VA Re-examination

Wally3430

Wally3430

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--Does anyone know what the current ACTUAL re-evaluation time frame is for the VA? The books says a re-eval will be conducted within 5 years since rating award, but I read others that are never re-eval'd at all. If a re-evaluation is scheduled based on potential for your disability to get better or worse, how do you know which one will be re-eval'd? As it stands, I'm coming up on 15 months on TDRL and I've been told I will be re-evaluated at that time for my PTSD and nothing else. But I'm wondering if/when all my other rated items will be evaluated?

--I have numerous minor ratings such as tendinitis, sciatica, joint pain with movement ect. that I havent been seen for once since being on TDRL. There's not much that can be done, so I don't bother getting seen for them. Should I be concerned those ratings will decrease? I worry that I'll be scheduled for a re-eval and have little or no paperwork post-retirement on some of my minor ratings. I know after 5 years, I will enter into a protected rating status which requires the VA to find proof that the disability is better to reduce a rating. I'm assuming no news does not automatically mean "he's better"? Anyone have experience with this?
 
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I always follow up with my Dr at least once a year. Until
He tells me that it’s permanent and no need to be seen anymore.
 
Deno said:
I always follow up with my Dr at least once a year. Until
He tells me that it’s permanent and no need to be seen anymore.
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Follow up once a year for every condition you've been rated on? How would your doctor know it is permanent in the VAs eyes?

Most doctors that Im used to seeing will only see you for one issue at a time. If I were to go in and drop every VA rated condition I have on him at the same time...well, that wouldn't work. He'd likely schedule me for numerous appointments. Since I'm Tricare Prime and live far away from a VA facility, scheduling multiple appointments gets expensive quick.
 
So I called the VA 1800 line and spoke to a very nice lady about this. She was able to pull my record up and she said PTSD was the only item that will definitely be re-evaluated...which I already knew. As for all other disabilities on my record, she said there is no indication that they WILL be re-evaluated in the future. BUT, she spewed what sounded like a company line when she said "the VA has the authority to review any and all of your conditions in the future". When I pressed her on when can I expect re-evaluations for that she again repeated that line verbatim. My concern being that if I'm hit for a re-evaluation for some of my minor disabilities and I have no paper trail of treatment, the VA would consider me all better (I don't get seen for minor things that I know can't reasonably be fixed..like joint pain or sciatica for example.) Finally, I broke thru to her on a personal level and she said her husband is disabled retired and uses Tricare only, not VA. She said he just brings up all the stuff he is rated for at his yearly checkup to keep it documented (besides the disabilities that actually REQUIRE regular treatment). She said some folks that are disabled retired and using Tricare have never again been seen by the VA.

Does this check with anyone else?
 
Wally3430 said:
She said some folks that are disabled retired and using Tricare have never again been seen by the VA.
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^^^^This right here is my ultimate goal, retired and Tricare eligible, no longer forced to rely on substandard VA care/services which are usually far away and lack appointment availability.

Wally3430, I'm aware this isnt a new post but were you ever examined for your other conditions since posting this thread?
 
Ncummi6 said:
^^^^This right here is my ultimate goal, retired and Tricare eligible, no longer forced to rely on substandard VA care/services which are usually far away and lack appointment availability.

Wally3430, I'm aware this isnt a new post but were you ever examined for your other conditions since posting this thread?
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Ncumm---I had a re-eval done earlier this year. My VSO filed for increases on just about everything I had...plus IU. Because of that, they re-eval'd me on almost everything. Most ratings stayed the same, PTSD went up and I was awarded IU. But I think the reason I was re-eval'd on everything was solely due to my VSO looking for increases on everything. If he would've just put in for a PTSD increase and IU, I imagine I would've only had a mental health evaluation. I was pretty PO'd about evals on everything; many of my minor disabilities didn't have a paper trail (since I'm not going to continuously have doctors appointments for tendinitis or back pain). I try to remember to at least mention each disability whenever I do my yearly doctor visit from now on---just so it's documented.
 
I recently filed for IU and the Va scheduled me for a psych exam and for all my other claims. Prior to filing for IU i paid out if pocket to see a psychiatrist so id have documented proof of not being able to work due to mental issues. But the va wouldnt take it. Instead they sent me to see a psychiatrist at "THEIR" QTC. I handed that psychiatrist my report (scoring 38 on the global assessment functioning test) from my doctor. Literally had that done on October 10th. This new exam was done on November 8th. Now i go back tomorrow November 14th to have my neck, lower back, both shoulders, both knees & right ankle checked again. What baffles me is i filed IU cause of mental illness not physical. I personally think the va is looking to deny me on purpose.
 
