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Administrative Review/gathering Evidence After Rating Decision Received


lotzaspotz

Question

We received a July 2014 rating decision, effective January 2014, of a 10% disability for coronary artery disease/IHD presumptive to AO exposure filed in January 2014. We did not appeal it. Looking in E-benefits today, I noticed that the claim is under Administrative Review, is in the Gathering Evidence phase, and that a development letter has been mailed, which we have not yet received. It specifically references the IHD claim. The VA has also apparently mailed my husband's cardiologist (non-VA) a request for the records that we had already provided prior to the rating decision that was based upon those records.

I've seen all this occur prior to a rating decision, but not afterwards. Does anyone have any idea of what gives here?

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If they were aware of the private cardio records and did not attain them prior to the decision, or consider them at all, when received from you, It looks to me that they called a CUE on themselves and are attempting to fix it.

Those cardio records might be critical to a proper IHD rating because the 10% might be too low.

Did your husband ever claim the IHD in any past claim that was denied prior to Nehmer 2010 regulations?

Or did IHD appear as NSC with a percentage in any past rating regarding other disabilities?

If so,under Footnote One of the Nehmer training guide by NVLSP, that could impact on his retro and EED.

The letter will hopefully tell you more.

"I've seen all this occur prior to a rating decision, but not afterwards."

Yes , me too.

When VA has probative evidence ,that could manifest an altered outcome, and they do not consider it or mention it is the Evidence list of a decision they have violated 38 CFR 4.6.

Footnote one is explained here:








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Thanks, Berta. We never filed a claim for IHD prior to December 2013 when my husband was first diagnosed, and he had the stent surgery in January 2014. The VA never filed an inferred claim, either, and there was no prior rating, not even at 0%.

I was wondering if they're trying to reduce it.

There is no retro involved, we filed because of the cardiac nature of the condition. My husband is already 100% P & T schedular.

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I think a 10% rating is too low. I have 60% and I think I may be in better shape than your husband.. I started out at 0% but appealed with new evidence and got 60%. When I got the 0% thanks to idiotic C&P done by ARPN, I asked my PCP for some testing. I got testing and appealed the rating. I was TDIU at the time and the 60% I got was good enough to get SMC "S". Does your hubby have DMII? You still have time to appeal it. I would appeal considering the stent and current condition of the heart. What kind of meds is your husband on now?

John

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John, my husband doesn't have DMII. As far as his medications, he takes a bunch. A number of them related to total hormone replacement, including CORTEF and Depotestosterone injections bi-weekly. HTHZ. Niacin and blood pressure meds, a statin for cholesterol, and blood thinner meds.

We have an appeal headed to the Board for denial of SMC(s) due to the fact that the RO told my husband solely because he's already 100% P & T schedular rated, he's ineligible for consideration for TDIU. His highest rating is 60% for the hormonal disorder caused by a pituitary brain tumor, and the next highest is 50% for organic mental syndrome caused by the tumor. He's on SS disability due solely to the condition rated at 50%.

I'm just wondering if what I initially posted about has anyting to do with this or perhaps, to the other extreme, they're trying to lower the IHD rating.

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No C&P Exam and they made a decision? Did you file a Fully Developed Claim? This also could be a reason they didn't do a C&P Exam. A FDC is if a private or some other doctor performed the examination on him. Then the VA won't do a C&P exam unless its critical. They are trying to get away from C&P Exams IMO to save money and I think they are tired of the "quotas" the C&P examiners are doing in getting claims denied.

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Yes, we sent in the private medical records, and that was all. No C&P, and that's the first time that has happened in 21 years. As I mentioned previously, I've seen a claim under administrative review and evidence gathering before a rating decision was made and the veteran notified, but never after.

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