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Transient Ischemic Attack (Micro/minni Strokes)


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24 replies to this topic

#1 chiefhouse00

 
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Posted 18 September 2011 - 01:58 AM

Greetings

I may have ask this question before but don't know for sure. I have a history of mirco strokes and would like to know how I can get it service connected. CT scan and MRI of my brain showed that I have a history of micro strokes...a surprize and scare to me. I submitted a claim but the VA denied it saying it was not service connected. What should I do next?

Best Regards
Chiefhouse

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#2 Berta

 
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Posted 18 September 2011 - 07:06 AM

I am very familiar with this facet of neurology- but I have never seen TIAs rated by the VA at all.

They are symptomatic of something else.

When the VA did the CT and MRI they had to prepare a full narration of the MRI findings.Have you obtained a copy of that yet?

What did VA say was the cause of these TIAs?

If you have DMII from AO or IHD from AO this would be a way to claim the TIAs.As long as there are no serious residuals then this would already be a service connected factor even if they rate at Zero SC if you ever have a major stroke.

If the VA had properly assessed my husband's TIAs (I took him to the ER every time they happened)
he might well be alive today.

There are many medical causes of TIA as well as preventive medical steps the VA can take. The VA needs to assess the cause of the TIAs and then treat the cause.

Their lack of proper diagnosis and treatment for the initial multiple presentations my husband had of this symptom (TIA) of his undiagnosed and untreated IHD and DMII was a very strong factor in my FTCA case and 1151 claim.
Cardio embolism, HBP, cerebral atherosclerosis, cerebral thrombosis – there are numerous types of TIAs as well as many causes.

The VA has to diagnosis the cause for you and then provide proper treatment.The cause could be something you potentially could have service connected.

When I get my IHD claim resolved, there might be a statement or even a rating for my husband's TIAs as I proved all of his brain trauma was due to his IHD.His CVA which VA rated but incorrectly should be 100% for 2 years in that decision.I have no guess on the IHD rating.

VA told me Friday they want to get all AO Nehmer claims resolved by end of October.

If I do receive a rating fr his TIAs I sure will post that here but I really dont expect any rating on them,nly on the Stroke that resulted from leaving them untreated.

#3 Berta

 
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Posted 18 September 2011 - 07:23 AM

Their might be ratable TIA cases at the BVA web site-and this info indicates there could be a ratable residual.

My husband as a VA employee at time of his TIAs, had a definite and documented decrease in his work performance. His vision changed abruptly that fall. The year before he had the first deer kill in the county on opening day of Hunting season (and 20/20 vision without glasses)but after these TIAs, the next fall, I pushed out 7 deer to him in our woods and they all ran by him but even with a new scope on the Mossberg he didnt take a shot.He didnt trust his vision anymore and asked for a documented accomodation at the VA job because the glasses VA gave him didnt help with his damaged peripheral vision.
Your question here made me realize that I did send this info to the VA and if they dont rated the TIAs maybe I will appeal that.

Everyone needs to know symptoms of TIAs:




“The warning signs of a TIA are exactly the same as for a stroke:

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body

Sudden confusion, trouble speaking or understanding

Sudden trouble seeing in one or both eyes

Sudden trouble walking, dizziness, loss of balance or coordination

Sudden, severe headache with no known cause”
From:http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/TIA/TIA_UCM_310942_Article.jsp
and
“American Stroke Association meeting report:
SAN ANTONIO, Feb. 24, 2010 — Nearly four in 10 transient ischemic attack (TIA) and minor ischemic stroke patients may experience mental impairment, according to a study presented at the American Stroke Association’s International Stroke Conference 2010. “

http://newsroom.hear...pr/aha/948.aspx

#4 chiefhouse00

 
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Posted 18 September 2011 - 10:42 PM

Greetings Berta

Sorry to hear about your husband but very glad that you are still fighting for justice.
Here is an clip of my claim for TIA and results:

