What are VA disability reduction methods?

[Jake206th]

HLR for EED was returned for duty to assist error based on; 38 CFR §4.70 Inadequate examinations.

The Higher level review return says that the c&p examiner did not specifically address the board remand directives even though the c&p examiner did specifically and explicitly address all of the noted board remand instruction directives.

 

They are questioning all of the basis that the original C&P examiner gave that the VA used to grant the increased evaluation of 100%, even though it was clearly sufficient.

They are questioning the diagnosis, the frequency, the symptom severity level, and the duration.

 

What are their options to reduce in this scenario?

Difference of opinion? Cue? Reduction process?

Can they bypass all of those option and just re adjudicate it at a lower rating because the decision was less than 1 year ago?

 

Does this mean that the favorable findings laws and cue laws don't apply and that they can just issue a new rating decision to revise my 100% rating without any CUE or reduction due process?

 

 

I am not a lawyer and nothing I write is legal advice. It is just how things appear to me based on my limited understanding. and I may be incorrect.

Edited February 3, 2023 by Jake206th

[Dustoff1970]

This is above my pay grade, but more knowledgeable others will answer you soon.

[pacmanx1]

1 hour ago, Jake206th said:

The Board correctly remanded it for duty to assist error, due to lack of c&p exam to contemplate severity level of symptoms.

A C&P exam occurred. The examiner selected all the qualifying favorable criteria on the DBQ form specifically matching the language in the CFR rating schedule for the 100% rating criteria, and described in notes.

The VA granted 100% P&T with SMC-S based on statutory 60 plus 100 criteria.

However the VA assigned effective date as 2021 date of exam and not 2010 date of claim, despite the examiner contemplating the symptoms retrospectively back to the 2010 date of claim in the c&p exam as ordered by BVA remand instructions.

I then filed the HLR for an earlier effective date, using the non hearing option.

Called the hamster wheel, since you have been rated 100% P & T with SMC-S, it is not likely that the VA would reduce your rating. Even if they did, you can file a disagreement that would have to go back to the BVA and if you disagree with their decision, you can always file your appeal to the CAVC. 

[Jake206th]

On 6/25/2022 at 11:26 PM, pacmanx1 said:

Called the hamster wheel, since you have been rated 100% P & T with SMC-S, it is not likely that the VA would reduce your rating. Even if they did, you can file a disagreement that would have to go back to the BVA and if you disagree with their decision, you can always file your appeal to the CAVC. 

I am familiar with the hamster wheel and some dirty tricks after having appealed my claims for over 20 years now.

I am trying to understand what happens if my new c&p exam has evidence which counters against the c&p exam that they based my 100% off of, what easy options they have to reduce me.

I thought they could only file a CUE or initiate the separate reduction process. Not from a difference of opinion.

But it appears that since my 100% evaluation decision is less than 1 year old it is not final, so any negative new and material evidence they could just change the initial 100% rating decision without any due process, meaning without filing a CUE, and without a predetermination hearing option. I am not finding much info about that process but under the AMA that would seem to conflict with; 38 CFR 3.104(c) Favorable findings, and 38 CFR 20.801(a) General,

 

 

M21-1MR, Part III, Subpart iv, chapter 2, section b.

a.  Finality of Determinations                                      

Once a determination is made, and the time limit for filing appeal has passed, it is final and binding.

 Exception:  A determination is not binding if

•             revised on the basis of new and material evidence, or

•             reversed on the basis of a clear and unmistakable error (CUE).

 Important:  Cite 38 CFR 3.105(a) for reversals on the basis of CUE.

 

 

(...) New or recently developed facts or changes in the law subsequent to the original adjudication may provide grounds for reopening a case or for a de novo review (...) Caffrey v. Brown, 6 Vet. App. 377 (1994).

 

 

Document Type: Rule

Document Citation: 84 FR 138

Page: 138-194 (57 pages)

The AMA requires that any pre-decisional duty to assist error discovered by an adjudicator be cured and that the decision be readjudicated by the agency of original jurisdiction.

 

 

So can they just revise the original 100% rating decision and reduce me without filing a CUE or using the standard reduction process which both have due process?

Thanks

 

 

 

I am not a lawyer and nothing I write is legal advice. It is just how things appear to me based on my limited understanding. and I may be incorrect.

