the decrease though. I think on the issues which aren't temporary and are chronic they are less likely to reduce. Raises the question though.

How often do they try to reduce ratings? If you are constantly at VA about you SC disability getting treatment does that keep them off your back?

Thank you. I know I'm quite happy that I do not have to puff albuterol everytime I run or just play outside (not a lot though). But it saddens me that I won't receive that money anymore... I knew and expected that one day this will be like this.

I am not constantly in the VA, I dont want to be their favorite patient and have them look at my improvement as a case of reduction but ALAS... they reduced mine from my tricare records and medical checks from EMT.

 

Now, Would they still reduce my last 40% though? it is the minimum I could get but I want that protected for the rest my life. Hopefully.

[Vync]

8 hours ago, jayodizzle said:

 

Thank you Vync,

Yes I looked at my award letter but it says that I got reduction from 100% to 40%. It is not actually permanent but total is what the medical officer at VA said. Asthma can be controlled they said and this time I have shown improvement (I have to or I will fail any acceptance to EMT jobs because they require proper pulmonary functions at a certain level). The reason they also can monitor my status is that albuterol cannot be procured anywhere without prescription of the VA. So I have to go to VA to get mine, which ofcourse they monitor to know if I improve or not. This is in Tennessee by the way. 

The VA here is quite on the spot with their care, and I even received my ID card too. Sad part is... well, no more 100% but 40% now. Quite a big reduction. I went to VRO yesterday, he himself told me that my case may be hard to disprove because I got good medical results- kind of saddening that when you receive good results, you will receive less money. 

 

Anyways, I have moved on... I got a job and a life. Nothing could replace that. Now my question is.... 

Would they also lower my 40% from my other ratings any time in the future?

Thank you again you answer helped me so much. 

Hey JayO,
I know what you mean. I have family who was an EMT and said it can get physical at times.

The VA is famous for falsely assuming that all veterans get care only from the VAMC. In my case, I still work and have private insurance through my employer. The VA tried to use the presumption that "no news is good news", which is why they often try to reduce people in this fashion.

 

By the way, you can get albuterol from any pharmacy, not just the VA. You just need a prescription. The benefit of getting it from the VA is that it is free if you are SC for asthma.

 

Reducing your asthma rating from 100% to 0% seems wrong, especially if you are still taking asthma medications. If they really did reduce your asthma rating to zero, I strongly recommend you look at your medications. There is a chance that someone at the VARO screwed up and reduced you too far. You likely will not get back to 100%, but could get 10%, 30%, or maybe even 60%. However, 10% or 30% are most likely.

1. Check your VA prescription history for the past 12 months
2. Look for albuterol inhalers.
-- If you use them regularly, you should have a 10% rating.
-- If you use them daily, you should have a 30% rating.
3. Look for anti-inflammatory inhalers (advair, asmanex, mometasone furoate, etc...). If you use them daily, you should have a 30% rating.
4. Look for prednisone, medrol, etc... If you received 3+ courses over 12 months, you should have a 60% rating and this will be considered temporary.

 

Until you maintain a rating for 20 consecutive years, there is always a chance they might reduce you. After 5 consecutive years, they must be able to prove sustained improvement. However, in reality you may have to actually prove to the VA that you have not improved. Basically, that means that if you continue to have problems, and then have one "good" day, they are not supposed to use that good day against you. Keep in mind that the VA often does incorrectly do this.

If you have a good asthma doctor, they should have given you a peak flow meter. I recommend you use it daily and keep an "asthma diary". When you have an attack, use the meter (if you can) before and after, and log the results too. I submitted a copy of my asthma diary to the VA when they tried to reduce me. I know it's not the same as digital spirometry, but it's the cheap solution you can do from home.

 

[jayodizzle]

8 hours ago, Vync said:

Hey JayO,
I know what you mean. I have family who was an EMT and said it can get physical at times.

The VA is famous for falsely assuming that all veterans get care only from the VAMC. In my case, I still work and have private insurance through my employer. The VA tried to use the presumption that "no news is good news", which is why they often try to reduce people in this fashion.

 

By the way, you can get albuterol from any pharmacy, not just the VA. You just need a prescription. The benefit of getting it from the VA is that it is free if you are SC for asthma.

 

Reducing your asthma rating from 100% to 0% seems wrong, especially if you are still taking asthma medications. If they really did reduce your asthma rating to zero, I strongly recommend you look at your medications. There is a chance that someone at the VARO screwed up and reduced you too far. You likely will not get back to 100%, but could get 10%, 30%, or maybe even 60%. However, 10% or 30% are most likely.