Service connection for ischemic strokes and seizures as secondary to the service connected
disability of hepatitis C {also claimed as short term memory and concentration levels}.
We have considered but denied your claim for service connection for ischemic strokes
and seizures because there is no evidence of a chronic condition incurred in or as a result
of active military service; nor were strokes manifest to a compensable degree within a
presumptive period following your discharge from active military service. Additionally,
the VA examiner also noted there is no association between hepatitis C or interferon
treatment, and no seizure activity was found. Also short term memory or concentration
levels are considered symptoms only, and by themselves are not subject to compensation.
Service treatment records are negative for any complaints, diagnosis, or treatment for
strokes, seizures, or problems with memory or concentration.

VA treatment records document ongoing evaluation and management for multiple
medical conditions. There are no records of any confirmed diagnosed or treatment for
strokes or seizures. A record dated August 18, 2009, noted you had received emergent
care on May 29, 2009 in Virginia, when you had an elevated blood sugar up to 399, with
associated limb twitching. The results of subsequent diagnostic testing that included a
computed tomography (CT) scan dated June 4, 2009, showed findings compatible with
multiple small nonacute infarcts in the bilateral parietal deep white matter and is also
chronic ischemia in the white matter. There was no evidence of any brain swelling,
circumscribed tumor or hemorrhage seen. Mild frontal and temporal lobe atrophy was
also seen. An electroencephalogram study was also accomplished, which was noted as
normal. The examiner noted it was unlikely for you to have epilepsy, and the seizure you
were most likely experiencing in the emergency room was due to hyperglycemia, due to a
blood sugar of 399. The examiner attributed it to your diabetes mellitus, and noted the
best way to avoid a repeat episode was to have good control of your diabetes mellitus.

There are no records which address any problems with memory or concentration levels.
In your statements you related having an undiagnosed and untreated stroke condition
which was manifested by the treatment used for your Hepatitis C, and you related the
types of associated symptoms you experienced. You further detailed your history of the
emergent care you received in May 2009, as well as the associated symptoms you
experienced leading up to this emergent episode of care. You also provided copies of
printed web based documents regarding Hepatitis C, as well as the treatments and side
effects thereof. Also provided were multiple copies of prior treatment records which are
duplicate of records already received, and included an emergency record from the Reston
Hospital Center dated May 29, 2009, which noted treatment for a diagnosis of poorly
controlled type II diabetes mellitus with associated peripheral neuropathy. The statement
provided by your spouse relates her observations of your symptoms leading up to your
emergent care at Reston Hospital Center. She also discussed the advice you had been provided
by your primary care provider.

On VA examination, you related the history of your transient ischemic attacks which you
related to have begun in 1996. You reported symptoms of light headedness, with sudden
numbness, weakness, and blurred vision during these attacks. Your current treatment for
this condition consists of use of Aspirin. You continue to have moderate attacks of
dizziness every 2 to 3 weeks, that radiates into the arms, legs and right side of the body.
You are not able to walk during attacks, your tongue swells, and you have been
hospitalized four times for these attacks in 1996, 2003, 2009, and 2010. You also noted
you do not have seizures, but have transient ischemic attacks.

The VA examiner noted coordination, speech, memory, cranial nerve function were all
normal. Romberg's and Babinski's testing was normal. You were oriented to person,
place, and time, and are competent to manage your financial affairs, and the examiner
noted you have no cognitive impairments. The final diagnosis was recurrent transient
ischemic attacks, with associated symptoms of dizziness, numbness, weakness, blurred
vision, tremors, and swollen tongue during attacks. Based on a review of your active
military service records and history pre and post military service, the VA examiner
opined it is not at least as likely that your recurrent ischemic attacks are secondary to
your hepatitis C or the treatment provided in conjunction with that condition, as there is
no association between hepatitis C and ischemic attacks. Additionally, the examiner
noted no seizure activity was found or claimed.

