[Proposal to Reduce Part 2]

11 minutes ago, shrekthetank1 said:

I think Bronco meant to put your conditions have gotten worse.  

PS. Good catch on the "template" catch, Shrek.

"I am in dispute of the proposed reduction as my conditions have gotten worse."

[Proposal to Reduce Part 2]

7 minutes ago, shrekthetank1 said:

I think Bronco meant to put your conditions have gotten worse.  

Thank you Shrek. It may not have been said, but I got the gist of what he meant. Thank you for clarifying though!

[Proposal to Reduce Part 2]

Thank you, Broncovet!

[Proposal to Reduce Part 2]

Good morning,

So a couple of months ago I posted that VA had sent me a Proposal to Reduce. In the proposal they alleged that the radiculopathies in both my lower extremities had showed improvement and would currently rate as "moderate" from the "moderately severe" that I had been evaluated for previously.

As such, I requested the report from the current C&P exam that they used to "show that improvement" and I got the DBQs from that yesterday. All the while I was thinking that I got a "bad exam", but to my surprise the C&P examiner stated in one DBQ that my radiculopathies were "Severe" and in another he marked my Sciatica as "moderately severe". So, can anyone tell me why I might have received this proposal to reduce and how do I go about correcting this?

Thanks.

[Automatically Secondary to?]

Good morning,

 

I have a question I can't find an answer to.

I am currently service-connected for L5-S1 of my lumbar spine. Over the years my L4-L5 and L3-L4 have become involved and I have assumed that those areas of the spine were automatically considered either as a part of the original L5-S1 service-connection or secondary to it. But, I have never seen it mentioned it my decision letters.

Do I have to claim those areas as secondary for them to be considered?!

Thanks

[Can a VSO file a claim on your behalf]

How to I rescind the POA? And can the VSO see your medical records?

[I received a proposal to reduce]

1 hour ago, Berta said:

This vets law firm has some excellent info on your disability- and be sure to read the  Radiculopathy info 

 https://cck-law.com/news/intervertebral-disc-syndrome-ivds-and-va-disability/

I think and hope your medical evidence will help rectify this-

What are the diagnostic codes they have used in the past for your disability....?

The VA should be attaching those C & P results to our claims decisions.

You stated that VA said:

 "We have reviewed medical records concerning your service-connected disabilities and noted some improvement, We propose to reduce our evaluations of the disabling effects for conditions as follows:"

Did they even specifically  mention at all the 2 C & P exams- or any medical rationale  from any doctor ,in the decision and in the evidence list

They say "we reviewed" etc - and ' we' could mean just some rater anxious to get the file off his/her desk.

I just I am concerned because of a C & P exam the VA has failed to release to me since August.

I called the WH last week about it.

I do not believe ( and shared that with the WH and the OAWB,) that any medical person prepared it.I named the VARO individual  ( a VSO or lackey for their director)who told me he knew who would do it - and I believe it could have been that  VARO person himself , who has no medical background at all, and whoever prepared it attempted to reverse Probative evidence, listed on the denial- but they reversed in 3 weeks to an award-

My Probative evidence came from the Top Cardiologist at VA Central. I think  even a 12 year old could read it.

In my CUE I specified all the statements this VACO doctor made regarding what the disability claim was for, and why it was a contributing factor in my husband's death.

( maybe the C & P  was done by an 11 year old)

Vets I hate to remind, again but this is the crap your survivors might have to put up with.

Make sure your hadit password is in your files with the most important stuff he/she will need when you die.

I bet some widows would have accepted their outrageous denial-and never even Cued or Nodded it.

 

 

 

 

 

 

 

 

They said they used 2 C&P exams to propose the reduction and that was all. They did not mention considering anything else (i.e. years of medical-industrial history, etc.).

[I received a proposal to reduce]

24 minutes ago, Buck52 said:

Contact the VBA (Veterans Benefits Administration) at your local VAMC for one free copy of your last QTC  Exam or the one you need.

Hello Buck,

I did, about a month ago. Still waiting on it!

