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Rating Reductions

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pacmanx1

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12.3. Rating Reductions

There are circumstances where the VA can reduce your disability benefits. When the VA proposes to reduce a Veteran's disability compensation, it is of the upmost importance that the Veteran act quickly by seeking the services of either an aggressive Veterans Service Organization or an Attorney accredited by the VA.   The law is very clear that to assist a Veteran in the preparation, presentation, and prosecution of a claim for VA benefits, the individual must be accredited by the VA as an agent, attorney, or representative of a Veterans Service Organization, VSO, 38 U.S.C. §§ 5901-5902, 5904; 38 C.F.R. § 14.629.   There is a onetime only exception for a non-accredited individual to assist a Veteran in processing a claim under 38 C.F.R. § 14.630. 

To verify the VA accreditation of an Attorney, Claims Agent, or VSO Representative, go to website:  http://www.va.gov/ogc/apps/accreditation/

Some of the most common reasons for the reduction of you VA disability Compensation are:

  I.   Failure to Report for the "Pre-Reduction" Examination.

 II.  Unprotected Benefit Rating and Your Condition Improves

Rating Reductions (vetsfirst.org)

 

Yes, it is more to a reduction that a veteran can do but the VA can just deny the claim base on failure to report to an examination. 

Edited by pacmanx1
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20 - Year Protection

3.951 Service connection.

 
(a) A readjustment to the Schedule for Rating Disabilities shall not be grounds for reduction of a disability rating in effect on the date of the readjustment unless medical evidence establishes that the disability to be evaluated has actually improved. 
 
(Authority: 38 U.S.C. 1155
 
(b) A disability which has been continuously rated at or above any evaluation of disability for 20 or more years for compensation purposes under laws administered by the Department of Veterans Affairs will not be reduced to less than such evaluation except upon a showing that such rating was based on fraud. Likewise, a rating of permanent total disability for pension purposes which has been in force for 20 or more years will not be reduced except upon a showing that the rating was based on fraud. The 20-year period will be computed from the effective date of the evaluation to the effective date of reduction of evaluation. 
 
(Authority: 38 U.S.C. 110
 
[34 FR 11970, July 16, 1969, as amended at 57 FR 10426, Mar. 26, 1992]
 

10-Year Protection

38CFR.957 Service connection.

 

Service connection for any disability or death granted or continued under title 38 U.S.C., which has been in effect for 10 or more years will not be severed except upon a showing that the original grant was based on fraud or it is clearly shown from military records that the person concerned did not have the requisite service or character of discharge. The 10-year period will be computed from the effective date of the Department of Veterans Affairs finding of service connection to the effective date of the rating decision severing service connection, after compliance with § 3.105(d). The protection afforded in this section extends to claims for dependency and indemnity compensation or death compensation. 
 
(Authority: 38 U.S.C. 1159
 
[33 FR 15286, Oct. 15, 1968]
 

5-Year Protection

38CFR3.344 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.
 
A good InfoGraph from CCK Law
 

A399D351-D07D-4300-9F84-4D75C12469D6.png

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Additional protections include the "over age 55 rule"

§ 3.327 Reexaminations.
(a) General. Reexaminations, including periods of hospital observation, will be requested whenever VA determines there is a need to verify either the continued existence or the current severity of a disability. Generally, reexaminations will be required if it is likely that a disability has improved, or if evidence indicates there has been a material change in a disability or that the current rating may be incorrect. Individuals for whom reexaminations have been authorized and scheduled are required to report for such reexaminations. Paragraphs (b) and (c) of this section provide general guidelines for requesting reexaminations, but shall not be construed as limiting VA's authority to request reexaminations, or periods of hospital observation, at any time in order to ensure that a disability is accurately rated.


