I was rated in March of 2008, over 6 years ago. I have not been back to the VA since my rating. The time spend dealing with the claim process was one of the hardest times in my life. Since my rating, I have been fired twice, laid-off twice, divorced twice, had a child, remarried a third time, and have had 6 different jobs. The mother of my child does not let me have a relationship with her because of the issues I have. My problems are not better, I am not better. I have moved at least 10 different times. I have changed VA regional offices at least 4 times, and have lived over seas on two separate occasions for work. The VA tried to examine me for an increase in 2010, but due to me being overseas, and moving so often it was impossible to schedule the exam. In Jan of 2012 I was notified that the claim was closed, no changes were made. Today I go on ebenifits to check the status of the dependent adjustment I made in 2012, and found out that a claim type "predetermination" with the contentions of "Due Process/propose to reduce for PTSD (New)" was open on 25 Jan 2012, the day after my last claim was closed. I was NEVER notified of this claim being opened. I was NEVER scheduled for an appointment. It was NEVER requested of me to provide documentation on equip. The status of this claim is currently "Pending Decision Approval". Upon noticing the claim I called the VA and requested the information on what exactly this is. I was told it is not a "claim" it is a predetermination stating they will be reducing my my rating due to the fact they could not adequately contact me. Since the 2012 claim was initiated, I purchased a home using a VA loan, I also opened a dependent claim with the same VARO. NOT one single time did they notify me or request me attend a C&P exam. I promptly requested the VA lady help with this and clear the matter up prior to the Decision Approval, and then requested the file be transferred to the RO of the State I am currently living and not the International RO. She gladly did this, and was VERY helpful, but she also said that nothing is guaranteed. If a decision is made prior to the new info being reviewed there will be nothing I can do other than request a hearing. I also immediately called the DAV and requested the personally visit the office and ensure that I am more than willing to go to a C&P exam, and for them to schedule it immediately.
I realize the correct action is to go to therapy, go to meetings, but when there are people counting on my income for support, and I have to continually move from contract to contract to provide this income, the VA becomes a last priority. As most everyone holding down a schedule, a job, a live, a relationship with PTSD is hard enough. I cope, and deal the best ways I can. It has nearly cost me my life more than once, but it has provided for a better life for the ones who count on me. Being expected to go into meetings to talk about life enrages me. I cannot do it, and being expected to go is intolerable for me. SO WHY DOES THE VA INSIST ON MAKING IT EVEN HARDER BY REDUCING A STABLE RATING????? This is speculative. The decision has not been made, and this could be all for not, but it has me scared that my life and family will now suffer more at the hands of these people.
Now my questions are:
1) How can they legally reduce the rating after 5 years without an examination disclosing an improvement. The federal code (see below) is clear on this, and no examination has been completed.
2) How can they legally reduce a rating without due process of notification?
3) Can a "predetermination" type claim be withdrawn prior to decision approval?
4) What is the opinion of the members here when it comes to fighting this during a hearing if the VA decides to follow through with the reduction? Do I have a leg to stand on????
§3.344 Stabilization of disability eval- uations.
