Is it likely to get a downgrade in VA disability % if you ask for a reassessment due to worsening conditions related to the original one?

MAJ Frederick Helfrich — Wed, 06 Jan 2016 11:01:16 -0500

So I have a 20% VA service connected disability, 10% for each knee, ever since I left active duty around 15 years ago. Even with the disability, I was still able to run, although at a much slower rate, shorter distances, and with pain. In the last couple years, the pain has gotten much worse, such that I had to stop running altogether. I've been to the VA ortho folks and have been doing PT on my own, which helps but there is still pain and I can't run. due to the fact that I've had to stop running, I've gained over 20 pounds and my cholesterol is now high, for which I'm taking medication. I'm considering asking the VA for a reassessment, based on the fact that my quality of life in the past couple of years has gone down (higher weight, high cholesterol, can't exercise without pain) due to the knee injury and pain (again, this is service connected). Does anyone know if the VA would entertain such a request for reassessment, what the results for others in this situation have been, and whether a downgrade is possible. Thanks.

Response by MSG Private RallyPoint Member made Jan 6 at 2016 11:11 AM

MSG Private RallyPoint Member — Wed, 06 Jan 2016 11:11:43 -0500

Call me cooky, but with my using common sense, if your conditions are worsening then you should not be downgraded in % after a re-assessment. But then, it is the VA, so one truly never knows.

Response by SFC William Adamek made Jan 6 at 2016 11:22 AM

SFC William Adamek — Wed, 06 Jan 2016 11:22:33 -0500

I have gone from 0% to 30% to 60% to 80% and am now looking at 100% based on worsening conditions. Generally I have only seen two situations where downgrades have happened. For missing appointments and after disabilities have been somewhat fixed. I'm not saying that it can't happen but in the 14 years of being a veteran advocate, these are the only two situations that I have seen downgrades for.

Response by LCDR Rabbah Rona Matlow made Jan 6 at 2016 11:25 AM

LCDR Rabbah Rona Matlow — Wed, 06 Jan 2016 11:25:50 -0500

MAJ Frederick Helfrich The VA will not give you a service connection for cholesterol. That is a CFR 38 issue. However, other issues can be related, such as high blood pressure and diabetes due to the weight gain. Similarly if other leg joints or spinal problems are starting, they can be service connected due to secondary condition from the original issue.

As far as the knees go, the VA uses a range of motion measure for the condition itself; as long as your ROM hasn't gotten better, there would be no reason to reduce the rating. Further, the only place they could go on your knees is 0% disabling; not likely to happen.

For any secondary conditions, it is vital that you get a letter from your doctor stating that the secondary condition is just as likely as not caused by weight gain and other limitations from the service connected knee injuries. Also, if there is a pertinent Disability Benefits Questionnaire (DBQ), get that completed by your doctor. You can search for those on the VA forms website.

For any of this, PLEASE go to your DAV or other VSO service officer. Don't do this on your own, or through the VA itself.

If you need more info, contact me off line...

Response by SSgt Jim Gilmore made Jan 6 at 2016 11:32 AM

SSgt Jim Gilmore — Wed, 06 Jan 2016 11:32:04 -0500

File a claim for a re-evaluation. It is rare a disability is reduced but it does happen occasionally. Filing for an increase in disability can only help IMO. Get with a service officer TODAY and file.

Response by SSG Audwin Scott made Jan 6 at 2016 11:33 AM

SSG Audwin Scott — Wed, 06 Jan 2016 11:33:54 -0500

I originally started at 20%. 5% for each knee and 10% for PTSD. I re-assessed a request to get an increase for PTSD and depression. That was then bumped up to 70% for PTSD and depression alone. My knees then dropped down to 0%, so yes it can be done. They told me it was not about the pain in my knees but the range of motion.

Response by Capt Tj Feeley made Jan 6 at 2016 12:24 PM

Capt Tj Feeley — Wed, 06 Jan 2016 12:24:52 -0500

Range of motion is the determining factor. There is always the possibility of losing some percentage also but if what you are saying is true, you should be ok I would suspect.

