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likely to improve?

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pwrslm

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So I was reading a VA decision. It stated that a condition was likely to improve. 

Where do they get that information? I read their DBQ and the questions they asked the examiner and the phrase is not there. It appears to be a medical determination, so the RO has no authority to make this type of determination without a reason and basis to do so. How do you approach this? Appeal?

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There are a lot of possible reasons for this. Without knowing more, I can only assume an award letter was received stating the condition was expected to improve and a new exam would be scheduled in the future. Been through this myself a couple of times.

I don't have the specific CFR references so I will paraphrase. Some medical conditions are known to improve over time either on their own or due to medical treatment. Asthma is a good example because ratings for 30% or higher can be based on begins prescribed certain medication to treat it (exacerbation or long-term). If the medication is no longer needed, a reduction is possible. However, if the treatment continues long enough to classify the disability as static or if the doc states you are not likely to improve, then future exams are unlikely.

There are some factors which are likely to prevent a rating reduction:

- Over age 55
- Static disability (such as a loss of limb)
- Permanent disability not expected to improve (blindness, deafness).
- Disability is at minimum rating
- When reduction would not affect the combined disability rating percentage

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Thanks Vync.

Any idea how they make the conclusion? I suspect that it would need to be made by a medical professional, or not?

I understand the nature of how a condition can improve and be subject to a rating decrease, but what does a rating official need in order to make that decision. I never saw anything in the M21 or CFR that cites any list of conditions that may improve.

 

My Argument;

It actually appears to be a medical determination that a condition will improve over time.  The RO is not qualified to make that type of determination.

Edited by pwrslm
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I agree with you pwrslm.  I like your argument.  Order your file, and see if it was documented that a doctor stated your condition was likely to improve.  If not, the VA is making medical determinations, and rating specialists are not competent to diagnose or treat your diseases.  

Some conditions are simply "likely to improve" on their own.  If you get a cold, its "likely to improve".  If you have arthritis, or are diabetic, those are unlikely to improve.  VA probably has a chart somewhere of conditions which are likely to improve while others are not.  

However, YOUR condition may or may not be likely to improve, even tho its a condition on one of the lists I mentioned.  

You see, VA does not award benefits on "most people".   They award them only when your doc says that it applies to YOU.  That is why you have to have a nexus.  

Example:   Most of the time, when people fracture a bone, they develop arthritis in it in later years.  This does not help me.  I fractured my leg and need to prove MY arthritits was at least as likely as not related to MY in service fracture.  Right now, I can not do that.  I have not gotten an IMO in no small part because I "doubt" that an award of arthritis, even tho I have it, will be enough to get me to 100 plus 60 for SMC S.  In other words, Im not hiring an IMO unless its likely to result in additional benefits.  

Edited by broncovet
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pwrslm

Did you get a proposal to reduce letter?

what was there reason to reduce (your disability has shown improvement?)

They have to let you know how they came to that conclusion.

Usually a VA Dr gives his ''unbiased opinion.  without  given the veteran notice.  from a past exam or even a C&P.

re check all your Myhealthvet notes!

Edited by Buck52
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Hi PWRSLM,

I would read over the treatment notes very carefully.  I told my new Primary care doc that I used a drug called Toviaz (for neurogenic bladder related to MS) and she wrote in the notes "bladder is well controlled by Toviaz".  Hmmmm, if one (the one being a medical doctor) considers not urinating for 18 hours well-controlled you can call me a giraffe's Aunt.  Total Bravo Sierra.  Plus, since the raters are not medical doctors who the Foxtrot knows how they would interpret a medical statement thus potentially screwing up the VETERANs claim.  The devil is in the details, or in this care, the treatment notes.

If raters are making medical decisions it is beyond wrong.  Did I hear someone say "Appeal" ?

Hang in there.

HG 

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