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    • The 5, 10, 20 year rules...



      Five Year Rule) If you have had the same rating for five or more years, the VA cannot reduce your rating unless your condition has improved on a sustained basis. All the medical evidence, not just the reexamination report, must support the conclusion that your improvement is more than temporary.



      Ten Year Rule) The 10 year rule is after 10 years, the service connection is protected from being dropped.



      Twenty Year Rule) If your disability has been continuously rated at or above a certain rating level for 20 or more years, the VA cannot reduce your rating unless it finds the rating was based on fraud. This is a very high standard and it's unlikely the rating would get reduced.



      If you are 100% for 20 years (Either 100% schedular or 100% TDIU - Total Disability based on Individual Unemployability or IU), you are automatically Permanent & Total (P&T). And, that after 20 years the total disability (100% or IU) is protected from reduction for the remainder of the person's life. "M-21-1-IX.ii.2.1.j. When a P&T Disability Exists"



      At 55, P&T (Permanent & Total) or a few other reasons the VBA will not initiate a review. Here is the graphic below for that. However if the Veteran files a new compensation claim or files for an increase, then it is YOU that initiated to possible review.



      NOTE: Until a percentage is in place for 10 years, the service connection can be removed. After that, the service connection is protected.



      ------



      Example for 2020 using the same disability rating



      1998 - Initially Service Connected @ 10%



      RESULT: Service Connection Protected in 2008



      RESULT: 10% Protected from reduction in 2018 (20 years)



      2020 - Service Connection Increased @ 30%



      RESULT: 30% is Protected from reduction in 2040 (20 years)
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    • How to get your questions answered...


      All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

      Tips on posting on the forums.

      Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.


      Knowledgable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title. I don’t read all posts every login and will gravitate towards those I have more info on.


      Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.


      Leading to:

      Post clear questions and then give background info on them.

      Examples:

      A. I was previously denied for apnea – Should I refile a claim?


      I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?



      B. I may have PTSD- how can I be sure?

      I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?



      This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.

      Note:

      Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview.

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ThomasGray

Proposed Rating Reduction Questions

Question

First off, hello and thank you in advance for any help that can be provided. Also, I apologize if something is not clear, trying my best to keep things concise.

  • On Friday, May 15, I received letter from the VA, dated May 11, proposing a rating reduction from 100% to 70% for PTSD. The only evidence for the change listed is Rating Decision - Narrative(17SEP18) and DBQ PSYCH PTSD Review(06MAY20), whereas on my initial decision letter there was an abundance of evidence used. The major takeaway appears that my medical records(both prior to and after the initial rating, also from VA facilities) were not considered in this proposal. Is this normal?

 

  • I have yet to obtain the most recent C&P as I just received the proposal letter, but intend to attempt on Monday, May 18. Looking at the proposal letter though it seems that examiner didn't check a few specific boxes that were checked on my previous C&P. Other than that the differences appear to be minor. The two lists are as follows:
  • Original C&P
    • Gross impairment in communication
    • Suspiciousness
    • Depressed mood
    • Suicidal ideation
    • Near-continuous depression affecting the ability to function independently, appropriately, and effectively
    • Disturbances of motivation and mood
    • Chronic sleep impairment
    • Near-continuous panic affecting the ability to function independently, appropriately, and effectively
    • Difficulty in understanding complex commands
    • Total occupational and social impairment
    • Panic attacks (weekly)
    • Difficulty in adapting to stressful circumstances
    • Neglect of personal appearance and hygiene
    • Difficulty in adapting to work
    • Inability to establish and maintain effective relationships
    • Flattened effect
    • Panic attacks (less than weekly)
    • Intermittent inability to perform maintenance of minimal personal hygiene
    • Difficulty in adapting to a worklike setting
    • Anxiety
    • Difficulty in establishing and maintaining effective work and social relationships
    • Intermittent inability to perform activities of daily living
    • Gross impairment in thought processes
  • New C&P
    • Forgetting names
    • Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgement, thinking, and mood
    • Depressed mood
    • Suicidal Ideation
    • Near-continuous depression affecting the ability to function independently, appropriately, and effectively
    • Disturbances of motivation and mood
    • Mild memory loss
    • Forgetting recent events
    • Chronic sleep impairment
    • Near-continuous panic affecting the ability to function independently, appropriately, and effectively
    • Difficulty in understanding complex commands
    • Panic attacks more than once a week
    • Difficulty in adapting to stressful circumstances
    • Neglect of personal appearance and hygiene
    • Difficulty in adapting to work
    • Inability to establish and maintain effective relationships
    • Impairment of short- and long-term memory
    • Flattened effect
    • Difficulty in adapting to a worklike setting
    • Anxiety
    • Difficulty in establishing and maintaining effective work and social relationships
    • Forgetting directions
  • I bolded the important items not that were not checked on the new c&p which led to the reduction proposal. It seems strange to me that new symptoms were added, however the very specific ones that would've caused the rating to remain the same all disappeared in just 1.5 years even though there is no noted improvement in my actual medical records.

 

  • What exactly is my next step? I have written a few statements of disagreement contesting the proposed reduction and pulled my VA medical records and will be getting a copy of the new C&P shortly. I have no idea were send the items as it is unclear in the packet. It says I have 30 days for one option and 60 days for the other. I don't think I need a notice of disagreement or start the appeal process as the final decision hasn't been made(this is a poorly worded question)?

 

  • Can I also request that they consider TDIU if the rating reduction is finalized or will I have to start a new claim for that? Should i send TDIU forms with my statements of disagreement and records?

 

  • I have been avoiding poking the bear and not filing claims for other conditions, some of which are caused by the various medications they have me taking, should I start filing claims for those as well?