Response by SFC Michael Hasbun made Jan 6 at 2016 1:44 PM

SFC Michael Hasbun — Wed, 06 Jan 2016 13:44:41 -0500

Would it be cheaper for the VA to downgrade you? Probably...

Response by SSG Private RallyPoint Member made Jan 6 at 2016 2:35 PM

SSG Private RallyPoint Member — Wed, 06 Jan 2016 14:35:15 -0500

Yes, indeed, the Department of Veterans Affairs does have the right to re-examine you, and if the facts warrant it, downgrade your disability percentage(even if you requested the reevaluation). This is generally true for any veteran whose disability rating is anything less than “P & T,” or “permanent and total,” and for veterans whose disability is not considered “static.” However it may be unlikely you stated what may be considered a static disability.

“Permanent and total” is, of course, self-explanatory - if the disability is permanent, there is of course no point in periodically reassessing it.

The same is true for a static disability. A static disability is simply disability that is not going to go away over time. For example, if you are missing a leg, that leg is not going to grow back, no matter how much therapy the VA throws at it. That would be an example of a static disability: The VA does not need to reexamine you in order to verify that you haven’t grown another leg since you were last evaluated.

These ratings are called “protected” ratings. The VA cannot reduce your benefit for a permanent and total or static disability. However, even 100 percent ratings that have been in effect for less than five years may be reevaluated.

Rating in effect for 5 or more years (Stablized ratings):
38 C.F.R. § 3.344(a) requires that “all the evidence of record” support the conclusion that sustained improvement in the disability has occurred in order to reduce a rating. The VA cannot view the single examination upon which the reduction is proposed “in isolation from the rest of the record.” Schafrath v. Derwinski, 1 Vet. App. at 594.

This means that the entire medical history of the disability must always be considered together with any rating examination upon which a reduction is proposed.

The court explained in Schafrath v. Derwinski:

"These requirements for evaluation of the complete medical history of the claimant’s condition operate to protect claimants against adverse decisions based on a single, incomplete or inaccurate report and to enable VA to make a more precise evaluation of the level of the disability and of any changes in the condition. These considerations are especially strong in a ratings reduction case."

There are other rules the VA must follow before reducing a rating that has been in effect for five years or more. The VA must review “the entire record of examinations and the medical-industrial history . . . to ascertain whether the recent examination [upon which the VA is relying to reduce the rating] is full and complete.” Brown, 5 Vet. App. at 419 (citing 38 C.F.R. § 3.344(a)). Any examination that is not as full and complete as the examination that resulted in the grant or continuation of a rating may not be used as a basis of reduction. 38 C.F.R. § 3.344(a) (2016)

If the disability is subject to temporary/episodic improvement, it will not be reduced based on any one examination, except in those circumstances in which all the evidence of record “clearly warrants the conclusion that sustained improvement has been demonstrated.” 38 C.F.R. § 3.344(a) (2016). Even if material improvement in the disability is clearly demonstrated, the VA “will [consider] whether the evidence makes it reasonably certain that the improvement will be maintained under the ordinary conditions of life.” 38 C.F.R. § 3.344(a) (2016)

Cholesterol, in itslef, has no rating. It is simply a lab finding. Now, if you have problems associated with hyperlipidemia, you may have a rateable illness. Cholesterol is a risk factor for certain disabilities such as heart disease, just as being overweight, failing to exercise, smoking, etc. are also risk factors for heart disease.

Response by PO1 Glenn Boucher made Jan 6 at 2016 2:52 PM

PO1 Glenn Boucher — Wed, 06 Jan 2016 14:52:25 -0500

I never heard of anyone who was downgraded but who knows with the VA and how quirky they are.
I did have a conversation with a medically retired HM3 who said he was advised to get reassessed at least every 2 years on service connected disabilities to evaluate them for worsening. He told me he started out at 40% 10 years ago and now he is 100% with documented evaluations.
Nothing to lose by contacting your local VA rep and asking them to assist you in being reevaluated.
Good luck.

Response by SGT Rick Ash made Jan 6 at 2016 5:40 PM

SGT Rick Ash — Wed, 06 Jan 2016 17:40:50 -0500

Well, it is the VA but,,,, It's not likely that you would get a downgraded for a condition that is getting worse. Maybe even a slight increase in percentage because of the additional conditions your knees have caused. Good Luck!