(a) Examination reports indicating im-provement. Rating agencies will handle cases affected by change of medical findings or diagnosis, so as to produce the greatest degree of stability of dis- ability evaluations consistent with the laws and Department of Veterans Af- fairs regulations governing disability compensation and pension. It is essential that the entire record of examina- tions and the medical-industrial his- tory be reviewed to ascertain whether the recent examination is full and com- plete, including all special examina- tions indicated as a result of general examination and the entire case his- tory. This applies to treatment of intercurrent diseases and exacer- bations, including hospital reports, bedside examinations, examinations by designated physicians, and examina- tions in the absence of, or without tak- ing full advantage of, laboratory facili- ties and the cooperation of specialists in related lines. Examinations less full and complete than those on which pay- ments were authorized or continued will not be used as a basis of reduction. Ratings on account of diseases subject to temporary or episodic improvement, e.g., manic depressive or other psy- chotic reaction, epilepsy, psycho- neurotic reaction, arteriosclerotic heart disease, bronchial asthma, gas- tric or duodenal ulcer, many skin dis-eases, etc., will not be reduced on any one examination, except in those in- stances where all the evidence of record clearly warrants the conclusion that sustained improvement has been demonstrated. Ratings on account of diseases which become comparatively symptom free (findings absent) after prolonged rest, e.g. residuals of phlebitis, arteriosclerotic heart disease, etc., will not be reduced on examinations reflecting the results of bed rest. Moreover, though material improvement in the physical or mental condition is clearly reflected the rating agency will consider whether the evidence makes it reasonably certain that the improvement will be maintained under the ordinary conditions of life. When syphilis of the central nervous system or alcoholic deterioration is diagnosed following a long prior history of psychosis, psychoneurosis, epilepsy, or the like, it is rarely possible to exclude persistence, in masked form, of the preceding innocently acquired manifestations. Rating boards encountering a change of diagnosis will exercise caution in the determination as to whether a change in diagnosis rep- resents no more than a progression of an earlier diagnosis, an error in prior diagnosis or possibly a disease entity independent of the service-connected disability. When the new diagnosis reflects mental deficiency or personality disorder only, the possibility of only temporary remission of a superimposed psychiatric disease will be borne in mind.
(b) Doubtful cases. If doubt remains, after according due consideration to all the evidence developed by the several items discussed in paragraph (a) of this section, the rating agency will con- tinue the rating in effect, citing the former diagnosis with the new diag- nosis in parentheses, and following the appropriate code there will be added the reference ‘‘Rating continued pend- ing reexamination lll months from this date, §3.344.’’ The rating agency will determine on the basis of the facts in each individual case whether 18, 24 or 30 months will be allowed to elapse before the reexamination will be made.
Question
Ryan H.
Hi all.... this place saved me once, maybe again.
I was rated in March of 2008, over 6 years ago. I have not been back to the VA since my rating. The time spend dealing with the claim process was one of the hardest times in my life. Since my rating, I have been fired twice, laid-off twice, divorced twice, had a child, remarried a third time, and have had 6 different jobs. The mother of my child does not let me have a relationship with her because of the issues I have. My problems are not better, I am not better. I have moved at least 10 different times. I have changed VA regional offices at least 4 times, and have lived over seas on two separate occasions for work. The VA tried to examine me for an increase in 2010, but due to me being overseas, and moving so often it was impossible to schedule the exam. In Jan of 2012 I was notified that the claim was closed, no changes were made. Today I go on ebenifits to check the status of the dependent adjustment I made in 2012, and found out that a claim type "predetermination" with the contentions of "Due Process/propose to reduce for PTSD (New)" was open on 25 Jan 2012, the day after my last claim was closed. I was NEVER notified of this claim being opened. I was NEVER scheduled for an appointment. It was NEVER requested of me to provide documentation on equip. The status of this claim is currently "Pending Decision Approval". Upon noticing the claim I called the VA and requested the information on what exactly this is. I was told it is not a "claim" it is a predetermination stating they will be reducing my my rating due to the fact they could not adequately contact me. Since the 2012 claim was initiated, I purchased a home using a VA loan, I also opened a dependent claim with the same VARO. NOT one single time did they notify me or request me attend a C&P exam. I promptly requested the VA lady help with this and clear the matter up prior to the Decision Approval, and then requested the file be transferred to the RO of the State I am currently living and not the International RO. She gladly did this, and was VERY helpful, but she also said that nothing is guaranteed. If a decision is made prior to the new info being reviewed there will be nothing I can do other than request a hearing. I also immediately called the DAV and requested the personally visit the office and ensure that I am more than willing to go to a C&P exam, and for them to schedule it immediately.
I realize the correct action is to go to therapy, go to meetings, but when there are people counting on my income for support, and I have to continually move from contract to contract to provide this income, the VA becomes a last priority. As most everyone holding down a schedule, a job, a live, a relationship with PTSD is hard enough. I cope, and deal the best ways I can. It has nearly cost me my life more than once, but it has provided for a better life for the ones who count on me. Being expected to go into meetings to talk about life enrages me. I cannot do it, and being expected to go is intolerable for me. SO WHY DOES THE VA INSIST ON MAKING IT EVEN HARDER BY REDUCING A STABLE RATING????? This is speculative. The decision has not been made, and this could be all for not, but it has me scared that my life and family will now suffer more at the hands of these people.
