diabetes So I Received The Proposal To Reduce

[Greg88]

So the VA sent the Proposal to Reduce my Diabetes Type 2 from 100% to 40%, theirs only 1 problem, I don't have Type 2 I have Type 1. I have been at 100% for the last 15.5 years and 60% before that. I used the VA healthcare for 22 years for my diabetes and then switched to my present private Dr. 17 years ago, I continued to use the VA till 2002 or 2003 for my eye checks. When I went to the C&P exam in Sept. 2012, I brought a DBQ for diabetes filled out by my Dr., a letter from my Dr. explaining my condition and present complications, and that in his opinion it was permanent and total (he is the head of Internal medicine for a big NY hospital) the only evidence that was reviewed was the Medical records going back to 2004 that I brought and the DBQ that I brought. I'm writing up the letter for the hearing, I'll bring it down Monday. I guess that battle begins now for real.

Edited July 26, 2013 by Greg88

[Greg88]

Hi guys, my hearing is set up for the beginning of Oct, I see my private MD next week and are getting a new IMO letter from him and having him fill out a new DBQ. The new DBQ will cover the things he treats me for, the VA has already proven the retinopathy, peripheral neuropathy, and ED. The ignored the autonomic neuropathy (which causes most of the life threatining problems) because it's not on the DBQ, though ED is a sign of Autonomic neuropathy and the NP who did my C&P exam saw it, my blood sugar when I left the exam was 48.

I talked to my DAV rep today and it looks like he like most people have no real knowledge of diabetes mellitus type 1 and he admits to it. So I have to go to the hearing without a real knowledgable backup. I can talk about the medical aspects of my condition, I'm just worried I may be tripped up by some hidden CFR rule. To be truthful it's like George Carlin said: "the game is rigged"

[Philip Rogers]

Best thing you can do is follow Harleyman's advice. As for a VSO, you don't need one. You have your evidence. Bring your diary of insulin taken and your prescription records and you should be golden. jmo

pr

[broncovet]

An attorney who represents Veterans, Katrina Eagle, suggests you NOT argue that your conditions complies with the current rating schedule. You do not need to prove you meet the rating criteria. Instead, if you are P and T and/or your rating has stabalized (more than 5 years, not 20 years), then the VA has to prove your rating "actually improved" under ordinary conditions of life, ie, working. Further, if your rating was continued, while you were rated with other issues, then the VA will have to show how it improved since that rating decision. Stare decisis prevents VA from re rating you each time your condition "waxes and wanes", where everyone, inevitably, has "good days" and bad days.

This difference is important. Dont try to prove you meet the rating criteria. Make the VA show you "actually improved". The burden is on them.

Read Katrina's take on reductions thoroughly and see how it applies to you:

http://www.jimstrickland912.com/Reductions.html

[Greg88]

Broncovet, I had read Katrina Eagles essay on it and it had slipped my mind about arguing conditions (nobody else mentions these things even though the CFR states it). This is the funny thing here, I thought they had to look at the C&P exam from 1997 and compare it to the 2012, they keep using the rating schedule as there reason (even though they say you must have all the problems listed, they forgot to include the "or", they say you must have A, B, C, D the ratings say A or B, C or D.

Like I metioned earlier I have not worked for 16 years due to the diabetes, so the CFR say's you must show "material improvement", all they say in their proposal "we noted some improvement" but compared to what. Compared to the C&P in 1998 I'm operating at 15-20% of that level now. They see improvement compared to what and they do not go into any detail on exactly where they see improvement.

[harleyman]

Gregg88, they are not comparing your exams. They are comparing your new exam"findings" with the rating schedule for DMII. (I know you have DM I ). Anyways they are looking at the newest exam as compared to the current rating schedule for DMII and what percent of disability you are currently rated at.

Initially they are looking to break out the diabetes from the secondary conditions. Which means a reduction in the diabetes rating. Once the secondary conditions are rated they will be added to the total combined disability. I know they examined you for at least some of the secondary coniditions as you said your exam was 38 pages long. DMII is usually only about 8 or so pages. SO they must have looked and some of the secondarys.

Like you said, they do not understand nor do they have provisions for all the issues involved with DM type I. That's where you need to be proactive and open a claim for all the secondary conditions that you have not had to claim until now.

The VA will order OPINION exams for all those conditions too. Then then will have a complete picture of your DM I and your current secondary conditions. You may end up getting SMC out of this if your diabetes is a serious with hospitalizations and medications as you have been relateng to us here. Hang in there, but do file those claims for ALL your secondary conditions, as you are entitled to being service connecting for them.

Edited August 23, 2013 by harleyman

[Greg88]

Harley, yes but according to the CFR before they reduce they have to be able to look at a baseline ie: the exam in 1997 and all the medical history that preceded it. It's not smart to say well I see you as being somewhat improved, you need to compare especially in medicine. As broncovet said it's not a matter of arguing what has already been decided 15.7 years ago, there not showing any material improvement, truth be told how they see improvement is something I find amazing. They say they see improvement, but they don't say where.

In the proposal they freely admit to the neuropathy, retinopathy and ED, the C&P examiner stated she saw signs of the Autonomic neuropathy, but there's no box for it so they act like it does not exist. Actually Harley if they would have read the letter and DBQ that my Dr. prepared, then I would not where I'am. I also like how they completley omit any mention of IU, which they should be looking at, according to the CFR 3.343. I really think this is all because of in 4 years, I'm at 20 years.

Going back through the documentation, it really pisses me off that they say "the evaluation for diabetes mellitus was not considered permanent", for 23 years they provided me with insulin and they don't think it's permanent.