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Is Re-Examination inevitable?


DisplacedCoastieinCanada

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Hey there. I'm just trying to get an idea of what to expect over the next few months. I'll summarize my situation briefly here.

I have 2 VA-rated disabilities. 70% for Major Depression and Anxiety, 40% for a back injury. Both of these are listed as not permanent.

I was discharged in January of 2015. May 2015 I received my ratings. I was bumped up from 70% to 80% in December of last year when I had my back re-examined. Prior to the re-examination last year, my back was only rated at 10%. 

I know that the VA likes to re-exam at the 5-year mark. I'm wondering if I should be expecting a re-exam for depression and anxiety early next year. I'm very much hoping that I'll slide under the radar because I live in another country and I was just seen a year ago for my back, but I know this is unlikely. I'm guessing the VA has an automated system that shows a glaring red mark for people coming up for re-examination. Honestly, I think my depression and anxiety has gotten worse and has further affected my quality of life, but I will have major issues affording the trip down to the VA, and if they did drop my rating, I stand to potentially lose my house since I have to re-qualify for my mortgage next year. Side worries, I know, but big ones for me.

Anyways, is there any chance that I might not be called in for a re-exam, or is it pretty much inevitable these days?

Thanks!

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  • Subscription Holder

So it sounds like it has gotten worse?  If so you need to apply for an increase. Don’t wait on the VA who knows what they will do. Also do you have any secondary conditions you need to claim?  

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I have had disability awards from the VA since 1986..... I have never had a re-look at any condition that I am rated for unless I asked for an increase in disability. I never heard of any automatic 5 year re-look either.

I am not saying re-looks don't happen but in all years I honestly don't know anyone who had a re-look based on a 5 year mark..

anyway it does sound like you should request an increase in disability if you think your condition has gotten worse .

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Coastie

Shrek and Richard have offered good advise. This is one of those 50-50 deals; some are going to tell you if you believe your disability has  gotten worse , ask for the increase. If it really has, not sorta-kinda, I would agree. But, you are only 7 months away from hitting that 5 year mark. That is significant according to the VA's M-21 manual also. If you just waited a few months, you have to show significant IMPROVEMENT in your symptoms for them to try and reduce, and it can't be based on just one C&P exam either. And, if your conditions have indeed gotten worse, you have opportunity to challenge it. Do you have additional evidence from a doc that show a worsening condition? From what I have seen on Hadit, the VA is totally unpredictable, so be aware. Personally, I would wait until May.

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As stated above, if your condition has gotten worse then file for an increase.

I would suggest not worrying about something that has not happened. There is nothing you can do if they do re-schedule you, but don't worry about it. Only worry about it IF it happens, after all we have no control over these things.

Here is a link in case you were not aware of when you live overseas, it tells you want benefits you can still get when living overseas. https://www.benefits.va.gov/persona/veteran-abroad.asp 

Also as a side note, did you know that the VA has an office in the Philippines? I believe it is the only foreign office they have.

Relax and enjoy your life!

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The VA isnt supposed to order an exam for no reason.  If you have been going to the doctor, then your symptoms should be already documented.  

While its true the VA is well aware of 5 year, 10 year and 20 year protections, (See https://www.law.cornell.edu/cfr/text/38/3.344  ) and, of course, the VA recognizes these deadlines.  

I have heard someone say that if you give a 7 days to do a 1 day job, he will often put the job off until the seventh day.    If you go to the post office on April 14, you will see lots of activity and people filing their taxes before the April 15 deadline.  At least some post offices remained open until midnite on April 14, so that last minute filers can still get an april 14 post  mark on their tax return, saving them penalties.  

In a similar way, there is no doubt VA "tracks" people who are about to reach their 5, 10, and 20 year protections.  Alex has mentioned in his writings that an unsual number get Proposed reductions just shy of these deadlines.  

One rating specialist reported, on another website, that they flag a Veteran at 5 years whenever they award a non p and t rating.  Probably about six months before that 5 year protection someone is assigned to "look at" your case to see if you should be reduced.  Like most stuff at VA this may or may not happen, but this ex va employee did mention the computer flagged this so that it could be reviewed in order to meet the 5 year, 10 year, or 20 year deadline.  

When you get a decision, they often state somthing like, "no future exams are scheduled".  This is VA's way of saying you are P and T.  The trouble is, your tax office that gives you a tax exemption if you are P and T, is unfamiliar with VA lingo, and they dont know what "no future exams are scheduled" means.  

 

Edited by broncovet
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Great advice from the other members who responded.

Before filing for an increase in your MH rating, I recommend you familiarize yourself with the rating criteria for the next higher rating tier which happens to be 100%. If you happen to be employed, you're likely not going to be approved. The "Total occupational and social impairment" basically means you SC MH disability is so bad that it precludes you from working. However, if it does worsen and prevent you from working, indeed consider filing an increase. I included an excerpt from the MH rating criteria below.

If you are unable to work due to your SC disabilities, and don't happen to meet the criteria for the 100% MH rating, consider filing for Individual Unemployability (IU). Each year you have to submit an income statement. They would pay you as if you were 100%. Eventually, or if your doc says your conditions are not expected to improve, you could request it be made permanent (TDIU) and that is pretty much the same thing as being rated 100% P&T, but cannot work. If you work, but are in a sheltered environment, you might qualify for TDIU and still be able to work. More information about IU/TDIU can be found elsewhere on this site.

Further below, I included some additional reference links that you might find interesting. They involve how rating increases work and how to get secondary SC. Both contain information which can be helpful on your journey to get a 100% rating.

 

§4.130   Schedule of ratings—Mental disorders.

Quote

General Rating Formula for Mental Disorders

    Rating
Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 100
Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. 70
   

 

 

 

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