Just haphazard, bewildering C&P exam. What happened? What can I do?

[aoneinsun]

Hi,

I had an interesting and bewildering C&P exam with a Dr. covering three items of evaluation; lower extremity varicose veins, piriformis syndrome (left hip), and lumbar condition with herniation (for a disc bulging 5 mm to the left at L4-L5).

 

Here is about how it went…

Firstly, I had filled out the summarized history questions for each of the three items. The papers I had diligently filled out simply laid on his desk the entire exam though, and he simply asked me questions as he went through his DBQs. I was very well versed in my medical record and could tell him the brief history (or development) of each condition (along with my medications) in a quick, concise fashion. He was reasonably personable, and he seemed to be pretty pleased with my being quick and to the point (it was towards the end of the day and he was delayed in getting to me). And he seemed to whip through the DBQs with speed. He did inspect my legs for varicose veins (which are really obvious). I was surprised that he didn’t ask if I had aching and fatigue in my legs after prolonged standing or walking or if the compression hosiery I was wearing was helping. He could have found out the answers to those questions if he had read the packet I filled out (he didn’t bother to read that it seemed, nor did I get sense that he read my medical record). I had to specifically say that I had aching while standing for long periods of time, and I didn’t realize I had varicose veins for years until recently. I think he should have asked me that when filling out the Artery & Vein Conditions DBQ at 3B. And I hope he filled that part out…

I also explained how I had hip/low back issues after some long runs and landing weirdly on my left leg while playing volleyball. He had me walk (which is in my case limp, barely putting my left foot forward to step) to the office door and back to see my gait. He had me try to lean backwards, forwards, side-to-side, and twist. I could do all pretty well except the leaning forward to touch toes. I could only lean forward maybe 15-20 degrees. I glanced at his notes, and they almost all looked like they said 30 degrees (normal) except I don’t know what he put for forward flexion (I saw nothing but 30 degrees on the sheet, and I don’t know if he put something down later to give an accurate reflection of my forward flexion). I’m wondering about this because the Back (Thoracolumbar spine) conditions DBQ specifically says in Section III (before 3A) to “Measure ROM with a goniometer.” In fact it says 3 repetitions of ROM (at a minimum) are needed. I only did forward flexion twice, and that was because the first time I leaned over he didn’t seem to like it that I couldn’t lean down very far, and so he stood up and showed me how to lean down to touch one’s toes to demonstrate what he was looking for from me. Again I leaned down about as far as I could without pain (which was not much). I don’t know what he wrote down, and I never saw a goniometer once in the exam. Should he have used a goniometer?

He didn’t examine me at all, as in seating me on the table, having me attempt to perform straight leg raise tests (which is required at step 12) or palpating for tenderness, etc. It was most like a reporter’s interview (aside from him observing me having trouble touching my toes and him encouraging me to try to do it). One thing he did do that I thought was indeed good was to run a pointy object up and down my legs while I was seated. Interestingly, I had slightly less sensation on the left leg, and I told him this.

He also didn’t test my hip flexion, or ankle flexion/dorsiflexion, great toe extension, etc, which is required per the DBQ at step 8A. That seems like that would have been a pertinent thing to assess, especially after observing how small of a step I took with my left foot while demonstrating walking for him. And he was supposed to test for piriformis syndrome (left hip) during this exam, and I even told him that just last week I was also diagnosed by the VA Pain Mgt clinic with IT band syndrome of the left hip for my tension and pain along the outside of the left hip. I have no idea what he put for ROM for my left hip...

He got to the end of the last DBQ form that he whipped through (after skipping what I think are essential parts), and then he finished the exam abruptly saying, “Well, that’s it. That’s all. We are done.” When I asked if there was anything else, he was like “No. That’ll do.”

At the end of the exam, he seem to notice the envelope full of the papers I had filled out along with my medication list I had diligently prepared. He was like, “What’s this”? I was like, “That is for you, which my medication list and everything.” He acted like “Oh,” and seemed to grab it and take it somewhere. I wonder what he did if anything with that. He seemed to be completely done with me at that point.

 

My Questions:

How can I get record of his notes and when might they become available? 

