Proposed Reduction from 100% to 40%

[VietNamVet1969]

What is advisable to do following the receipt of this letter of proposed reduction in disability rates?

 

After 3 1/2 years and just visiting an outside, C&P doctor, (QTC Medical), I received a letter from the VA to reduce my 100% temporary disability. 3 1/2 years ago I underwent a radical prostatectomy, (surgery removing all they could find of prostate cancer).  A week after visiting this outside doctor that the VA ordered, came this reduction letter. When I read the conditions under which the VA can reduce a disability it reads as follows:

1. The VA must determine whether there has been an actual change in the disability since the last rating decision.

Prior to surgery my PSA reading reached a high of 5.6 and for the last 3 1/2 years there has been only the very slightest of changes varying from  >0.10 and <0.10 and nothing more or less than these numbers and symbols on myhealthevet.

2. The VA must determine whether there has been an actual change in the disability since the last rating decision

Again, only the slightest changes, as above, have occurred since my surgery

3. The VA must outline the time period during which the condition is said to have materially improved

I cannot find in their letter any specific range of time for improvement. Directly below is their letter in full without actual dollar amounts:

We have enclosed a copy of our rating decision for your review. It provides a detailed explanation about our proposal, the reason for it, and the evidence considered.

We have reviewed medical records concerning your service-connected conditions and noted some improvement in your Malignant growth of genitourinary system. Based on this evidence,we are preparing to reduce your prior evaluation of its overall disabling effect. The combined evaluation for all of your service-connected disabilities will drop from 100% to 50%. This proposed action does not affect your entitlement to treatment for service-connected conditions. We propose to reduce your monthly rate of compensation from $$$$ to $$.

We have reviewed medical records concerning your service-connected disabilities and noted some improvement. We propose to reduce our evaluations of the disabling effects for conditions as follows

        Malignant growth of genitourinary system    100%    40%

Please keep in mind I have a 5" scar, which was re-measured at this outside C&P exam, ED and incontinence at 5-6 Depends daily and the same number of bathroom visits nightly.

What's my next step? If I've missed anything just ask please

 

Edited December 18, 2020 by VietNamVet1969

[VietNamVet1969]

Well I just spoke with the outside 3rd party medical provider, QTC, and they are not allowed to get me any records. I was told to call the VA at 1-800-827-1000 so after talking with someone there, I was told I'd have to mail a Form 21-4138 Statement of Support to request a hearing. But I doubt I can get this done in time for the 60 days to run out. I should mail it or fax it to

DEPARTMENT OF VETERANS AFFAIRS

CLAIMS INTAKE CENTER

PO BOX 5235

JANESVILLE, WI 53547-5235

FAX: 844-531-7818

I was hoping I could do this online, since I don't drive as much as I used to, but doesn't look like it. I have called my VSO and awaiting their call back. After reading what Berta included in her reply I see that I should have only been reduced from 100% to a 60% disability rather than a 40% disability, because of the number of Depends I am changing daily.

This has really got me in a conundrum, worried if I can get this done on time before their decision is irreversible, it's quite a stiff reduction

[VietNamVet1969]

GBArmy,

I must apologize as I have had a computer down for quite awhile and finally just got it up and running. Thanks for your last comments, "VietNamVet1969 Good question. When they pay you 100% temp, they are not paying you for SMC's because your 100% isn't permanent. No, not for the scar; that would also have to be submitted as a new claim. Look up the criteria for scars, by the way. It isn't as straight forward as one might think. You could submit for those when you get a permanent rating, 100% , 40% whatever. "

I will follow up on that once I get a permanent then.

[VietNamVet1969]

And btw I got my VSO to file a NOD, within less than 60 days, including a letter from VA staff, who prescribed a recent updated PSA test showing an increase in my reading, and not a decrease as the VA letter was claiming, and their determination in that letter to C*P , was that my readings have increased not decreased. I am hoping the letter and the test results will provide me with some evidence to the contrary.

Also since from what I have read, that if the rating is reduced prior to 5 years of payment history, that the reduction can be a permanent reduction, but if a Vet makes it past 5 years that it will be considered a permanent rating.

Does that sound correct?

 

[Marine Corp 69/70]

The five year rule is that the VA needs to show that you improved with more than one C&P exam and haven’t gone the see doctors for the disability. The ten year rule is if you have a s/c disability for ten years or more the s/c connection can’t be terminated. Unless fraud was found. You can be reduced.

[VietNamVet1969]

On 1/15/2021 at 8:52 AM, Marine Corp 69/70 said:

The five year rule is that the VA needs to show that you improved with more than one C&P exam and haven’t gone the see doctors for the disability.

SO if I'm hearing you correctly, after 5 years of improvement, they can shut it down? Not really clear on your meaning, sorry

[Marine Corp 69/70]

It take more than one C&P exam after you s/c disability is over the Five year mark to be reduced, after the Ten year mark the s/c is permanent but the % can be reduced to 0%.