I received a proposal to reduce

[mclevela726]

Hello,

I received a proposal to reduce the evaluations of my  Intervertebral Disc Syndrome with Radiculopathy (previously rated as intervertebral disc syndrome w/ DDD of L5-S1); Radiculopathy, Left Lower Extremity; Radiculopathy Right Lower Extremity on February 7th, 2019. 

To be more specific, the proposal states "We have reviewed medical records concerning your service-connected disabilities and noted some improvement, We propose to reduce our evaluations of the disabling effects for conditions as follows:

Intervertebral Disc Syndrome with Radiculopathy (previously rated as intervertebral disc syndrome w/ DDD of L5-S1) - Current: 40% | Proposed: 20%

Left Lower Extremity - Current: 40% | Proposed: 20%

Radiculopathy Right Lower Extremity - 40% | Proposed: 20%"

The proposal also states, "What Evidence Can you Submit...the best type of evidence is a statement from a physician who recently treated or examined you". As such I submitted a letter from my Private PCP February 12th, 2019, containing his statement. In his statement, my PCP said that my conditions of lower extremity radiculopathies are "moderate to severe". and there has been "no change". I also submitted a record from a recent urgent care visit (regarding the above conditions) and an SOC with that letter.

In the SOC I stated, "Lastly, I argue that the evidence VA used to propose reduction in evaluations, in addition to the evidence I am submitting here, does not support a reduction in evaluations (with all above named conditions being currently evaluated at 40% and being proposed to reduce to 20%) nor does it support the idea that a material improvement in the above named conditions is clearly shown nor would clearly be shown under ordinary conditions of life. (38 CFR § 3.344 Stabilization of disability evaluations)." [Of note: In the last year I have had a new MRI of my lumbar spine (which showed "significant abnormalities"), been through acupucture (with no improvement shown), been through the pain clinic (with no improvement shown), been through aqua therapy (with no improvement shown), as well as a trip to the ER and a trip urgent care and placed on medications. Which is why I argued what I argued.

Additionally, my Neurologist also prepared a Thoracolumbar DBQ, for which I just received and that I will be submitting to VA on Monday.

Having said all that, I am completely exhausted when it comes to fighting VA. I hope all of what has been done works! Because I no longer have it in me to fight for something that is already taking so much out of me.

What more can I do?

Thanks.

Clyv

 

[mclevela726]

Hello Buck,

What is "P/P/T/R"?

Thanks.

[mclevela726]

53 minutes ago, Buck52 said:

This is all good. However you need a qualified Dr to give his opinion , they won't listen to us, were not Dr's

a IMO/IME from a specialist would seal the deal on this P/P T/R  of what you mention above.

via DRO Hearing at your R.O..

  ALSO you can look the DRO in the eyes and he can see up close your disability is real, sometimes these P/P/T/R  are not as bad as most would think,  if you have shown your condition has actually got worse a increase is applied and not a reduction.  but this needs to come from a Qualified Dr.

I agree that getting an IMO/IME would be a home run, but I was hoping the following would at least get me to the fences?!

From the report of C&P exam 1:

“Does the Veteran's thoracolumbar spine (back) condition impact on his or

Her ability to work?

[X] Yes [ ] No 

If yes describe the impact of each of the Veteran's

Thoracolumbar spine (back) conditions providing one or more examples:

Occupation: XXXX

Says work is sedentary, writing policies and supervising people. Veteran says he has asked for reasonable accomodations and he is working from home 2 to 3 times week. He says he has missed about 50 to 52 days from work in the past 12 months secondary to back pain. Since the veteran's symptoms are heightened by everyday Physical activities, the lumbar spine condition might regularly limit his/her ability to safely perform tasks in physical occupations that require prolonged standing or walking, heavy lifting, repetitive bending. If performing sedentary work involving prolonged sitting, he/she would likely need frequent breaks to allow for ambulation to minimize symptoms associated with inactivity.”

From the DBQ prepared by my Neurologist:

“Do the conditions listed in the diagnosis section impact his or her ability to perform any type of occupational Task (such as walking, lifting, sitting, etc.)?

[x] Yes [ ] No

Standing, walking, lifting are all impaired by his chronic back and leg pain. It is a significant functional impairment. Pain reaches 8/10 with such activities.”

Unfortunately, still waiting on report for C&P 2 (performed by QTC).

Thanks again.

Edited February 24, 2019 by mclevela726
Errors in spacing, corrected a word

[mclevela726]

For anyone following this thread. Below is an updated version of my contentions with regard to the proposed reductions.

