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

[justrluk]

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 March 26, 2015 by justrluk

[justrluk]

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...

[broncovet]

That sounds like a favorable or even highly favorable c and p exam. It sounds like you are "unable to work" but dont have "pain productive of severe economic inadaptability".

[Guest]

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 April 15, 2015 by pete992