Although there is a diagnosis of transient ischemic attacks found on VA examination, the
examiner did not relate it to your hepatitis C or the treatment thereof, nor is there no
objective evidence of a chronic condition incurred in or as a result of active military
service. Additionally, it does not establish this condition to a compensable degree
(severe enough to be evaluated at least 10 percent disabling) within one year following
your discharge from active military service. In the absence of a diagnosed transient
ischemic attacks that can be attributed to active military service or in relation to your
hepatitis C or the treatment thereof, your claim for service connection cannot be
established.

Best Regards
Chiefhouse

#5 Berta

 
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Posted 19 September 2011 - 06:28 AM

I agree with VA that the TIAs have no association to the Hep C.

Poorly controlled or undiagnosed and untreated diabetes mellitus can cause TIAS.

And then it can cause a major cerebral vascular event.

Are you service connected for the Diabetes?

"The examiner noted it was unlikely for you to have epilepsy, and the seizure you
were most likely experiencing in the emergency room was due to hyperglycemia, due to a
blood sugar of 399. The examiner attributed it to your diabetes mellitus, and noted the
best way to avoid a repeat episode was to have good control of your diabetes mellitus."

That could have caused a TIA.

"and noted the
best way to avoid a repeat episode was to have good control of your diabetes mellitus."

"She also discussed the advice you had been provided
by your primary care provider."

These statements alarm me.

They indicate either VA is trying to blame you for these TIAs or you are not following the VA's advise as to the treatment program.

The claim-in my opinion- was written wrong if you are service connected for diabetes.

#6 justrluk

 
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Posted 19 September 2011 - 07:51 AM

Have you had any head trauma or other medication that might be connected to the conditions that are rated? If not, you may have a losing fight on your hands. Not that your condition isn't severe, but because the nexus (in VA eyes) is weak. By what you've posted, that's what I read.

My experience: head injury due to auto accident while on active duty. Started having migraines that lasted weeks (wouldn't wish this on anyone). I was rated for migraines - not TIA. A few years ago, I was having a migraine when I dropped to my knees in excruciating pain and facial numbness. This has happened twice since then. My neurologist said that they would become more frequent and severe over time, and potentially more destructive. I take aspirin for other reasons, but was told it may help. I also take several other drugs for other reasons that have secondary benefits for migraine prevention/reduction. I haven't had a TIA in a year or so; I feel lucky.



#7 Berta

 
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Posted 19 September 2011 - 08:12 AM

I found an older post you made here in 2005 Chiefhouse:

"Greetings Berta

Yes, I'm still working and want too as long as I'm able...got to stay busy. I will find out more on the DMII and HCV biopsy over the next couple weeks. I served in CCK, Thailand, and one day in Viet Nam enroute to Thailand (Korat & NKP) in 1970. I do have a full plate but will keep a positive mind about all of this stuff.

Best Regards
Chiefhouse"

You have claimed numerous issues- proof of the stop over in Vietnam would potential get you deemed as an AO veteran.
If you can prove that stop over (which would involve the one boot on ground criteria-you could claim the diabetes and any complications from it as due to your exposure to AO.

Do you have a vet rep?

DO you have your complete 201 file and med recs from the Mil?

Are you still employed?

#8 Berta

 
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Posted 19 September 2011 - 08:16 AM

The VA does hold to the 'boots on ground' criteria.

This vet was only in Vietnam for a few hours stop over:
http://www.va.gov/ve...es1/1001344.txt

He was awarded SC for his Diabetes mellitus.

#9 chiefhouse00

 
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Posted 19 September 2011 - 09:01 AM

Greetings

I was denied service connection for DMII eventhough I provided medical record, performance reports, and Vietnam Medals for evidence showing that I was stationed at NKP and Korat Air Bases in Thailand in 1970, and 1972...this is currently in appeal status. My VA rep is DAV...very little help.

