Complete Disability Reevaluation Upon Each New Claim?

Wally3430

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I could've swore I read somewhere last year that as a cost-saving measure, the VA will not be reevaluating ALL disabilities a veteran is rated for whenever a veteran submits a single new claim. They will only evaluate the specific claim a veteran has submitted. Is this true? I can't find that information anywhere--perhaps I imagined it.

I've accumulated a few disabilities, some original, some secondary to what I have already, and wondering if I should just keep that documentation handy or submit a claim and have them added?
 
I could've swore I read somewhere last year that as a cost-saving measure, the VA will not be reevaluating ALL disabilities a veteran is rated for whenever a veteran submits a single new claim. They will only evaluate the specific claim a veteran has submitted. Is this true? I can't find that information anywhere--perhaps I imagined it.

I've accumulated a few disabilities, some original, some secondary to what I have already, and wondering if I should just keep that documentation handy or submit a claim and have them added?
Hello @Wally3430

The following is somewhat related to the issue you mentioned:

This does not pertain to the PEB/MEB/IDES processing.

A fellow member of another board to which I belong recently posted the recommendations below. They are important since he is a current rater with the VA. His comments follow:

[start]
About twice a year I’d say I post warnings like the following. Cases where you just have to shake your head. Some info may or may not be tweaked to protect the guilty.

Rated a claim for increase that wound up being a GIANT decrease.

Vet a couple week ago received a BVA decision that denied an increase in conditions but granted IU and there were no future exams, so this vet would soon be TDIU. This will be important later; the increases where denied by BVA because improvement was indicated on the last exams 2 years ago, but was not “sustained improvement” under 3.344, so the ratings were continued. No RFE set as vet is over 55. 3.327.

So, this vet had it, made TDIU, just had to wait for the rating decision to execute BVA’s decision....but no....

The vet files a regular claim for increase on the issues just denied an increase by BVA. BVA decision is executed giving vet years of back pay. But days after that, has the increase claim C&Ps [exams].

You guessed it, the new exams confirm improvement. So the result is proposed reductions which takes this vet to an overall of 30%. Thus resulting also in proposing the discontinuance of IU and chapter 35.

Sent the case info to a VBA friend of mine to review something for me, his response, “too bad the vet didn’t have a VSO.”

If you don’t know what you’re doing, get a VSO. I’ll remember this case for awhile. Peace.
___________________
Author: "Spunky"
USAF (ret) 1991-2012
VBA Counselor 2014-2016
VBA RVSR 2016-current
[end]
 
Hello @Wally3430

The following is somewhat related to the issue you mentioned:

This does not pertain to the PEB/MEB/IDES processing.

A fellow member of another board to which I belong recently posted the recommendations below. They are important since he is a current rater with the VA. His comments follow:

[start]
About twice a year I’d say I post warnings like the following. Cases where you just have to shake your head. Some info may or may not be tweaked to protect the guilty.

Rated a claim for increase that wound up being a GIANT decrease.

Vet a couple week ago received a BVA decision that denied an increase in conditions but granted IU and there were no future exams, so this vet would soon be TDIU. This will be important later; the increases where denied by BVA because improvement was indicated on the last exams 2 years ago, but was not “sustained improvement” under 3.344, so the ratings were continued. No RFE set as vet is over 55. 3.327.

So, this vet had it, made TDIU, just had to wait for the rating decision to execute BVA’s decision....but no....

The vet files a regular claim for increase on the issues just denied an increase by BVA. BVA decision is executed giving vet years of back pay. But days after that, has the increase claim C&Ps [exams].

You guessed it, the new exams confirm improvement. So the result is proposed reductions which takes this vet to an overall of 30%. Thus resulting also in proposing the discontinuance of IU and chapter 35.

Sent the case info to a VBA friend of mine to review something for me, his response, “too bad the vet didn’t have a VSO.”

If you don’t know what you’re doing, get a VSO. I’ll remember this case for awhile. Peace.
___________________
Author: "Spunky"
USAF (ret) 1991-2012
VBA Counselor 2014-2016
VBA RVSR 2016-current
[end]
I suppose that "sorta" relates to my questions. Not sure why a guy would file for an increase when past exam indicated improvement. Also not sure if the "increase claim C&Ps" were going over EVERYTHING in his file or just what he filed an increase claim for---the heart of my question.

