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Brave and the Bold

Proposed Reduction of Benefits



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Proposal to reduce combined rating from 70% to 60%

Wanted to see if anyone has ever heard of the VA "proposing to discontinue the separate compensable evaluation for radiculopathy, left lower extremity currently evaluated as 20 percent disabling and combine the radiculopathy, left lower extremity with the disability of degenerative disc disease of the lumbar spine under diagnostic code 5243 and assign a single evaluation"

A brief summary is as follows.  In November 2014 I was assigned a 60% evaluation under diagnostic code 5243 for intervertebral disc syndrome based on incapacitating episodes.  I was also assigned a separate compensable evaluation for left lower extremity lumbar spine radiculopathy of 20%.  These two ratings along with another rating of 10% for tinnitus brought a combined evaluation of 70%.
After a recent C&P Feb 24th of this year(2016) I had a combined ROM of 80* as well as moderate/severe radiculopathy in my left leg and moderate radiculopathy in my right leg.  I again had a 60% evaluation under diagnostic code 5243 based on incapacitating episodes due to 3 recent lumbar minor surgeries.  My combined rating was continued at the 70%.  My VSO noted that the right radiculopathy was never mentioned in the Decision Letter.  We submitted VA 21-526EZ on April 18, 2016 as well as VA 21-4138.  

Today I received a Decision Letter with the proposed discontinuance of the separate evaluation for radiculopathy in the left extremity currently evaluated as 20% disabling and combine the radiculopathy with the DDD under diagnostic code 5243 and assign a single evaluation.  I was granted service connection for right extremity radiculopathy which was also combined with the DDD under diagnostic code 5243 and assigned a single evaluation of 60%.

Per the VA they stated the following reason for their decision as, "When an evaluation is assigned under diagnostic code 5243 for Inter-vertebral Disc Syndrome based on incapacitating episodes regulation prohibit the assignment of separate compensable evaluations for objective neurologic abnormalities to include radiculopathy of the lower extremities.  The result of this proposal would reduce your combined evaluation from 70% to 60%."

So now I have a rating of DDD with Bi-lateral radiculopathy all under a single evaluation.  Everything that I have read and researched states the complete opposite.  It clearly states that if rating under diagnostic code 5243 consider the assignment of seperate compensable evaluations for objective neurologic abnormalities.  Even with the VA fuzzy math I can't understand how I didn't recieve an increase rather then a decrease in combined rating.  

What should I do now to dispute this or am I wrong in what I'm understanding?  Is the VA actually right in their decision?

Thanks in advance for any help you may be able to give


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