100% SC P&T Can they reduce payment amount after re-examination ?

[James G.]

I'm 100% SC P&T . Can they reduce the payment amount after they re-examination . They scheduled  me for re-examination when I was awarded the 100% SC P&T .

I did try searching for an answer .

[GBArmy]

James G The answer is of course the VA can and does reduce ratings. They make the rules and they can break the rules. However, it isn't usual for them to make a 100% P&T and in the same award letter give you a re-schedule exam date. The first big milestone is 5 years; after going 5 years they have to have strong  evidence that your disability has improved. When did you get the granted condition? Obviously, heart conditions are not in that category; the get progressively worse. If your rating was correct when it was awarded, you should not have a worry.

[brokensoldier244th]

I still have yearly exams by my PCP but they aren't part of my disability. 

[FormerMember]

I think the answer is simple on this one. Mr. James G was just awarded 100% SC for his heart (The award letter (received Sept. 5th 2019) say's they will schedule says they will re-exam me between April & October 2020 !!!)  100% is an extreme rating for a heart. The note under §4.104 DC 7000-7011 says:

 Note: A rating of 100 percent shall be assigned from the date of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia or for ventricular aneurysmectomy. Six months following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter.

The Examiner discusses April to October-well within an acceptable re-examination period for a final rating after the temporary 100% rating is over. September 5th plus six months is... March 5th. 

[jbasser]

James here is a thought. The VA has just changed the criteria for heart conditions. The old ones took Ejection fraction into play. Less than 30 was a 100 percent rating. Now it appears the new rating schedule puts the main focus on MET's. Even though there is no accurate test for METS as it is just a doctors guess. I think this one will fail in the courts once it gets pushed through. 

[Valhalla0321]

I wanted to comment as a scenario response to and a question myself. I am

"entitled to disability compensation at the 100 percent rate due to service-connected disability(ies). This total disability is considered permanent. You are not scheduled for future examinations."

I was awarded this almost shy of 5 years ago and it was based on a combination of 10's and a 50- They bumped me up because i think' i was homeless had letters from Voc Rehab and HUDVASH that i was unemployable due to mostly my migraines. I was able to get a place for me and my Son and finally put past all the chaos like medical and housing which was hard to deal with as i had a child in need.

I also had a old claim started before approved TDIU and even though my POA told me to withdrawal old claim for OSA and sinus "or ill shake up my claims and put tdiu at risk" i just let it go through appeals and i was just recently awarded backpay. It moved me from a combined 70TDIU to a 90TDIU. I was then told that if i had any disabilities old or new that i thought would put me at a combined 100 that i should apply so i did. I only applied for "PTSD" which i had been treated for years and having a VA doctor connect it to inservice, so i felt confident to go this route.

A week goes by and instead of noticing the entry of "new claim for Ptsd" in VA.Gov i notice:

• Post Traumatic Stress Disorder (PTSD) Combat - Mental Disorders (New)
• TBI (New)
• fractured jaw/teeth (Increase)
• broke and rearranged nose (New)
• tension headaches (previously denied as headache due to concussion and head injury) (Increase)                        

And i go apeshi... this happened on a Thursday and i called my POA however was not able to get a hold of them till today. And in the meantime i had a barrage of qtc contractor appointments scheduled before that weekend "5 of them"

When i finally go a hold of my POA i talked with the same person who told me to withdraw my old appeal i had started before i was awarded TDIU. And they told me this...  They don't know why the VA put in a increase for all the other claims that show's i did not apply for (and they verified this) concluding that they are puzzled. The put me on hold and had to call me back indicating they were going to call 937 or some number which i think is inhouse slang for a regional VA office. My POA informed me that they tried to have the VA pull the plug on the mishap however told me that they could not.

This Same POA told me " you see we tell Veterans not to get greedy " You already have TDIU ' you would have received treatment for any condition but you started the TRAIN and now you can't stop it" WHY do the POA talk to Veterans like that .. so so demeaning in my opinion " and i tried to avoid this particular POA because i found 1 in there office that is very on point and nice and thought i was going to get him again.

Anyway the POA did tell me that who ever received my request for new claim read my notes i put in the new claim area comments for example, On delployment during a situation i fell 9 feet to my face, broke or fractured jaw, concussion and blacked out. ( The POA explained that the VA generated a new claim for what they thought should be done per my comments) So interesting odd, i replied why would they also put in for a increase for headaches when the maximum is 50% and i have that' the POA said, maybe they will try and reduce the rating (Like so much negative not positive help here)

 

Anyway' i went to my first appointment for (NEW) claim that i didn't select or start and i think it went well.

I'm not concern about the real situation at hand which amounts to ... my disabilities have also gotten worse and it's notated. The VA doctors have also filled out reports like medical summary reports and DBQ that indicate "no expectations to get better" would miss more that 8 days a month if i worked and be of task 80% of the day if i did work.

My concern is for my SON and his medical issues as well as my service DOG and his medical treatment, everyone get medical assistance covered and if i loose TDIU, i will be reduced to a mere miserable situation.

Hope this helps anyone and i hope anyone helps me with a reply.

[James G.]

22 hours ago, brokensoldier244th said:

What are they examining? If you are P/T you shouldn't have re-examinations. 

Yes I'm 100% P&T ,10% for tinnitus , 40% for hearing loss & 100% for Ischemic heart disease. All SC .The award letter (received Sept. 5th 2019) say's they will schedule says they will re-exam me between April & October 2020 !!!