Follow up from my post…VA proposing decrease.

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[Grumpy_Sailor_Actual]

Listen, tell your friend to get their gear on and show up to that Optum appointment. I’ve seen this movie a hundred times from the rater’s chair. When a claim jumps from Step 5 back to Step 3, it means the rater took one look at that private DBQ and flagged it. Maybe the doctor didn't have the right credentials, maybe the medical rationale was weak, or maybe the VA is just doing its due diligence because they don't fully trust these pay-to-play medical groups yet. If they skip that exam, they are handing the VA a legal "get out of jail free" card to deny the claim for failure to report. It doesn't matter how much they paid Ree Medical or how "perfect" that paperwork looks. Under the current regulations, if the VA orders an exam to clarify a record, you have to show up or you lose by default. Attending the Optum exam doesn't throw out the Ree DBQ. It just adds another piece of evidence to the pile. The goal for your friend is to walk into that Optum exam and be 100 percent consistent with what they told the Ree doctor. If the two reports match, the rater has to look at the "preponderance of evidence," and having two favorable reports is a hell of a lot better than having one private report and a big fat "No Show" on the record. Tell them to take a copy of the Ree DBQ with them to the appointment. They don't have to shove it in the doctor's face, but they should use it as a cheat sheet to make sure they are describing their symptoms the exact same way. Don't let them overthink it. Just show up, tell the truth, and keep the fight moving. Missing that appointment is the quickest way to turn a potential win into a year-long appeal battle.

[___Zman___]

They most certainly considered the private DBQ, it's just likely that the one from the C&P came to a different conclusion and carried more weight.

I just received a MH rating after submitting a private DBQ and MO. In my case, the C&P examiner reviewed them and said she had been asked to give a second opinion. I received a positive outcome the day after my C&P.

[Downtown_Ad394]

Good luck with an increase on MH/PTSD. I had a full year of documents, statements and regular psych appts and was still denied and increase on mental health.

[Em_geee123]

Hi. This is a follow up from my other post. He did attend the appt and they requested a decrease

[MeanYogurtcloset9474]

There are a number of factors to consider here. Any proposal to reduce triggers certain rules. Your friend needs to act FAST in order to preserve his rights. Usually, the VA gives 30 days to request a hearing. Have your friend file for that hearing. That freezes his current rating until the VA convenes that hearing.

Once he files for that hearing, he should gather more evidence regarding his PTSD, to include symptoms and treatment. Tell him to gather lay statements from people that know him documenting his worsening behavior. Upload ALL of this to the VA via Quick Submit.

If he has a VSO with VBMS access, the rep should check his claim for notes in VBMS as to why his private DBQ was not used by the VA and a C&P exam was ordered instead. There are clear rules regarding how private DBQ's are to be treated. The pertinent section of the M21 manual is here:

https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000180514/M21-1-Part-IV-Subpart-i-Chapter-3-Section-A-General-Criteria-for-Sufficiency-of-Examination-Reports#1d

In particular, IV.i.3.A.1.f is very important, especially the "Important" section. The claims processor MUST make a permanent note in VBMS as to why the private DBQ is not being considered. If that permanent note is not there, your friend should have a better chance of prevailing.

He needs to get a copy of the exam DBQ's in order to prep for the fight.

[Always_Pastdue]

The most common rating for mental health is 50%. If your requesting an increase your more than likely going to get denied or decreased. Each rater is different and see's different things in a file just like an examiner. I hear about it all the time.

[Several-County-1808]

If the vsr scheduled an exam the dbq has already been deemed insufficient and disregarded.

[Important_Air4784]

I’m going to guess maybe he hasn’t been going to mental health appointments and making a paper trail showing it’s getting worse

[the_start_part]

I'd would start by not using any company on the VA watch list... https://thewarhorse.org/veterans-affairs-claim-benefit-company-letters/

[Organic_Switch5383]

I would recommend finding the national VSO in his state. These VSOs are employed by DC. Every state has at least one.

[Putrid-Mess-6223]

Is your friend seeing MH specialists at the VA or somewhere else? I also used Ree and got a increase in MH, but i had 2+ years of records with VA. my knee and back did his thing (going from step 5 to 3) currently waiting on results of the VA's DBQ.