"The C&P examiners surely must realize that they don't work at the VA of 20 years ago. Back in the 90's, I had no way to know if the examiner was being thorough or not. Now, we are empowered with knowledge here from Hadit and also are fortunate enough to have the DBQ's and C&P exam questionnaires available to us online."
That is SO true! In the late 1980s I realized how much the RO could manipulate what a C & P actually said.
They deliberately left out a final statement by a C & P examiner to deny my DIC claim.11997. He had speculated a ridiculous Cause of death , but what the RO failed to add was ,that he wrote, "that an autopsy could have ruled out."
They did have the doctor's name in the denial so I called him up and raised Hell...to learn that VA not only did not give him the 6 page autopsy (which they had) but also what it revealed would have completely changed his opinion. He then got angrier than I was and I could tell the VA had pressured him for exactly what they expected from him.He sent me a copy of his exact opinion that they had and that gave me the evidence I needed to keep fighting them and draw them out on the autopsy.
(They also removed it from the files they sent to the General Counsel. I fought back on that and when the VA got the 12th copy of it , OGC awarded the FTCA case and then after another RO denial, the RO awarded DIC under 1151.
It is the C & P exam that controls our claims.
As Vync said, because we can get copies of it these days, the R0s cannot get too creative with the results.
But the fact remains that C & P doctors are paid by the VA.
If the APRN rule goes into affect, I guess AP nurses will be doing the C & Ps.
The 2 main reasons, in my decades of experience, that most claims are denied is that:
the evidence does not establish a nexus ( this is really the claimant's responsibility)
that a C & P was done improperly or by someone with no expertise to adequately do it.
One more reason...secondaries even if absolutely obvious, need a strong C & P opinion but
many of those claims need an opinion from a real doctor.(a non- VA doctor with expertise in the field)
Unfortunately C & P exams do not fall under the malpractice regulations.
I have fought back vigorously every bogus posthumous C & P exam they ever did on my claims.
They knew the veteran could not speak for himself or have input into those C & P exams,because they killed him in 1994 with outrageous piss poor medical care. Pres.Clinton said months before he died that VA was the Best Government- run health care system in the world.My husband almost dropped his 1151 claim when we heard that on TV.
Since then the malpractice stats of the VA have gotten much worse.
Maybe the medical incompetence has not really gotten worse, but for sure, veterans and their survivors have gotten smarter because of the internet and their ability these days to file and prove malpractice claims, if it has occurred, and their willingness to get an opinion from a real doctor.(IMO/IME)
Your Appeal is at the BVA, just no Docket # yet, right. You do have a copy of your husbands C-File? We need to see a redacted copy of the initial Denial and the "Statement of Case." What exactly is your "Evidence of Record?"
Many vet's that get caught up in the VA Appeals process, get a negative attitude, right away. They believe that there is a VA conspiracy to Deny and/or limit their Comp Benefits.
VA Raters base their Award/Denial Decisions on "Evidence of Record," if the provided Evidence doesn't substantiate the claim, you get a Denial. That's not to say Rater's don't make errors, but a conspiracy (takes more than 1 person) to Deny is hard to believe, these are mid-level VA Employees.
What does your VSO say about your Evidence regarding the linkage to CAD or Kidney Disease? Which condition is most likely the causative SC for the Secondary issue?
Could you post redacted Dr's Clinician Notes, or other Medical Evidence supporting your claim?
Andyman is correct, i ALWAYS ask that all my issues are taken care of through the VA. I refuse to even accept the Choice program even though it is available to me. My C&P was done by a VA psychologist, i was literally approved the day after. For those of us who are not yet P&T 100%, it is wise to always use the VA's system, Rating Officers really don't listen to the opinions outside of the VA anyways. Make your case stronger by always using their system to get what is Owed
To add to Ham's intel, you also would get an additional 10% added to any bilateral rating, that is, if you have a SCD involving opposing body parts, L and R side, doesn't have to be both knees, could be L knee and R ankle...how that works is like this 10% + 10%...10+9=19, bilateral factor would be 10% of that, or 1.9, added to the 19 + 20.9, or rounded to 21.
And more importantly, if you have dependents, 30% is the magic number because you get an allotment for each one, at that point.
Not sure, off the top of my head I actually can't recall either way! But I do believe any in house C&P exam should be on there, however, if it was done by a contracted provider it will not be on there. Anyone with better intel on this can speak to it.