1. Check your VA prescription history for the past 12 months
2. Look for albuterol inhalers.
-- If you use them regularly, you should have a 10% rating.
-- If you use them daily, you should have a 30% rating.
3. Look for anti-inflammatory inhalers (advair, asmanex, mometasone furoate, etc...). If you use them daily, you should have a 30% rating.
4. Look for prednisone, medrol, etc... If you received 3+ courses over 12 months, you should have a 60% rating and this will be considered temporary.

 

Until you maintain a rating for 20 consecutive years, there is always a chance they might reduce you. After 5 consecutive years, they must be able to prove sustained improvement. However, in reality you may have to actually prove to the VA that you have not improved. Basically, that means that if you continue to have problems, and then have one "good" day, they are not supposed to use that good day against you. Keep in mind that the VA often does incorrectly do this.

If you have a good asthma doctor, they should have given you a peak flow meter. I recommend you use it daily and keep an "asthma diary". When you have an attack, use the meter (if you can) before and after, and log the results too. I submitted a copy of my asthma diary to the VA when they tried to reduce me. I know it's not the same as digital spirometry, but it's the cheap solution you can do from home.

 

Thank you Vync,

I don't take my asthma medications at all anymore, actually, I was not able to show them that I have been using it. I pretty much do natural approach with my asthma and this was recommended by my mother who is a nurse. Thing is, it took I think 2 years or so until I have no longer use my albuterol too much (there are days before that I use them but its like 2 a week or so). 

As of now, I stay away from too much stress and allergies which might exacerbate my asthma, but not too much now. I don't use my albuterol as regular or none at all at times.

Yeah, I know what you mean about the good day but as the medical officer looked at my civilian medical sheet, my asthma was presumed "controlled" now that I also work with  a strenuous job which I defended that I do not do anything on it except Lift, Drive, and poke people out with a needle (yeah, kinda hurts me because I'm trying to get financial backing by injuring my job-credibility as an exchange lol.). I tried to attempt to get a 10% or so rating by providing a asthma diary but EMT life is so busy I barely manage to get my diary done (and often I forget because I don't use albuterol as much or at all).

 

So would they still reduce my 40% over all rating even though that was the minimum that I could get now without asthma?

[Vync]

On 6/2/2016 at 10:58 PM, jayodizzle said:

Thank you Vync,

I don't take my asthma medications at all anymore, actually, I was not able to show them that I have been using it. I pretty much do natural approach with my asthma and this was recommended by my mother who is a nurse. Thing is, it took I think 2 years or so until I have no longer use my albuterol too much (there are days before that I use them but its like 2 a week or so). 

As of now, I stay away from too much stress and allergies which might exacerbate my asthma, but not too much now. I don't use my albuterol as regular or none at all at times.

Yeah, I know what you mean about the good day but as the medical officer looked at my civilian medical sheet, my asthma was presumed "controlled" now that I also work with  a strenuous job which I defended that I do not do anything on it except Lift, Drive, and poke people out with a needle (yeah, kinda hurts me because I'm trying to get financial backing by injuring my job-credibility as an exchange lol.). I tried to attempt to get a 10% or so rating by providing a asthma diary but EMT life is so busy I barely manage to get my diary done (and often I forget because I don't use albuterol as much or at all).

 

So would they still reduce my 40% over all rating even though that was the minimum that I could get now without asthma?

Regarding your 40% rating being reduced, I have heard of veterans getting a rating and it is never changed. However, the VA seems to take an interest in some types of ratings more than others. I have no way to tell you if it will or will not be reduced in the future. There are a lot of factors, such as the type of rating (asthma is usually targeted for reduction), severity, has it improved, etc...

 

Regarding a 10% asthma rating, I think it comes down to the interpretation of "intermittent inhalational or oral bronchodilator therapy" because your FEV/FVC is good. Let's explore each part of the 10% criteria:

"Oral bronchodilator therapy" would equate to some form of rescue inhaler. If you have one and use it "intermittently" that would qualify. Personally, I would tell you that if you had asthma, you would potentially be prone to it again, regardless of natural remedies. If you get to a point you are unable to breathe because the natural remedies fail, it only makes sense to have a backup plan.

"Intermittent inhalational therapy" would not necessarily need to be constrained to medication. For example, when I was first diagnosed with asthma by the Army, they gave me an albuterol inhaler, trained me how to use it, and also taught me how to try to take control of my breathing without the inhaler via breathing exercises. Granted it did not always work, the idea was to either avert the need for the inhaler, buy me time to get to it, or to get medical help if it was broken or lost. They said to do the breathing exercises regularly so I would instinctively know to do what I needed. I would consider that "inhalational therapy", but please keep in mind I am not a doctor.