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C & P Exam Rating Re-Opening Old Claims


Hello, I am a 30% rated veteran. i recently submitted additional (new) claims with the VA. I was informed by the VA that they were re-opening some of my old claims which I have been paid for years. My new claims are just that, new I am not trying to increase old injury ratings. I understand that if the VA re-opens an old claim, if your condition has improved - your rating may go down. During my recent C & P exam the QTC doctor re-examined me for old ratings and found me to be much worse off than I was when given my initial rating.

If the VA chooses to re-open a claim (and can reduce your rating) - if you are found to be worse off, can your claim be increased as well??

Your input is appreciated.

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5 answers to this question

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Welcome to Hadit!

The door swings both ways. Improvement may decrease your rating. Worsening can increase your rating.

Increases work differently than initial claims because you might be able to get a better effective date for an increased rating, per the 12 month window (below).

1. Get copies of your C&P results

2. Check the rating criteria for each rated condition they re-opened.

3. Compare your C&P results with the criteria. Some criteria are very cut and dry.

4. Dig through your medical records for the past 12 months. Look for any treatment record where your condition meets any level of an increased rating because they can tier your rating.

5. Make sure this gets pointed out to the VA, in writing, and hope they don't hose it up.

The 12 month period is based on when the claim is reopened. So, if your claim was re-opened on June 1, 2010, look for records going back to June 1, 2009.

Asthma ratings are a good example here because the rating criteria is very obvious. I had a 10% asthma rating for over 10 years. Thanks to Hadit, I learned that a 30% rating is given for daily inhaled steroids and a 60% rating is given for three or more systemic (ingested/injected) steroid treatments in 12 months. I checked my records and found I was put on inhaled steroids last Fall and met the third steroid treatment last Winter. That was within the last 12 months. I gathered my evidence and submitted my claim. They gave me a 30% rating as of Fall and a 60% rating as of Winter. Because my combined rating increased twice, I got tiered retro based on the different effective dates. Of course, they said my 60% rating will be reviewed in a year because they expect it to improve.

I hope this helps.

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That is exactly the type of information that I needed. Armed with this knowledge, I can review my claim accurately. Now.....the waiting game.....waiting on my new rating......I wonder how far backlogged Muskogee is?

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There is really no telling because it varies from RO to RO. I got my asthma increase turned around pretty quick, but my other claims took almost a year.

Just be sure to do your homework. I made my claims almost painfully simple for the VA to process. It was concise and to the point.

Good luck!

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I have attended all of my QTC C&P exams. All paperwork has been filled out. The ball is in their court. It has taken me 5 months to get to this point. Surely, as many claims as they have you would think that it would be in their best interest as well as mine to handle the remaining procedures in a timely matter. Well, that is what *would* make sense anyway - sometimes I forget who I am dealing with....


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