What to do next?

[seaprincesskm]

Sorry for the long post! Seems like we all have a story that we want heard! I tried to be brief but it’s hard when you have so many things at once! 

I just received on Saturday that I have a proposal for reduction for a secondary service connected disability that was rated “temporary due to possibly improvement” back in July! I have yet to have treatment on this knee but somehow my “future” C&P appointment that they put in months ago that I had in March didn’t go as well as expected and was completely contradicting my surgeons notes and even the C&P doc I seen in July! She was also not as thorough as she said she was and I believe fradualant info from her and a congressional could even be in play here! But that’s a whole other issue! Anyway the rating for that particular knee is going to go from 20% to 0%! This would take my overal rating from 50% to 30%! I know I have rights I just don’t know how to tackle this! I have an appointment with a lawyer next week but it will fall after the 30 day cutoff to freeze your rating!

Should I wait until I have everything together and submit the NOD with all of that at once and not worry about the freezing of my rating or should I put in the NOD to start the clock? I also would really like info on the appeals and asking for a board? What’s the “real” difference in rating officials and which in your experience had a better outcome! 

And for some more info into my situation I currently have a pending “claim” started in November when i knew something was wrong with a knee replacement I had done in July that started this whole mess of relooking into my service connected disabilities! The replacement i had is a direct result of an Active Duty misdiagnosis and surgery performed that caused so much damage it needed replaced! That in itself is another fight!

Anyway some Direction, insight, experience all of which would be highly appreciated! Thank you in advance! 

[Buck52]

You need to be careful here  because a proposal to reduce benefits and and NOD are two different things   in a proposal to reduce your benefits  you only have 60 days to respond from the date of the proposal   and in a regular denial you have a year to respond.

Most veterans opt to request a DRO Review or DRO Hearing in person between you and the DRO at your Local VA Regional Office to settle the reduction proposal.

''DRO'' =( Decision Review Officer)

You need an IMO from a quailfied Dr on your current disability the VA sent you a proposal letter on. you need the Dr to examine you read your medical records on this condition and it needs to be favorable on your part   the Dr needs to say in detail just how bad your condition is and opien on that, sometimes a proposal backfires on the VA and in increase is warranted and not a reduction.

''IMO'' (Independent Medical Opinion)

Main thing is don't miss your proposal deadline. GET NEW EVIDENCE TO PROVE YOUR DISABILITY HAS NOT IMPROVED  With a GOOD Qualified Dr and in good detail.

Your Attorney should Advised you on all of this and maybe more.

 

Edited April 25, 2018 by Buck52

[broncovet]

I agree with Buck.  Dont file a NOD.  This is a proposed reduction, not a final decision.  

Instead, request a hearing, so that you can tell your side, ASAP.    When you do so, go prepared.  If there are errors in your medical records, use this regulation to correct them.  38 cfr 3.1579

1.579 Amendment of records.

(a) Any individual may request amendment of any Department of Veterans Affairs record pertaining to him or her. Not later than 10 days (excluding Saturdays, Sundays, and legal public holidays) after the date or receipt of such request, the Department of Veterans Affairs will acknowledge in writing such receipt. The Department of Veterans Affairs will complete the review to amend or correct a record as soon as reasonably possible, normally within 30 days from the receipt of the request (excluding Saturdays, Sundays, and legal public holidays) unless unusual circumstances preclude completing action within that time. The Department of Veterans Affairs will promptly either:

(1) Correct any part thereof which the individual believes is not accurate, relevant, timely or complete; or

(2) Inform the individual of the Department of Veterans Affairs refusal to amend the record in accordance with his or her request, the reason for the refusal, the procedures by which theindividual may request a review of that refusal by the Secretary or designee, and the name and address of such official.

(Authority: 5 U.S.C. 552a(d)(2))

(b) The administration or staff office having jurisdiction over the records involved will establish procedures for reviewing a request from an individual concerning the amendment of anyrecord or information pertaining to the individual, for making a determination on the request, for an appeal within the Department of Veterans Affairs of an initial adverse Department of Veterans Affairs determination, and for whatever additional means may be necessary for each individual to be able to exercise fully, his or her right under 5 U.S.C. 552a.

(1) Headquarters officials designated as responsible for the amendment of records or information located in Central Office and under their jurisdiction include, but are not limited to:Secretary; Deputy Secretary, as well as other appropriate individuals responsible for the conduct of business within the various Department of Veterans Affairs administrations and staff offices. These officials will determine and advise the requester of the identifying information required to relate the request to the appropriate record, evaluate and grant or deny requeststo amend, review initial adverse determinations upon request, and assist requesters desiring to amend or appeal initial adverse determinations or learn further of the provisions for judicial review.

(2) The following field officials are designated as responsible for the amendment of records or information located in facilities under their jurisdiction, as appropriate: The Director of each Center, Domiciliary, Medical Center, Outpatient Clinic, Regional Office, Supply Depot, and Regional Counsels. These officials will function in the same manner at field facilities as that specified in the preceding subparagraph for headquarters officials in Central Office.

