[VA Raters - Can they lower existing disability ratings?]

6 minutes ago, jfrei said:

Yup but yes they could lower it if they see improvement it’s harder to do that when’s it’s P and T. 

Got it. I appreciate the feedback!

[VA Raters - Can they lower existing disability ratings?]

9 minutes ago, jfrei said:

I actually meant your headaches a and p sorry since it says your chronic fatigue causes headaches I’m trying to see if ones secondary connected to each other. Kinda like my headaches are service connected due to my TBI 

Ah, got it. My headaches are listed as secondary to Fibro. That was from my initial claim notes, not addressed in the latest CFS claim

PTSD is a straight combat stand alone.

Hope that clarifies.

-M1

[VA Raters - Can they lower existing disability ratings?]

3 hours ago, jfrei said:

Hey honestly what was the cause of the fatigue syndrome. Did they list any of the other ones as being the cause. Just guessing headaches or ptsd? If that’s the cause they may try to combine them together so you don’t hit that mark. Can you attach a copy of the C and P?

Added to main post

[VA Raters - Can they lower existing disability ratings?]

Thanks for the info broncovet! Will research that as well.

[VA Raters - Can they lower existing disability ratings?]

I added the exam notes to the main.body of the question.

Thanks for replying jfrei.

[VA Raters - Can they lower existing disability ratings?]

Hi all,

Quick question but may not be a quick answer...

During the rating/decision process, can they LOWER a existing rating? I am asking because I recently finished a C&P for CFS (CFS only on the DBQ), and in looking at the DBQ/exam notes, it's written as a definite 60% SC disability with all the proper Nexus and evidence met.

So, via the funny VA math calculations, that 60% CFS would get me to a 100% Schedular (I'm at 90% overall currently).

I am currently rated at the below as an FYI:

50% PTSD

40% FIBRO

30% Headache/Migraine

30% IBS

10% Restless Leg

So I'm wondering if they will try and lower an existing rating so I don't hit my 100%. I don't know why they would, I think all of the SC disabilities I have rate and stand alone (outside of my 50% PTSD rating, all based on Gulf War Syndrome/undiagnosed illness etc.).

My existing ratings are only about two years old, so not much has changed regarding symptoms or therapy. So no new evidence has been offered for those.

So what do you think? Will they lower any existing to keep me off the 100% total rating?

Thanks all in advance, below are the Exam Notes:

 1. Diagnosis

 ------------
 Does the Veteran now have or has/she ever been diagnosed with chronic 
fatigue
 syndrome?
 [X] Yes [ ] No
 
 [X] Chronic fatigue syndrome
 ICD code: R53.82
 Date of diagnosis: 2014
 2. Medical History
 ------------------
 a. Describe the history (including onset and course) of the Veteran's chronic fatigue syndrome:
 Veteran was in active service in the U.S. Marine Corps from 10/1989 to
 8/1993 with a tour of duty in Kuwait during the Gulf War. While there
 he was exposed to intense air pollution from burn pits and burning oil
 wells. He subsequently developed chronic fatigue, weakness and general
 malaise made worse by physical exertion and mental stress. He was seen at the Branch Medical Clinic on 3/6/1992 for general malaise. He has since continued to have chronic fatigue which has gradually increased
 as he has become older. When seen in C&P Clinic in 2016 his chronic fatigue was documented but felt possibly to be due to obstructive sleep apnea (OSA). That diagnosis has since been confirmed by Sleep Study and appropriately treated with CPAP with good control. However, he continues to have chronic fatigue and generalized weakness increased 
by physical exertion and mental stress unchanged from before.
  b. Is continuous medication required for control of chronic fatigue 

syndrome?
 [ ] Yes [X] No
 
 c. Have other clinical conditions that may produce similar symptoms been
 excluded by history, physical examination and/or laboratory tests to the
 extent possible?
 [ ] Yes [X] No
 
 If no, describe: Veteran has been diagnosed with OSA which has since been effectively
 treated without improvement in his chronic fatigue. TSH has been WNL on multiple occasions ruling out hypothyroidism.
 
d. Did the Veteran have an acute onset of chronic fatigue syndrome?
 [ ] Yes [X] No
 
 e. Has debilitating fatigue reduced daily activity level to less than 50% of
 pre-illness level?
 [X] Yes [ ] No
 
If yes, specify length of time daily activity level has been reduced 
to less than 50% of pre-illness level:
 [ ] Less than 6 months [X] 6 months or longer
 
