5 Year Review (All ailments or only some?)

[ArmyVet270]

Hello,

I have a question about the first 5 year review of C&P Exams. I have 7 conditions that are rated Lumbar Spine 40%, Insomnia/Anxiety Disorder 10%, Migraines 0%, Ankle 10%, Bilateral Pea Plants 30%, Tinnitus 10% & Gastro 60% for a combine rating of 90%.

My gastro was a reconsideration with surgical scope and biopsies and private dbq was accepted. All other ailments were from initial ETS physical and 1st C&P Exam. 

I currently use the VA for primary medical care and have all my medications prescribed through them. 

 

My question is the 5 year review for each and every ailment or is the VA going to let me know what is under reconsideration?

Only 1 condition Back states at the bottom of the write up "Since there is a likelihood of improvement, the assigned evaluation is not considered permanent and is subject to a future review".

The majority of my conditions are basically treated with a regiment of medication I get from the VA and the standard 6-9 month checkups barring any acute instances. 

The VA Health care is great but the administrative side of consistently proving or re-justifying ones ailments is mentally stressful. I guess I just don't know what the threshold of acceptable is like is there a certain amount of appointments I need or checkups with specialists other than just continuing my regiment of medications and VA checkups like I have been. 

Thanks for any potential insights and have a great day!

ArmyVet

[broncovet]

When ever someone asks, "What will VA do when.....x happens", the answer is always the same.  Va does exactly what they please, when they want to do it, and not a minute earlier.  

So, we dont know.  However, your post indicated "only one" (your back) was "up for review"in 5 years.  We take your word for that, so you can presume none of the others are "up" to schedule you for a re evaluation exam.  

The big deal is, "did your conditions improve" since the c and p exam when you were rated? And only you know that.  There are 4 sets of rules for C and P re exams.

1.  Those conditions "under 5 years" or that are flagged "temporary".  You can likely get a re exam on these.

2.  Those conditions over 5 years but less than 10 years, or if you are rated P and T.  These have protections.  

3.  Those 10 years or more (protection from severance of SC).  Even more protections. 

4.  Those over 20 years.  The highest protection level..can not be reduced except for fraud.  

    I would advise you to read these regulations and see which apply to you:

https://www.law.cornell.edu/cfr/text/38/3.344

   

[ArmyVet270]

Bron,

 

Thanks for the insight. On my end I can certainly say none of the conditions improved and many have gotten worse. Im working a Neuro/Psych consult for the Migraines and Anxiety classifications.

 

I suppose Im asking an overly simplistic insight as to what would inprovement be. 

Would be only staying on prescribed medicine and going to routine visits be considered Improved? I suppose that subjective. For instance when I had my scope procedure and was awarded 60% for gastro does that remain sufficient or do I need annual or periodic new dbq’s submitted once the connection has already been made?

Im unsure of if all are considered temporary or not only my back has a “may be reviewed note” in its write up where other conditions do not say this.

Also all conditions have been service connected in 2014 so technically my 5 year review will be happening at beginning of year 6.

Thanks for any additional insight 

[MarkInTexas]

3 hours ago, broncovet said:

When ever someone asks, "What will VA do when.....x happens", the answer is always the same.  Va does exactly what they please, when they want to do it, and not a minute earlier.  

So, we dont know.  However, your post indicated "only one" (your back) was "up for review"in 5 years.  We take your word for that, so you can presume none of the others are "up" to schedule you for a re evaluation exam.  

The big deal is, "did your conditions improve" since the c and p exam when you were rated? And only you know that.  There are 4 sets of rules for C and P re exams.

1.  Those conditions "under 5 years" or that are flagged "temporary".  You can likely get a re exam on these.

2.  Those conditions over 5 years but less than 10 years, or if you are rated P and T.  These have protections.  

3.  Those 10 years or more (protection from severance of SC).  Even more protections. 

4.  Those over 20 years.  The highest protection level..can not be reduced except for fraud.  

    I would advise you to read these regulations and see which apply to you:

https://www.law.cornell.edu/cfr/text/38/3.344

   

Bronco,

Excellent information!  One question though.  Are those 5, 10, 20 deadline dates from the date earliest date the condition was claimed, the date of the last C&P or the date of that the condition(s) were granted?  I can see where somebody might sit in a vacuum for 10 years waiting for an appeal and then get a grant, then wonder if they are about to immediately called back for a re-evaluation C&P.  Thanks again for the information!

Mark

 

[vetquest]

As I understand the dates are reflected to your effective date of your award.  You will not normally be called back immediately for a condition grated on a backdated effective date but as Broncovet states you never know what the VA is up to.  That is the only nice thing about getting backdated ten years, your ratings are already protected on the five year rule.  In my situation I was supposed to be called back for reduction before my case ever finished but I never got called, I guess because my appeal was still pending.

[MarkInTexas]

Thanks, Vetquest!  I always wondered about how that was determined.  Of course, as you mentioned, the VA plays by their own rules, and we all know they change them as they need.

Have a great weekend!

Mark

[broncovet]

I agree with vetquest.  The effective date on your VARO decision is the determining factor for protections.  And, yes, it can take VA so long to process your application, that you are "protected" from the get go.  That is one advantage of massive delays, more than 5, 10, or even 20 years.  

Once service connected, your conditions are rated on "symptoms".  

If your symptoms got worse, (from the date of the c and p exam where you were awarded benefits) , then you can apply for an increase.  

As far as your symptoms improving due to medications, this should not affect your rating.   Now, if you lose a leg due to the war, and VA gives you a wooden leg and you can walk on it, then they take away your benefits.  (Just kidding).  

I view it as the "wooden leg" principal.  Sure, taking meds helps, but you have to keep on taking those meds, often increasing the dosage over time and, you have to put up with the side effects of the meds.  Sometimes, VA may list in the criteria, whether the symptoms are with or without meds.  (tho I cant think of an example, right now).  

Reread over the criteria for reductions.  https://www.law.cornell.edu/cfr/text/38/3.344

Pay attention to this part (applies to P and T or over 5 year rating):

Quote

 

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. 

 

 

Ok, so let's say you are a diabetic for example, and you are SC for it, and you take meds for it.  Your conditions improve because you are faithful with your meds.  

VA tries to reduce you because you got better.  You get a lawyer, and he cites the above regulation, especially that underlined.  "Under ordinary conditions of life" does not mean you are taking insulin every day at 8 am, 12, 5 pm, and 10pm.  "Ordinary" people dont take those meds.  Diabetecs or sick people do, however.  I dont  think VA would be able to reduce you unless your improvement was permanent and without meds.  A wooden leg may help you cope with a missing leg, but its not the same as your original leg, no matter what you do..