C&p Evaluation For Appeal

[hp1030]

Sir's And Madams:

I will be evaluated this next Friday by C&P in the continuation of my appeal.This after they reduced my disability benefits(2004-2005) from 50% to 10% disabling after over 10 years of this condition been established without any improvement .

The evaluating doctor will be the same doctor that reduced my benefits without even looking at my medical record, as per copy of the evaluation for skin disorders that reduced my benefits.

I have lesions on my face, back, trunk,upper and lower extremities and buttocks, but he wrote that the extent of involvement was only 10%. Should I express my concern to him about this???

Some weeks after, I saw this doctor for the first time as a Dermatologist in consult from my PCC(not a "C&P evaluator") and he wanted to take me to the local Medical School for a conference in regards to my skin condition...???!!! Very interesting case, he said.

I have plenty information from my VA medical records of treatment consult, and procedures for my skin disease and also Independent Medical Opinions, should I bring those to be included with the C&P record?

This taking into consideration that my record was not taken in account at all for the last inaccurate decision.

Any advice or previous experience will be appreciated.

Thanks in Advance;

HP

[Jay Johnson]

Jay:

The doctor did not meet ANY requirement, But they still went ahead and reduced my benefit from 50% to 10 % after over 10 year without improvement and the condition worsening. I have many medical opinions stating so. What else do you think I might need to do?

What else can I Do before Friday??

I thank you guys.

Was the contrary opinion(s) done around the time of the C&P exam? If so, the totallity of the medical evidence should clearly be in your favor and you could appeal on that grounds and, perhaps, CUE it at the same time for reasonable doubt not being used. However, if the C&P was new information and all the RO had to go on (IE - they didn't have any recent IMOs), then you would have to take only the appeals route while adding as much contrary evidence as you can. In the end, you should win, provided you get the right documentation....the VA can't dismiss more qualified doctor's based on less qualified opinions (they do, but they'll lose in the end if you present your case properly).

[hp1030]

Jay:

I have appealed.

This C&P evaluation(next Friday), I guess was ordered by the RO, before deciding if they send the appeal to the board(?).Problem is, it will be the same evaluating doctor who reduced the benefit in the first place.

Yes, all the opinions were done close to the C&P exam.

The RO had information with contrary evidence against the C&P evaluation at his disposal.They allegedly did a "di novo" review!?.

They based the reduction on the % of skin involvement, the C&P doctor said it was 10 percent,with a progressive condition involving face, trunk, upper and lower extremities and the buttocks.????

Please describe "right documentation" and what a "proper case" is if you will.

Because there is nothing more I want right now, with you guys help;

than to win.

Thanks to all in advance.

[Jay Johnson]

Jay:

I have appealed.

This C&P evaluation(next Friday), I guess was ordered by the RO, before deciding if they send the appeal to the board(?).Problem is, it will be the same evaluating doctor who reduced the benefit in the first place.

Yes, all the opinions were done close to the C&P exam.

The RO had information with contrary evidence against the C&P evaluation at his disposal.They allegedly did a "di novo" review!?.

They based the reduction on the % of skin involvement, the C&P doctor said it was 10 percent,with a progressive condition involving face, trunk, upper and lower extremities and the buttocks.????

Please describe "right documentation" and what a "proper case" is if you will.

Because there is nothing more I want right now, with you guys help;

than to win.

Thanks to all in advance.

If the RO is setting you up with a C&P AFTER making a decision to lower you than they are not very sure of their rating in my opinion. They did the same thing to my wife when they tried to lower her....they basically sent us a letter saying she had been lowered, but asked for a C&P at the same time, which is odd. In VA terms, it is more difficult on them to argue a claim down, so starting you off on a lower level gives them the upper ground. Basically, in order to lower a claim the VA is "supposed" to have new, material evidence that outweighs prior evidence and a mere review (short of CUE) does not meet that standard, but they do it anyway.

Were you seeing a regular doctor for your skin problem during this entire period? The "right documentation" would be any and all information about your disbaility that is as recent as possible.

Also, find out what this C&P doctor's credentials are....does he specialize in skin disorders? Is he an MD, PA, NP, etc? What is your primary doctor's credentials? Is he a specialist? If not, can you see one ASAP?

The VA does this stuff all the time.. they see a case that looks iffy and they get some doctor to go over the medical records as a basis for lowering the case (without even seeing the veteran). This can work if the vet has not been seeing a regular doctor and has no recent medical evidence to back up a claim, but if you have recent medical opinions this doctor's opinion will mean very little.

So, don't panic or anything and get as much medical evidence as you can and see where it goes. You may even want to consider a CUE at this point because lowering based on a single doctor's review of your case seems like a violation of the regs (unless that doctor could prove CUE himself).

[hp1030]

Jay:

I have to see a "regular" doctor since my condition continues to worsen. All this information has been provided to VA.

Is there a criteria or a format to prepare a CUE claim???

Should I wait for the resolution of this matter?? recently I called the regional office and they said I only had my appeal on file no more claims, and this is not true.Do they stop all claim to go ahead with the appeal??

Thanks in advance to all.

HP

[Berta]

This isn't a scenario for a CUE claim at all.

CUE info can be found here under the search feature.

It appears to me that they have not considered all of your medical evidence-

I dont know what type of skin disorder you have but I suugest you go to the BVA web site and search it and see how they determined the ratings for it-

then again it should be in the proposed reduction paperwork-

Your medical evidence has to support that you still warrant the 50% based on the Schedule of Ratings for your skin disability.

[Jay Johnson]

This most certainly could be a CUE claim, as the VA may have violated both reg 3.102 and 3.104, but that depends, in part, on whether or not you furnished them with "new and material evidence", which would allow them to reopen and review the case (the VA cannot reopen a case based on old information unless it determines CUE on itself, even though they do all the time).

Even if you did prompt the review with new medical evidence, you may still have a CUE claim with reasonable doubt (3.102), but that is a very grey area to be in. Basically, if all of your prior information says you are 50% and all of your new information says you are worse than before, one doctor's opinion cannot meet the reasonable doubt criteria.

However, if, as berta says, they made a scheduling error in the first place (IE - your disorder did not warrant a 50%), then you have a very uphill battle and no CUE would apply. But, I'm doubting this is the case, though it's possible.

To me, this is another great reason why vets should NEVER use VA health care. I don't care what they say about the medical part being separate from the compensation part, once you add new medical evidence to your Cfile, they can review you whenever they see fit. If you go to a civilian they are not privy to that "new and material evidence".