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  • 14 Questions about VA Disability Compensation Benefits Claims

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    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
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  • Most Common VA Disabilities Claimed for Compensation:   

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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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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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    • Wonderful news way to hang in. I hope this gives you some well deserved peace. 
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      Our traffic is going up and so are our expenses, however revenues have gone down and so I am reaching out to you to see if you can help me keep Hadit.com up and running.
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    • https://community.hadit.com/searching-for-va-claims-information-on-hadit.com/

       

      Your question has probably been asked before so the fastest way to find the information you need is to search for it.
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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.

      This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
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USMC_VET

How to avoid reductions

Question

Reductions are something every SC veteran worries about.  Its often a fear that keeps vets from seeking increases in disabilities that have worsened or appealing bad decisions.

I had my own scare a few years back when i filed for an increase, had a bad C&P on a disability and the VA sought to reduce me which freaked me out.  I eventually beat them at their own game but i wanted to put out some information that are preventative measures to stop reductions from occuring or provide the evidence needed to fight them if the VA decides to push it.  Unfortunately there is no silver bullet that makes a reduction ironclad, just as there is no ironclad approach to filing initial or increase claims that that VA cant argue with. Since rating is done by humans and humans are prone to fault and bias there is no guarantee with anything only higher or lower probabilities with getting claims granted and providing more armor for the appeals process.

1) Schedule regular checkups

I know alot of vets here dont have access to secondary care outside the VA whether its location or money.  If you do have the money/insurance outside the VA to see a outside primary care/specialist or can access the VA's choice program to see non VA medical professionals take advantage of that. I am lucky that I have access to this through my employer so outside of my annual checkups/specialists at the VA i go to private doctors at least annually to document the state of my current conditions.  I am honest with my doctors and ask them to make detailed notes of each condition i talk to them about and its current symptoms, etc because i need to provide the VA with documentation of my disabilities.  It doesnt matter if my condition hasnt worsened i still talk to them or a specialist about it so that i have the documentation.  If you dont have access to this make sure that when you do your VA checkups you specifically talk to them about all your disabilities as well, how its impacts you, pain severity, how often it bothers you, etc. If your VA provider DOESNT address something in your medical record make sure you send a secure message through myhealthevet so that it is recorded that you spoke to them about it.

2) Start a Diary

I would start a diary, preferrable on a word document or even better on the "activity journal" on myhealthevet and record symptoms, sick days, etc for ALL your disabilities and even things not SC that might in the future be something that is secondary to a SC condition.  I prefer to keep these journals on a word doc, you dont have the write a novel just the big things like, "ran today, bad pain in shins after 10 minutes, 4/10 then 7/10 after i walked back home. took naproxen and stayed off for the rest of the day", "back pain after being at work for 2 hours, no relief with 800mg IBprufen and flexeril"

This diary especially when its updated on myhealthevet in a timely manner say every month or a couple times a year is great for establishing what symptoms you have been experiencing regularly day by day, week by week or month by month in between doctors visits.  The VA likes to take one or two visits where you are stressed, rushed or dont want to be there and answer "fine" to "how are you doing" or "how has _____ disability been " and use that as a justification that you are showing "material improvement" in your condition.  The main takeaway is NEVER approach a C&P or ANY VA MEDICAL VISIT as routine. You dont need to stress but always describe how X disability is doing as how it feels on the WORST day not on the best or how you are felling at that moment.  That being said meticulous diary entries can help bolster your case you have not experienced material improvement.  Regularly updating you myhealthevet journal also timestamps it to show this has been done regularly over months, years or even decades so that a rater cant just say you made it up on the spot, and you can point to that you ahve regularly updated this journal to show over X number of months, years or decades to show what its like with your disabilities on a daily basis.

3) Dont let Medications Lapse

Never let your medications with the VA lapse. If you need 3x daily naproxen and 1x daily muscle relaxant to deal with back pain and your med refills show a 6 month gap the VA can make the claim your condition has improved.  The VA CANNOT reduce you if your symptoms improve with medication, but if you are not taking your medication it can be an indicator that you are getting better.  I know i sometimes get private Rx's not throught he VA and have them lapsed so i document and keep records of those medications (the sheet they staple on the bag with the name, doseage, date, etc) so i can scan and upload as needed for C&P, claims, reductions, etc.  the VA may not prescribe the Rx you want so i get why you would go elsewhere but send a message to your primary care stating that you have gotten a Rx through a private physician, ask to be prescribed it through the VA, if they refuse then keep screenshots of these discussions for reference as well so its documented. 

