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Andyman73

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Hello all,

Been a long time since I was here. Was checking ebenefits for current status on CUE claim that is in final review/authorization stage. I noticed that my rating for low back was reduced from 40%-20% back in August. There was no exam, or notification of this. I did receive a letter stating they were going to review with possibility of reduction. I scheduled appointment with the physical rehab Dr., at the VA,  that had been treating me. He wrote up a letter stating that my back had not improved. And he did use a goniometer to take measurements...the ROM kept me squarely in the 40% rating. He also went over the various treatments he had ordered, that hadn't offered any improvements....pt, chiro, and accupuncture. I sent this all off.

I received no notification of the results of the review, much less an exam to overturn the treating doctor's statement.

Can someone please tell me what I should do from here? I am not in a mental state of mind for handling this on my own. Thanks in advance.

Semper Fi.

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You posted:

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I did receive a letter stating they were going to review with possibility of reduction.

This is a notice of proposed reduction.  You should have take immediate action.  Reread that letter, its important.  Maybe some one can chime in, but one way is to apply for an increase.   They give you sixty days to respond to the propsed reduction, but Im guessing the VA figures if you are not opposed, then full steam ahead (with the reduction).  

You will get a decision letter from VA (showing the reduction), and you will have to appeal it.  

The VA does not always give a c and p exam, and they dont always need a reduction c and p exam, either.  So the no exam is rather irrelevant.  

You will have to file a nod when it arrives, and cite the letter (send a copy) that your doc wrote.  

 

 

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If you reread my post, you see that I wrote that I responded by seeing the VA Dr who had been treating my back. He did write a statement and I did send it in with additional exam notes from the treatments he had given/ordered in the year before hand. 

What I did Not get was a Decision letter stating that they overruled the treating Dr in favor of a PA, and that they chose to reduce anyway. 

I had no expectations of expediency, so I was not concerned when i didn’t hear back. As we all know the VA takes its own sweet time. 

And since there was no change to my compensation $$$ or overall rating, there was again no cause for alarm. I only noticed because I was checking on another claim that is nearly finalized. That 20% reduction in the back rating may well keep me from 100%, once the current claim is awarded. 

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Possibly, though a 20% rating doesn't affect much once once you get closer to 100%- once you get to 90%, for example, it takes something almost 50% to push you over the top. They may have also reduced your back but awarded or raised something else related to it. Do you know for certain that your doctor was over ruled by a PA? That's seems a bit improbable since PAs can't diagnose or treat without it being signed off on by a doctor.

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16 minutes ago, brokensoldier244th said:

Possibly, though a 20% rating doesn't affect much once once you get closer to 100%- once you get to 90%, for example, it takes something almost 50% to push you over the top. They may have also reduced your back but awarded or raised something else related to it. Do you know for certain that your doctor was over ruled by a PA? That's seems a bit improbable since PAs can't diagnose or treat without it being signed off on by a doctor.

True, however I am expecting a 20% bump in my ptsd rating, which now will just bring me back to where I once was. 

The PA is the one who wrote that my back seems to be better, while examine me for something totally unrelated to my back. Their bases for reduction is staked to the PA’s casual observations. She took no measurements of my back at all. However my Dr, who had been treating my back for a year or more, did use a goniometer to take measurements, which keep me in the 40% rating box.

There are no increases anywhere else to offset that. 

What other explaination is there, for them to reduce, when my PhD wrote his statement in rebuttal to the claim based on PA’s observation? And with no exam or letter, I have no clue as to what or why.

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A proposal to reduce benefits letter is different from a possibility of reduction letter.

A proposal should be that they have reason to reduce the veterans benefit and give the reason why in the letter  and all the things broncovet mention  about the 60 days to respond with NOD or a DRO Hearing to explain your case and why you think a reduction should not be.

A Possibility  for reduction is just that a possibility  meaning they need more evidence to reduce a veteran   if they don't have the information letter detailing what your rights are like in the proposal  then its just a scare tactic they use.

BUT CAUTION IF YOU GET A PROPOSAL LETTER?  AS SOON AS YOU RECEIVE IT RESPOND THE SAME DAY...OR ASAP Failure to respond will result in a reduction and possibly all the way back to 0% however you do have a 60 day time frame.

.At a DRO Hearing a DRO Can order up a new C&P If Veteran agrees to it or the DRO Thinks its needed.

I'd wait and see if you get a proposal to reduce letter?

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