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kent101

The VA is trying to reduce ratings of Vets with PTSD who show improvment from medication.

Question

I'm reading this VA Citation :NR 1231506 and the VA is saying that because a Veteran with PTSD is getting improvement from his psychiatric medication, that he's showing less symptoms because of it, that he is having his rating reduced from 70% to 30% for PTSD. The VA did reverse the reduction at the BVA. Is this still something to worry about? At a C&P exam does the Veteran have to make it clear that the medication is the reason for improvements and needed to sustain them?   

 

Citation NR: "

An October 2009 VA medical record reflects that the Veteran reported that the medication he had been prescribed helped with ability to be out in public and that, while leery about being around people, he could go out in public much more easily.  His mood overall was good, and he indicated that he continued to enjoy dining out with his wife and stopping by the VFW to socialize with friends.  The examiner assigned a GAF score of 76-80".

 

Over at Veteran's Law Blog it says

"As an example, say a Veteran has been able to service-connect Irritable Bowel Syndrome (DC 7319).

Undiagnosed, the symptoms of IBS might be a component of Gulf War Illness

With prescribed medication, our hypothetical Veteran’s condition moderates from a severe form of the disease to a milder form.

The severe form of IBS is rated at 30% and the moderate form of IBS is rated by the VA at 10%.

Let’s say the VA gives the Vet a rating of 10%, claiming that the Veteran’s medication limits her symptoms.

Is that 10% rating correct?

No . The Diagnostic Criteria in the VA Rating Schedule for Irritable Bowel Syndrome does not specifically list the effects of medication.

Therefore, the VA is not allowed to consider the relief it provides when determining the degree of disability.

Has this happened to you?

When have you seen the VA use “improvement due to medication” as an excuse to give a lower rating"?

https://www.veteranslawblog.org/va-disability-claim-medication-reduce-va-ratings/

 

https://www.va.gov/vetapp12/files5/1231506.txt

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Before determining if you need to worry about a rating reduction, the best place to check is the award letter and the rating criteria. Some ratings may have been considered temporary because your condition is expected to improve. These are typically stated in the award letter to let you know an exam will happen in the future. That is why it is a good idea to thoroughly read award letters and additional documentation that came with it.

Regarding medication and reductions, this precedent case plays a big role:

Jones v. Shinseki, 26 Vet. App. 56, 61 (2012) held that where effects of medication are not contemplated by the rating criteria, the effects of the medication on the disorder may not be considered.

Basically, check the rating criteria to see if medications are part of it. If they are, then medication may apply.

The asthma ratings are, in my opinion, the best examples which factor in medication use to meet higher level ratings. Aside from breathing tests, a veteran may go from 30% to 60% if their asthma was treated with injected/swallowed steroids 3+ times in 12 months. If an increase is granted solely by medication use, it may be considered temporary, expected to improve, and a future exam scheduled. If the veteran does not continue to meet the requirements, they VA likely will usually propose to reduce it.

 

The MH ratings also briefly mention medication, but only at the 10% level. If the veteran meets and maintains the requirement for a rating higher than 10%, then reduction based on improvement due to medication should not apply.

§4.130   Schedule of ratings—Mental disorders

10% Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.

 

After maintaining a rating for 5+ years, "3.344 Stabilization of disability evaluations" will also apply. After 5 years, the rating is considered stable. Reduction proposals should not happen unless VA meets pretty stiff requirements to prove materially sustained improvement to mandate reduction to a lower percentage. The idea is to prevent reductions based off of incomplete or one-off doctor's visits. However, the VA is known to make mistakes and propose reductions in error.

Additionally, some criteria include explicit 0% ratings.

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@Vync

This question does not pertain to this discussion directly; however, indirectly it does, thus why I ask.

I am seeking some expert knowledge on the last paragraph you penned above: "3.344 Stabilization of disability evaluations".

Does this maintenance of 5+ years for disability start from the effective date or in my case a DOD Medical Retirement?  

My situation and why I asked.  I was medically retired 11 Nov 2011.  See ratings in my profile.  