 3. Findings, signs and symptoms
 -------------------------------
 a. Does the Veteran now have or has the Veteran had any findings, signs and
 symptoms attributable to chronic fatigue syndrome?
 [X] Yes [ ] No
 
 If yes, check all that apply:
 
 [X] Debilitating fatigue
 
 [X] Low grade fever
 
 [X] Nonexudative pharyngitis
 
 [X] Generalized muscle aches or weakness
 
 [X] Fatigue lasting 24 hours or longer after exercise
 
 [X] Headaches (of a type, severity or pattern that is different from
 headaches in the pre-morbid state)
 
 [X] Migratory joint pains
 
 [X] Neuropsychological symptoms
 
 [X] Sleep disturbance
 
 For all checked conditions, describe:
Veteran has constant fatigue limiting physical and mental activities. He tends to have low grade fever with malaise (for which seen in clinic during active service in 3/1992). Intermitent sorethroat improved with rest but returns after phsycial exertion and mental stress.  Generalized weakness and muscle aches are contatnly present. Veteran state that increased fatigue after physical exertion will last from hours to days
 (up to 1 week). Veteran has intermitent headaches 2-3 times per week.
 He states that he has constant joint pains involving shoulders, 
elbows,
 knees, hands and feet. His sleep is disturbed by OSA for which he 
uses
 CPAP and by nightmares. He has to constantly change position at night
 due to myalgias and arthralgias.
 
 b. Does the Veteran now have or has the Veteran had any cognitive impairment
 attributable to chronic fatigue syndrome?
 [X] Yes [ ] No
 
 If yes, check all that apply:
 
 [X] Poor attention
 
 [X] Inability to concentrate
 
 [X] Forgetfulness
 
 [X] Confusion
 
 For all checked conditions, describe:
 Poor attention span, inability to concentrate and forgetfullness are constantly present. He has mild confusion when he is extremely
 fatigue.
 
 c. Specify frequency of symptoms:
 
 [X] Symptoms are nearly constant
 
 For checked conditions, describe:
 fatigue, generalized weakness, poor attention, inability to concentrate and forgetfullness are almost constantly present. Confusion waxes and wanes and mainly occurs with extreme fatigue after exertion and mental stress.
 

 d. Do the Veteran's symptoms due to chronic fatigue syndrome restrict 
routine
 daily activities as compared to the pre-illness level?
 [X] Yes [ ] No
 
 If yes, specify % of restriction (check all that apply):
 
 [X] Symptoms restrict routine daily activities to less than 50% of the pre-illness level.

e. Do the Veteran's symptoms due to chronic fatigue syndrome result in
 periods of incapacitation?
 [X] Yes [ ] No
 

If yes, indicate total duration of periods of incapacitation over the past 12 months:
 [ ] Less than 1 week
 [ ] At least 1 but less than 2 weeks
 [ ] At least 2 but less than 4 weeks
 [ ] At least 4 but less than 6 weeks
 [X] At least 6 weeks total duration per year
 [ ] Other, describe:
 4. Other pertinent physical findings, scars, complications, conditions, signs, symptoms and scars
 -----------------------------------------------------------------------
 a. Does the Veteran have any other pertinent physical findings,
 complications, conditions, signs or symptoms related to any conditions
 listed in the Diagnosis Section above?
 [ ] Yes [X] No
 
 b. Does the Veteran have any scars (surgical or otherwise) related to any
 conditions or to the treatment of any conditions listed in the Diagnosis Section above?
 
 Yes [X] No [ ]
 
 5. Diagnostic testing
 ---------------------
 Are there any significant diagnostic test findings and/or results?
 [ ] Yes [X] No
 
 6. Functional impact
 --------------------
Does the Veteran's chronic fatigue syndrome impact his or her ability 
to work?
 [X] Yes [ ] No
 
 If yes, describe the impact of the Veteran's chronic fatigue syndrome, providing one or more examples:
Veteran is limited in his ability to perform work that requires physical exertion due to worsening fatigue and generalized weakness. He is also limited in his ability to perform work that requires mental alertness and concentration and involves mental stress due to his difficulties with concentration and forgetfullness and an increase in his fatigue.

7. Remarks, if any:
 -------------------
 The veteran's chronic fatigue syndrome is a diagnosable but medically unexplained chronic multisymptom illness of unknown etiology,