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Reduction in VA disability benefits - 100% to 0%

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Armyvet1987

Question

Hello everyone, 
Today I received a letter stating I will be getting a reduction of benefits from 100% to 0% for PTSD. I was awarded this amount in October 2010 and maintained the 100% rating until now. In November 2017 I had reexamination for PTSD, the results came back in December 2017 and I was again awarded 100%. Fast forward to February 2018, I received a letter in the mail saying I needed to go to a out of the VA doctor for them to fill out a DBQ form, I called the VA that day and stated I was not comfortable with speaking to another doctor about my PTSD, the women told me I could have my metal health doctor fill it out and send it back to them. I have an email from her with the attached document. My next appointment for the mental health doctor is in late April. The letter states that there is proof in my medical files and since I “missed” the DBQ appointment that they want to reduce my rating from 100% to 0%. 

So here is my question, how did my PTSD change significantly from December 2017 (when I was re-envaulted) to February 2018?
Next, should I hire a lawyer? VSO? I have never used the VSO or disabled veteran’s reps.
Finally, what should be my next step?


Thanks.

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  • HadIt.com Elder

Question?

If a Veteran is P&T  in  a condition that warrants it but gets a proposal to reduce his/her benefits in another  S.C. Condition , How does the P&T Come in to play here  'per say''

 

I remember  our beloved hadit member Ms Carlie Cash  got a letter for re examination.

She wrote a letter to the VA Undersecretary requesting the exam be canceled and she gave her reasons as to why , and they canceled the exam.

check out what Ms Carlie wrote...this is an excellent letter from her before she passed away., RIP Ms Carlie

All Veterans should read this. jmho

https://community.hadit.com/topic/61871-im-sc-100-smcs-over-10-yrs-varo-just-requested-a-cp/

 

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Buck -that is a good question.

Many years ago I got a local vet 100% P & T. At some point VA stated no future exams were necessary beause he had been P & T for quite some time.or maybe it was even stated in the award letter.

This vet is very difficult to deal with and finally got a PTSD rating too, in addition to the 100% for something else.

Out of blue one day , prior to the PTSD claim, he got a letter for a C & P exam on the  P & T 100% issue. He went ballistic, came over here with the letter and somehow ,by phone, we got them to drop the need for that C & P exam.

I dont think the above veteran has been back here since early April-

Years of experience tell me that only if the veteran can scan and attach the actual reduction letter-then that is the only way we can really opine on this and maybe he got it straightend out by now.

His initial post states:

"The letter states that there is proof in my medical files and since I “missed” the DBQ appointment that they want to reduce my rating from 100% to 0%. "

I wonder what they meant by ":proof".

Sometimes there is a lot more to the questions we get than we can know.That is why we need to read the actual words of VA on stuff like this.

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13 hours ago, Buck52 said:

Question?

If a Veteran is P&T  in  a condition that warrants it but gets a proposal to reduce his/her benefits in another  S.C. Condition , How does the P&T Come in to play here  'per say''

 

I remember  our beloved hadit member Ms Carlie Cash  got a letter for re examination.

She wrote a letter to the VA Undersecretary requesting the exam be canceled and she gave her reasons as to why , and they canceled the exam.

check out what Ms Carlie wrote...this is an excellent letter from her before she passed away., RIP Ms Carlie

All Veterans should read this. jmho

https://community.hadit.com/topic/61871-im-sc-100-smcs-over-10-yrs-varo-just-requested-a-cp/

 

Buck, its pretty much a moot point, though there are times when it may not be.  If its moot, the exam should never be scheduled and it should effectively just go away.  If its not going to lower what is paid, then it shouldn't be scheduled.  There are other reasons why VA wouldn't schedule it as well, FYI.  

If it is not, then they will schedule the exam.  Example of when its not moot: If it relates to SMC - like if you are 100 for deafness, but have a PTSD rating at 70, that will entitle you to statutory housebound.  But, if your last exam showed improvement in your PTSD and they scheduled an RFE for it, then you can be PT, but have a valid RFE.  It won't matter as far as the PT status, but really for your SMC.  Because if your PTSD drops to 50, you are then no longer entitled to housebound.  

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  • HadIt.com Elder

I understand this .

Its the unexpected exams that are presented to the veteran unfairly.

As in Carlie case,as I understand it she had went to her VAMC about a month prior the exam request for medical testing of her complaints to the Dr's   they did routine testing  and carlie went home   awaiting the results of the medical test from her PCP.