Edited February 3, 2023 by Jake206th
add disclaimer

[pacmanx1]

5 hours ago, Jake206th said:

I am familiar with the hamster wheel and some dirty tricks after having appealed my claims for over 20 years now.

I am trying to understand what happens if my new c&p exam has evidence which counters against the c&p exam that they based my 100% off of, what easy options they have to reduce me.

I thought they could only file a CUE or initiate the separate reduction process. Not from a difference of opinion.

But it appears that since my 100% evaluation decision is less than 1 year old it is not final, so any negative new and material evidence they could just change the initial 100% rating decision without any due process, meaning without filing a CUE, and without a predetermination hearing option. I am not finding much info about that process but under the AMA that would seem to conflict with; 38 CFR 3.104(c) Favorable findings, and 38 CFR 20.801(a) General,

This is not my first rodeo.

When the VA makes a decision that decision is protected even less than a years' old and especially ones that are in appeal status. I know this because I personally have been fighting the VA for well over twenty (20) years and I have been threatened by other veterans, VA employees, VSOs, and even a BVA judge that I could lose my current rating. My situation is that the VA granted me 100% P & T, but I had multiple claims on appeal and in remand status and I was told that I could lose my benefits. They all lied, or they did not know what they were talking about. After being rated 100% P & T, the BVA denied one of my appealed claims, it then went to the CAVC where they granted me a joint remand and then back to the BVA where they granted it. Now this new rating was not included in my 100% P & T rating so no big deal right. The VA low balled this rating, I filed an NOD, and the VA increased my rating but screwed up my effective date, I filed a new NOD, and the VA decreased this rating. When I filed a new NOD, this appeal went back to the BVA and they in turn called it a” Mischaracterization of Issue on appeal” and forced the VA to restore this rating percentage. So, once a decision is made the VA cannot just reduce a veterans rating or even take it away without due process. It is simply fearmonger. I posted this several years ago, pay close attention to the regulation and the rules.

Fear of Reduction Wait Read This - VA Disability Compensation Benefits Claims Research Forum - VA Disability Compensation Benefits Forums - HadIt.com Veterans

 

 

Edited June 26, 2022 by pacmanx1

[Jake206th]

pacmax1, thanks. That is very useful information.

 I am not seeing anything about revisions without due process then. I can handle the hamster wheel. I am prepared.

 

 

I am not a lawyer and nothing I write is legal advice. It is just how things appear to me based on my limited understanding. and I may be incorrect.

Edited February 3, 2023 by Jake206th

[pacmanx1]

38 CFR REVISIONS

38 CFR § 3.105 - Revision of decisions.

• CFR

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§ 3.105 Revision of decisions.

The provisions of this section apply except where an award was based on an act of commission or omission by the payee, or with his or her knowledge (§ 3.500(b)); there is a change in law or a Department of Veterans Affairs issue, or a change in interpretation of law or a Department of Veterans Affairs issue (§ 3.114); or the evidence establishes that service connection was clearly illegal. The provisions with respect to the date of discontinuance of benefits are applicable to running awards. Where the award has been suspended, and it is determined that no additional payments are in order, the award will be discontinued effective date of last payment.

(a)

(1) Error in final decisions. Decisions are final when the underlying claim is finally adjudicated as provided in § 3.160(d). Final decisions will be accepted by VA as correct with respect to the evidentiary record and the law that existed at the time of the decision, in the absence of clear and unmistakable error. At any time after a decision is final, the claimant may request, or VA may initiate, review of the decision to determine if there was a clear and unmistakable error in the decision. Where evidence establishes such error, the prior decision will be reversed or amended.

(i) Definition of clear and unmistakable error. A clear and unmistakable error is a very specific and rare kind of error. It is the kind of error, of fact or of law, that when called to the attention of later reviewers compels the conclusion, to which reasonable minds could not differ, that the result would have been manifestly different but for the error. If it is not absolutely clear that a different result would have ensued, the error complained of cannot be clear and unmistakable. Generally, either the correct facts, as they were known at the time, were not before VA, or the statutory and regulatory provisions extant at the time were incorrectly applied.

(ii) Effective date of reversed or revised decisions. For the purpose of authorizing benefits, the rating or other adjudicative decision which constitutes a reversal or revision of a prior decision on the grounds of clear and unmistakable error has the same effect as if the corrected decision had been made on the date of the reversed decision. Except as provided in paragraphs (d) and (e) of this section, where an award is reduced or discontinued because of administrative error or error in judgment, the provisions of § 3.500(b)(2) will apply.