Now my questions are:
1) How can they legally reduce the rating after 5 years without an examination disclosing an improvement. The federal code (see below) is clear on this, and no examination has been completed.
2) How can they legally reduce a rating without due process of notification?
3) Can a "predetermination" type claim be withdrawn prior to decision approval?
4) What is the opinion of the members here when it comes to fighting this during a hearing if the VA decides to follow through with the reduction? Do I have a leg to stand on????
§3.344 Stabilization of disability eval- uations.
(a) Examination reports indicating im-provement. Rating agencies will handle cases affected by change of medical findings or diagnosis, so as to produce the greatest degree of stability of dis- ability evaluations consistent with the laws and Department of Veterans Af- fairs regulations governing disability compensation and pension. It is essential that the entire record of examina- tions and the medical-industrial his- tory be reviewed to ascertain whether the recent examination is full and com- plete, including all special examina- tions indicated as a result of general examination and the entire case his- tory. This applies to treatment of intercurrent diseases and exacer- bations, including hospital reports, bedside examinations, examinations by designated physicians, and examina- tions in the absence of, or without tak- ing full advantage of, laboratory facili- ties and the cooperation of specialists in related lines. Examinations less full and complete than those on which pay- ments were authorized or continued will not be used as a basis of reduction. Ratings on account of diseases subject to temporary or episodic improvement, e.g., manic depressive or other psy- chotic reaction, epilepsy, psycho- neurotic reaction, arteriosclerotic heart disease, bronchial asthma, gas- tric or duodenal ulcer, many skin dis-eases, etc., will not be reduced on any one examination, except in those in- stances where all the evidence of record clearly warrants the conclusion that sustained improvement has been demonstrated. Ratings on account of diseases which become comparatively symptom free (findings absent) after prolonged rest, e.g. residuals of phlebitis, arteriosclerotic heart disease, etc., will not be reduced on examinations reflecting the results of bed rest. Moreover, though material improvement in the physical or mental condition is clearly reflected the rating agency will consider whether the evidence makes it reasonably certain that the improvement will be maintained under the ordinary conditions of life. When syphilis of the central nervous system or alcoholic deterioration is diagnosed following a long prior history of psychosis, psychoneurosis, epilepsy, or the like, it is rarely possible to exclude persistence, in masked form, of the preceding innocently acquired manifestations. Rating boards encountering a change of diagnosis will exercise caution in the determination as to whether a change in diagnosis rep- resents no more than a progression of an earlier diagnosis, an error in prior diagnosis or possibly a disease entity independent of the service-connected disability. When the new diagnosis reflects mental deficiency or personality disorder only, the possibility of only temporary remission of a superimposed psychiatric disease will be borne in mind.
(b) Doubtful cases. If doubt remains, after according due consideration to all the evidence developed by the several items discussed in paragraph (a) of this section, the rating agency will con- tinue the rating in effect, citing the former diagnosis with the new diag- nosis in parentheses, and following the appropriate code there will be added the reference ‘‘Rating continued pend- ing reexamination lll months from this date, §3.344.’’ The rating agency will determine on the basis of the facts in each individual case whether 18, 24 or 30 months will be allowed to elapse before the reexamination will be made.
© Disabilities which are likely to improve. The provisions of paragraphs (a) and (b) of this section apply to ratings which have continued for long periods at the same level (5 years or more). They do not apply to disabilities which have not become stabilized and are likely to improve. Reexaminations disclosing improvement, physical or mental, in these disabilities will warrant reduction in rating.
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Berta
"I was rated in March of 2008, over 6 years ago. I have not been back to the VA since my rating." I think that is the problem. "I was told it is not a "claim" it is a predetermination stating the
broncovet
You have to (stay) be in treatment because: 1. You were in treatment to get rated, nobody gets benefits without a doc's diagnosis. So, if you exit treatement, then you better write and tell em why,
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