Response by PO3 Michael James made Jan 6 at 2016 7:53 PM

PO3 Michael James — Wed, 06 Jan 2016 19:53:52 -0500

MAJ Helfrich, Sir; Sorry for your worsening conditions, you have had VA at every step of the way. they should be aware of the decline in your health.. I think you should apply.. However, it is the VA.. Best to you..

Response by SPC Rhonda Gulifield made Jan 8 at 2016 7:20 AM

SPC Rhonda Gulifield — Fri, 08 Jan 2016 07:20:09 -0500

I would submit a claim for increase as well as service connection for any condition secondary to the service connected conditions . Definitely follow LCDR Matlows advice on having a doctor provide medical evidence/statements attesting to the facts . As it is important to provide medical evidence of a current disability as well as providing the link. As far as reducing the ten percent I find that very unlikely . Objective evidence of pain with some limitation of motion warrants at least a dime. Hope this helps.

Response by MAJ Frederick Helfrich made Jan 8 at 2016 9:03 AM

MAJ Frederick Helfrich — Fri, 08 Jan 2016 09:03:28 -0500

Thanks to everyone for the great replies. I'll plan to go ahead with a reassessment but definitely heed the advice of many and go through a VSO or similar. Thanks!

Response by SSG Wayne Wood made Jan 8 at 2016 11:35 AM

SSG Wayne Wood — Fri, 08 Jan 2016 11:35:23 -0500

I accepted 10% from the MEB (didn't know any better at the time about my condition, don't think they really did either), got 10% from VA, five years and Congressional Intervention later got upped to 40%, then to 60% and finally 80% paid at 70% to pay back severance pay. When forced to completely retire in 2009 due to service-connected injuries was upped to 100%.

Bottom line, there is ALWAYS a chance you can get downgraded; but if you're condition is worsening it is highly unlikely. Also, if you can PROVE new conditions are secondary to your primary service-connected issues, you can get a rating on them as well. It has happened to me over the years as new complications to my primary condition arise.

Much of this has already been said, but wanted to add my two-cents to affirm. Best wishes and hope this helps a bit.

Response by SPC Stacey Lowell made Jan 8 at 2016 1:38 PM

SPC Stacey Lowell — Fri, 08 Jan 2016 13:38:40 -0500

Well you could certainly ask the VA for a reassessment of your condition and point out to the Pension and compensation board that you are in worse shape now than you were before and you need extra help. Granted I am not 100% sure how they are rating people nowadays, but I certainly would not be afraid to ask. I know I may very well have to ask due to a recurring rotator cuff and herniated disc injury myself..

Response by MSG David Johnson made Dec 21 at 2017 1:18 PM

MSG David Johnson — Thu, 21 Dec 2017 13:18:10 -0500

I agree with those above and will emphasize one thing. Get with a Veteran Service Officer NOW, make yourself a nusciunce. The more documentation the better.
I can not emphasize this enough, do this as soon as possible.

Response by SGT Matt Tschopp made Sep 2 at 2018 2:13 PM

SGT Matt Tschopp — Sun, 02 Sep 2018 14:13:48 -0400

I was at a 20% for my back and when filling to get an increase they actually dropped it 10% back to 10%. How exactly does someones back get better?

Response by SPC Nancy Greene made Sep 22 at 2019 11:52 AM

SPC Nancy Greene — Sun, 22 Sep 2019 11:52:00 -0400

Yes, you always have the option for reassessment. It means an evaluation by compensation &pension. Usually an angry PA whose job is to disapprove any increase. However, if you have the documentation to connect the dots, you have a good chance. Also would suggest deep water jogging to get in shape and drop weight without pain. I swam throughout my Military Career after Basic due to injuries sustained in Basic. Your increased cholesterol shows up in lab work. What you need is someone to help you connect the dots and a good Primary Provider and Psychiatrist are extremely useful for this. Documentation is the key to connecting the dots! Good Luck! Let me know if I can be of any assistance, I know how to speak disability rating language! Nancy