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

[carlie]

Just post the material stuff - the material part of your proposal

to reduce is most likely only one page.

[harleyman]

The reason there is no medical opinion is because you are already service connected for Diabetes. So a nexus opinion is NOT required. Since you are already s/c the rater just imputs the findings from the examiner into the evaluation builder and then the evaluation builder tells the rater what your percentage for diabetes should be. Since you were 100% before and now it is tellling the rater to rate you at 40%. That is why they are doing a proposal to reduce.

Your VA records were too old. They may have requested them and got a negative response for records from the VAMC as the archived records are usually a negative response as the VAMC people are to lazy to go look for those old paper records. You will not know what happened until you get a copy or your VAMC records.

If the VAMC does not find the old records the regional office will do Memorandum of no records availible and put it in your file. You will see the MEMO signed off when you get a copy of your VARO records. Which, by the way you should request so you know exactly what is or is not is the c-file.

It really wouldn't have mattered anyway,those old records will not change anything except they might help the VARO to understand that you have type 1 diabetes and not type 2.

The reason they think you have improved is becuase the computer is telling them you have. Like I have said before on a few posts, the VA is not reading the records and raters are not making decisions. They are simply doing DATA ENTRY and the computer is telling the rater what to do. This is mandated by Waashington folks. Files are being top sheeted and raters are nothing more than data entry clerks. They enter the information from the exam into the evaluation builder question by question and the builder tells what percent to rate the condition.

Geagg88, Stick with the game plan, and open claims for all those secondary conditions. File for your hearing within 30 days and meet with the VSO so they can be there with you when you meet with the DRO or rater. The VA will have to order exams for all those secondary conditions you are going to claim, as these conditions are known to be caused by your s/c diabetes. They will have to rate all those secondary conditions separately. Since you have not worked for a really long time, even if they don't add up to 100% schedular, your will get IU as your private doc says you can't work.

Edited July 27, 2013 by harleyman

[Greg88]

Harley, I'm guessing that the VA is using ICD codes so that the computer can "help" with the ratings. The problem with ICD codes is that Type 1 and Type 2 are are interspersed together and input of the last number means a lot. According to the CFR "rules" diabetes rated at 100% should not need all the secondaries claims opened at this point, here are the ratings for Diabetes mellitus :

7913 Diabetes mellitus

Requiring more than one daily injection of insulin, restricted diet,

and regulation of activities (avoidance of strenuous occupational

and recreational activities) with episodes of ketoacidosis or

hypoglycemic reactions requiring at least three hospitalizations per

year or weekly visits to a diabetic care provider, plus either

progressive loss of weight and strength or complications that

would be compensable if separately evaluated ........................................... 100

Requiring insulin, restricted diet, and regulation of activities with

episodes of ketoacidosis or hypoglycemic reactions requiring one

or two hospitalizations per year or twice a month visits to a diabetic

care provider, plus complications that would not be compensable

if separately evaluated ................................................................................... 60

Requiring insulin, restricted diet, and regulation of activities ........................... 40

Requiring insulin and restricted diet, or; oral hypoglycemic agent

and restricted diet .......................................................................................... 20

Manageable by restricted diet only ..................................................................... 10

Note (1): Evaluate compensable complications of diabetes separately unless they are part of the criteria used to support a 100 percent evaluation. Noncompensable complications are considered part of the diabetic process under diagnostic code 7913.

Note 1 being the most important and relevent to my claim.

The DBQ my Dr. submitted last year should have had all the ICD codes layed out, neither my Dr. or I realized the how important they are in the determinations.

[harleyman]

Nope the rater does not enter ICD codes.

The information is taken right off the DBQ forms. Certain combinations of answers to the questions the doctor checks on the DBQ, match up with the evaluation builder. Then the evaluation builder has the information from the 38 CFR schedule for rating that disability. All those little check boxes on the DBQ match up to the evaluation builder, or the vision calculator, or the PTSD evaluation builder or the TBI evaluation builder.

As the rater looks at the DBQ and what boxes are checked he then checks the same boxes or questins in the specific "builder" he is using. Then when done transfering checked boxed information they click enter and the evaluation builder gives him the 38 CFR schedule rating percentage. Take a look at the DBQ for Diabetes. You'll underrstand better once you look at one of the DBQ's.

Edited August 21, 2013 by harleyman

[Greg88]

I have looked at it, it covers a lot of diabetes problems, but it's tilted towards Type 2, it does not show all the complications that affect us Type 1s (granted the ratio of type 2s to type 1s must be 200-1) they have ED under neuropathys, but nothing saying that it's Autonomic neuropathy which also causes my hypoglycemic unawareness and urinary leakage. Like I said the C&P examiner took everything from the DBQ that I handed in with my Dr.s note and put it in her C&P. Harley in the last 15 years Type 1 has been totally eclipsed by Type 2, people in general think their the same, but it's a different situation entirley. I have to say your post on July 27th finally made me realize what there seeing, those ICD codes are very important, I barely paid attention to them, everything that goes in will be detailed, every ICD code will listed in order of importance.

[harleyman]

All the known secondary's will be evaluated on their own DBQ. Your peripheral neuropathy will be evaluated on the PN DBQ. Kidney will be a different DBQ. EYES will be a different DBQ.

Remember before, when I said they were going to break out the DMII by itself. You will probably be only 20% for the diabetes for diet and insulin, unless your having hospitalizations more than two times per year. The VA does not give the 40% rating out very often as most doctors do not restrict your exercise they want you to exercise more. So 40% is hard to get. So it is ususally 20% or 60% depending on severity of the condition.

Once they break everything out you will get ratings for those conditions found during the diabetes exam. PN of the upper and lower extremities, the eyes, kidneys, any thing that your diabetes is causing you problems with will be looked at as possibly secondary to your DMII. Then VA wll use the "combinator" to add everything back up and figure out your true combined disability.

IF YOU HAVE NOT YET CLAIMED ALL THE SECONDARY ISSUES DUE TO DM, YOU NEED TO DO THAT NOW. Do not wait to file a claim for all those conditions and do not trust the VA examiner to examine you for those secondary conditions. They are going to do the least amount of work they have to do, and if they think they can skip an exam, or if they were ONLY ASKED TO ADDRESS THE DM by the rater, then they will only address the DM and not examine you for the other conditions.

PN, Kidney, eyes, ed, all of those things. You want to make sure you have exams and in order to get the exams, you have to file a claim. And you need to provide your CURRENT private medical records for the past two year period in support of your claim.

This can be tricky because I don't know what the VA asked the examiner to do. So YOU need to be pro active.

Edited August 21, 2013 by harleyman