Source: https://vaclaim.wordpress.com/category/usca/
Timestamp: 2019-04-23 08:03:50+00:00

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Prestabilization Rating of 100% is for Veterans who have experienced, during active, an unstable condition resulting in a severe disability that renders gainful employment either not feasible or adviseable. Such conditions would include: residuals resulting from a head injury or gunshot wound residuals.
The VA is not allowed to assign a 100% prestabilization rating if the Veteran’s case warrants a 100% regular rating.
Assigned immediately after discharge from the military and continues for 12 months after discharge.
During the 12 months, the Prestabilized rating can change to a “another rating authorizing a greater benefit” if the change would be a better benefit for the Veteran.
There must be a VA exam of the Veteran between the 6 month and the 12 month. following discharge. If the exam calls for a reduction in benefits, the VA can not make the reduction until the end of 12 month period.
The condition must be service-connected.
The period of hospitalization or observation must exceed 21 days.
The Increased rating starts on the first day of continuous hospitalization and ends on the last day of the month of hospital discharge.
If hospialization occurs for a non-service connected condition and during the hospitalization a service connected disability is treated for over 21 days, then the 100% can be granted.
The Veteran has a major joint immobilzed by a cast.
Benefit is for up to a year.
The conditions must be service connected and the medical documentatin indicates that the Veteran needs time to convalesce after hospital discharge or outpatient release.
Home Confinement is not necessary. Ruling from Felden v. West, defines convalescence as ” the act of regaining or returning to a normal or healthy state after a surgical operation, or injury” Medical documentation is necessary. If Veteran’s doctor prescribes: “Do not return to work for 12 weeks”, then the CAVC has ruled that the note establishes 12 weeks of convalescence.
VA is authorized to compensate eligible individuals only for “service connected” conditions. A service-connected condition is a condition caused by, aggravated by, or the result of, an event during military service or a condition considered service-connected by law (such as Section 1151 claims). As such, “service connection” is a critical concept in VA benefits law. In practice, the determination of service connection can be difficult for VA and frustrating for the veteran. As a result, service connection is one of the most contested issues in the VA claims process.
medical evidence of either a nexus between the claimed in-service disease or injury and the current disease or injury.
As a practical matter, establishing the existence of a current medical condition or disability is usually straightforward because the condition is often the motivation for filing a claim. A past condition that has been corrected or resolved or the anticipation of a future condition are not current conditions and do not provide a basis for service connection.
Next, the condition must have occurred in or resulted from the veteran’s military service. In most cases, the evidence of the event (wounded by enemy action, training injury) can be found in service records, service medical records, or unit records. Under certain circumstances, a claimant may establish an in-service event by other evidence, such as “buddy statements” or testimony by other service members witnessing the event or private medical records. Whatever the case, VA will also review service medical records to determine if the claimed condition existed when the veteran entered service. If a condition is determined to be “pre-existing” and not aggravated in service, the claim will be denied.
There are also certain “presumptions” regarding specific conditions and in-service events (atomic test participation, agent orange exposure) that may apply. A presumption is when the law assumes an event occurs except when there is evidence that the event actually did not happen. So, for veterans who were exposed to radiation during atomic bomb tests, that radiation is assumed to cause certain diseases. If the veteran now suffers from one of those diseases, he or she does not have to prove the radiation actually caused the disease: VA must accept that the disease as service-connected.
Finally, VA must find a “nexus” (a “connection”) between the current condition and the in-service disease, injury, or event. In practice, most service-connection issues boil down to whether a claimant can establish a nexus. For many medical conditions, such as cancer, it is extremely difficult to connect the current disease to specific events, even when occurrence of the event is not disputed. In such cases, it is especially important for the claimant to obtain strong medical evidence supporting nexus. This is not easy. Providing adequate nexus evidence becomes even more difficult as the time between service and the claim grows.
Although a condition must result from actions “in the line of duty,” service-connected conditions are not limited to “battlefield” wounds or similar injuries. The “in the line of duty” requirement has been broadly interpreted to mean almost anything that occurs during service, including such things as car accidents, sports injuries, and illnesses unrelated to specific military activity. The condition generally need only have occurred or begun during service, including authorized leave periods.
“Secondary” service connection is awarded when a disability “is proximately due to or the result of a service-connected disease or injury.” 38 C.F.R. § 3.310(a); Roper v. Nicholson, 20 Vet. App. 173, 181 (2006); Libertine v. Brown, 9 Vet. App. 521, 522 (1996); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). “Proximate cause” is defined as “[t]hat which, in a natural and continuous sequence, unbroken by any efficient intervening cause, produces injury, and without which the result would not have occurred.” BLACK’S LAW DICTIONARY 1225 (6th ed. 1990); Forshey v. West, 12 Vet. App. 71, 74 (1998), aff’d sub nom. Forshey v. Principi, 284 F.3d 1335 (Fed. Cir. 2002), rev’d on other grounds by Morgan v. Principi, 327 F.3d 1357 (Fed. Cir. 2003); VA Gen. Coun. Prec. 6-2003, at *3-4, n.4 (Oct. 28, 2003).