(iii) Record to be reviewed. Review for clear and unmistakable error in a prior final decision of an agency of original jurisdiction must be based on the evidentiary record and the law that existed when that decision was made. The duty to assist in § 3.159 does not apply to requests for revision based on clear and unmistakable error.

(iv) Change in interpretation. Clear and unmistakable error does not include the otherwise correct application of a statute or regulation where, subsequent to the decision being challenged, there has been a change in the interpretation of the statute or regulation.

(v) Limitation on Applicability. Decisions of an agency of original jurisdiction on issues that have been decided on appeal by the Board or a court of competent jurisdiction are not subject to revision under this subsection.

(vi) Duty to assist not applicable. For examples of situations that are not clear and unmistakable error see 38 CFR 20.1403(d).

(vii) Filing Requirements -

(A) General. A request for revision of a decision based on clear and unmistakable error must be in writing, and must be signed by the requesting party or that party's authorized representative. The request must include the name of the claimant; the name of the requesting party if other than the claimant; the applicable Department of Veterans Affairs file number; and the date of the decision to which the request relates. If the applicable decision involved more than one issue, the request must identify the specific issue, or issues, to which the request pertains.

(B) Specific allegations required. The request must set forth clearly and specifically the alleged clear and unmistakable error, or errors, of fact or law in the prior decision, the legal or factual basis for such allegations, and why the result would have been manifestly different but for the alleged error. Non-specific allegations of failure to follow regulations or failure to give due process, or any other general, non-specific allegations of error, are insufficient to satisfy the requirement of the previous sentence.

(2) Error in binding decisions prior to final adjudication. Prior to the time that a claim is finally adjudicated, previous decisions which are binding will be accepted as correct by the agency of original jurisdiction, with respect to the evidentiary record and law existing at the time of the decision, unless the decision is clearly erroneous, after considering whether any favorable findings may be reversed as provided in § 3.104(c).

(b) Difference of opinion. Whenever an adjudicative agency is of the opinion that a revision or an amendment of a previous decision is warranted on the basis of the evidentiary record and law that existed at the time of the decision, a difference of opinion being involved rather than a clear and unmistakable error, the proposed revision will be recommended to Central Office. However, a decision may be revised under § 3.2600 or § 3.2601 without being recommended to Central Office.

(c) Character of discharge. A determination as to character of discharge or line of duty which would result in discontinued entitlement is subject to the provisions of paragraph (d) of this section.

(d) Severance of service connection. Subject to the limitations contained in §§ 3.114 and 3.957, service connection will be severed only where evidence establishes that it is clearly and unmistakably erroneous (the burden of proof being upon the Government). (Where service connection is severed because of a change in or interpretation of a law or Department of Veterans Affairs issue, the provisions of § 3.114 are for application.) A change in diagnosis may be accepted as a basis for severance action if the examining physician or physicians or other proper medical authority certifies that, in the light of all accumulated evidence, the diagnosis on which service connection was predicated is clearly erroneous. This certification must be accompanied by a summary of the facts, findings, and reasons supporting the conclusion. When severance of service connection is considered warranted, a rating proposing severance will be prepared setting forth all material facts and reasons. The claimant will be notified at his or her latest address of record of the contemplated action and furnished detailed reasons therefor and will be given 60 days for the presentation of additional evidence to show that service connection should be maintained. Unless otherwise provided in paragraph (i) of this section, if additional evidence is not received within that period, final rating action will be taken and the award will be reduced or discontinued, if in order, effective the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final rating action expires.

(Authority: 38 U.S.C. 5112(b)(6))

(e) Reduction in evaluation - compensation. Where the reduction in evaluation of a service-connected disability or employability status is considered warranted and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance will be prepared setting forth all material facts and reasons. The beneficiary will be notified at his or her latest address of record of the contemplated action and furnished detailed reasons therefor, and will be given 60 days for the presentation of additional evidence to show that compensation payments should be continued at their present level. Unless otherwise provided in paragraph (i) of this section, if additional evidence is not received within that period, final rating action will be taken and the award will be reduced or discontinued effective the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final rating action expires.