Upon my initial medical retirement, I was 50% for PTSD.  One year later (this was in Aug/2012), VA bumped me to 100% and have been to this date.  However, 20 Oct 2017, VA requested their 5 year C&P Exam.  The results from VA decision is still pending in my Ebenefits and not projected for a decision until Jan/Feb 2018.  

Major question: Do I meet this 5+ year (3.344 Stabilization of disability evaluation)?  Math tells me I would; however, I've learnt to never, ever trust logic when at the hand of the VA.  

 

Any input is very appreciated, Vync!!!

Grumpbox

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Alex answered this question some time ago.  The 5 year time is from the effective date.  

You should spend your time worrying about other stuff.  For example, you should worry about North Korea dropping a bomb on the US.  Or, worry about Yellowstone in Wyoming erupting and wiping out man kind.  

Or, you COULD just "give up" on worrying and enjoy your life, instead.  

Worry is a prison you put yourself in, voluntarily.  

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On 11/25/2017 at 11:59 AM, Grumpbox said:

@Vync

This question does not pertain to this discussion directly; however, indirectly it does, thus why I ask.

I am seeking some expert knowledge on the last paragraph you penned above: "3.344 Stabilization of disability evaluations".

Does this maintenance of 5+ years for disability start from the effective date or in my case a DOD Medical Retirement?  

My situation and why I asked.  I was medically retired 11 Nov 2011.  See ratings in my profile.  

Upon my initial medical retirement, I was 50% for PTSD.  One year later (this was in Aug/2012), VA bumped me to 100% and have been to this date.  However, 20 Oct 2017, VA requested their 5 year C&P Exam.  The results from VA decision is still pending in my Ebenefits and not projected for a decision until Jan/Feb 2018.  

Major question: Do I meet this 5+ year (3.344 Stabilization of disability evaluation)?  Math tells me I would; however, I've learnt to never, ever trust logic when at the hand of the VA.  

 

Any input is very appreciated, Vync!!!

Grumpbox

@Grumpbox

From what you explained, you should be covered by the 5 year stabilization rule. Keep in mind that the VA can still request C&P exams, but if they ended up proposing a rating reduction, they would still have to meet all the requirements set forth in the 5 year rule.

I agree with Broncovet's advice, but realize that it is natural to worry until the decision letter arrives in the mail. Even if the VA continues your current ratings, it is still worth the time to double-check and make sure the VA got it right. The VA overlooked one of my ratings which clearly qualified for a higher percentage, so I politely let them know their error.

Good luck!

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On 11/25/2017 at 3:12 PM, broncovet said:

Alex answered this question some time ago.  The 5 year time is from the effective date.  

You should spend your time worrying about other stuff.  For example, you should worry about North Korea dropping a bomb on the US.  Or, worry about Yellowstone in Wyoming erupting and wiping out man kind.  

Or, you COULD just "give up" on worrying and enjoy your life, instead.  

Worry is a prison you put yourself in, voluntarily.  

@broncovet - You are SO VERY RIGHT!  I shouldn't worry so much.  I have always been able to admit when I am wrong. You have me and my anxiety pegged.   I appreciate you insisting I should turn elsewhere to pass the time.

In the background however, and as a very new member, I stumble across so many cases where I see Vets struggling to:

1.  understanding the VA System;

2. unsure what steps to take;

3. issues understanding the regulations and how it applies;

4. or what sources to rely upon to mitigate unforeseen future steps.

I find myself trying to learn as much as I can, as well.  If I had only 10% of the knowledge you and the many others that have helped me on here, then I could sit back, have my plan mapped out, and then unleash chaos on the VA as all the experts do.   

In the end though...you are right @broncovet - I should ease back on my cyclic rate of fire...

 

@Vync - thanks for clarifying the 5+ year rule.  This was one of the first times where I researched something I had just learned, applied to my situation, and wondered if my research was right, thus why I asked for

15 minutes ago, Vync said:

but if they ended up proposing a rating reduction, they would still have to meet all the requirements set forth in the 5 year rule.

 As for this statement above, I will do the research and attempt to determine where I can stand on this one. After all, double-checking never hurts.  And most of all, thank you for taking the time to answer my post/question!!

GB

RLTW!

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