4) IMO's are key

I know when i got hit with a reduction attempt by the VA my IMO saved me. 100%. no doubt.  I had a terrible C&P for PTSD increase, they took me to a deserted wing of this old hospital and scanned me into what i think was the psych wing with no lights, was put in a dimly lit room where a psychologists was on a telecon line.  It freaked me out and i wanted to leave, so i rushed the exam to get done.  This was my fault, but it resulted in him saying my symptoms had gotten better. I started looking for help and came to HADIT. the best piece of advice i got was about IMO's so i found a psychiatrist who did a full workup and submitted a fantastic IMO.  It was hard coming up with the money but $500 vs losing $600 a month was a no brainer.  You dont need to get preemptive IMO's thats a waste of money but I would make sure, if possible, that you take a little money out every month and have $1500 in savings for an IMO if this ever happens to you.

 

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Same here bro.  But I had the IMO in hand when I went into the C&P for a PTSD increase.  Thought I would save her some time.  She got pissed and did her damnedest to discredit my Psycs IMO.  Except she failed.  I immediately upon getting my hands on the C&P filed a complaint with the VARO.  Three follow up C&P's later, 100% P&T.  

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Posted (edited)

Some good advice here, especially about the IMO’s. I’m facing a 5-year eval for PTSD/Anxiety and have no doubt they will be calling me in for a C&P soon. I’m pretty fed up at this point and have started shedding that fear of challenging them on their bs. My conditions have remained static for 10+ years and they’re still making me come in and explain myself...it gets old. The notes from my therapist don’t help a whole lot...she’ll add that I’m doing better with this, with that, just random improvements I’m trying to make to lead a somewhat normal life...but the issues haven’t left. I have good days, I have bad days...period. I’m glad I recently surpassed my 10 year mark so it would be quite difficult for them to reduce, but that’s not the point..when will they realize that the conditions are static and rate me P&T. THAT is my question.. I cringe every 5 years when I see the very last sentence they add is “since there is likelihood of improvement, subject to further examinations are warranted” blah blah blah 

Edited by MarineLCpl

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MarineLCpl The reason they put in your case review " since there is likelihood of improvement, subject to further exams are warranted" is usually a cop out. It is easier to take the rubber stamp approach than cut a new trail, so it is a lazy approach. With MH disabilities, they just find it easier to kick the can down the road. Depending how old you are (not supposed to be a factor), how long you have been diagnosed, among other evidence of "no significant improvement,"  the VA will possibly consider P&T. Once you are in your late 50's, it should be appropriate to ask them to consider change in status. Of course, every case is different, but the "Rubber stamp" approach is hard to overcome.

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Posted (edited)
59 minutes ago, GBArmy said:

MarineLCpl The reason they put in your case review " since there is likelihood of improvement, subject to further exams are warranted" is usually a cop out. It is easier to take the rubber stamp approach than cut a new trail, so it is a lazy approach. With MH disabilities, they just find it easier to kick the can down the road. Depending how old you are (not supposed to be a factor), how long you have been diagnosed, among other evidence of "no significant improvement,"  the VA will possibly consider P&T. Once you are in your late 50's, it should be appropriate to ask them to consider change in status. Of course, every case is different, but the "Rubber stamp" approach is hard to overcome.

I mean, I do get it. I suppose there are people that do overcome the suppressing nature of their shortcomings, but the fear of reduction is something no veteran should have to face if they know their conditions are here to stay, regardless of how much “improvement” they make along the way. I also understand that it’s partially their job to weed out potential fraud cases, which I do understand, but that should be obvious from the beginning. I was recently watching some YouTube videos on preparing for a PTSD C&P and came across comments like “Should I drive myself or have someone drop me off.” To me, this seems like someone trying to make their condition appear worse than it really is, and that, doesn’t sit well with me. I’m always 100% upfront and honest when I do these C&P’s, but the fear of reduction alone is enough to rattle my nerves and make me want to prepare myself any way I can. I have a family to support and bc of my SC conditions, I don’t feel adequate enough to support them without VA comp, so it always bothers me when these come up. Truth be told, I don’t think I meet the requirements for 100% PTSD bc I’m not suicidal, or mentally incompetent...but I’m an easy 70...and feel I’ll fall under this category until I’m in the ground...why can’t they see that by now after 10+ years...countless years of therapy and doctor notes, etc, means nothing apparently...so many rules, so many procedures...so many headaches...

