Ratings Prior to MEB (C&P Exams)

ctbenja1015

PEB Forum Veteran
Registered Member
#1
I have seen many posts stating after 6 months or a year you have to get a new exam. The way I read this regulation is not less than 2 years. Am I not reading it properly?

(a) General. Reexaminations, including periods of hospital observation, will be requested whenever VA determines there is a need to verify either the continued existence or the current severity of a disability. Generally, reexaminations will be required if it is likely that a disability has improved, or if evidence indicates there has been a material change in a disability or that the current rating may be incorrect. Individuals for whom reexaminations have been authorized and scheduled are required to report for such reexaminations. Paragraphs (b) and (c) of this section provide general guidelines for requesting reexaminations, but shall not be construed as limiting VA's authority to request reexaminations, or periods of hospital observation, at any time in order to ensure that a disability is accurately rated.
(Authority: 38 U.S.C. 501)
(b) Compensation cases—
(1) Scheduling reexaminations. Assignment of a prestabilization rating requires reexamination within the second 6 months period following separation from service. Following initial Department of Veterans Affairs examination, or any scheduled future or other examination, reexamination, if in order, will be scheduled within not less than 2 years nor more than 5 years within the judgment of the rating board, unless another time period is elsewhere specified. not less than 2 years be
(2) No periodic future examinations will be requested. In service-connected cases, no periodic reexamination will be scheduled: (i) When the disability is established as static;
(ii) When the findings and symptoms are shown by examinations scheduled in paragraph (b)(2)(i) of this section or other examinations and hospital reports to have persisted without material improvement for a period of 5 years or more;
(iii) Where the disability from disease is permanent in character and of such nature that there is no likelihood of improvement;
(iv) In cases of veterans over 55 years of age, except under unusual circumstances;
(v) When the rating is a prescribed scheduled minimum rating; or
(vi) Where a combined disability evaluation would not be affected if the future examination should result in reduced evaluation for one or more conditions.
 

Warrior644

PEB Forum Veteran
Registered Member
#2
I have seen many posts stating after 6 months or a year you have to get a new exam. The way I read this regulation is not less than 2 years. Am I not reading it properly?

(a) General. Reexaminations, including periods of hospital observation, will be requested whenever VA determines there is a need to verify either the continued existence or the current severity of a disability. Generally, reexaminations will be required if it is likely that a disability has improved, or if evidence indicates there has been a material change in a disability or that the current rating may be incorrect. Individuals for whom reexaminations have been authorized and scheduled are required to report for such reexaminations. Paragraphs (b) and (c) of this section provide general guidelines for requesting reexaminations, but shall not be construed as limiting VA's authority to request reexaminations, or periods of hospital observation, at any time in order to ensure that a disability is accurately rated.
(Authority: 38 U.S.C. 501)
(b) Compensation cases—
(1) Scheduling reexaminations. Assignment of a prestabilization rating requires reexamination within the second 6 months period following separation from service. Following initial Department of Veterans Affairs examination, or any scheduled future or other examination, reexamination, if in order, will be scheduled within not less than 2 years nor more than 5 years within the judgment of the rating board, unless another time period is elsewhere specified. not less than 2 years be
(2) No periodic future examinations will be requested. In service-connected cases, no periodic reexamination will be scheduled: (i) When the disability is established as static;
(ii) When the findings and symptoms are shown by examinations scheduled in paragraph (b)(2)(i) of this section or other examinations and hospital reports to have persisted without material improvement for a period of 5 years or more;
(iii) Where the disability from disease is permanent in character and of such nature that there is no likelihood of improvement;
(iv) In cases of veterans over 55 years of age, except under unusual circumstances;
(v) When the rating is a prescribed scheduled minimum rating; or
(vi) Where a combined disability evaluation would not be affected if the future examination should result in reduced evaluation for one or more conditions.
In my opinion, it depends on how exactly the DoVA Rating Agency adjudicates a disability compensation claim in accordance with the 38 CFR VASRD.

For example, if an military veterans has a mental disorder disability evaluated under §4.129 Mental disorders due to traumatic stress then "the rating agency shall assign an evaluation of not less than 50 percent and schedule an examination within the six month period following the veteran's discharge to determine whether a change in evaluation is warranted."

Moreover, under 38 CFR VASRD §4.128 Convalescence ratings following extended hospitalization, "if a mental disorder has been assigned a total evaluation due to a continuous period of hospitalization lasting six months or more, the rating agency shall continue the total evaluation indefinitely and schedule a mandatory examination six months after the veteran is discharged or released to nonbed care. A change in evaluation based on that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter."

Otherwise, it seems that the criteria under 38 CFR §3.327 Reexaminations would be applicable as annotated. For example, after the completion of my PTSD examination in accordance with the criteria under 38 CFR VASRD §4.129 Mental disorders due to traumatic stress, the DoVA Rating Agency stated a future reexamination date which was "scheduled within not less than 2 years nor more than 5 years" per 38 CFR §3.327.

