VA Health

If the VA thinks I'm "cured" will they reduce my rating?

Hi Jim,

          I've never done this before and my VSO is clueless! I am currently being treated by the VA for the Hep C virus with the new drug Harvoni.  I am genotype 1 and this drug has 98% success/cure rate.
 

If after treatment my viral load is undetectable or zero will the VBA reduce my combined rating of 80%?? I am 60 years old but have only been receiving SC benefits since December 2010. I was a Navy Corpsman and thus granted the SC for exposure to blood from 1979-1986.  I have read your other posts and the rating decision says "no future exams scheduled". Even if they get rid of this virus with Harvoni I will still have cirrhosis from the effects and deterioration of the Hep C virus over 20 years!

 

Reply:

You're entering uncharted territory. These new and super expensive drugs are said to cure Hep-C. The word "cure" isn't one that's used a lot when talking about Hepatitis but it appears they're really on to something here.
 

So...we can't be sure just what they'll do. However, with other "cured" diseases, like a service connected cancer, once the disease is no longer active or detectable, VA rates us on the "residuals" of treatments. For example, the residuals of prostate cancer might be incontinence, the residuals of a lung cancer might be shortness of breath and so on.
 

If I had to guess, I'd guess that Hep-C will be viewed the same way.  If it's no longer detectable, you'll be rated for any residual effects based mostly on how normally your liver functions. That's lab tests of course...there may be other lab values that come in to play...like kidneys.
 

Always keep in mind that when VA tells you that no future exams are scheduled they don't say they won't ever require an exam. They just say nothing is scheduled. The guys who develop the words VA uses are sneaky bastards. You have to understand their language.
 

I'd have to say that your first thought must be how lucky you are to have access to a cure. Having the disease in the first place is rough but now you can get fixed. So far as your benefits go, I'd advise that you leave the sleeping dog alone. If you go asking VA what they're going to do, they'll be more likely to open your file and try to modify your rating. As a rule, wait for VA to act before you stir anything up. They may never do anything.
 

If I were to guess, I'd guess that your benefits are safe over the long run. If VA did propose to reduce the benefit because you're 'cured', there's a lot of room to argue your side of that. It's not been an easy disease for you, I know...and that counts for a lot.
 

If they do notify you, let me know. I've wondered about this and you're the first guy I know of going through it. I'm interested in hearing the rest of your story as it unfolds and I know a handful of advocates, lawyers and doctors who'll also be interested.
 

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No such thing as a "Reconsideration"? Jim explains:

Jim,

I was diagnosed with prostate cancer in August, 2013. Since I am a Vietnam veteran and served on a brown water ship, the USS Krishna, I filed a claim with the VA in September 2013 for exposure to Agent Orange. At first, the VA said that I had not been in VN. After proving through DD214 and a copy of my original orders, they said that they did not have proof that the ship I was on was in an area that was exposed to Agent Orange, even though my ship was listed as one of those on the presumptive list for Agent Orange exposure. Finally, they denied my claim and gave me a 0% rating.

My urologist and I decided to go the "watchful waiting" route and I was prescribed Finasteride for three months to shrink the prostate. I am still on "watchful waiting" and see the doctor every three months for a PSA test and a DRE, as well as a possible biopsy every year. The VA's reasoning for my denial was that I had undergone androgen deprivation treatment for taking Finasteride and had no residuals. My research on Finasteride indicates that it really is not a treatment for prostate cancer, but a treatment to shrink the prostate. The cancer still exists even after taking the Finasteride. I understand that based on the diagnosis, a 100% rating is demanded and that rating continues until a treatment is completed. Am I correct and what should be my next step? Should I just ask for reconsideration and provide information regarding medical expert’s opinions on Finasteride as not being a true treatment for prostate cancer? Thanks for any assistance you can provide.

 

Reply:

 

There is no such thing as reconsideration. Although the term is used a lot on the Internet and by "experts", it doesn't exist.

You should formally appeal. That means to file a NOD and then state your case.

As it happens, I agree with you. I see this all the time...VA tries to interpret watchful waiting as some sort of magic cure if you're given any of the prostate size reducing medicines.

If you got a 0% rating for prostate cancer, the claim was not denied.

It was approved as service connected at a 0% disabled rating. I know this makes no sense at all but it's a constant state at the VA...they pull this all the time. Finasteride is absolutely not a treatment for cancer, it's a treatment for BPH.

So, your nest step is to mail a NOD. Use this form http://www.vba.va.gov/pubs/forms/VBA-21-0958-ARE.pdf

In the NOD tell VA what you told me. If you can get a statement from the urologist that you have had cancer continually since the date of diagnosis, that would help a lot.

Get the NOD into the mail. Mail it using ONLY certified mail, RRR.

Don't deliver it any other way. Then wait patiently.