Received my VA letter, it says they're planning to reduce, letter contains no useful information. What now?

[dsteele713]

First things first: It wasn't a large yellow packet, it was a normal-sized white envelope with 4 pages inside, only 1 of which was actually correspondence. Is this normal for a denial/reduction? Or should I be expecting another envelope?

So I posted a week back (post is here). I filed for an increase, but I got a letter from the DAV that the VA plans to reduce two of the ratings I applied for an increase on. I finally got a letter from the VA this morning.

1. Reactive Arthritis - 60% to 10%

2. Facial scar - 10% to 0%

Except the letter contains no details whatsoever. The entire relevant portion is "We have reviewed medical records concerning your service-connected conditions and noted some improvement in your Systemic lupus erythematosus and Scars, head, face, or neck. Based on this evidence, we are proposing to reduce your prior evaluation of it's overall disabling effect"

Then they list the percentage proposals, what the new combined rating would be (40%, xxxx that noise), what my new payment would be, and then they let me know I have 30 days to request a hearing and submit evidence. It also says "We have enclosed a copy of a rating decision for your review", but that's it. The closest thing to a rating decision is what was stated above.

So how do they expect anyone to be able to respond to this? They don't actually tell you what the basis for their decision is. This experience is exactly the opposite of my first claim. VA took forever, and not only denied the increased but proposed a reduction but didn't explain why. Also, they continue to refer to it as lupus even though my claim was for reactive arthritis, my diagnosis is for reactive arthritis, etc. And looking through other cases I know it should be rated under 5009 (arthritis, other, rated as by analogy to 5002, Rheumatoid arthritis)

[Buck52]

Personal Hearings have been on-going for decades.

or Other Wise Known as a  DRO Hearing/Review!

 This is your chance to get your claim right and present new evidence , the DRO is usually a MALE with experience in the claims process and he is there to listen to you and  its your chance to explain about your claim and give new evidence that is favorable to your claim.

 The DRO (Decision Review Officer )puts on his pants the same as we all do they are no better than we , but he does have the Authority to make a decision on your claim  so treat him with all due respect.

 IMO means (Independent Medical Opinion) &  IME Means (Independent Medical Examination)  you need these some times to have Qualified Dr to Opine about your medical condition and read your Military or Private health Records to help substantiate your claim. or rebut against another Dr usually a VA Dr.

to Request the Personal Hearing  or DRO Hearing/Review..send your Request to your R.O.

Simply Request the DRO Hearing, you should be hearing from your R.O. any time after you make the Request

Usually after you are denied or recieved a letter of Proposal to Reduce your benefits  the VA is suppose to send you a letter explain to you the instructions and proper forms to use. dates and times for the Hearing if you so choose. but they need to let you know by sent letter from them.

This is called NOD  Notice of Disagreement  or Appeal the decision.

Some Veterans don't like to use a DRO and head straight to the BVA.....just my opinion, I think if a Veteran can settle his/her claim at the R.O. Level  with a DRO Hearing/Review he is better off and a lot faster in a decision.. However if the DRO Hearing/Review Fails to properly Adjudicate your claim or you are denied  then  you can head off to the long wait at the BVA if you disagree with the DRO Decision. 

You have one Year after a decision is made to Appeal.

Filing the Form 9 

Edited March 10, 2017 by Buck52

[Gastone]

Dsteel, some medical conditions do improve, therein lies your problem. This isn't a PTSD Claim, so a non-VA MD Specializing, preferably Board Certified in the treatment of Reactive Arthritis and Systemic Lupus, is your best bet.

What did you base your Claim for SC Increase on, New Medical DX or a worsening of your current condition?

The RO-Notice of Reduction letter specifically refers to a review of your VMC Med Records, triggered by your Increase Claim. What Clinician's Treatment Note did the Rater see, that you apparently weren't aware of?  I haven't reviewed Arthritis Ratings, how are they determined, range of motion?

File your NOD requesting a DRO Hearing, should give you 2 to 3 years without a cut to your Comp. Also, give you time to decide on a battle plan. You could stretch this out to 6+ yrs if you go BVA after DRO. Even if you lose in the end, better to pay back the overpayment with 2023 or 2025 $$ which will be worth less than 2017 $$. Use the time to your advantage.

Semper Fi

Semper Fi

 

[Buck52]

desteele713

I agree with Gastone, what is it your S.C for them to send a proposal to reduce?

[MikeHunt]

On 3/9/2017 at 7:03 PM, dsteele713 said:

Apparently there is a "narrative" letter that goes into detail about how they came to their conclusion, and the representative printed a copy and dropped it in the mail for me. He also mentioned that it may have been sent out separately, so I might already have a copy coming, but in any case I should find out soon what their reasoning is. Of course I'm surprised/pissed that the letter wasn't included with the original notification I received yesterday, but that's the VA for you.

You need to report that they didn't send the letter. This is a fav 'trick,' to upload a letter- but not actually send it. You likely 'no showed' to the C&P exam they also sent you an appointment letter for ...

So, the rater sends a rating letter, then the VSR send the letter you actually received.

Remember this is the organization that has to have Red boxes in every cube to throw away any paper- because people were simply throwing out claims- Put nothing past them.

Anytime anyone doesn't receive a letter, it needs to be reported.