Thanks

[I received a proposal to reduce]

For anyone following this thread. Below is an updated version of my contentions with regard to the proposed reductions.

CONTENTION 1: With regard to 38 CFR 3.344 (a) “It is essential that the entire record of examinations and the medical-industrial history be reviewed” I contend that none of the evidence for which VA relied upon to propose these reductions reviewed my entire personal medical-industrial history (e.g. my employment history as a Fire Fighter with the US Forest Service was considered during the Compensation and Pension Examination in which an evaluation of 40% for each condition named in the proposal was awarded. I am currently employed in a sedentary job in administration.) and therefore they do not clearly show sustained material improvement under ordinary conditions of life with regard to the personal history of my conditions of Intervertbral Disc Syndrome with radiculopathy (previously rated as intervertebral disc syndrome with degenerative joint disease of L5-S1); Radiculopathy, left lower extremity associated with intervertebral disc syndrome with radiculopathy; and Radiculopathy, right lower extremity associated with intervertebral disc syndrome with radiculopathy, therefore I contend that the reductions proposed on January 31^st, 2019, and February 1^st, respectively, be considered null and void and therefore should not be implemented. End of Contention 1.

CONTENTION 2: With regard to 38 CFR 3.344 (a) “Moreover, though material improvement in the physical or mental condition is clearly reflected the rating agency will consider whether the evidence makes it reasonably certain that the improvement will be maintained under the ordinary conditions of life” I contend that prior to the injuries, which caused my conditions including Intervertbral Disc Syndrome with radiculopathy (previously rated as intervertebral disc syndrome with degenerative joint disease of L5-S1); Radiculopathy, left lower extremity associated with intervertebral disc syndrome with radiculopathy; and Radiculopathy, right lower extremity associated with intervertebral disc syndrome with radiculopathy, and under the ordinary conditions of life, I was never medically prescribed 10 sessions of acupuncture nor did I seek medical treatment from a pain clinic, as I have in the last year.

I also contend that prior to the injuries, which caused my conditions including Intervertbral Disc Syndrome with radiculopathy (previously rated as intervertebral disc syndrome with degenerative joint disease of L5-S1); Radiculopathy, left lower extremity associated with intervertebral disc syndrome with radiculopathy; and Radiculopathy, right lower extremity associated with intervertebral disc syndrome with radiculopathy, and under the ordinary conditions of life, I never sought nor had I attended a medically prescribed KT Aquatic Program, as I have in the last year.  

And I further contend that prior to the injuries, which caused my conditions including Intervertbral Disc Syndrome with radiculopathy (previously rated as intervertebral disc syndrome with degenerative joint disease of L5-S1); Radiculopathy, left lower extremity associated with intervertebral disc syndrome with radiculopathy; and Radiculopathy, right lower extremity associated with intervertebral disc syndrome with radiculopathy, and under the ordinary conditions of life, I was never prescribed sedating/symptom inducing medications (i.e. Flexeril, Trileptal, Tramadol, Lyrica, Neurontin, etc.) nor was I given injections (i.e. Toradol, etc.), as I have in the last year.  

Therefore, I contend that the reductions proposed on January 31^st, 2019, and February 1^st, respectively, with regard to the conditions of Intervertebral Disc Syndrome with radiculopathy (previously rated as intervertebral disc syndrome with degenerative joint disease of L5-S1); Radiculopathy, left lower extremity associated with intervertebral disc syndrome with radiculopathy; and Radiculopathy, right lower extremity associated with intervertebral disc syndrome with radiculopathy, be considered null and void and therefore should not be implemented. 