VA will compensate claimants for medical conditions that existed at the time of entry into service that were made worse or “aggravated” by service. The essence of a claim for benefits based on a theory of aggravation is that a claimant’s service caused a worsening of a preexisting condition. See Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004) (“[I]f a preexisting disorder is noted upon entry into service, the veteran cannot bring a claim for service connection for that disorder, but the veteran may bring a claim for service connected aggravation of that disorder.”).
An appellant may obtain service connection for aggravation of a preexisting condition under 38 U.S.C. section 1153. In such a case, “the burden falls on the veteran to establish aggravation.” Wagner, 370 F.3d at 1096. If the veteran succeeds in showing aggravation, “the burden shifts to the government to show . . . that the increase in disability is due to the natural progress of the disease.” Id. Where there has been an increase in disability during service, the proof that the increase was due to the natural progress of the disease must also be by clear and unmistakable evidence. 38 C.F.R. § 3.306(b). Therefore, the first task for the Board in evaluating a presumption of aggravation claim is to find whether the appellant has shown an increase in disability during service. If the Board finds aggravation, the second task is for the Board to consider whether the increased disability is due to the natural progression of the disease. See Wagner, 370 F.3d at 1096.
Also see the discussion of the “presumption of soundness” as it applies to determining if a medical condition pre-existed service.
There are circumstances where the VA can reduce your disability benefits. When the VA proposes to reduce a Veteran’s disability compensation, it is of the upmost importance that the Veteran act quickly by seeking the services of either an aggressive Veterans Service Organization or an Attorney accredited by the VA. The law is very clear that to assist a Veteran in the preparation, presentation, and prosecution of a claim for VA benefits, the individual must be accredited by the VA as an agent, attorney, or representative of a Veterans Service Organization, VSO, 38 U.S.C. §§ 5901-5902, 5904; 38 C.F.R. § 14.629. There is a one time only exception for a non-accredited individual to assist a Veteran in processing a claim under 38 C.F.R. § 14.630.
I. Failure to Report for the “Pre-Reduction” Examination.
When reducing a total disability rating based on the severity of an appellant’s condition, the burden falls on VA to show “material improvement” in the veteran’s condition from the time of the previous rating examination that assigned the appellant’s 100% disability rating. Ternus v. Brown, 6 Vet. App. 370, 376 (1994); Hohol v. Derwinski, 2 Vet. App. 169, 172 (1992); see also Dofflemyer v. Derwinski, 2 Vet. App. 277, 280 (1992); 38 C.F.R. § 3 .343(a). The reduction must be based on “[e]xamination reports showing material improvement[, which] 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.” 38 C.F.R. § 3.343(a).
Pursuant to 38 C.F.R. section 3.105(e), when the RO determines that a rating reduction is warranted, it is required to issue a proposed rating reduction, setting forth the reasons for the proposed reduction, and to allow the veteran a period of at least 60 days to submit additional evidence to show that the rating should not be reduced. Furthermore, when, after such period, the RO issues a decision reducing the rating, that reduction does not become effective until the “[l]ast day of [the] month following 60 days after notice to [the] payee” of the reduction decision. 38 C.F.R. § 3.400(r); see 38 C.F.R. § 3.105(e). The effect of sections 3.105(e) and 3.400(r) combined is that a rating reduction cannot be made effective for a minimum of 120 days after it is proposed in writing to the veteran. Brown (Kevin) v. Brown, 5 Vet. App. 413, 418 (1993).
An important right that can easily be overlooked in the notice of a proposed reduction (because VA buries it in the notice), is the right for a “pre-determination hearing” under 38 C.F.R. section 3.105(i). A claimant has a right to this hearing if he or she requests it within 30 days of the notice of proposed reduction. Requesting a pre-determination is important because VA cannot implement the proposed reduction until after the hearing and it reaches a decision based on the evidence and the hearing. In practice, this means that a claimant can delay a reduction and continue to receive full payments for some months in order to obtain evidence or assistance.
In every rating reduction case, the Board must “ascertain, based upon review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations.” Brown v. Brown, 5 Vet. App. 413, 421 (1993); see also Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991) (requirements “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 disability and of any changes in the condition”); 38 C.F.R. §§ 4.1, 4.2, 4.13. Where the Court concludes that the Board has reduced a veteran’s rating without observing applicable laws and regulation, such a rating is void ab initio and the Court will set it aside as “not in accordance with the law.” 38 U.S.C. § 7261(a)(3)(A); Kitchens v. Brown, 7 Vet. App. 320, 325 (1995); see Brown, 5 Vet. App. at 422; Horowitz v. Brown, 5 Vet. App. 217 (1993).