If you look at the CFR, some conditions are rated for high at first, then require a rerate X months later. The number of months varies by condition.
 
RedDirtRay said:
I recently filed for IU and the Va scheduled me for a psych exam and for all my other claims. Prior to filing for IU i paid out if pocket to see a psychiatrist so id have documented proof of not being able to work due to mental issues. But the va wouldnt take it. Instead they sent me to see a psychiatrist at "THEIR" QTC. I handed that psychiatrist my report (scoring 38 on the global assessment functioning test) from my doctor. Literally had that done on October 10th. This new exam was done on November 8th. Now i go back tomorrow November 14th to have my neck, lower back, both shoulders, both knees & right ankle checked again. What baffles me is i filed IU cause of mental illness not physical. I personally think the va is looking to deny me on purpose.
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Welcome to the PEB Forum! :)

In retrospect, Individual Unemployability allows the DoVA VBA to pay certain veterans at the 100-percent disability rate even though their service-connected disabilities are not rated as 100-percent disabling. Veterans may be eligible for this rating increase if they are either unemployed or unable to maintain substantially gainful employment as a result of their service-connected disability.

In order to qualify for IU, the Veteran must have one of the following:

1) a 60-percent or more disability evaluation based on a single service-connected disability or,

2) a 70-percent or more combined disability evaluation based on multiple service-connected disabilities, with at least one disability rated at 40 percent or more.

In these cases, the DoVA VBA will consider a veteran’s eligibility for IU, if there is evidence showing he or she cannot work due to service-connected disabilities. In both instances, the DoVA VBA reviews all the evidence of record and decides if a veteran’s disability is, by law, severe enough to grant IU.

To any extent, when it comes to proving to the DoVA VBA that the veteran is eligible for IU (e.g., if the veteran is found to have met the rating threshold and employment criteria) the best evidence is a professional opinion from a vocational expert or competent medical doctor concerning the veteran’s ability to secure or follow a substantially gainful occupation. The DoVA VBA often times schedules a veteran for C&P exam(s) to get an opinion on IU. This report should include a rationale as to whether it is as likely as not (50/50 chance) that the service-connected disability or combined disabilities render the veteran unable to secure and maintain substantially gainful employment. Additionally, the report should also include and describe the functional impairment caused by the veteran’s disabilities and how that impairment impacts on physical and sedentary employment. Other evidence to support unemployability may include employment history, employer records, and any medical evidence that indicates that the veteran is totally disabled and unemployable.

For historical knowledge about IU, please reference the attached DoVA VBA fact sheet to obtain updated detailed information as of August 2018. Furthermore, it's important to note that if a veteran is qualified for IU then the veteran may have to complete an employment questionnaire once a year in order for the DoVA VBA to continue to pay the IU benefit. As such, the aforementioned employment questionnaire also verifies continued IU eligibility. Take care!

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer!"

Best Wishes!
 

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RedDirtRay said:
I recently filed for IU and the Va scheduled me for a psych exam and for all my other claims. Prior to filing for IU i paid out if pocket to see a psychiatrist so id have documented proof of not being able to work due to mental issues. But the va wouldnt take it. Instead they sent me to see a psychiatrist at "THEIR" QTC. I handed that psychiatrist my report (scoring 38 on the global assessment functioning test) from my doctor. Literally had that done on October 10th. This new exam was done on November 8th. Now i go back tomorrow November 14th to have my neck, lower back, both shoulders, both knees & right ankle checked again. What baffles me is i filed IU cause of mental illness not physical. I personally think the va is looking to deny me on purpose.
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As Warrior644 stated an application for IU means they can review all your disabilities its common for a reduction to occur if you haven't been rated for at least five years and some improvement can be shown.
 
oddpedestrian said:
As Warrior644 stated an application for IU means they can review all your disabilities its common for a reduction to occur if you haven't been rated for at least five years and some improvement can be shown.
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I did some digging around and can't seem to find where I read this, but just recently I came across an internal memo (training letter maybe) that stated the VA had done away with this (or language to a similar effect), that they no longer re-open your case file and look at all disabilities, but rather any disability for which you are applying for TDIU, they must presume you are looking for an increase on those specific disabilities as well, but they will only look at what's put on the initial form when filing for TDIU.

I may be mistaken, but I am pretty sure this is what it said.
 
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