How often should I get my issues treated? Fear of rate reduction one day.

[Ranmic]

Like most of the people on this forum I have multiple rated disabilities.  I go to the VA and see my PCP at a minimum once a year sometimes every six months depending on if I need to be seen.  I see one of my other Doctors (MH) at the VA when needed but usually every six months just to talk.  In fearing that the VA will one day come at me for a rating reduction is there anything I need to know or do to keep my doctor apprised that nothing has really changed with me or gotten better?  Basically I complain when something bothers me and don't when it's not but I don't want to screw myself either somewhere down the road.

[Vync]

@RanmicYou mentioned having already requested an increase. Here are some tips if you plan on doing that again. When considering whether or not to file for an increase, it might be helpful to first get copies of your medical records. For VA records, they are downloadable via blue button on my health evet. If you go to a non-VA provider on your own, keep in mind the VA will not have those records. When providing those to the VA, they will want you to do a release of information request. Once records are in hand, compare them to the rating criteria for your particular disability. If the records are from within the last 12 months -and- prove you meet the criteria for a higher rating, the VA is supposed to grant that date as the effective date. Many vets, including myself, have had increases approved without a C&P exam because the evidence in the records was clear. However, with changes over the years, the VA might send you for one anyway to confirm and/or look for any other side effect or other issues. Once you get a decision letter, go through it carefully. Compare it to the evidence of record and rating criteria. Sometimes the VA might grant a rating (increase or initial), but fail to grant you the highest rating for which you qualify.

Like @broncovetand others, I also had the VA attempt to reduce my rating in error. They sent me a letter to propose reduction and I responded promptly with overwhelming proof that I still met the rating percentage criteria. They reduced me anyway saying I never responded. I fought back with proof (return receipt of letter) that they received it. It took a bit, but they eventually conceded that they did receive it, but it was "misplaced". They corrected my rating.

[Ranmic]

7 hours ago, Vync said:

@RanmicYou mentioned having already requested an increase. Here are some tips if you plan on doing that again. When considering whether or not to file for an increase, it might be helpful to first get copies of your medical records. For VA records, they are downloadable via blue button on my health evet. If you go to a non-VA provider on your own, keep in mind the VA will not have those records. When providing those to the VA, they will want you to do a release of information request. Once records are in hand, compare them to the rating criteria for your particular disability. If the records are from within the last 12 months -and- prove you meet the criteria for a higher rating, the VA is supposed to grant that date as the effective date. Many vets, including myself, have had increases approved without a C&P exam because the evidence in the records was clear. However, with changes over the years, the VA might send you for one anyway to confirm and/or look for any other side effect or other issues. Once you get a decision letter, go through it carefully. Compare it to the evidence of record and rating criteria. Sometimes the VA might grant a rating (increase or initial), but fail to grant you the highest rating for which you qualify.

Like @broncovetand others, I also had the VA attempt to reduce my rating in error. They sent me a letter to propose reduction and I responded promptly with overwhelming proof that I still met the rating percentage criteria. They reduced me anyway saying I never responded. I fought back with proof (return receipt of letter) that they received it. It took a bit, but they eventually conceded that they did receive it, but it was "misplaced". They corrected my rating.

Thanks for the advice Vync!  I never thought of doing that but going forward I'll make sure I do.  Thanks again!

[Vync]

18 hours ago, Ranmic said:

Thanks for the advice Vync!  I never thought of doing that but going forward I'll make sure I do.  Thanks again!

The VA doesn't necessarily go about telling veterans that kind of advice, but I am glad it might be helpful. If considering filing for an increase, it's often better to do the legwork and connect the dots for the VA than expecting them to do that proactively.

[pacmanx1]

I would say that another thing to think about and consider is that when you feel that your symptoms are flaring/acting up, make sure you seek treatment. Get your symptoms documented, don’t tough it out. Keep in mind that in order to get an increase, the RO is going to be looking for some type of worsened/increased conditions.

[Rivet62]

MyHealth eVet messaging helps me stay in touch with providers for concerns I have in between visits. Not everything is an emergency but when I feel things have worsened I tell them and if they want appointments or tests then I go. My VA primary care doctor (VA outpatient clinic) has suggested I go to urgent care locally for increased difficulties or the emergency room of my local hospital if my pain is acute. I think it's important to do what they suggest. It's the medical protocol they're following and I'm assuming it's the continuity or disability progression that VA reviews on claims.

[pwrslm]

On 12/21/2021 at 9:18 AM, Vync said:

Sometimes the VA might grant a rating (increase or initial), but fail to grant you the highest rating for which you qualify.

They did this to me on my 1st claim. They lowballed the rating at first, but I raised the documentation in my VA Med Records and non-VA Med records that met the specs in the 38 CFR. After 4 months, they gave me the correct rating plus backpay.

This happens all the time with RO's. They are so backed up and loaded down with claims that they do not have the time to comb through your medical records, so they miss specifics and fail to get the correct ratings. The best thing any Vet can do when they submit a claim (new or increased) is to highlight relevant information and make a "shopping list" for the RO to use. By showing them the specific records, it avails them of combing through your records (which can be very time consuming when you have a hundred claims per week to process). 

If the RO still lowballs you, then you can document an error supported by medical evidence the RO had when s/he processed the denial/error.

Edited January 6, 2022 by pwrslm