When determining whether VA was justified in reducing a veteran’s disability rating that has continued at the same level for five or more years, “the Board is required to establish, by a preponderance of the evidence and in compliance with 38 C.F.R. § 3.344, that a rating reduction is warranted.” Sorakubo v. Principi, 16 Vet. App. 120, 12324 (2002) (citing Brown v. Brown, 5 Vet. App. 413, 421 (1993)); see also Kitchens v. Brown, 7 Vet. App. 320, 325 (1995) (holding that when the regional office reduces a veteran’s rating without observing the applicable VA regulations, the reduction is void). The regulatory requirements for reducing a disability rating that has continued at the same level for five years or more are more stringent than the general requirements for increasing or decreasing a disability rating that has been in effect for a shorter amount of time. See 38 C.F.R. §§ 3.344(a)-(c); Collier v. Derwinski, 2 Vet. App. 247, 24950 (1992). “Such disabilities are considered ‘stabilized,’ and the regulation thus requires a high degree of accuracy in decisions reducing those ratings.” Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991) (citing 38 C.F.R. § 3.344(c)). In addition, certain regulations “are applicable to all rating reductions regardless of whether the rating has been in effect for five years or more as required by section 3.344(c),” including 38 C.F.R. sections 4.1, 4.2, 4.10, and 4.13. Brown, 5 Vet. App. at 420.
Pursuant to sections 4.1, 4.2, and 4.13, VA is required in any rating-reduction case “to ascertain, based upon review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations.” Brown, 5 Vet. App. at 421; see also Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991) (such requirements “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 disability and of any changes in the condition”). In addition, “in any rating-reduction case not only must it be determined that an improvement in a disability has actually occurred but also that that improvement actually reflects an improvement in the veteran’s ability to function under the ordinary conditions of life and work.” Brown, 5 Vet. App. at 421; see also 38 C.F.R. §§ 4.2, 4.10.
The Court has specifically required VA to follow its own regulations when it attempts to reduce a veteran’s rating. See Fugere v. Derwinski, 1 Vet. App. 103 (1990) (holding that VA was required to give notice and opportunity to be heard prior to deleting provision of VA Adjudication Procedure Manual M211MR that had provided regulatory-like procedural protections prior to reducing veteran’s rating, and noting: “Where the rights of individuals are affected, it is incumbent upon agencies to follow their own procedures.” (citations omitted)), aff’d, 972 F.2d 331 (Fed. Cir. 1992). The Court determines de novo whether VA has followed and applied its own regulations in reducing or terminating VA benefits. See Wilson (Merritte) (making determination de novo without so stating) and Fugere (same), both supra; Brown (Kevin) v. Brown, 5 Vet. App. 413, 41621 (1993) (same); cf. Buzinski, supra (reviewing de novo compliance with VA regulation regarding mortgage foreclosure).
If VA affords to a veteran the applicable procedural protections and nonetheless determines that a reduction in rating is warranted, the determination as to the degree of disability under the applicable diagnostic code is a finding of fact subject to the “clearly erroneous” standard of review. See Smallwood v. Brown, 10 Vet. App. 93, 97 (1997); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Faust v. West, 13 Vet. App. 342, 348 (2000).
In reducing a rating of 100 percent service-connected disability based on individual unemployability, the provisions of section 3.105(e) apply but caution must be exercised in such a determination that actual employability is established by clear and convincing evidence. If a veteran with a total disability rating for compensation purposes based on individual unemployability begins to engage in a substantially gainful occupation during the period beginning after January 1, 1985, the veteran’s rating may not be reduced solely on the basis of having secured and followed such substantially gainful occupation unless the veteran maintains the occupation for a period of 12 consecutive months. For purposes of this subparagraph, temporary interruptions in employment which are of short duration shall not be considered breaks in otherwise continuous employment. 38 C.F.R. §§ 3.343(a), (c); Faust v. West, 13 Vet. App. 342, 352 (2000).
There is a clear distinction between a claim challenging a reduction in a schedular rating and one involving a claim for a restoration or an increase in a schedular rating. See Peyton v. Derwinski, 1 Vet. App. 282 (1991); Dofflemyer v. Derwinski, 2 Vet. App. 277, 280 (1992). “The initial procedural burden regarding proposed rating reductions [pursuant to section 3.343(a) ] … falls squarely on the VA to show material improvement from the previous rating examination that had continued a veteran’s 100% disability rating.” Ternus v. Brown, 6 Vet. App. 370, 376 (1994). “[T]he circumstances under which rating reductions can occur are specifically limited and carefully circumscribed by regulations promulgated by the Secretary.” Dofflemyer, 2 Vet. App.at 280.
That the Court has jurisdiction to review the BVA’s failure to decide the improper reduction claim is clear. See 38 U.S.C. § 511(a) (“The Secretary shall decide all questions of law and fact necessary to a decision by the Secretary to veterans …”); In the Matter of Fee Agreement of Smith, 10 Vet. App. 311 (1997) (BVA failure to adjudicate veteran’s claims properly before it was a final adverse decision with respect to that claim); Suttmann v. Brown, 5 Vet. App. 127, 133 (1993) (Board erred in failing to adjudicate a claim reasonably raised to it); see also Carpenter v. Gober, 11 Vet. App. 140 (1998) (an implied claim which is not reviewed by the BVA is considered a denial). Thus, while the Court may not review nonfinal BVA decisions to remand, it clearly mayindeed, mustreview claims explicitly or implicitly raised by the appellant and not adjudicated by the BVA.

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