CONTENTION 1: With regard to 38 CFR 3.344 (a) “It is essential that the entire record of examinations and the medical-industrial history be reviewed” I contend that none of the evidence for which VA relied upon to propose these reductions reviewed my entire personal medical-industrial history (e.g. my employment history as a Fire Fighter with the US Forest Service was considered during the Compensation and Pension Examination in which an evaluation of 40% for each condition named in the proposal was awarded. I am currently employed in a sedentary job in administration.) and therefore they do not clearly show sustained material improvement under ordinary conditions of life with regard to the personal history of my conditions of Intervertbral Disc Syndrome with radiculopathy (previously rated as intervertebral disc syndrome with degenerative joint disease of L5-S1); Radiculopathy, left lower extremity associated with intervertebral disc syndrome with radiculopathy; and Radiculopathy, right lower extremity associated with intervertebral disc syndrome with radiculopathy, therefore I contend that the reductions proposed on January 31^st, 2019, and February 1^st, respectively, be considered null and void and therefore should not be implemented. End of Contention 1.

CONTENTION 2: With regard to 38 CFR 3.344 (a) “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” I contend that prior to the injuries, which caused my conditions including Intervertbral Disc Syndrome with radiculopathy (previously rated as intervertebral disc syndrome with degenerative joint disease of L5-S1); Radiculopathy, left lower extremity associated with intervertebral disc syndrome with radiculopathy; and Radiculopathy, right lower extremity associated with intervertebral disc syndrome with radiculopathy, and under the ordinary conditions of life, I was never medically prescribed 10 sessions of acupuncture nor did I seek medical treatment from a pain clinic, as I have in the last year.

I also contend that prior to the injuries, which caused my conditions including Intervertbral Disc Syndrome with radiculopathy (previously rated as intervertebral disc syndrome with degenerative joint disease of L5-S1); Radiculopathy, left lower extremity associated with intervertebral disc syndrome with radiculopathy; and Radiculopathy, right lower extremity associated with intervertebral disc syndrome with radiculopathy, and under the ordinary conditions of life, I never sought nor had I attended a medically prescribed KT Aquatic Program, as I have in the last year.  

And I further contend that prior to the injuries, which caused my conditions including Intervertbral Disc Syndrome with radiculopathy (previously rated as intervertebral disc syndrome with degenerative joint disease of L5-S1); Radiculopathy, left lower extremity associated with intervertebral disc syndrome with radiculopathy; and Radiculopathy, right lower extremity associated with intervertebral disc syndrome with radiculopathy, and under the ordinary conditions of life, I was never prescribed sedating/symptom inducing medications (i.e. Flexeril, Trileptal, Tramadol, Lyrica, Neurontin, etc.) nor was I given injections (i.e. Toradol, etc.), as I have in the last year.  

Therefore, I contend that the reductions proposed on January 31^st, 2019, and February 1^st, respectively, with regard to the conditions of Intervertebral Disc Syndrome with radiculopathy (previously rated as intervertebral disc syndrome with degenerative joint disease of L5-S1); Radiculopathy, left lower extremity associated with intervertebral disc syndrome with radiculopathy; and Radiculopathy, right lower extremity associated with intervertebral disc syndrome with radiculopathy, be considered null and void and therefore should not be implemented. 

Further evidence for Contentions 2 can be found in the Compensation and Pension Exam Note of November 16^th, 2017, where the examiner opines under ‘16. Functional Impact’ that, “Since the veteran's symptoms are heightened by everyday Physical activities, the lumbar spine condition might regularly limit his/her ability to safely perform tasks in physical occupations that require prolonged standing or walking, heavy lifting, repetitive bending. If performing sedentary work involving prolonged sitting, he/she would likely need frequent breaks to allow for ambulation to minimize symptoms associated with inactivity.” And because it can be argued that what the examiner opined clearly shows that material improvements under ordinary conditions of life would not be sustained and therefore cannot be shown, I contend that the reductions proposed on January 31^st, 2019, and February 1^st, respectively, and with regard to the conditions of Intervertebral Disc Syndrome with radiculopathy (previously rated as intervertebral disc syndrome with degenerative joint disease of L5-S1); Radiculopathy, left lower extremity associated with intervertebral disc syndrome with radiculopathy; and Radiculopathy, right lower extremity associated with intervertebral disc syndrome with radiculopathy, be considered null and void and therefore should not be implemented. End of Contention 2.

 

[Buck52]

Sorry

P/PT/R.

Proposal TO Reduce

 

[Buck52]

Contact the VBA (Veterans Benefits Administration) at your local VAMC for one free copy of your last QTC  Exam or the one you need.

[mclevela726]

24 minutes ago, Buck52 said:

Contact the VBA (Veterans Benefits Administration) at your local VAMC for one free copy of your last QTC  Exam or the one you need.

Hello Buck,

I did, about a month ago. Still waiting on it!

Thanks