(2) No periodic future examinations will be requested. In service-connected cases, no periodic reexamination will be scheduled: (i) When the disability is established as static;

(iv) In cases of veterans over 55 years of age, except under unusual circumstances;

I however do not know what would constitute "unusual circumstances"

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Veterans over the age of 55 can be reexamined. I found this out to be very interesting that we are told that when a veteran hit 55, the veteran can no longer be reexamined but this seems to be a little off. I am not trying to put fear in anyone, but this is the regulation, and you can look it up for yourselves. Please pay close attention to the highlighted paragraph. The highlighted portion stated that even though paragraphs (b) and (c) are listed they only provide a general guideline for requesting reexamination but should not be construed (interpreted) as limiting the VA’s authority to request reexaminations, at any time in order to ensure that a disability is accurately rated. This particular regulation pretty much covers all ratings to include static ratings, permanent ratings, ratings over five years and even a rating that would not result in a reduction. As stated, I am not trying to put fear into anyone. Just because the VA request a reexamination it does not mean that they would try to reduce a veteran rating. It just gives the VA authority to request an exam and a lot of veterans think that VA can’t reexamine their rating.

38 CFR 3.327(a) (a) General. Reexaminations, including periods of hospital observation, will be requested whenever VA determines there is a need to verify either the continued existence or the current severity of a disability. Generally, reexaminations will be required if it is likely that a disability has improved, or if evidence indicates there has been a material change in a disability or that the current rating may be incorrect. Individuals for whom reexaminations have been authorized and scheduled are required to report for such reexaminations. Paragraphs (b) and (c) of this section provide general guidelines for requesting reexaminations but shall not be construed (interpreted) as limiting VA's authority to request reexaminations, or periods of hospital observation, at any time in order to ensure that a disability is accurately rated.

(Authority: 38 U.S.C. 501)

(b) Compensation cases -

(1) Scheduling reexaminations. Assignment of a pre-stabilization rating requires reexamination within the second 6 months period following separation from service. Following initial Department of Veterans Affairs examination, or any scheduled future or other examination, reexamination, if in order, will be scheduled within not less than 2 years nor more than 5 years within the judgment of the rating board, unless another time period is elsewhere specified.

(2) No periodic future examinations will be requested. In service-connected cases, no periodic reexamination will be scheduled:

(i) When the disability is established as static.

(ii) When the findings and symptoms are shown by examinations scheduled in paragraph (b)(2)(i) of this section or other examinations and hospital reports to have persisted without material improvement for a period of 5 years or more.

(iii) Where the disability from disease is permanent in character and of such nature that there is no likelihood of improvement.

(iv) In cases of veterans over 55 years of age, except under unusual circumstances.

(v) When the rating is a prescribed scheduled minimum rating; or

(vi) Where a combined disability evaluation would not be affected if the future examination should result in reduced evaluation for one or more conditions.

 

Edited by pacmanx1
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As noted, the regulations don't state that a vet over 55 can't be reexamined.  The regulations state that that a reexamination is only supposed to happen in "unusual circumstances".

Who the heck knows what the VA considers to be "unusual circumstances". 

The one consistent justification to the VA going around the 20 yr, 10 yr,  5yr (and other) protections is suspected fraud. 

I suppose  a jerk doctor or nurse practitioner who disagrees with a rating could initiate a reevaluation.  I have received medical care from the VA for almost 40 years and have only crossed paths with 3 VA medical people I would throw into this camp.  As soon as I recognized that they were sketchy, I  wrote an email to the patient advocate and asked to be seen by someone else, they immediately made a switch. I believe patient advocates report directly to the facility director.

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1 hour ago, scottinmt said:

suppose  a jerk doctor or nurse practitioner who disagrees with a rating could initiate a reevaluation.  I have received medical care from the VA for almost 40 years and have only crossed paths with 3 VA medical people I would throw into this camp.  As soon as I recognized that they were sketchy, I  wrote an email to the patient advocate and asked to be seen by someone else, they immediately made a switch. I believe patient advocates report directly to the facility director.

 Now I have been treated at the va for over 25 years I never seen it happen

And yes I have had to change doctor and there was no problem.

Now let's look at today these private company comp exam doctor.

Are workman comp doctors ssi  doctor they are from system they are not friendly.

The va system is to be a veteran friendly.

I say that to say veterans are taking more chances with these doctors.

I see more reduction now than before.

Just my opinion

 

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