More specifically, the aforementioned PTSD reexamination was scheduled exactly two years from the date of the initial PTSD examination (performed by QTC Services for the VBA).

Nonetheless, with the recent award of a DoVA 100% P&T official rating and entitlement to SMC-P as based on A&A, my total disability is now considered permanent; therefore, I am not scheduled for any future examinations. As such, during my second DoD military TDRL reexamination for PTSD in June 2016, I now have validated medical evidence for another DoD PDRL adjudicated recommendation but at the 100% rate for sure; if not, I shall definitely appeal (once again)! Take care! :cool:

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

Best Wishes!
 
Last edited:

ctbenja1015

PEB Forum Veteran
Registered Member
#3
As a reservist I had been off of Active duty for 4 years prior to my C&P exam. In 9/2014 I was rated 70% for PTSD/Anxiety and 90% overall. After a complaint to the SecVA it was administratively reviewed and given 70% PTSD/Anxiety and 100% P&T overall. Now that I am finally going through the MEB/PEB, at least hope to start soon, in Pinellas Park, Fla since July of 2014. Have received both VA decisions, SSDI, 2nd and 3rd Permanent Profile, additional PHA and had C5/C6 ACDF since my first permanent profile stating a MEB is required. Two of my kids are using chapter 35 benefits and I am receiving several State benefits that will go away if I even lose just the P&T. With VA math I barely clear the 95% that puts me at 100. So to say the least it could hurt me financially to have any type of decrease. I have had 5 different VA psychiatrists' either diagnose or agree with the diagnosis of PTSD, however I had one that wanted to classify it as an Adjustment Disorder. So it scares me that one doctor doing a C&P can completely screw up 5 years of fighting for benefits and treatment with the stroke of a pen. It appears the VA doesn't have to follow their rules until some one takes them to court and they are told to follow the rules again.
 

gsfowler

Staff Member
PEB Forum Veteran
#4
You are definitely in a situation in which you will need to protect your disability rating. I highly recommend getting a competent attorney. I'm going to tag @Jason Perry to see if he could provide any insight.

This is not something that I think you should go alone with, my children's chapter 35 award was worth almost $200,000 per child.
 

Warrior644

PEB Forum Veteran
Registered Member
#5
As a reservist I had been off of Active duty for 4 years prior to my C&P exam. In 9/2014 I was rated 70% for PTSD/Anxiety and 90% overall. After a complaint to the SecVA it was administratively reviewed and given 70% PTSD/Anxiety and 100% P&T overall. Now that I am finally going through the MEB/PEB, at least hope to start soon, in Pinellas Park, Fla since July of 2014. Have received both VA decisions, SSDI, 2nd and 3rd Permanent Profile, additional PHA and had C5/C6 ACDF since my first permanent profile stating a MEB is required. Two of my kids are using chapter 35 benefits and I am receiving several State benefits that will go away if I even lose just the P&T. With VA math I barely clear the 95% that puts me at 100. So to say the least it could hurt me financially to have any type of decrease. I have had 5 different VA psychiatrists' either diagnose or agree with the diagnosis of PTSD, however I had one that wanted to classify it as an Adjustment Disorder. So it scares me that one doctor doing a C&P can completely screw up 5 years of fighting for benefits and treatment with the stroke of a pen. It appears the VA doesn't have to follow their rules until some one takes them to court and they are told to follow the rules again.
Indeed, appreciate your updated information/feedback for historical insight.

In accordance with 38 CFR §3.343 Continuance of total disability ratings, it states...

(a) General. Total disability ratings, when warranted by the severity of the condition and not granted purely because of hospital, surgical, or home treatment, or individual unemployability will not be reduced, in the absence of clear error, without examination showing material improvement in physical or mental condition. Examination reports showing material improvement must be evaluated in conjunction with all the facts of record, and consideration must be given particularly to whether the veteran attained improvement under the ordinary conditions of life, i.e., while working or actively seeking work or whether the symptoms have been brought under control by prolonged rest, or generally, by following a regimen which precludes work, and, if the latter, reduction from total disability ratings will not be considered pending reexamination after a period of employment (3 to 6 months).

In accordance with 38 CFR §3.344 Stabilization of disability evaluations, it states...

(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.

With that all said, upon your eventual referral with acceptance into the DoD IDES MEB/PEB process, the DoVA D-RAS should evaluate your IDES case file in accordance with the 38 CFR as based upon the aforementioned (and other) statues in my opinion.

As such, it may seem that your particular DoD IDES case file (when officially accepted into the IDES process) as based on the available medical evidence and/or medical documentation upon reaching the DoVA D-RAS may need close monitoring to ensure proper adjudication.