 

  • And finally, if I do have to file for TDIU separately, should I start the claim now so that the date is saved? Do I submit the claim before or after I receive the final decision on the proposal?

Sorry for the long post. I'm lost as to what to do next. It took me over 5 years of being denied before they would actually service connect anything and now this. Thanks again for any help, it is appreciated.

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Posted (edited)

My first thoughts are what does your current treatment records say about your condition and or your employment?  What does your current treating doctor say about your condition and or employment?  What does your current treating doctor say about this proposal of reduction? If you have other disabilities then you should file claims for them or at least file an intent to file and you have one year to complete your intent to file the claims. If you are unsure where to send your evidence, the proposal of reduction letter should have that information and if it doesn't contact 1 (800-827-1000) and ask for the information and they should assist you. It doesn't matter what type of claims or how many claims you have but you should always file for claims that could/should be service connected.  Make sure you don't miss any deadlines. According to VA regulations CFR 3.303(b):Symptoms, not treatment, are the essence of any evidence of continuity of symptomatology.” Savage, 10 Vet.App. at 496. (1997)

 

Not sure why it has the line trough it.

 

Edited by pacmanx1

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Posted (edited)

ITS a bogus reduction proposal "hoping" you wont protest it or wont know how.    You have just proved my point, there is no such thing as "poking the bear" at VA, and "fear of reduction" is a bad reason to not seek all the benefits to which you deserve.  Instead, get all the benefits you deserve and read this over to see about reductions.  

This is why your reduction is bogus:

Quote

...Examinations less full and complete than those on which payments were authorized or continued will not be used as a basis of reduction. Ratings on account of diseases subject to temporary or episodic improvement, e.g., manic depressive or other psychotic reaction, epilepsy, psychoneurotic reaction, arteriosclerotic heart disease, bronchial asthma, gastric or duodenal ulcer, many skin diseases, etc., will not be reduced on any one examination, except in those instances where all the evidence of record clearly warrants the conclusion that sustained improvement has been demonstrated. Ratings on account of diseases which become comparatively symptom free (findings absent) after prolonged rest, e.g. residuals of phlebitis, arteriosclerotic heart disease, etc., will not be reduced on examinations reflecting the results of bed rest. 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. 

Source:  https://www.law.cornell.edu/cfr/text/38/3.344

Send in a 21:4138 disputing the "proposed reduction" on the bases which applies to you, above.  Since PTSD is a "psychotic reaction" the VA cant reduce this on any one exam.  Of course this assumes you have been rated with PTSD over 5 years or are P and T, as explained in 38 CFR 3.344 (c).  

As Berta says, the enemy has guns, but we have guns, too.  Use the regulations.  I have had 2 proposed reductions, the first was overturned, and the second is the same as the first!!!!!

The VA cant get it through their thick noggin that my dependents did not change, I did not get a divorce and dont have multiple wives!!!!!!!  Altho my wife watched the show "Sister Wives", not everyone who watches that show runs out and gets multiple wives.  My wife has "nixed" the idea of multiple wives, and its a mutually agreed upon idea.  I have difficulty enough keeping "one" wife happy, and dont need the challenge of trying to keep 5 or 6 wives happy.   My newest proposed reduction will also not fly.  Frankly, Im not even worried about it.  

If I need something to worry about, I have plenty already with corona virus.  However, I have taken to heart my pastor's sermon on "Pray more, Worry less".   As my father used to say, "Worry never robs tommorrow of its sorrow, only today of its happiness."  

Edited by broncovet

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I believe they  (your Dr  or VA Therapist) are overstepping their bounds in their after session reports saying things like this > Veteran shows improvement in today's session  saying things like this to think they got the Veteran condition to Improve

(veterans therapist notes in myhealthyvet  >) ''We did a breathing treatment today because I ask him on a scale form 1 to 10  how high would you say your Anxiety Level is right now? ''''

''The veteran responded back I am not sure but maybe its a 9 or 10  I am very nervous and  its got my anxiety level is up''   so his therapist ask the veteran  ''lets do some breathing treatments together   they do the breathing treatments and at every end of the treatment

  ''The therapist ask on a number from 1 to 10 how high is your anxiety level?''  veteran says well it seems a little better  its down to about a 7/8..''

''.The therapist says let do another breathing treatment ,  they do another one and the therapist ask ok now on a scale from 1 to 10 how high would you say your anxiety is? 

The veteran responds well its getting better its about a 4/5     then the therapist says  '' lets do another breathing treatment and get your anxiety level back to 0''

..So they do another breathing treatment and she again ask the veteran well how high is your anxiety level now?  veteran responds back well I think its a 0 now....

Anyway point is  if VA Regional gets or see these reports this is usually what causes a proposal to reduce benefits.

  They think your condition as improved because your therapist got your anxiety lever back down to 0...all veterans with PTSD be aware of this method it could cause you a lot of problems. 

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    • The 5, 10, 20 year rules...



      Five Year Rule) If you have had the same rating for five or more years, the VA cannot reduce your rating unless your condition has improved on a sustained basis. All the medical evidence, not just the reexamination report, must support the conclusion that your improvement is more than temporary.



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      If you are 100% for 20 years (Either 100% schedular or 100% TDIU - Total Disability based on Individual Unemployability or IU), you are automatically Permanent & Total (P&T). And, that after 20 years the total disability (100% or IU) is protected from reduction for the remainder of the person's life. "M-21-1-IX.ii.2.1.j. When a P&T Disability Exists"



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      Tips on posting on the forums.

      Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.


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      Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.


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      Post clear questions and then give background info on them.

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      I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?



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      I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?



      This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.

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