Best Regards
ChiefHouse

#10 Berta

 
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Posted 19 September 2011 - 10:24 AM

Dozens of Thailand vets have gotten AO awards due to the help of our hadit member Kurt Priessmah who posted his info on the net for them to use in their claims.Kurt was also instrumental n the C & P bulletin involving Thailand AO claims.


But they proved their MOS exposed them to AO on sprayed base perimeters in Thailand.

In your case= proof of having stepped on Vietnam land will garner you the VA concession of AO exposure.Even if only one hour or one day In Vietnam.

#11 chiefhouse00

 
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Posted 19 September 2011 - 10:30 PM

Greetings

My claim centers around the drug "Interferon" used to treatment my Hep C, which I've had for nearly 40 years. Interferon injections and ribavirin pills treatment can cause serious depression, suicidal behavior, strokes, heart attacks, and other severe side effects. I underwent and failed three treatment sessions and developed a lot of health problems as a result of interferon/ribavirin treatment.

It's becoming a very difficult and long process to win or prove my case that my DMII, PN, and TIA could have been triggered by interferon treatment. VA doctors have confirmed that I have these conditions but will not service connect them. I was able to get the VA to service connect my Celiac Disease, sleep apnea, high blood pressure, lower back problem and a few other aliments.

I will cherish everyone advice and take whatever direction to get service connected for DMII and TIA. Is TIA a ratable condition? Thanks for your listening ears.

Best Regards
Chiefhouse

#12 chiefhouse00

 
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Posted 19 September 2011 - 10:34 PM

Dozens of Thailand vets have gotten AO awards due to the help of our hadit member Kurt Priessmah who posted his info on the net for them to use in their claims.Kurt was also instrumental n the C & P bulletin involving Thailand AO claims.


But they proved their MOS exposed them to AO on sprayed base perimeters in Thailand.

In your case= proof of having stepped on Vietnam land will garner you the VA concession of AO exposure.Even if only one hour or one day In Vietnam.



Greetings
I spent a lot of time delivering fuel to aircraft and age equipment on the flightline and support tanks and generators all over the bases [to include perimeters] in NKP and Korat.

Best Regards
Chiefhouse

#13 chiefhouse00

 
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Posted 23 September 2011 - 09:45 PM

Greetings

Can TIA be rated service connected?

Best Regards
Chiefhouse

#14 Berta

 
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Posted 24 September 2011 - 07:51 AM

I answered that question in detail here on Sept 18th.

No TIAs cannot be rated.

They are symptoms of something that could possibly have SC potential.

#15 chiefhouse00

 
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Posted 24 September 2011 - 11:09 PM

I answered that question in detail here on Sept 18th.

No TIAs cannot be rated.

They are symptoms of something that could possibly have SC potential.


Thanks Berta

I missed or didn't understand when I read your 18 Sep post. Can TIA's lead to other aliments that can be rated I don't want to wait until I have a stroke to file a claim.

By the way, I received a notice today informing me of another C&P scheduled for 28 Sep. I don't know what this one is for.

Again, thanks for your advice.

Best Regards
Chiefhouse

#16 Berta

 
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Posted 25 September 2011 - 07:43 AM

TIAs are serious business.

They contributed to my husband's death because the VA failed to properly diagnose and treat the condition that caused them.

In your case you have the proper diagnosis.

What did the VA say caused the TIAs?

How is the VA treating the cause to prevent further TIAs or major CVA?

The cause could be something service connectable.

More importantly -the cause, with proper treatment, will stave off more serious disability (or death)

If the VA knows the cause of these TIAs and fails to treat the cause, then that is basis for a Section 1151 claim.

I feel you need a good vet rep who can take the time to look over your medical records.

The TIAs (as I proved in my recent claim) in my husband's case were directly due to his undiagnosed and untreated DMII.

They could be claimed as secondary to your DMII claim but you need to fulfill the Thailand criteria regarding AO claims.