So, please don't forget about invoking the necessary DoD IDES appeal opportunities if warranted while in the IDES process. Also, I definitely concur with @gsfowler's comment about the potential need for a competent attorney with PDES experience. Take care! :cool:

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

Best Wishes!
 
Last edited:

ctbenja1015

PEB Forum Veteran
Registered Member
#6
Thank you both, that at least relieves some of my anxiety. I did get an update this afternoon, just waiting on my last NCOER and my Packet will be ready to send up. I talked to my Unit last week and they were already working on it.

I know I should probably get representation just because so few people seem to know how things are suppose to work. I feel completely overwhelmed trying to figure this stuff out. My memory is getting so bad its hard even retaining anything.

To top all this off I have to go to court to try to get my son arrested so he will have to pay for the damage he did to my car throwing my Christmas present at it. trying to get my oldest son on his feet and back out of the house, youngest daughter getting married in August and my oldest daughter getting married the following May. Just had to put my step-dad in a home after moving he and my mon in. Found out today my bother has had internal bleeding or something going on and been under testing for the last 10 days and they haven't found anything. My natural father had his throat cancer come back and has to have surgery again next month. My wife is probably going to lose her long term disability because the doctors here in Georgia don't agree with the University of Chicago, Mayo Clinic and Stanford University. Just trying not to have a meltdown. sorry for the rant, just needed to vent.
 

Warrior644

PEB Forum Veteran
Registered Member
#7
Thank you both, that at least relieves some of my anxiety. I did get an update this afternoon, just waiting on my last NCOER and my Packet will be ready to send up. I talked to my Unit last week and they were already working on it.

I know I should probably get representation just because so few people seem to know how things are suppose to work. I feel completely overwhelmed trying to figure this stuff out. My memory is getting so bad its hard even retaining anything.

To top all this off I have to go to court to try to get my son arrested so he will have to pay for the damage he did to my car throwing my Christmas present at it. trying to get my oldest son on his feet and back out of the house, youngest daughter getting married in August and my oldest daughter getting married the following May. Just had to put my step-dad in a home after moving he and my mon in. Found out today my bother has had internal bleeding or something going on and been under testing for the last 10 days and they haven't found anything. My natural father had his throat cancer come back and has to have surgery again next month. My wife is probably going to lose her long term disability because the doctors here in Georgia don't agree with the University of Chicago, Mayo Clinic and Stanford University. Just trying not to have a meltdown. sorry for the rant, just needed to vent.
Indeed, you are welcome! :)

Wow, you definitely have a lot of issues/concerns at this point in your life albeit please continue to be "positively proactive" and I would tend to truly believe that your situation(s) shall become better in time.

For sure, I have constant physical and behavioral battles affecting my entire family on a daily basis due to the totality of my medical disabilities from military active duty service; I can definitely comprehend at this point in time! :(

With that all said, please take care brother and enjoy life as feasibly as possible! ;)

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

Best Wishes!
 

adidashoch

Registered Member
#9
Ctbenja. I have recieved my 100% p&t a month ago. I did active duty for 8 yrs and now reserve for 6 months. The reserve unit is doing a military retention packet. I dont know if that is good or not. I want to protect my rating. Did you lose your p&t? Did the new examination change your rating?
 

ctbenja1015

PEB Forum Veteran
Registered Member
#10
@adidashoch . Not done with PEB yet. It took from July 2014 until January of 2016 to get my packet from Pinellas Park to the IDES. The exams went well, mostly went off original exams from August 2014 to create the new ones. I talked to someone at the VA who told me as far as they could tell all ratings are intact. I will let you know if I get any updates, probably a couple weeks before I hear from PEB.
 

ctbenja1015

PEB Forum Veteran
Registered Member
#13
No, just the MEB/PEB packet, LOD's and LOD memos of approval. I moved from California to Georgia in January of 2015, but am still in my unit in Bell, CA. We have had 3 new commanders during that period, so my "pre-IDES" paperwork took a long time as well as multiple versions of my Permanent Profile, with the final being approved in December of 2015. I did make a conscious decision not to claim any additional conditions because if something is changed I feel it would be easier to defend current ratings.
 

oceantrav

PEB Forum Veteran
Registered Member
#14
No, just the MEB/PEB packet, LOD's and LOD memos of approval. I moved from California to Georgia in January of 2015, but am still in my unit in Bell, CA. We have had 3 new commanders during that period, so my "pre-IDES" paperwork took a long time as well as multiple versions of my Permanent Profile, with the final being approved in December of 2015. I did make a conscious decision not to claim any additional conditions because if something is changed I feel it would be easier to defend current ratings.
How did everything play out for you?

I was 50% for PTSD threw the VA. In the guard also, and just started the MEB process about 3 months back, not sure how long that will take, or what exactly will happen. Also, was just raised to 100% for PTSD threw the VA.
 
data-matched-content-ui-type="image_stacked" data-matched-content-rows-num="3" data-matched-content-columns-num="1" data-ad-format="autorelaxed">