Sudden VA proposal for medical exam

[Richard Williams]

I've submitted a VA NOD for a reduction the VA has made of my disability rating for prostate cancer residuals and I asked why my rating was reduced without a medical re-examination. VA said the decision was based on an in-house review of my records and their tables of benefits. Now, out of the blue, they have asked me to have a complete medical examination with their VA contracted doctor to assess all of my individual disabilities, including wounds in combat and other service connected disabilities. But the re-examination I requested for prostate cancer was not on the list to be assessed in the medical examination.  They are requesting this complete exam and have not given me a reason why they are doing so. I have had most of these benefits since my retirement from the military nearly 22 years ago. I'm concerned that this could be some kind of retribution for my NOD. I will be grateful for your advice.

[Buck52]

When Not to Expect a Reexamination

In certain cases, the VA will not ask you to come for a reexamination, and if they do, it may be an error on their part. If you are part of one of the groups listed below and you get a letter asking you to show up for the reexamination, call the phone number on the letter you receive to explain why you think you should not have to go.

VA normally does not schedule reexaminations for veterans:

over age 55

with static disabilities, such as loss of a limb

with a disability resulting from disease that is of a permanent nature

who have been assigned the minimum rating for their disability

who have a combined disability rating, and the individual ratings that were combined are so high that even if one or two of these ratings were reduced, the combined disability rating would remain the same.

If you are not subject to reexamination, your disability rating cannot be reduced.

If you do have to attend an examination, the VA can only reduce your benefits in some situations. Go on to the next page to learn about VA disability benefit reductions.

Note  you do have the 20 year protection rule applies here and unless they can prove your benefits were fraud    the 20 year protects you from any proposed reductions  and of course your disability were chronic in nature and not expected to improve  and  it helps if your  over the age of 55

I certainly would appeal this and ask that the exam be canceled  and give your reason why.

[Berta]

This link might help:

https://cck-law.com/news/rating-reductions/

In Part:

RATING REDUCTIONS: WHAT VA CAN AND CANNOT DO

WEDNESDAY JULY 5, 2017LAST UPDATED: APRIL 2ND, 2019

Under certain conditions, VA may reduce your disability rating. Legally, VA is entitled to rating reductions but there are rules they must follow when doing so. But unfortunately, mistakes are still made and VA often does not get rating reductions quite right. So, in this post, we’ll discuss what VA can and cannot do when reducing your rating and what you should do if VA sends notice that your rating may be adjusted.

 

 

 

 

 

 

 

 

 

 

 

1. 1Why does VA reduce ratings?
2. 2When does VA reduce ratings?
3. 3Rules VA must follow when proposing a rating reduction
4. 4What to do if VA proposes a rating reduction
5. 5How to appeal a VA rating reduction
6. 6Conditions that are more vulnerable to rating reductions
7. 7Stabilized Ratings
8. 8Continuous Ratings
9. 9Permanent and Total Ratings
10. 10What to do if your appeal deadline has passed
11. 11Will VA reduce your rating if you appeal?

 

 

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RELATED READ: The VA Rating Schedule – Read to find out what your disability rating means; how ratings are determined (through the VASRD); how to calculate combined ratings; and more. 

WHY DOES VA REDUCE RATINGS?

The idea is that some service-connected conditions will improve over time or with treatment and VA wants to make sure they are compensating each veteran according to their present level of disability. For example, if you had service-connected cancer and but it goes into remission, VA would propose a rating reduction because, presumably, your cancer is less disabling – i.e. has less of an impact on your ability to function in life and at work.

VA normally starts the process of reducing a rating under two circumstances:

• Scheduled re-examinations. Usually, VA will evaluate (after you are granted service-connection) whether your disability should be scheduled for a future re-examination (a C&P exam) to determine if your benefits need to be adjusted. VA usually makes this determination if they believe your disability can be expected to improve. Typically, the first re-exam will be scheduled 2-5 years from the date of your first Rating Decision.
• Evidence of change in condition. VA can also order a re-examination at any time if there is new, relevant medical evidence that your disability has improved.

But disabilities, as you likely know, are complicated. Symptoms of a disability may temporarily decrease but resume at baseline level soon after. Or, for example, symptoms may improve but not enough to significantly (or, as VA would say, materially) improve your ability to function under the ordinary stressors of life or work. So VA has strict rules guiding the process of rating reductions. But, those guidelines are not always applied correctly, so it can help to have an idea of what VA is required to do.

GENERAL RULES VA MUST FOLLOW FOR RATING REDUCTIONS

"There are a number of things VA must do when reducing ratings under any circumstances:

• A proposed rating (as well as a final decision) must be based on a review of the veteran’s entiremedical history
• VA must show that there has been an actual change in the disability since the last rating decision
• VA must show that change in the disability reflects material improvement in the veteran’s ability to function under the ordinary conditions and stressors of life and work
• Examination reports must be based on thorough examinations

Additionally, the procedural manual (M21) that VA adjudicators use to process claims states that VA must outline the time period during which your condition is said to have (materially) improved."

Your NOD might have caused them to realise the reduction was done without an exam.That would be a CUE.

I wrote a NOD for my husband on a proposed reduction and they dropped the idea when they got the NOD.

I wrote a NOD for my daughter many years ago that she said I threw in CUE as well, and in three weeks they reversed their decision. She had 7 years of Military service- Chapter 35 and the DEA application  specifically states she was eligible for 7 years added to her DEA entitlement date. This was a VA Education Department issue. She could not believe how stupid the initial decision was. They had granted only one month of DEA.

I replied to her- "Welcome to my world."

Sorry if this reply is messed up because I am in a cloud and might not be able to use PC until it lifts.

 

[Berta]

Richard can you scan and attach here their letter?

Cover C file # , name etc prior to scanning it. 

Buck can you give us a link for your info above? Thanks.

It is very concerning that they left out the Prostate cancer issue.

Edited April 30, 2019 by Berta

[Buck52]

Yes Sorry Ms Berta

I left out my source/research.

its Military Wallet

https://themilitarywallet.com/can-the-va-reduce-disability-benefits/

WHEN THE VA WILL NOT SCHEDULE YOU FOR A REEXAMINATION

[vetquest]

I also filed an NOD on my effective date and they have decided to re-evaluate my major ratings that brought me up to 100%.  I will not say they did it out of spite but it is suspicious and I would not put this past my RO.