Further evidence for Contentions 2 can be found in the Compensation and Pension Exam Note of November 16^th, 2017, where the examiner opines under ‘16. Functional Impact’ that, “Since the veteran's symptoms are heightened by everyday Physical activities, the lumbar spine condition might regularly limit his/her ability to safely perform tasks in physical occupations that require prolonged standing or walking, heavy lifting, repetitive bending. If performing sedentary work involving prolonged sitting, he/she would likely need frequent breaks to allow for ambulation to minimize symptoms associated with inactivity.” And because it can be argued that what the examiner opined clearly shows that material improvements under ordinary conditions of life would not be sustained and therefore cannot be shown, I contend that the reductions proposed on January 31^st, 2019, and February 1^st, respectively, and with regard to the conditions of Intervertebral Disc Syndrome with radiculopathy (previously rated as intervertebral disc syndrome with degenerative joint disease of L5-S1); Radiculopathy, left lower extremity associated with intervertebral disc syndrome with radiculopathy; and Radiculopathy, right lower extremity associated with intervertebral disc syndrome with radiculopathy, be considered null and void and therefore should not be implemented. End of Contention 2.

 

[Can a VSO file a claim on your behalf]

This might be a crazy question, but can a VSO file a claim for you without your knowledge?

Thanks

[I received a proposal to reduce]

53 minutes ago, Buck52 said:

This is all good. However you need a qualified Dr to give his opinion , they won't listen to us, were not Dr's

a IMO/IME from a specialist would seal the deal on this P/P T/R  of what you mention above.

via DRO Hearing at your R.O..

  ALSO you can look the DRO in the eyes and he can see up close your disability is real, sometimes these P/P/T/R  are not as bad as most would think,  if you have shown your condition has actually got worse a increase is applied and not a reduction.  but this needs to come from a Qualified Dr.

I agree that getting an IMO/IME would be a home run, but I was hoping the following would at least get me to the fences?!

From the report of C&P exam 1:

“Does the Veteran's thoracolumbar spine (back) condition impact on his or

Her ability to work?

[X] Yes [ ] No 

If yes describe the impact of each of the Veteran's

Thoracolumbar spine (back) conditions providing one or more examples:

Occupation: XXXX

Says work is sedentary, writing policies and supervising people. Veteran says he has asked for reasonable accomodations and he is working from home 2 to 3 times week. He says he has missed about 50 to 52 days from work in the past 12 months secondary to back pain. Since the veteran's symptoms are heightened by everyday Physical activities, the lumbar spine condition might regularly limit his/her ability to safely perform tasks in physical occupations that require prolonged standing or walking, heavy lifting, repetitive bending. If performing sedentary work involving prolonged sitting, he/she would likely need frequent breaks to allow for ambulation to minimize symptoms associated with inactivity.”

From the DBQ prepared by my Neurologist:

“Do the conditions listed in the diagnosis section impact his or her ability to perform any type of occupational Task (such as walking, lifting, sitting, etc.)?

[x] Yes [ ] No

Standing, walking, lifting are all impaired by his chronic back and leg pain. It is a significant functional impairment. Pain reaches 8/10 with such activities.”

Unfortunately, still waiting on report for C&P 2 (performed by QTC).

Thanks again.

[I received a proposal to reduce]

Hello Buck,

What is "P/P/T/R"?

Thanks.

[I received a proposal to reduce]

Just to clarify. Other than the acupuncture, all the other the treatments, medications, and such took place during the dates of the evidence VA relied upon, and continue to take place!

[I received a proposal to reduce]

55 minutes ago, broncovet said:

It makes a big difference "when" you received that raitng. Was it 5 years or less, 10, or 20 years?  Are you P and T?    Attorney Katrina Eagle had an excellent post up on what to do with PR's.  Her post has been taken down for several years now.  

I do however, think it still applies.  

In sum, she suggested asking for a hearing.  

Perhaps more importantly, she suggested you argue your condition has NOT improved since your last rating decision.  You see if they did not address your IDS, and added SMC S, or another condition, the VA acknowledges you still qualify as of the decision date.  So she suggested not attempting to show you meet the criteria today, but rather it has not had "sustained improvement" under ordinary conditions of life.  Ordinary people work, while disabled people dont.  Therefore, if you have been rated 5 years or more, and you are not working, its unlikey they will be able to reduce you.  

Of couse if you dont dispute it, the va will be happy to reduce you.  

