24 May 2014

VA headache

Coincidental to all the latest headlines, I yesterday received a letter from the VA, (improperly addressed to "Mr." - thanks for that) which stated that they were changing the rating for one of my conditions. The letter stated, "We have enclosed a copy of our rating decision for your review. It provides a detailed explanation about our proposal, the reason for it, and the evidence considered."

The evidence line stated "VA exam dated 7 April 2014." So, based on one exam, which lasted one hour, with a doctor I had never previously met until I was sent there for the mandatory periodic VA evaluation, and no other information from the two other primary doctors under whose care I have been for over a year nor the physical therapist who has been treating me for almost two years, they made a decision that I have improved.

Let's look at the timeline of events, shall we?

Apr 2013 - Final formal physical evaluation board findings completed and accepted by SNM (me)
May 2013 - Final VA and DoD disability ratings determined and accepted by SNM
Jun 2013 - Terminal leave starts
Aug 2013 - TDRL* (i.e. retirement) begins
Mar 2014 - Mail notification of a mandatory VA evaluation appointment in May. I am told to bring NO medical records except a list of both prescribed and OTC medications. This means the VA has no record of the twice- to thrice-weekly medical appointments over the past year, the 5-day hospitalization last fall, the postponed reconstructive surgery, nor the recent issues re: my broken ankle in March
Apr 2014 - VA-directed medical "evaluation" appointment (see above)
May 2014 - VA says they "noted some improvement" so I no longer rate the initial evaluated percentage

I have 60 days to "submit medical or other evidence to show that we should not make this change." The letter wisely advises me that "the best type of evidence to submit is a statement from a physician who recently treated or examined you." Oh, hey, thanks for the tip.

So.....less than a year after I am retired, I am so improved that they want to downgrade my rating - without actually reviewing my full, recent medical history. Sort of a bizarre way to make a determination, IMHO. (Incidentally, I am still awaiting the appointment date for my DoD annual medical review - the one where they decide whether or not to take me off TDRL and permanently retire me - and they want ALL records of medical treatment received since I left active duty.)

I looked it up and the VA actions fall under the Code of Federal Regulations (CFR), Title 38:  Pensions, Benefits and Veterans' Relief, Chapter 1: Department of Veterans Affairs, Part 3: Adjudication, Subpart A: Pension, Compensation, and Dependency and Indemnity Compensation, Heading 311: Administrative, Section 3.105: Revision of decisions. (There are specific instructions and provisions for how long they have to make revisions as well, under Sections 3.343 and 3.344, to name the ones under which I would most likely fall.) 

The sword continues to cut both ways: condemned to a lower quality of life if you don't push to better your physical and mental conditions and yet, penalized by the system if you do. Thank you, Mr. Joseph Heller, for the appropriate lexicon for this cycle. Sigh....all this really means is more paperwork. 


*See blog post 'Retired...with a catch, pt.1'

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