Is this super relaxed approach, and skipping through what I think are required sections normal? Is this anything like how a C&P exam should go?

Is this lack of use of an accurate measuring device going to lend itself to an accurate rating? Should I document that he did not use any accurate measuring device and have my own physician measure my ROM with a goniometer (or would that come later with a VA attorney after the VA denies my claim)?

 

 

What just happened? Was I supposed to be somehow more demanding during the exam, and if so how could I have done so appropriately?

 

 

Any advice appreciated!

[Buck52]

You can request another C&P and give your reasons.

Yes he was suppose to use a measuring device  for ROM Known as a  goniometer.

If he didn't then he is guessing and that will be an Inadequate exam.

And not reading your medical records and medications list.

During an exam  you do need to speak up...if you have to Just say Excuse me  but I have these medical records and medication list for you to look at  ect,,,ect,,

Don't be shy when it comes to C&P Dr's examining you.

if it was late he wanted to get out of there  that's to bad  he still needs to do a complete exam.

C&P Exam is one of the most important exams for  veterans.

either check with the C&P Dr incharge or call your RO

AS for as getting his notes for this exam, wait 3 days and then you can get them from your VAMC  ''Release of Medical Records imformation''

If you have MyhealthyVet  you can get copies of the Notes off those , there in PDF and just select what you want  (the notes are Numbered) and in decented order  just print off what you want. or read.

jmo

....................Buck

[green]

If it was a VA Doctor you should be able to access your C&P within a couple weeks by logging onto myhealthevet.gov and pulling up your blue button information (select notes).

[TALON II FE]

Wait and see the results before you get too spun up.  Keep in mind, these are not he best doctors around, generally speaking, and that your C&P is more of a 'legal proceedings records review' than it is a medical exam.  Obviously, the doc was lazy, but that may work out for you, he may give you what you are looking for.  Once you see the C&P, then you can decide how to proceed.

[aoneinsun]

Thanks. I do think it prudent to see what notes he did make first.

I think he probably got the problem with my touching toes issue notated, albeit with his rough eyeball assessment of the angle. The VA Doctor locally eyeballed it as well to be about 15 degree forward flexion. I imagine it should be close to that, and that would be about right (though not done with a goniometer).

He didn't measure ROM of the left leg at all though. It would be interesting to see if he put values in there or not. If not, presumably it was skipped by mistake? If it was skipped by mistake would another C&P examiner need to measure those, or perhaps I should have my own Doctor measure the ROM?? If there are values for left leg ROM that seem to indicate that I am perfectly fine (no issues) when he didn't even measure my left leg ROM at all, then at that point should I raise this concern?

He did ask if my medical record documented my issues, and I said yes, my medical record does document my issues, and I obviously could verbally articulating my issues to date quite well. If he was running behind, and assumed he didn't need to undertake a full exam to check ROM (particularly of the left hip), then I think that is to error on the side of incompleteness.

I guess I will not know until I see the notes... I feel like that is good/prudent to wait and see the notes. And yet I got the distinct impression when he said, "That'll do" at the end that he was somehow holding back and or not fully doing what would be the complete thing to do regarding the left hip examination and documentation of its ROM limitations.

Best advice to wait for the notes? Then go from there if/when the left hip ROM is not properly documented?

Appreciate the help.

 

[Buck52]

Yes wait and read his report..it could go in your favor  but if not  then the measurements he was assuming..its hard to tell what there thinking  when he said ''That will do it'??

[Vync]

It is not unusual for some C&P examiners to leave your records untouched while you are in there. The time with you is supposed to be focused on the actual exam/DBQ and they probably will read the documents later. I have actually had a couple of examiners tell me they never received my c-file.

You mentioned not being able to move very much due to pain. This is very important for exams which have rating criteria based on range of motion (ROM). There should be two sets of numbers. One is the maximum possible ROM and the other is where pain begins.

For example, you bend to 10 degrees and pain begins, but can continue to bend to a max of 25 degrees. Some examiners and raters have no clue what they are doing and might try to rate that axis of ROM at 25 degrees, but it should really have been 10 degrees.

When you get your results, see if painful motion was factored in. If it wasn't, then you have another reason to request a new exam.