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

[vetquest]

I agree that medications should not affect your rating.  There is an issue here though.  I take seizure medications and we have had a very difficult time getting the VA to recognize that these medications cause some pretty clear symptoms.  They only want to recognize the number of occurrences I have.  Some of this most likely falls under the rule that with negative and positive evidence the benefit of the doubt is supposed to be in favor of the veteran.  This is were a lawyer comes in handy, they have a legal background and are more familiar with the regulations.

[MarkInTexas]

4 hours ago, broncovet said:

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):

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..  

Thanks, Bronco!

Mark

 

[Buck52]

Just my 2 cents

I don't think any disability were rated for will improve  if we are rated P& T But the VA Can call us up any time they want for a C&P If they get word your s.c. disability has improved  or shown improvement. 

Veterans need to read what their PCP Dr writes in their report every time you see the Dr...even specialty clinics...they do write things in their report that was never ask about to the Veteran they just assume way to much and the VA Dr will say things in there report that is not true..

.why they do this I just don't know  but it could cause the Veteran a lot of problems, so I suggest all veterans that are service connected and given a rating...wait 3 days and go into MyHealthvet and check the Notes as to what your Dr mention..if the Dr mention things that was not ask or things that is not true and you think it will harm your rating or think a reduction may be sent if your R.O. Reads some of these reports as to what your Dr mention.

Bring it up with your Dr  just ask the Dr why was this said in your report? I may not have understood you dr but I just don't recall you asking me this  and let the Dr know your disability is about the same  even taking the medications for it    but its far from showing improvement like you mention in your report   ...so I ask kindly for you to correct this in my medical records.

 CFR/38/1.579

 

Edited February 4, 2019 by Buck52

[MarkInTexas]

Great idea, Buck!  That's true too.  The nurses at the VA clinic typically "pencil whip" most of the preliminary questions in the system, and when I get look at my Blue Button report, I see that they provided answers to questions that they never asked me.  I also note that different VA doctors will write different things, and sometime tend to berate another doctor for prescribing this or that, then enter a prescription for something totally different.  Kind of a roller coaster ride.

I also note that the nurses will mention that the veteran turned down a flu shot or TDAP when offered, but had never asked.  I asked them about it the last time I was there, and they promptly gave me the vaccinations.  Never mentioned why it was shown as denied in the previous clinic visit though.

Also, I don't know about y'all.  But I seem to get a different nurse each time and just when I get used to one VA doctor, they ship him or her out and I get a totally different one.

Ok, off my soapbox!

Mark

 

[ArmyVet270]

Thanks for everyones insights! I was able to review the primary care providers notes and while nothing was inaccurate its wasn't quite as substantive as it should have been. I drafted up some notes to update my Problem Lists, Notes, Medications, & Assessment & Plan that covers all conditions I am being treated for. 

On a final note I am rated 0% for Migraines although its service connected and been being treated for about 5 years with 4-5 episodes a week. Didn't  realize I met parameters of CFR as everyone has pointed out for this.

Should I get my VA Primary Care Doctor( Been my doc for 5 years) to fill out a Migraine DBQ for me or would I be better off to bring my records to a private doc and try to get a Neurologist to fill one out for me after I provide records and my log? 

Thanks for any additional insight and have a great night!

[broncovet]

YOU pay your doc.  VA pays VA docs.  The dog will be loyal to the one who feeds him. 

So, feed the dog, dont depend on others to feed YOUR dog.