I'd say I know "a little" about what I'm doing, but filling in the blanks is what this forum is for! The two experiences I've personally have had with VSOs and the one my father recently used have all been complete garbage, no exaggeration, so my confidence in going directly to them first without making the effort to educate myself as much as possible prior to that, is low. As the saying goes, "No one cares about you more than you."
 
I suspect is you file a new claim:
a. as secondary, the original will be re-rated.
b. the body system in which the new claim falls, may be re-rated
 
I suspect is you file a new claim:
a. as secondary, the original will be re-rated.
b. the body system in which the new claim falls, may be re-rated
There is also anecdotal evidence that everything is open to review upon receipt of a new claim. At least that is what the two VA raters I know have stated.

Ron

cc: @Wally3430
 
Ron,

I agree that everything may be rated, but I suspect systems come into play. Example: Heart, lungs, and kidneys typically interplay. So if your rated for heart and then later claim lungs, all three systems would be examined. Your are rated for mobility (ROM) and you claim radiating pain, both would be re-rated. The VA has many factors for deciding to re-rate. Under 55 is more likely to be re-rated for example. Some conditions require re-rating after a certain time (heart failure for example requires a 6 month re-rate). The system is complicated. I agree with your bottom line of consulting a VSO.
 
I suspect is you file a new claim:
a. as secondary, the original will be re-rated.
b. the body system in which the new claim falls, may be re-rated
I would expect (a). Body system...as in respiratory system, musculoskeletal system, cardiovascular system? Do you have a reference for that? Much appreciated.
 
General Information.

From an active VA claims rater, one year ago:

”Any time an RVSR rates a claim, they are responsible for all prior rating decisions for that Veteran. The quality review checklist that is used to assess RVSR performance includes addressing/reviewing previous rating decisions. Because of this most RVSRs are going to take a look at previous rating decisions for any obvious errors. CUEs are discovered every day, with the overwhelming majority of CUEs discovered when an RVSR reviews a prior rating decision(s). So bottom line is every time you submit a claim all previous rating decisions are likely to be reviewed.”

Perhaps that process has changed; I do not know since I am not a rater.


Ron
 
I would expect (a). Body system...as in respiratory system, musculoskeletal system, cardiovascular system? Do you have a reference for that? Much appreciated.
See my reply to RonG above.
 
”Any time an RVSR rates a claim, they are responsible for all prior rating decisions for that Veteran. The quality review checklist that is used to assess RVSR performance includes addressing/reviewing previous rating decisions. Because of this most RVSRs are going to take a look at previous rating decisions for any obvious errors. CUEs are discovered every day, with the overwhelming majority of CUEs discovered when an RVSR reviews a prior rating decision(s). So bottom line is every time you submit a claim all previous rating decisions are likely to be reviewed.”
Note this quality review!

Hypothetically a vet has a rating >0 for heart failure and a hearing rating of 0.

The vet submits a DBQ from an audiologist for hearing loss change that should result in a rating >0.

In quality review all rating will be looked at again BUT since the only new medical evidence is audiology; one ought to expect the heart rating to remain as is becuase there would be no evidence of a heart change.
 
Hello chaplaincharlie,

I agree with this: "one ought to expect the heart rating to remain as is becuase there would be no evidence of a heart change."

The rater said: "Any time an RVSR rates a claim, they are responsible for all prior rating decisions for that Veteran." The quality review he mentioned is a quality assurance feature at the VA.

I am not a SME on this issue, but I suspect the rater is an expert; I have "known" him for years. To me, a non-SME, "Any time" = all. I inferred from his remarks that errors in previous ratings are often found.

I will now return to my lane...

Thanks,
Ron

Edited to add 9/2/2021: I asked a rater to review this thread and he took a few minutes to offer this reply:
"I would say your post #9 is still correct. We are responsible for ALL prior ratings. Now, how often this is actually checked by the rater and quality review folks (RQSRs) is a subject for debate.

Personally I generally don’t re-look all issues. I will look for anything that stands out such as an unusually high or low rating. For example any 0 percent eval for major joints and most minor joints since 2016 when the court rule subjective pain is sufficient for the minimum compensable for the particular joint. On the other end, a 100 rating on mental health when the vet is full time employed. "

"We really have to balance our time to maintain high production and quality scores. Slip for too long, you get the boot from being a rater. "
 
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