All of a sudden she gets the letter or phone call I can't remember what she mention,  but she got the request to go to a re evaluation on her S.C. Conditions  and these conditions were of static status with no future exams scheduled and she had these s.c. conditions over 10 years and her age was over 55.

 Below is Just my opinion and speculation as to what happen as this is only my opinion and in some parts as to what Ms Carlie has mention here on hadit

''It's like the VA Dr's had talked about her S.C. Conditions in an unlikely setting and concluded to request the exam as they write in the medical notes things that were never discussed with the veteran or go way beyond exaggeration as to show an improvement in her medical conditions  in this reference  they refer to her S.C. Conditions.''

This hippicritical actuations act  prompt the  RFE  re evaluation for possible reduction of benefits.(ROB)

''As there were no change in these conditions  as carlie had mention and took all her va prescribe medications as prescribed by the VA Dr's''.

I just find this unfair to any Veteran and to just up and request an exam of this nature for no good reason  is an act on the VA part to reduce a veterans benefits because of the power or authority of the VA Dr's

Ms Carlie made a good point as to this was a waist of time on the VA part when thousands of veterans need this time  to adjudicate their claims they been waiting years for.

Why they don't see or understand the pain and high anxiety this puts on the Veteran?

Not long after this happen Ms Carlie passed away.  due to heart failure as I understand it.

A big crush/blow to hadit and the veterans that come here for help with their claims.  Ms Carlie is missed here dearly not only for these reasons but she was a dear special friend to many of us here on Hadit.

JMHO

Edited by Buck52
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An RFE is "request future examination in the M21-1. (M21-1, Part III, Subpart iv, Chapter 3, Section B - Scheduling Examinations, 2. Determining the Need for Review Examinations).  Criteria:

"b. Exercise prudent judgment and refer to 38 CFR 3.327(b) in determining the need for review examination. It is the policy of VBA to request future examinations only when absolutely necessary, and every effort should be made to limit cases where future examinations are requested. Consider whether the Veteran’s current condition is an acute exacerbation the Veteran is still recuperating following hospitalization, and/or
improvement or recovery can be anticipated. Important: Medical evidence from any of the sources listed in 38 CFR 3.326(b) and (c) may satisfy the need for reexamination."

So the VBA policy is to do RFE only when absolutely necessary. (First point) It also directs that medical records can be requested from the VHA to satisfy 38 CFR 326 as indicated here:

"(b) Provided that it is otherwise adequate for rating purposes, any hospital report, or any examination report, from any government or private institution may be accepted for rating a claim without further examination. However, monetary benefits to a former prisoner of war will not be denied unless the claimant has been offered a complete physical examination conducted at a Department of Veterans Affairs hospital or outpatient clinic.

(c) Provided that it is otherwise adequate for rating purposes, a statement from a private physician may be accepted for rating a claim without further examination."

"Otherwise adequate for rating purposes" can be defined in "M21-1, Part Ill, Subpart iv, Chapter 5, Section A - Principles of
Reviewing Evidence and Decision Making"
. (YES, your private, non-VA doctor medical records are sufficient to complete an RFE if they properly identify the problem and provide a current diagnosis.)

Acceptible Clinical Evidence (ACE) process involves a request by the VBA to the VHA for an examination. The VHA examiner can review the records of the Veteran and if there is sufficient info in the VA Medical Record, or private records submitted by the Veteran, they dont need an appointment for an examination.

M21-1, Part III. subpart iv. Chapter 3. Section A.4.a.Examinations Based on ACE

In lieu of scheduling an in-person examination, VHA examiners generally (subject to some limitations) have the option to complete a DBQ based on review of existing paper and/or electronic medical evidence.  They may also conduct a telephone interview with the claimant.  Examinations based upon medical records and history without an in-person clinical examination or testing are known as ACE examinations or the ACE process

So they dont need to establish an appointment for anyone if they are in treatment at the VA or you submit your private treatment records.

If the VA fails to review the records available to them from the VHA, they have not fulfilled this policy. This is grounds for complaint to the rating authority and if you are not confident that they will take action, a complaint to the WH hotline, Congresscritter, or the press (in that order) is the wake up call to the VBA telling them that they MUST follow their own rules and provide a competent service for Veterans in accordance with Laws (US CODE) and Regulations (CODE OF FEDERAL REGULATION-CFR) established by Congress. This is the purpose of the M21-1 manual, so they do follow the laws that are established.

Edited by pwrslm
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