Optum Serve ACE C&P exam

[Dustoff1970]

Received this notice from Optum Serve for them to conduct a VARO request ACE exam of my medical records for IMO evaluation of my Vietnam Agent Orange Ischemic heart disease rating level of 60%.  No in person appearance is required of me.

On May 30, 2023 the BVA Judge granted my appeal for increase of the IHD/CAD heart disease from 30 to 60% and now already the unhappy jealous VARO and  VA C&P examiner  are requesting an independent IMO on this increase approved by BVA.  As an old experienced dog dealing with the VA claims and appeals successfully since 1985 I am not concerned or too surprised by this as this confirms VARO raters narrow small mindedness. I have been highly critical of this biased  VA C&P examiner in post on veterans benefits forums with no regrets.  He was overruled twice by BVA judges on my two separate claims/appeals.  The judges said both times correctly that his negative opinions against me were deficient, defective and without merit.

I will of course contest any proposed reduction although a reduction would not effect my overall solid 100%P&T rating with SMC-S. Their government fun and games with vets continues on and on and on.  May they burn in  I encourage fellow vets to grow some guts and challenge the VARO and their examiners.  You are no longer in the **********military.

They cannot reduce me below mandatory 30% because of confirmed enlarged heart.  Next the pukes will probably order a field examination of my daily activities that is fine by me as they can waste their personnel time and taxpayer money.   "trust us we are from the government" HA

My comment/opinion is not legal advice as I am not a lawyer, paralegal or VSO.

Edited September 18, 2023 by Dustoff1970

[broncovet]

While I can understand your skepticism, my VA has "earned" its reputation that Veterans dont trust VA.  

This said, sometimes VA does suprise me favorably.  

While I wont bore you with examples, this could also be "something favorable" or good.  The regulation is somewhat hard to read, so I highlighted important parts.  

 

Will Rogers is quoted as saying "Worrying" is like paying a bill that may never be due".  

REPEATEDLY, my guess is that at least 20 times more Veterans worry about a reduction, than those who have actually received a proposed reduction.  (This is my guess, but I have. noticed that "proposed reduction letters" are much more frequent than Veterans who are worried about the same). 

Its actually very hard for VA to reduce P and T Vets, that is, if the Veteran opposes the PR, and disputes a reduction with an appeal.  

But, many Vets dont dispute a PR (Proposed Reduction), and then wonder why it happens, when they did not bother to dispute the PR.  

Once again, my unsubstantiated opinion is that there are 20 PR's to every reduction.  

In my years of being on hadit, I can only think of "one" reduction that stuck, if the Veteran disputed it and appealed.  It was many years ago, and was a rather famous case.  

I dont worry about a PR, and never have.  The regulations are just restrictive to VA, good for us.  

Im sure you are aware of the regulations, Im posting them for others who may also be worried about a reduction:

The worst is when the Vet never seeks an increase and settles for less than he deserves because he fears a reduction:

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.

 

[Dustoff1970]

Well said Broconvet.  I suppose she could recommend an unlikely increase to 100% for heart disease as I filed my claim for increase to the highest rating allowed and courts has ruled many years ago that VARO raters are to assume vets are always filing for/seeking the highest rating allowed for a particular disability.  Many vets don't know this.

This is as I said is of no concern but a very interesting mystery for me.  Going fishing for maybe a week for fun and pleasure.

[Dot09]

Got my fingers crossed for you but you would think they would leave you alone by now. 

[Dustoff1970]

I just received final decision letter from VARO and they are continuing my AO heart disease rating at the correct 60% level.  The decision letter actually appeared on my VA.GOV webpage 11 days before it came in the regular mail.  Good stuff.

The VA raters ordered up two separate Optum serve ACE exams on this heart disease increase within two weeks of each other and evidently both NP examiners recommended my continued 60% rating after they both review my medical record history on this heart disease.  Another win for me and Zero for the raters.

[Dot09]

Glad to hear it worked out for you. Hopefully they leave you alone now. What’s your protection rating dates?

[Dustoff1970]

I actually won this heart disease increase to 60% on a BVA appeal and backdated to 2017.  So I am over the 5 year mark for stable rating status but the VA raters were unhappy with my win at the BVA so they ordered up the two Optum Serve ACE exams.  Their bad and loss.