(Authority: 5 U.S.C. 552a(f)(4))

(c) Any individual who disagrees with the Department of Veterans Affairs refusal to amend his or her record may request a review of such refusal. The Department of Veterans Affairs will complete such review not later than 30 days (excluding Saturdays, Sundays, and legal public holidays) from the date on which the individual request such review and make a final determination unless, for good cause shown, the Secretary extends such 30-day period. If, after review, the Secretary or designee also refuses to amend the record in accordance with therequest the individual will be advised of the right to file with the Department of Veterans Affairs a concise statement setting forth the reasons for his or her disagreement with the Department of Veterans Affairs refusal and also advise of the provisions for judicial review of the reviewing official's determination. ( 5 U.S.C. 552a(g)(1)(A))

(d) In any disclosure, containing information about which the individual has filed a statement of disagreement, occurring after the filing of the statement under paragraph (c) of this section, the Department of Veterans Affairs will clearly note any part of the record which is disputed and provide copies of the statement (and, if the Department of Veterans Affairs deems it appropriate, copies of a concise statement of the Department of Veterans Affairs reasons for not making the amendments requested) to persons or other agencies to whom the disputedrecord has been disclosed. ( 5 U.S.C. 552a(d)(4)) ( 38 U.S.C. 501)

[seaprincesskm]

Thank you Buck and Boncovet! I did some further digging after I posted the question and in fact found out that this is not the final and I have to request a hearing! Do not go NOD as that’s what they want you to do to get stuck in the system! I have 1 week before the 30 day deadline and 60 days for final decision! I am already lining as much as I can!  I just got off the phone with a representative located in South Carolina “Regional office?”  who said I needed to in writing request the hearing and fill out VA Form 21-4138! I just printed it off and will muster up my awesome writing skill! And have this turned in by the end of the week! 

A couple of questions

Is it okay to request the hearing without having absolutely everything I need? Or do I have to submit it all at once?

I had an appointment with my surgeon yesterday! I handed him a Comp Questionair from the VA Rep! Told him the situation and his response was “she’s an idiot and doesn’t know what she is talking about!” He is very much to the point and rough around the edges but he knows his stuff he has 50 years of surgical experience! He was so worked up! He said I need to write Congress and they can call him! While he is in the back I hear him say that the paperwork is ridiculous! He comes back in with a questionair that is barely filled out! What he did manage to fill out will help my case on the left knee but nothing is mentioned about my right! I asked him to put something down about that as well and his response “we need to deal with one knee at a time!” He has no ties to the military and doesn’t understand the importance of Forms! That him completely filling this form out could stop all this nonsense before it’s finalized! 

I guess my question here.

Will this negatively impact me with being partially filled out and tons of notes all over it saying that the Navy misdiagnosed me did a surgery that caused so much damage he needed to replace my knee, and that it still needs another surgery because of the original damage? 

Should I attempt to get my primary care physician to fill out the form? 

Is there any possible way to get a new C&P appointment since the last one so grossly contradicts everything in my record and even other VA comp appointments? 

Legally can they request reduction with a C&P appointment alone without any supporting documents outside of that appointment? 

I cant wait around for my VA rep to “return my call” I have to be diligent and precise and with in deadlines! I don’t know all the lingo and wording or even what exactly I’m entitled to! I really appreciate the info! I didn’t think to have the C&P notes revised! That is def a route I will also take! 

Thank you so much for the info!

 

 

[vetquest]

I will second Buck52's recommendation for an IMO.  Your doctor apparently does not understand the gravity of the situation.  You also need to have an opinion written by a doctor who understands what the VA is looking for.   A DBQ form for knees can be found here:   https://www.vba.va.gov/pubs/forms/VBA-21-0960M-9-ARE.pdf

Will this negatively impact you if you use a partially filled out document.  Yes.  The VA wants all of the t's crossed and the i's dotted.

Should you get your primary care physician to fill this out.  No.  You need to look up doctors in your area that IMO's and see one.  Yes it might cost one or two thousand dollars but it is the best route.

Is there a way to get another C&P done.  Not too sure on that one.

Now fill out the required paperwork and move forward.  Good Luck.

 

[Gastone]

A VA Notice of Reduction is Appealable, follow the instructions on the Last page regarding the Appeal, DO NOT DRAG YOUR FEET, File the Appeal requesting a personal Hearing. You only have 60 Days from the Date of the Notification Letter.

You might want to do an, "At Ease" as to the VA Lawyer at this point.

How about posting Redacted Copies of both Knee C & P's? Might not be a bad idea to refrain from the "Liar" and conspiracy assertions, doesn't help your case.

[Buck52]

seaprincesskm

When you request a hearing the DRO will send you a letter letting you know the date & time for the hearing and rather or not you want an informal hearing to formal hearing  that's your choice,  I' recommend the informal hearing.

  So between then and now is when you need to start gathering up your evidence IMO's if you need it?

if you have enough ''current medical records'' and evidence to prove your proposed reduction on this disability is the same or as worsen  that's about all you may need,  usually this is why we need the IMO/IME

Make sure the private Dr that does your IMO/IME is licensed and qualified to render his/her opinion  I recommend a Specialist in this field of medicine that your claiming.

You can take any new & material evidence you have to your hearing and especially if it shows your disability has got worse since your last evaluation (C&P)  IF it has , then instead of a reduction an Increase would be warranted/Awarded.

Depending on whay type DRO you get  but it could be a good time to ask about any other claims your on appeal with...so just incase the DRO will want to try to solve those claims   then besure you have your evidence for those to  but the DRO may tell you he is only doing the proposed to reduce your benefits...DRO can do other claims as well it just depends on the DRO   They have the Authority to make a decision right then and there.

If the DRO Denies your claimS  then you will need to Appeal to the BVA  using the Form #9

Hopefully you will get your proposed reduction settle and maybe some of the other claims as well  Again a lot of this depends on the DRO Attitude and rather or not he/she is Veteran Friendly.

I wish you the best and remember never give up if this don't work out  you can always appeal.

Thank you for coming to Hadit and allowing us older Vets to help steer you in the right direction.

Reguards

Buck