Proposed Reduction

[texboyer]

I recently attended a C&P Exam after requesting an increase for Post Lumbar Laminectomy rating of 40%. The examiner could not access my records due to a computer glitch, and refused to review any information I brought with me. I could not perform the forward flexion exam and so she simply wrote it up as 70* (which is impossible for me to achieve). She also answered "No Response" for the question regarding whether I walk with an assistive device (I walk with a VA issued cane) and whether I had debilitating episodes (I was bed ridden for 3 months last year and not allowed to drive or go to work). This triggered a Proposal for Reduction from 40% to 10% for my lumbar condition. They tell me that I must request a hearing to prevent this reduction. I have NO idea how to respond or how to prepare for a Proposed Reduction Hearing. I assume I must request a Hearing, but how do I fight this as it is an obvious issue of a problem with the examiner. She was an NP, by the way.

[Vync]

Did the C&P doctor use a goinometer (see image below) to measure your ROM or did they just "eyeball" it?

If the doctor did not use one, be sure to include that in your response. Far too many CA C&P examiners feel overconfident in their ability to measure ROM degrees. What they do not realize is the fact that just a one degree difference can mean being assigned an incorrect rating percentage tier.

Keep in mind the VA's C&P doctor is not the final decision here. If you can get evidence from your doctor, preferably a specialist, showing you meet criteria to help maintain your 40% rating, get and submit it.

[SemperFiGeek]

If you are still within the 60 days from the date of the proposed reduction letter then file a new claim for increase for that issue. It will trigger a new exam.

Edited February 26, 2016 by SemperFiGeek

[ndy856]

On 2/26/2016 at 12:20 PM, SemperFiGeek said:

If you are still within the 60 days from the date of the proposed reduction letter then file a new claim for increase for that issue. It will trigger a new exam.

you know what Material Improvemet mean? not going to VA hospital or Clinic in the 5 years would mean improvement? I'm 100 P&T

[ndy856]

On 2/26/2016 at 12:20 PM, SemperFiGeek said:

If you are still within the 60 days from the date of the proposed reduction letter then file a new claim for increase for that issue. It will trigger a new exam.

you know what Material Improvemet mean? not going to VA hospital or Clinic in the 5 years would mean improvement? I'm 100 P&T

[GBArmy]

ndy856 You are adding onto a 2016 posting. If you have a question, start a new original post. If you are P&T, you should not be going to a new exam. Start a new post.

[broncovet]

GB is correct, you should move this to a new topic, so you get more answers.  Since Ndy856 is new, I will answer it just this once, but GB may want to split this in a new topic.  

    NDY856  Great question.  No, material improvement is not proven by the Veteran simply not seeking treatment at the VA any more.  There can be many other reasons that the Veteran is no longer seeking treatment any more "other than" material improvement:

1.  The Veteran may have moved, and its no longer practical for the Veteran to go to the VA for his treatment.  

2.  The Veteran my have discontinued VA treatment and sought treatment instead in the private sector.  

3.  The VAMC may change its policies and not longer offer that treatment at that VAMC site.  An example of this is the Va lose a doctor, and no longer be able to offer care, "at least" until a physician replacement is found.  This could take years!  

       The important thing is this.  Its material improvement in symptoms, not material improvement in treatment.  Treatments vary over time.  The doc may try pills, he may try counseling, or many different treatments..this does not mean the Veteran "materially improved", it means either the Veteran or his doctor altered their treatment plan.  

        It is true that it looks kind of bad, when a Veteran goes to the VA, gets his benefits, then stops treatment.  But, its just not that simple.  The Veteran could easily have decided that VAMC treatment was not helping so he chose alternatives, instead.  There are many alternatives, such as holostic therapy, nutrition therapy, chiropractic, and a host of others.