 

Thanks Broncovet,

It have had my rating for more than 5 years.

As such, while I feel like I need to work on it, this is what I'm adding to my SOC regarding the proposal (please let me know if I should change/clarify anything):

Enclosed with this Statement of Claim is VA Form 21-0960M-14; prepared by my neurologist, Dr. XXXX, MD, in support of my claim with regard to the reductions proposed on January 31^st, 2019, and February 1^st, respectively, of my conditions of Intervertbral Disc Syndrome with radiculopathy (previously rated as intervertebral disc syndrome with degenerative joint disease of L5-S1); Radiculopathy, left lower extremity associated with intervertebral disc syndrome with radiculopathy; and Radiculopathy, right lower extremity associated with intervertebral disc syndrome with radiculopathy.

 

Additionally, I contend that

 

CONTENTION 1: With regard to 38 CFR 3.344 (a) “It is essential that the entire record of examinations and the medical-industrial history be reviewed” I contend that none of the evidence for which VA relied upon to propose these reductions reviewed my entire medical-industrial history and they do not show that my entire medical-industrial history has been taken into consideration (e.g. I was employed as a Fire Fighter for the US Forest Service after military service and now I am employed in a sedentary job in administration.) and therefor they do not clearly show improvement, neither implied or actual, in the conditions of Intervertbral Disc Syndrome with radiculopathy (previously rated as intervertebral disc syndrome with degenerative joint disease of L5-S1); Radiculopathy, left lower extremity associated with intervertebral disc syndrome with radiculopathy; and Radiculopathy, right lower extremity associated with intervertebral disc syndrome with radiculopathy, therefore I contend that reductions proposed on January 31^st, 2019, and February 1^st, respectively, be considered null and void.

 

CONTENTION 2: With regard to 38 CFR 3.344 (a) “Moreover, though material improvement in the physical or mental condition is clearly reflected the rating agency will consider whether the evidence makes it reasonably certain that the improvement will be maintained under the ordinary conditions of life” I contend that ordinary people under the ordinary conditions of life do not attend 10 medically prescribed sessions of acupuncture in two months to control their symptoms nor do they seek medical treatment from a pain clinic during the same year and after the acupuncture sessions. I also contend that ordinary people under the ordinary conditions of life do not seek nor do they attend a medically prescribed KT Aquatic Program to control their symptoms (i.e. pain, etc.).  And I further contend that ordinary people under the ordinary conditions of life are not placed on sedating/symptom inducing medications (i.e. Flexeril, Trileptal, Tramadol, Lyrica, Neurontin, etc.) nor are they given injections (i.e. Toradol, etc.) nor would they continually seek treatments for such.  Lastly, with regard to 38 CFR 3.344 (a), I contend that no reasonably placed person would conclude that “sustained, material improvement under the ordinary conditions of life” has been shown with having such knowledge as above, and for which is clearly outlined in my VAMC treatment records and C-File. Therefore, I contend that the reductions proposed on January 31^st, 2019, and February 1^st, respectively, with regard to the conditions of Intervertbral Disc Syndrome with radiculopathy (previously rated as intervertebral disc syndrome with degenerative joint disease of L5-S1); Radiculopathy, left lower extremity associated with intervertebral disc syndrome with radiculopathy; and Radiculopathy, right lower extremity associated with intervertebral disc syndrome with radiculopathy be considered null and void.

Thanks again!

[I received a proposal to reduce]

1 hour ago, Berta said:

It looks to me that you have excellent evidence to combat the proposed reduction.

Make sure the VA gets it all ( copies that is) before the deadline for any response.

It is a travesty that we have to fight for what we get and then often have to fight to keep it.

 

Thank you Ms. Berta.

 

 

[I received a proposal to reduce]

Hello,

I received a proposal to reduce the evaluations of my  Intervertebral Disc Syndrome with Radiculopathy (previously rated as intervertebral disc syndrome w/ DDD of L5-S1); Radiculopathy, Left Lower Extremity; Radiculopathy Right Lower Extremity on February 7th, 2019. 