(Authority: 38 U.S.C. 5112(b)(6))

(f) Reduction in evaluation - pension. Where a change in disability or employability warrants a reduction or discontinuance of pension payments currently being made, a rating proposing the reduction or discontinuance will be prepared setting forth all material facts and reasons. The beneficiary will be notified at his or her latest address of record of the contemplated action and furnished detailed reasons therefor, and will be given 60 days for the presentation of additional evidence to show that pension benefits should be continued at their present level. Unless otherwise provided in paragraph (i) of this section, if additional evidence is not received within that period, final rating action will be taken and the award will be reduced or discontinued effective the last day of the month in which the final rating action is approved.

(Authority: 38 U.S.C. 5112(b)(5))

(g) Reduction in evaluation - monetary allowance under 38 U.S.C. chapter 18 for certain individuals who are children of Vietnam veterans or children of veterans with covered service in Korea. Where a reduction or discontinuance of a monetary allowance currently being paid under 38 U.S.C. chapter 18 is considered warranted, VA will notify the beneficiary at his or her latest address of record of the proposed reduction, furnish detailed reasons therefor, and allow the beneficiary 60 days to present additional evidence to show that the monetary allowance should be continued at the present level. Unless otherwise provided in paragraph (i) of this section, if VA does not receive additional evidence within that period, it will take final rating action and reduce the award effective the last day of the month following 60 days from the date of notice to the beneficiary of the proposed reduction.

(Authority: 38 U.S.C. 1805, 1815, 1821, 1832, 5112(b)(6))

(h) Other reductions/discontinuances. Except as otherwise specified at § 3.103(b)(3) of this part, where a reduction or discontinuance of benefits is warranted by reason of information received concerning income, net worth, dependency, or marital or other status, a proposal for the reduction or discontinuance will be prepared setting forth all material facts and reasons. The beneficiary will be notified at his or her latest address of record of the contemplated action and furnished detailed reasons therefor, and will be given 60 days for the presentation of additional evidence to show that the benefits should be continued at their present level. Unless otherwise provided in paragraph (i) of this section, if additional evidence is not received within that period, final adverse action will be taken and the award will be reduced or discontinued effective as specified under the provisions of §§ 3.500 through 3.503 of this part.

(Authority: 38 U.S.C. 5112)

(i) Predetermination hearings.

(1) In the advance written notice concerning proposed actions under paragraphs (d) through (h) of this section, the beneficiary will be informed that he or she will have an opportunity for a predetermination hearing, provided that a request for such a hearing is received by VA within 30 days from the date of the notice. If a timely request is received, VA will notify the beneficiary in writing of the time and place of the hearing at least 10 days in advance of the scheduled hearing date. The 10 day advance notice may be waived by agreement between VA and the beneficiary or representative. The hearing will be conducted by VA personnel who did not participate in the proposed adverse action and who will bear the decision-making responsibility. If a predetermination hearing is timely requested, benefit payments shall be continued at the previously established level pending a final determination concerning the proposed action.

(2) Following the predetermination procedures specified in this paragraph and paragraph (d), (e), (f), (g) or (h) of this section, whichever is applicable, final action will be taken. If a predetermination hearing was not requested or if the beneficiary failed without good cause to report for a scheduled predetermination hearing, the final action will be based solely upon the evidence of record. Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant or beneficiary, death of an immediate family member, etc. If a predetermination hearing was conducted, the final action will be based on evidence and testimony adduced at the hearing as well as the other evidence of record including any additional evidence obtained following the hearing pursuant to necessary development. Whether or not a predetermination hearing was conducted, a written notice of the final action shall be issued to the beneficiary and his or her representative, setting forth the reasons therefor and the evidence upon which it is based. Where a reduction or discontinuance of benefits is found warranted following consideration of any additional evidence submitted, the effective date of such reduction or discontinuance shall be as follows:

(i) Where reduction or discontinuance was proposed under the provisions of paragraph (d) or (e) of this section, the effective date of final action shall be the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final action expires.

(ii) Where reduction or discontinuance was proposed under the provisions of paragraphs (f) and (g) of this section, the effective date of final action shall be the last day of the month in which such action is approved.

(iii) Where reduction or discontinuance was proposed under the provisions of paragraph (h) of this section, the effective date of final action shall be as specified under the provisions of §§ 3.500 through 3.503 of this part.

(j) Supplemental claims and higher-level review. VA may revise an earlier decision denying benefits, if warranted, upon resolution of a supplemental claim under § 3.160(c) or higher-level review under § 3.2601.