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Va Opened A Request For Increase For A Condition Already At Max %


justrluk

Question

Now I'm really puzzled. I'm almost finished with the items in the remand order for my appeal, and suddenly (today) a new claim - request for increase - pops up for a condition already rated the maximum. Doesn't say "Administrative Review", but request for increase. I know they can review any condition at any time, but really don't understand why they would pick this condition now. Any thoughts???

EDIT: The claim is dated 2/27/2015. Not dated anywhere near another anniversary event, appeal activity, nada... 6 years, 7 months since the date of increase to max % for this condition.

Edited by justrluk (see edit history)
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I'm rated at 70% for another condition. I'm wondering if either they thought the condition should have been increased earlier or if it is the periodic review of the rating itself. Who knows!

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Update: I contacted the VAMC where the C&P is scheduled. The person working/scheduling confirmed it was a claim for increase. When I told her I was already @ max for the condition, she said it was definitely a re-evaluation. NOW, I'm nervous! Also, it was to be scheduled ASAP, so I go Saturday (this Saturday) at 0830. Geez - won't be able to get neurologist records by then to present/discuss while at the C&P.

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This happened to me bud, I submitted an FDC in Nov 14 for a few previously denied conditions and a few new Secondarys. Claim was at Prep for Decision from Dec-Jan 14. Then all of a sudden in Feb in went back to Gathering of Evidence and the RO scheduled multiple C&Ps and a few Reviews including my PTSD which I was not up for Review until Feb 2016. Those Review exams were brutal especially the PTSD review which was over 2 hours long. It ended up backfiring on the VA though, all of my conditions will continue and a few look to even be increased. Just go in there and be honest, and you have nothing to worry about. Good luck and God Bless!!! Keep us posted

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  • HadIt.com Elder

The last line of your rating is SMC for loss of reproductive organ. It sounds a little like your getting 100% compensation plus Special Monthly Compensation for a service connected condition rated 60%. If you go scrolling down the list of topics on this forum you'll find one on Bradley v. Peake and Howell v. Nicholson involving housebound benefits. I suggest you read that topic and read Howell v. Nicholson carefully.

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Update: saw the C&P results in my healtEVet file pull. The doc answered the question:
Does the Veteran's treatment plan include taking medication for the diagnosed condition?
[X] Yes [ ] No
If yes, describe treatment (list only those medications used for the diagnosed condition):
see above
3. Symptoms
-----------
a. Does the Veteran experience headache pain?
[X] Yes [ ] No
[X] Pulsating or throbbing head pain
[X] Pain localized to one side of the head
[X] Pain worsens with physical activity
[X] Other, describe:
(description...)
b. Does the Veteran experience non-headache symptoms associated with headaches? (including symptoms associated with an aura prior to headache
pain)
[X] Yes [ ] No
[X] Nausea
[X] Sensitivity to light
[X] Sensitivity to sound
[X] Changes in vision (such as scotoma, flashes of light, tunnel vision)
[X] Sensory changes (such as feeling of pins and needles in extremities)
c. Indicate duration of typical head pain
[X] More than 2 days
d. Indicate location of typical head pain
[X] Right side of head
[X] Other, describe:
(redacted)
4. Prostrating attacks of headache pain
---------------------------------------
a. Migraine / Non-Migraine- Does the Veteran have characteristic prostrating attacks of migraine / non-migraine headache pain?
[X] Yes [ ] No
If yes, indicate frequency, on average, of prostrating attacks over the last several months:
[X] Once every month
b. Does the Veteran have very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability?
[ ] Yes [X] No
5. Other pertinent physical findings, complications, conditions, signs and/or symptoms
-----------------------------------------------------------------------------
a. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis section above?
[ ] Yes [X] No
b. Does the Veteran have any other pertinent physical findings, complications, conditions, signs and/or symptoms related to any conditions listed in the Diagnosis section above?
[ ] Yes [X] No
6. Diagnostic testing
---------------------
Are there any other significant diagnostic test findings and/or results?
[ ] Yes [X] No