To be more specific, the proposal states "We have reviewed medical records concerning your service-connected disabilities and noted some improvement, We propose to reduce our evaluations of the disabling effects for conditions as follows:

Intervertebral Disc Syndrome with Radiculopathy (previously rated as intervertebral disc syndrome w/ DDD of L5-S1) - Current: 40% | Proposed: 20%

Left Lower Extremity - Current: 40% | Proposed: 20%

Radiculopathy Right Lower Extremity - 40% | Proposed: 20%"

The proposal also states, "What Evidence Can you Submit...the best type of evidence is a statement from a physician who recently treated or examined you". As such I submitted a letter from my Private PCP February 12th, 2019, containing his statement. In his statement, my PCP said that my conditions of lower extremity radiculopathies are "moderate to severe". and there has been "no change". I also submitted a record from a recent urgent care visit (regarding the above conditions) and an SOC with that letter.

In the SOC I stated, "Lastly, I argue that the evidence VA used to propose reduction in evaluations, in addition to the evidence I am submitting here, does not support a reduction in evaluations (with all above named conditions being currently evaluated at 40% and being proposed to reduce to 20%) nor does it support the idea that a material improvement in the above named conditions is clearly shown nor would clearly be shown under ordinary conditions of life. (38 CFR § 3.344 Stabilization of disability evaluations)." [Of note: In the last year I have had a new MRI of my lumbar spine (which showed "significant abnormalities"), been through acupucture (with no improvement shown), been through the pain clinic (with no improvement shown), been through aqua therapy (with no improvement shown), as well as a trip to the ER and a trip urgent care and placed on medications. Which is why I argued what I argued.

Additionally, my Neurologist also prepared a Thoracolumbar DBQ, for which I just received and that I will be submitting to VA on Monday.

Having said all that, I am completely exhausted when it comes to fighting VA. I hope all of what has been done works! Because I no longer have it in me to fight for something that is already taking so much out of me.

What more can I do?

Thanks.

Clyv

 

[C&P less than 5 minutes (Augusta, GA)]

It may have been longer, but sure didn't feel like it.

Not sure how to feel about it, though! Was through QTC. Anyone else have dealings with this company in Augusta, GA?

 

[C&p With Qtc]

silverdollar22 I know this is an old post, but is this doctor on Central Ave?

 

[New Claim I didn't file]

Thanks Ms. Berta. I had figured it out in the meantime!

[New Claim I didn't file]

Ms. Berta, what does SMC stand for again?

Thanks

[New Claim I didn't file]

*Update*

 

I received the Development Letter in the mail today. No mention of the upcoming C&P exam in it. No mention of what the "claim" is even for. Just says "We are working on your claim"?!

I know someone said they can be generic, but can they be this generic?!

 

 

[New Claim I didn't file]

Brokensoldier How does that explain my dad then?! His VA Doc put his claim in for him!

[New Claim I didn't file]

Thanks for the info BigRed!

QTC sent me a letter spelling out the conditions and they are what the Pain Clinic/Aquatic Therapy, etc is seeing me for - IVDS with bilateral radiculopathies!

[New Claim I didn't file]

These are what is showing in my eBenefits and VA.Gov accounts. I received the phone call from QTC on December 5th!

[New Claim I didn't file]

No, I did not receive a letter from the Regional Office notifying me of the C&P. The "New" claim is for something I am currently rated for. I am, however, experiencing additional nerve/level involvement to what I had been for years. For instance, I've had Radiculopathies for years now, but I started having stabbing pains down the leg in question (marked "New" claim) which I hadn't had before. 

As such, VA performed an MRI which, according to the Radiologist, correlated with my newly complained pains and of which were later affirmed by my Pain Clinic's Doctors. Could those Docs have filed a claim on my behalf?

I got the "New" claim info off eBenefits. Strangely, eBenefits is now showing that the request for the C&P Exam was closed 2 days before I received the call from QTC. Regardless, until VA themselves tell me the request has been closed, I am going to the exam!