How long are C & P exams and ratings good for?

mrchase1

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PEB Forum Veteran
Registered Member
I am an active duty Army service member that just completed the IDES with a fit rating. I have just received my retirement orders and are due to leave on Terminal Leave and PTDY on March of 2016. MY proposed ratings from the VA were done on July 28, 2015. My VSO just told me the following: If you were determined fit for service and retiring after 20 year. You will need to complete a VAF 21-526 and VA will transfer claim to home of record to have finalized used all the IDES information. These examinations and proposed rating is good for 6 months after discharge. Is this correct? Is this saying that I will not have to get re-examined for C & P exams prior to leaving active duty and retiring? Will my ratings stay the same or may they change?
 
Once the VA receives your DD-214 they will restart the claim process, at least ebenefits updates to show each step again. Generally they complete things and send out the first check in ~2 months.

There is no guarantee that the rater won't see something that says he needs a new C&P exam to decide your case. Nor is there a guarantee that the rater won't see something that says the rating is off. Both scenarios are unlikely, unless you send in some new evidence that influences thing. The 6 months rule about the exam and rating being GTG is more of a guideline than a straight out "this must happen", for the majority of people it is accurate.

There is no set rule for how old a C&P exam is, its really the rater's discretion to order a new one if it looks questionable. Its up to you to argue if the rater comes to the wrong decision. I have read of cases where the rater decided based on exams over 30 years old.
 
In my case, the examiner stated I was fine, nothing was wrong, no bleeding, no previous exams, so the VA tried reducing my claim percentage for Crohn's... I called DC the day I saw the exam notes and had a field day. They ended up reopening my claim and sent me through Palo Alto for an exam but due to lack of appointments, I was then referred out to a private, contracted doctor. Needless to say... still 30 on crohns but my mental health went up to 50... IU claim approved. Be persistent and be vigilante.
 
Yeah i just had a total proctocolectomy/permanent ileostomy from Ulcerative Colitis/Crohn's .. anyone have any ideas what the precedent is for DOD and VA percentages for members who underwent that surgery?
 
Okay, there has been some good discussion on the original post and some good information put out.

Here are some comments:

In some respects, the question in the original post is not framed well. Why? Because it is framed in the abstract and does not address whatever the original poster is trying to do and/or what problems faced in achieving what they want.

I concur with scoutCC's comments.

The "real issue" is whether the VA can rely on "old exams" to make a decision. Recall that the VA has a statutory (and regulatory) duty to assist Veterans in developing their claims.

38 U.S. Code § 5103A - Duty to assist claimants ( https://www.law.cornell.edu/uscode/text/38/5103A );
38 CFR 21.1032 -VA has a duty to assist claimants in obtaining evidence.(https://www.law.cornell.edu/cfr/text/38/21.1032),

Exams must be sufficient for making a determination on the claim(s):

"§3.326 Examinations.
For purposes of this section, the term examination includes periods of hospital observation when required by VA.

(a) Where there is a claim for disability compensation or pension but medical evidence accompanying the claim is not adequate for rating purposes, a Department of Veterans Affairs examination will be authorized. This paragraph applies to original and reopened claims as well as claims for increase submitted by a veteran, surviving spouse, parent, or child. Individuals for whom an examination has been scheduled are required to report for the examination.

(b) Provided that it is otherwise adequate for rating purposes, any hospital report, or any examination report, from any government or private institution may be accepted for rating a claim without further examination. However, monetary benefits to a former prisoner of war will not be denied unless the claimant has been offered a complete physical examination conducted at a Department of Veterans Affairs hospital or outpatient clinic.

(c) Provided that it is otherwise adequate for rating purposes, a statement from a private physician may be accepted for rating a claim without further examination.

(Authority: 38 U.S.C. 5107(a))"​


A few further thoughts....there may be issues that impact "faster" adjudication of claims, such as submitting a Fully Developed Claim. http://www.benefits.va.gov/fdc/

So, to sort of "corral" some of the issues, if you submit earlier exams and they are accepted and the result is an outcome you hoped for, then no problem. The timeliness did not matter. if the result was poor, but based on the earlier exam, and you think you need a new exam, then there is a potential for appeal on that point. (The issues start to also break down and implicate as to whether the issue is factual- and, therefore, perhaps, dependent on facts that need to be addressed in the exam- or whether the issue is legal; i.e., the exam stated the facts correctly, but the VA came to the wrong conclusion based on legal issues.