The fairly new Thailand VA directive is here. I will bump it up in the AO forum.

MANY Thailand vets have succeeded with the vast info on the net ( as well as links here at hadit) that helped them prove they were exposured by their MOS and TDY (sch as guard duty) to AO on base perimeters in Thailand.

If you have a vet rep, they should be up on all that info.

If not- you need to find a much better vet rep.

#17 Berta

 
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Posted 25 September 2011 - 07:47 AM

Here is the VA Thailand bulletin in this thread. There is plenty more info regarding this available at hadit under a search.:

http://www.hadit.com...-thailand-vets/

#18 chiefhouse00

 
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Posted 27 September 2011 - 12:32 AM

Greetings

The VA has confirmed that I have DMII (currently being treated with Metformin 1500 mg AM / 1000 mg PM and Glyburide 10 mg since 2006) and Diabetic Peripheral Neuropathy of the lower and upper extremities but have not rated them service connected. My last major TIA, when I was admitted to the hospital emergency center) my blood sugar was 399. The VA concluded that my DMII may have been the sole cause for my micro stroke but still denied my claim. As mentioned earlier, I have an appeal for DMII and severe joint space loss with subchondral sclerosis, cystic change and marked marginal osteophytosis at the first MTP joints which also were denied in an earlier claim. As a gas passer (no fun intended) I delivered fuel everywhere (perimeter, flightline, chow halls, hospital support tanks) at NKP and Korat base in Thailand from 1970 to 1973, but that cliam was also denied by the VA. As you can see, I have a long fight ahead to win my cases. Your listening ear and advice are very helpful.

Best Regards
Chiefhouse

#19 justrluk

 
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Posted 27 September 2011 - 07:00 AM

JMHO: A TIA (I've had three now) won't be rated because as the name implies: it's a temporary event, not a condition. As Berta stated, find/treat the root cause ASAP. It looks as though you've done that. Also, you can claim the effects, although I've not done this yet. I was left with numbness in the front of my right leg, face and right side of the tongue. It's more of an inconvenience, but if you're left with other lingering effects, I would go for it. I've complained about the residual effects to my neurologist for two years now, and I know she's documented them. I'm waiting until other claims have cleared and the two issues on appeal are completed - unless of course I have another and other residuals pop up. Also, I was told by the neurologist that if you've had one, you will have more and they may become more frequent. The fact that you're incapacitated for days or weeks (in my case) at a time is disabling as well but it's another effect of the TIA. Best of luck, and I pray you don't have any more!



#20 chiefhouse00

 
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Posted 28 September 2011 - 09:05 PM

Greetings

Here are the results of my last MRI:

MRI Brain with and without IV Contrast [Sep 2009] Findings: There is mild to moderate diffuse brain parenchymal atrophy with commensurate enlargement of the intra and extra axial CSF-containing spaces. There are multiple small left greater than right bilateral basal ganglia and bilateral supratentorial white matter lacunar infarcts…chronic microvascular ischemic disease.

To me this is more of a serious disease of my brain which may be causing the TIAs. I'm scheduled to do another MRI and CP Scan next month, and see a neurologist. Any good advice/comments.

Best Regards
Chiefhouse

#21 jbasser

 
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Posted 29 September 2011 - 06:19 AM

I see that you are service connected for Hypertension.

Strokes, regardless of their severity can be secondary to that condition. Many Docs would nexus TIA's to that in my opinion.

Do you have an IMO for that condition?

J

#22 Berta

 
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Posted 29 September 2011 - 06:55 AM

That is a good point John- so the TIAs (not ratable) could potentially be at least SCed to the SC HBP in the event this became a more serious disorder.

Reading the MRI, this certainly shows that they could also be due to the DMII as they are consistent with diabetic vascular brain disease but this vet has to prove AO exposure in Thailand so your suggestion is great.

In my opinion ( due to the research and IMOs I got for my last claim), a IMO from a neuro would most likely focus on the TIA -DMII link and that will not help this vet until he can prove exposure to AO in Thailand.

