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Unnecessary C&P


glenda h
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Had an upper and lower GI that was requested by the Primary care Dr in Jan 2019 at the VA hospital.  Due to the results I then filed a request for an increase on 6  Mar 2019.  Ive been rated 10 % for GERD only,  since 2007, even tho Ive had gastritis as well, even before I got out of service.  I find out on myhealthvet that an ACE was completed on 27 Mar 2019.  Im curious as  if this was really necessary as the procedure was done by the VA system and all rater had to do was view the evidence.  And they downgraded to 0% on 27 Aug 2019.  Nope, did not receive notification that they were going to do this.  Since I received my Cfile Ive learned to view my BlueButton every chance I get.  I found out that the info I submitted back in 2007 from a civilian Dr, as well as my VA records was never given to the examiner during a C&P,. Which I understand, by  regulations a C&P wasn't necessary then.  This is two different VAs.  

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Without viewing the previous exam, we dont know if or what it was missing.   A VA exam could be incomplete, lacking specific information, such as missing symptoms, or a lot of stuff.  There can be a number of reasons for a re exam.  

However, here is the big deal.   You posted:

Quote

 And they downgraded to 0% on 27 Aug 2019.  Nope, did not receive notification that they were going to do this

This is clear error "unless" this was some sort of temporary or convalescent rating.  The VA is required to give you 60 days notice and an opportunity for a hearing, as well as notice of proposed reduction.  See:  https://cck-law.com/blog/what-happens-when-va-proposes-to-reduce-my-disability-rating/

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2 minutes ago, broncovet said:

Without viewing the previous exam, we dont know if or what it was missing.  It could have been missing symptoms, or a lot of stuff.  

However, here is the big deal.   You posted:

This is clear error "unless" this was some sort of temporary or convalescent rating.  The VA is required to give you 60 days notice and an opportunity for a hearing, as well as notice of proposed reduction.  See:  https://cck-law.com/blog/what-happens-when-va-proposes-to-reduce-my-disability-rating/

Could be that the reduction from 10% to 0% didn’t reduce his overall rating?  That happened to me when I had a surgical scar reduced from 10% to 0%. 

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sounds like maybe temporary or convalescent rating.??

but this NEW C&P could benefit this Veteran as he has new & relevant evidence to show...show the examiner.  it could be an increase and not a reduction.  unless you want to CUE it as broncovet mention?

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 This is clear error "unless" this was some sort of temporary or convalescent rating".  The VA is required to give you 60 days notice and an opportunity for a hearing, as well as notice of proposed reduction. 

 I was rated 0% for GERD only  when I retired.  Had gastritis with h-pylori a year before I retired, but it wasnt mentioned in the initial C&P. In 2007 I submitted EGD results  from my Gastro Dr,  but it wasnt provided to the examiner, to include my VA record. I had GERD as well as chronic gastritis with h-pylori. The C&P examiner noted that he was not provided any records to review.  Found this out when I requested my Cfile and it stated this on the C&P exam.   But yet the rater in the decision stated that my records were reviewed, which contradicts.   "At the recent VA examination, your medical history was reviewed".     VA mailroom date stamped my info I submitted as received and shown on the documents in my file. I was given 10% for GERD  only and have held this rating since 2007 or 12 years.     Again, in the 2019 request for an increase I noted Class C esophagitis. erosive gastritis diverticulosis.  This was based on a EGD I had done by the VA in Jan 2019. An ACE was done, and again only GERD was mentioned and I was downgraded to 0%.   And no notification that they were going to do this.  

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You are apparently rated at 70 percent now?  Did your overall rating decrease when they reduced your GERD?  As somone mentioned "IF" it does not change your overall compensation, then it may not matter.  That is, did your combined rating change?

When was the decision which reduced you from 10 percent to 0 percent?  (Was it within a year so you can appeal it?)

Also, did they give you an increase in some sort of "GERD" alternative rating?  Such as gastritis diverticulosis?  

If you will post the decisions "reasons and bases" (redact your name and address), then maybe we can help more.  

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"When was the decision which reduced you from 10 percent to 0 percent?  (Was it within a year so you can appeal it?)

Also, did they give you an increase in some sort of "GERD" alternative rating?  Such as gastritis diverticulosis?  

If you will post the decisions "reasons and bases" (redact your name and address), then maybe we can help more".

 

C&P given 7 May 2007-Examiner-"The veterans C-file has not been provided  and is not reviewed." Veteran states that currently being followed by a gastroenterologist in private practice who performd EGD on Nov 2006.  That report is not available for review."  Yet this report is in my Cfile stamped with " VARO Received Apr 19 2007   Mail Clerk #3"

Rater in decision 29 May 2007- "at the recent VA examination, your medical history was reviewed.  On direct examination, the VA examiner reports diagnosis of hiatal hernia and reflux"

10% was given for GERD (7346)only in 2007-no mention of the gastritis.  Filed increase 6 Mar 2019 to include the gastritis again and the diverticulitis.  Given 0% on 27 Mar 2019, based on an ACE.  Examiner did not mention the gastritis nor the diverticulitis on the GERD worksheet.  I would assume did not have the 2007 info or 2019.       Examiner would have access to the medical info, as I had the EGD done at that hospital in Jan 2019.

"(2019) Rater:  We have assigned a noncompensable evaluation for your gastroesophageal reflux disease based on:  Pyrosis.

ACE on 27 Mar 2019-Examiner:    (1)the VBMS -with info from the initial 1998 C&P - (Mild GERD) (2) "does the veteran have any other pertinent physical findings.....  "NO".  (3) Does the Veteran have any of the following signs or symptoms due to .....Yes, Pyrosis, reflux. (did not mention the medium sized hiatal hernia) (4) VAMC records 1/31/19- EGD pathology, esophagitis, gastritis, hiatal hernia (Esophagitis listed on EGD as being Class C) (5) Does the Veteran now have or has he/she ever been diagnosed with .....Gastroesophageal reflux disease  Yes-(GERD), ICD code:  unknown, Date of diagnosis:  see prior exams" 

That is what I am complaining about as well-I had gastritis with H-pylori a year prior to when I retired from Service, but never mentioned in the "well-grounded claim" in 1998.   I submitted a civilian's Gastroenterologist's report that I had GERD , small hiatal hernia as well as chronic gastritis with H-pylori when I filed for an increase in 2007.  The C&P states examiner did not have my VA records or my documentation.  Rater did not mention the other condition (gastritis) as well, but I did get 10%.

In the 2019, I again filed for increase to INCLUDE the now erosive gastritis and diverticulitis, but again it was not mentioned on the ACE or the rater even noted it.    It seems VA is completely ignoring the other digestive condition I have and for years.

It wont change my rating if they just keep me at 10%.  But, at the time I filed this I was temporary 100% due total knee replacement, plus I was given a housebound rate.  With them reducing it, I lost the housebound.  It was to end 1 Jun 2019, so I lost two months worth.  

I filed with Board of Appeals so I hope I get my 10% back-It is the principal of it.  They never notified me they were doing this, and I dont even think they even noted how long I had this 10% rating.  Absent was the fact that the rater didnt mention this in the decision nor that  they supposedly  sent me a letter 60 days prior.  I'm just upset that they keep ignoring this other symptom, shown in black and white.  

Thank You

 

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