C&P Exam for PTSD increase - might have backfired!

[Navy4life]

C&P Exam PTSD:MST Eating Disorder.pdf

^^^^^^Well the attached report indicates to me a 10% PTSD rating.  I am currently 30% and I do not understand how this happened but I might be in for a reduction.  I thought the exam went well.  I had a PTSD and Eating Disorder C&P.  

Regarding the occupational/social impairment she checked the one that resembles 10% and for "b" she marks YES and goes on to say my trauma impacts my occupational/social impairment.

Look at the symptoms she notes:

Anxiety; Panic Attacks more than once a week; Chronic sleep impairment; difficulty in establishing and maintaining effective work and social relationships

She even stated in the exam that I was BDD (Body Dysmorphic Disorder) but her reports indicates while I have BDD characteristics I don't warrant the BDD rating.

She states for the VA established diagnosis of SPECIFIED TRAUMA AND STRESSOR RELATED DISORDER, there is NO CHANGE in the diagnosis.  At this time the claimant's condition is active.

Does this Exam mean I am going to be reduced or would I fall under the below???

3.344 Stabilization of disability evaluations.

(a) Examination reports indicating improvement. Rating agencies will handle cases affected by change of medical findings or diagnosis, so as to produce the greatest degree of stability of disability evaluations consistent with the laws and Department of Veterans Affairs regulations governing disability compensation and pension. It is essential that the entire record of examinations and the medical-industrial history be reviewed to ascertain whether the recent examination is full and complete, including all special examinations indicated as a result of general examination and the entire case history. This applies to treatment of intercurrent diseases and exacerbations, including hospital reports, bedside examinations, examinations by designated physicians, and examinations in the absence of, or without taking full advantage of, laboratory facilities and the cooperation of specialists in related lines. Examinations less full and complete than those on which payments 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 psychotic reaction, epilepsy, psychoneurotic reaction, arteriosclerotic heart disease, bronchial asthma, gastric or duodenal ulcer, many skin diseases, etc., will not be reduced on any one examination, except in those instances 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 represents 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 super-imposed 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 continue the rating in effect, citing the former diagnosis with the new diagnosis in parentheses, and following the appropriate code there will be added the reference “Rating continued pending reexamination ___ 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.

(c) 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.

 

Edited February 23, 2016 by Navy4life

[Navy4life]

So I actually spoke to the doctor and I am screwed if this goes through!  I will be reduced to 10% from 30% based SOLELY on the occupational and social impairment.  I explained to her that she contradicted herself with her rationale and the fact that she checked the occupational/social box that warrants 10%.  She basically told me that my work environment is not stressful which it is not.  She went on to say that her rationale was that I was still at the same level regarding my issues with MST and my eating disorder.  She told me to appeal it....

So now I have to sit and wait to get the denial for this increase and see when I will be subjected to a reduction.

Just really pisses me off!

I am a prime example of what could happen when you go in for an increase and it back fires!

Ugh... 

[SemperFiGeek]

Tip I learned recently If they send you a proposal to reduce immediately request a personal hearing within 30 days and file a new claim for increase within the 60 day period following and you will get a new exam before they decided on the reduction which gives you another shot to get it right. I received a proposal to reduce on 12/9/2015 and have all new exams scheduled for next week because i filed for increase again for the conditions they wanted to reduce. It confuses the heck out of them and they have to follow the rule most favorable to the veteran.

[Navy4life]

21 minutes ago, SemperFiGeek said:

Tip I learned recently If they send you a proposal to reduce immediately request a personal hearing within 30 days and file a new claim for increase within the 60 day period following and you will get a new exam before they decided on the reduction which gives you another shot to get it right. I received a proposal to reduce on 12/9/2015 and have all new exams scheduled for next week because i filed for increase again for the conditions they wanted to reduce. It confuses the heck out of them and they have to follow the rule most favorable to the veteran.

Not quite following...So if I get a proposal for reduction you are saying I should request a personal hearing within 30 days?  What am I am requesting the personal hearing for and who would I submit the request to?

Secondly, you are saying to immediately file for an increase?

Sorry just want to be clear on what I should do!

Thanks!

[SemperFiGeek]

19 hours ago, Navy4life said:

Not quite following...So if I get a proposal for reduction you are saying I should request a personal hearing within 30 days?  What am I am requesting the personal hearing for and who would I submit the request to?

Secondly, you are saying to immediately file for an increase?

Sorry just want to be clear on what I should do!

Thanks!

Every reduction proposal comes with a letter that says if you don't agree with the adverse action you have the right to personal hearing if requested within 30 days of the date of the proposal to reduce. The law says the VA cant reduce your rating until you have the personal hearing which at this point its taking the VA about 6 months to actually get the hearing. Thus the benefit in filing a new claim for increase a few days after you request the personal hearing is that you will get new exams long before they get to a hearing and thereby have strong new evidence against the reduction for the hearing or they'll cancel out the proposed reduction completely and just decide the new claim(which is happening in my case).

The best way to request the personal hearing is in writing. Use the IRIS system the day you get the letter or fax it to the centralized mail system. If you live far from the regional office you can request a video hearing. 

[flores97]

That's good advice, Navy!! 

[Navy4life]

Well UPDATE on this thread!!!  My thread is a PRIME example to NOT draw conclusions from a C&P exam!!!  I was granted 50% from 30% yesterday.  I was completely shocked and happy at the same time.   I can't wait to get the decision letter to see the reasoning behind it.