7. Functional impact
--------------------
Does the Veteran's headache condition impact his or her ability to work?
[X] Yes [ ] No
If yes, describe the impact of the Veteran's headache condition, providing one or more examples:
see history above
8. Remarks, if any:
-------------------
No remarks provided.
(dr. signature)

My concern is the response to the statement:
"4. Prostrating attacks of headache pain:
...
b. Does the Veteran have very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability?
[ ] Yes [X] No"
...

while adding:
"Does the Veteran's headache condition impact his or her ability to work?
[X] Yes [ ] No
If yes, describe the impact of the Veteran's headache condition, providing one or more examples: (described in detail while providing data regarding the number of days missed due to migraine or migraine impact)."

Now, I'm waiting for the proposal to reduce the rating from 50% (max) because of the answer provided for 4.b. Great. Just what I needed...

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Update: saw the C&P results in my healtEVet file pull. The doc answered the question:

Does the Veteran's treatment plan include taking medication for the diagnosed condition?

[X] Yes [ ] No

If yes, describe treatment (list only those medications used for the diagnosed condition):

see above

3. Symptoms

-----------

a. Does the Veteran experience headache pain?

[X] Yes [ ] No

[X] Pulsating or throbbing head pain

[X] Pain localized to one side of the head

[X] Pain worsens with physical activity

[X] Other, describe:

(description...)

b. Does the Veteran experience non-headache symptoms associated with headaches? (including symptoms associated with an aura prior to headache

pain)

[X] Yes [ ] No

[X] Nausea

[X] Sensitivity to light

[X] Sensitivity to sound

[X] Changes in vision (such as scotoma, flashes of light, tunnel vision)

[X] Sensory changes (such as feeling of pins and needles in extremities)

c. Indicate duration of typical head pain

[X] More than 2 days

d. Indicate location of typical head pain

[X] Right side of head

[X] Other, describe:

(redacted)

4. Prostrating attacks of headache pain

---------------------------------------

a. Migraine / Non-Migraine- Does the Veteran have characteristic prostrating attacks of migraine / non-migraine headache pain?

[X] Yes [ ] No

If yes, indicate frequency, on average, of prostrating attacks over the last several months:

[X] Once every month

b. Does the Veteran have very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability?

[ ] Yes [X] No

5. Other pertinent physical findings, complications, conditions, signs and/or symptoms

-----------------------------------------------------------------------------

a. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis section above?

[ ] Yes [X] No

b. Does the Veteran have any other pertinent physical findings, complications, conditions, signs and/or symptoms related to any conditions listed in the Diagnosis section above?

[ ] Yes [X] No

6. Diagnostic testing

---------------------

Are there any other significant diagnostic test findings and/or results?

[ ] Yes [X] No

7. Functional impact

--------------------

Does the Veteran's headache condition impact his or her ability to work?

[X] Yes [ ] No

If yes, describe the impact of the Veteran's headache condition, providing one or more examples:

see history above

8. Remarks, if any:

-------------------

No remarks provided.

(dr. signature)

My concern is the response to the statement:

"4. Prostrating attacks of headache pain:

...

b. Does the Veteran have very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability?

[ ] Yes [X] No"

...

while adding:

"Does the Veteran's headache condition impact his or her ability to work?

[X] Yes [ ] No

If yes, describe the impact of the Veteran's headache condition, providing one or more examples: (described in detail while providing data regarding the number of days missed due to migraine or migraine impact)."

Now, I'm waiting for the proposal to reduce the rating from 50% (max) because of the answer provided for 4.b. Great. Just what I needed...

The Crazy one here, sorry just took my first round of meds so my brain is really off.

Be proactive, contact the C & P Office to give a message to the C & P examiner to do an addendum or a correction and state that he should have checked yes in block 4b.

Like I said I maybe off but without some type of remark provided the exam is not complete but the rater may make a decision.

Edited by pete992 (see edit history)
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