The VA in a past post here has already conceded that the TIAs are likely from the DMII :

"The VA concluded that my DMII may have been the sole cause for my micro stroke but still denied my claim."

One thing I think Chiefhouse should do is go through the med recs carefully to see if VA diagnosed and treated his DMII properly before he had these mini strokes.

If all else fails that would be basis for a Section 1151 claim.

As all here know, I was awarded a claim like that last year.Direct SC for untreated and undiagnosed DMII.

Diabetes is one of the most misdiagnosed conditions in the USA.

Often it isnt even diagnosed until a person has a TIA, CVA or heart attack.

However (as I proved to VA, there was evidence of DMII long before my husband died in his VA med recs.)

But No diagnosis at all and I missed considering this additional condition when I FTCAed them.

A proper diagnosis early on (and even during their cover up of his IHD) with proper treatment would have prevented the multiple TIAS, CVA, IHD he had as well as his untimely death.

It was a lot of work and research. Before I even paid for 2 IMOs I made sure I had a solid claim.

The VA saves lives everyday and does not set out to harm or be negligent with any vet.

However knowing diabetes is often misdiagnosed until major consequences occur, this is something you might consider, Chiefhouse.

BTW- HBP can often be difficult to get SC for-and I missed seeing that in your posts- how did you get the SC for the HBP?

Was it noted in your SMRs?

#23 chiefhouse00

 
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Posted 29 September 2011 - 07:40 AM

Greetings

Yes! I was service connected for HBP several years before I retired from military service in 1999 after 30 years of service. I'm going to pursue every measure to get properly treated and rated for my service connected conditions. I have three medical appointmens scheduled for next month by the VA to further diagnose my TIA and PN conditions. Also, I provided medical records for stomach pain while TDY to NPK Thailand in 1970 plus duty records for being stationed at Korat Thailand in 1972 timeframe. And as always I appreciate your advice.

Best Regards
Chiefhouse

#24 chiefhouse00

 
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Posted 04 October 2011 - 09:17 PM

Greetings

Just completed another C&P examine last week for a skin rash condition (currently rated 30%) that the VA is considering downgrading to 10% because the skin rash condition was noted as clearing up during a C&P examine last year. Well, I'm still using the same prescribed Hydrocortisone (Cortaid Eq.) Cream 1% Topical and Hydrocortisone Valerate (Westcort Eq.) Cream 0.2% Topical daily for this skin condition since 2006. Can they still reduce my rating. I'm still trying to build my case for TIA...scheduled for CT Scan and Neurologist appointment this month. I'll keep you posted...need lots of patience and determination. Again, thanks for your advice and support.

Best Regards
Chiefhouse

Edited by chiefhouse00, 04 October 2011 - 09:18 PM.


#25 Chuck75

 
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Posted 04 October 2011 - 11:12 PM

Greetings

Just completed another C&P examine last week for a skin rash condition (currently rated 30%) that the VA is considering downgrading to 10% because the skin rash condition was noted as clearing up during a C&P examine last year. Well, I'm still using the same prescribed Hydrocortisone (Cortaid Eq.) Cream 1% Topical and Hydrocortisone Valerate (Westcort Eq.) Cream 0.2% Topical daily for this skin condition since 2006. Can they still reduce my rating. I'm still trying to build my case for TIA...scheduled for CT Scan and Neurologist appointment this month. I'll keep you posted...need lots of patience and determination. Again, thanks for your advice and support.

Best Regards
Chiefhouse


If the treatment provides some visible/measurable improvement, The VA can reduce the %, subject to several limits. I hope you have filed or will file an NOD concerning the reduction, if you don't agree with it.
There are a lot of nagging details, and the VA can easily "screw up". 30% to 10% can be a very significant change, as far as benefits are concerned. Basing a change on one C&P can be a VA "screw up" by itself.




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