 

By the way, I’m in my mid-thirties, so it’s pretty obvious they think I’ll just magically be better one of these days....joke. 

Edited by MarineLCpl
sp.

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Posted (edited)

Most of the proposed reductions I have heard of on this board "didnt fly", because the VA didnt meet 38 CFR 3.344.    My advice is to know the regulation(s).  Here it is:

Quote
§ 3.344 Stabilization of disability evaluations.

(a) Examination reports indicating improvement. Rating agencies will handle cases affected by change of medical findings or diagnosis, so as to produce the greatest degree of stability of disability evaluations consistent with the laws and Department of Veterans Affairs regulations governing disability compensation and pension. It is essential that the entire record of examinations and the medical-industrial history be reviewed to ascertain whether the recent examination is full and complete, including all special examinations indicated as a result of general examination and the entire case history. This applies to treatment of intercurrent diseases and exacerbations, including hospital reports, bedside examinations, examinations by designated physicians, and examinations in the absence of, or without taking full advantage of, laboratory facilities and the cooperation of specialists in related lines. 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. When syphilis of the central nervous system or alcoholic deterioration is diagnosed following a long prior history of psychosis, psychoneurosis, epilepsy, or the like, it is rarely possible to exclude persistence, in masked form, of the preceding innocently acquired manifestations. Rating boards encountering a change of diagnosis will exercise caution in the determination as to whether a change in diagnosis represents no more than a progression of an earlier diagnosis, an error in prior diagnosis or possibly a disease entity independent of the service-connected disability. When the new diagnosis reflects mental deficiency or personality disorder only, the possibility of only temporary remission of a super-imposed psychiatric disease will be borne in mind.

(b) Doubtful cases. If doubt remains, after according due consideration to all the evidence developed by the several items discussed in paragraph (a) of this section, the rating agency will continue the rating in effect, citing the former diagnosis with the new diagnosis in parentheses, and following the appropriate code there will be added the reference “Rating continued pending reexamination ___ months from this date, § 3.344.” The rating agency will determine on the basis of the facts in each individual case whether 18, 24 or 30 months will be allowed to elapse before the reexamination will be made.

(c) Disabilities which are likely to improve. The provisions of paragraphs (a) and (b) of this section apply to ratings which have continued for long periods at the same level (5 years or more). They do not apply to disabilities which have not become stabilized and are likely to improve. Reexaminations disclosing improvement, physical or mental, in these disabilities will warrant reduction in rating.

Allow me to paraphrase the above.  

1.  The VA has to give the Veteran the benefit of the doubt. 

2.  The "entire record" has to be considered not just one bad exam.

3.  If you got better because of bed rest, it does not matter, VA cant reduce you.  That is, you have to have "material improvement" under ordinary conditions of life.  This means WORKING.  If you got better and can go back to work, then you can be reduced, but if you just get better with "prolonged rest" (away from work), you cant be reduced.

4.  The VA has to show your material improvement is permanent, and will be sustained throughout your life.  

NONE of the above applies if you are temporary or less than 5 years rated.

     If you get a proposed reduction read this over and argue "VA has not met the criteria found in 3.344"

Edited by broncovet

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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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    • Wonderful news way to hang in. I hope this gives you some well deserved peace. 
    • If HadIt.com has helped you or you believe in it’s mission then please donate even $1 helps. I hope HadIt.com has provided $1’s worth of help to you. Imagine waking up and there is no HadIt.com it could happen and that is why I’m asking for your help now.



       



      Our traffic is going up and so are our expenses, however revenues have gone down and so I am reaching out to you to see if you can help me keep Hadit.com up and running.
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    • https://community.hadit.com/searching-for-va-claims-information-on-hadit.com/

       

      Your question has probably been asked before so the fastest way to find the information you need is to search for it.
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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.

      This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
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