And then someone posted a new question about a separate rating issue...so, I won't address that question. Hijacking of threads and posts really causes confusion and makes searching for issues harder. If you have a question about your own case, start a new thread.
 
Okay, there has been some good discussion on the original post and some good information put out.

Here are some comments:

In some respects, the question in the original post is not framed well. Why? Because it is framed in the abstract and does not address whatever the original poster is trying to do and/or what problems faced in achieving what they want.

I concur with scoutCC's comments.

The "real issue" is whether the VA can rely on "old exams" to make a decision. Recall that the VA has a statutory (and regulatory) duty to assist Veterans in developing their claims.

38 U.S. Code § 5103A - Duty to assist claimants ( https://www.law.cornell.edu/uscode/text/38/5103A );
38 CFR 21.1032 -VA has a duty to assist claimants in obtaining evidence.(https://www.law.cornell.edu/cfr/text/38/21.1032),

Exams must be sufficient for making a determination on the claim(s):

"§3.326 Examinations.
For purposes of this section, the term examination includes periods of hospital observation when required by VA.

(a) Where there is a claim for disability compensation or pension but medical evidence accompanying the claim is not adequate for rating purposes, a Department of Veterans Affairs examination will be authorized. This paragraph applies to original and reopened claims as well as claims for increase submitted by a veteran, surviving spouse, parent, or child. Individuals for whom an examination has been scheduled are required to report for the examination.

(b) Provided that it is otherwise adequate for rating purposes, any hospital report, or any examination report, from any government or private institution may be accepted for rating a claim without further examination. However, monetary benefits to a former prisoner of war will not be denied unless the claimant has been offered a complete physical examination conducted at a Department of Veterans Affairs hospital or outpatient clinic.

(c) Provided that it is otherwise adequate for rating purposes, a statement from a private physician may be accepted for rating a claim without further examination.

(Authority: 38 U.S.C. 5107(a))"​


A few further thoughts....there may be issues that impact "faster" adjudication of claims, such as submitting a Fully Developed Claim. http://www.benefits.va.gov/fdc/

So, to sort of "corral" some of the issues, if you submit earlier exams and they are accepted and the result is an outcome you hoped for, then no problem. The timeliness did not matter. if the result was poor, but based on the earlier exam, and you think you need a new exam, then there is a potential for appeal on that point. (The issues start to also break down and implicate as to whether the issue is factual- and, therefore, perhaps, dependent on facts that need to be addressed in the exam- or whether the issue is legal; i.e., the exam stated the facts correctly, but the VA came to the wrong conclusion based on legal issues.

And then someone posted a new question about a separate rating issue...so, I won't address that question. Hijacking of threads and posts really causes confusion and makes searching for issues harder. If you have a question about your own case, start a new thread.
 
This answers my question perfectly. I understand where you are coming from, and I appreciate the references that you have listed.

You have made a great point about Hijacking threads as it makes it complicated to find answers to a specific question.

I have had no issues in this board in getting very good advice, and given the resources to find out more information if needed.
 
For the ostomy...

100-


percent evaluation for at least one

ostomy complication (such as infection

or signs of irritation of the peristomal

area, prolapse, retraction, or stenosis)

that is refractory to treatment; a 60-

percent evaluation for incontinence,

requiring the use of an external

appliance or absorbent material; and a

30-percent evaluation if the individual

is continent, with no external appliance

or absorbent material required.





Yeah i just had a total proctocolectomy/permanent ileostomy from Ulcerative Colitis/Crohn's .. anyone have any ideas what the precedent is for DOD and VA percentages for members who underwent that surgery?
 
Thanks for the previous answered question. Here is an update, perhaps it will help someone else. I was told to start a new claim last month and have just completed all seven exams for VA, and now I wait for another proposed rating. I will keep you board members updated on the outcome. Happy new year to everyone on the boards.
 
I am getting a tbi exam, hearing exam ( I swear it is just my wife and son can't speak up), and a slew of other stuff. I will let the C&P person... non VA because lucky me... NO VA APPOINTMENTS IN 200 MILES FOR 6 MONTHS... WOO HOO... Mather and McClellan suck anyways... hopefully they get me up to 100% without needing IU and I can look at doing something part time if I wanted to.
 
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