magnolia_318

Was this a VA or non VA doctor? This was a VA doctor, a neurologist that specializes in my disorder. He is also a doctor at a very prestigious hospital in the area. He also has numerous publications and has piloted numerous clinical trials and research into this specific disorder as well as codeveloping the medication, mestinon, that is a standard treatment for this disorder. So I am going to assume his credentials are a little How do you know the VA 'examiner' was even a Doctor? I checked him out, he is a doctor, just an unethical one What is the disability and have you gone to the VA Schedule of Ratings here, and been able to isolate documented medical evidence that you fit into a higher rating? Myasthenia gravis is the disablilty. I havent gone through the schedule of ratings. With this disorder, it affects numerous areas of your body so they are rating each area individually i.e. arms, legs, speech, eyes. How did you get 2 C & Ps? You must have challenged the first one like I did???. I didnt challenge anything. I was given 2 C&P exams by the same doctor. On the first exam, his write up was somewhat in my favor. I guess the RO had a talk with him and scheduled me for a second C&P 9 months later. On the second exam he said I was fine. Total 180 from the first C&P. After that second exam is when I reviewed my record and saw all that erroneous "mild" stuff. Being that my VA doctor pioneered the modern day treatment for this disorder, I am hoping his write up trumps this examiners "findings". So I have 1 good write up from the examiner and 1 good letter from my doctor and 1 bad write up from the same examiner.

I have had 2 C&P exams in the past 9 months. The first was somewhat in my favor but the second basically stated that every issue the examiner found in the first exam was now miraculously fine. After seeing this second exam, I went through my record and found that the examiner, who never actually performed an exam, was just copying and pasting notes from my VA medical record and using this as a basis for their findings. I also found that my condition was not being properly documented in my record. Verbally, my doc would tell me my condition was "moderate to severe" but in my record it was being notated as "mild". I addressed this issue with my doctor, who was kind enough to pen me a detailed letter describing the "true" nature of my illness and supporting my claim. So my question is, does this copy paste job of the C&P examiner carry more weight than a letter from my doctor who has treated me for the past 6 years? Their findings are in total contrast of each other. C&P examiner states my condition is "mild" and my doctors letter states it is "severe". He also goes in to more detail as to my limitations and how the frequency of my required treatments creates great limitations on my life. Let me know your thoughts.

Got the results from my second C&P. It was a total 180 degree difference from the first C&P. Same doctor that said " It is at least as likely as not that veteran is able to maintain substantial gainful employment based only on his service connected myasthenia gravis", now says I am absolutely fine and that "I am able to maintain substantial gainful employment based on my service connected myasthenia gravis AND pericarditis." The VA is so full of s#%t. I'm really frustrated and pissed at the underhanded nature of the VA system. There has been no substantial change between my first C&P 9 months ago and now, besides starting chemotherapy to treat the myasthenia gravis. So my questions are: How can they justify coming to such a different conclusion with no real improvement in my condition. Being that my case was remanded back to the RO and they are going to make a decision based of this bogus C&P exam, which will likely not be in my favor, will I still have the opportunity to bring this back up to the BVA being that the BVA already remanded it back to the RO? My case is 10 years old, so are they looking to make a decision based off a current C&P exam or are they looking at my condition over the past 10 years. i.e. 2 surgeries, chemotherapy every 6 months, plasma exchange once a week for the past 6 years, and numerous admission to the hospital or does this C&P carry the most weight I really fell like the RO gave this doctor a call after the first C&P and instructed her on what they wanted her to say. I'm really pissed off. Any guidance would be much appreciated.

Thats kinda what I am thinking. The first C&P was favorable so they will probably send me back until I get an unfavorable exam. I have a couple of question. Being that my claim is over 10 years old, are they basing the decision solely on the results of the C&P or are they going to review my record and take into account my hospitalizations and crisis episodes that I have experienced over the past 10 years? Also, being that I was involuntarily medically discharged from the military, shouldn't I have been given a higher rating than the minimum rating of 30%, being that my condition was severe enough to discharge me from active duty?

Just finished my second C&P exam. Same doctor, same questions, same exam. Do you guys think this second C&P had anything to do with the fact that my case was remanded back to the regional off by the BVA or that my case has been going on for over 10 years? BTW, this is the second C&P since the remand and not the second C&P overall.

Thank you so much for the quick response, Bertha. I pasted the findings from my C&P in July below. Its confusing that the examiner stated that my strength was 4/5 and 5/5, my VA doc rates me at a 2/5, yet still comes to the "it is at least as likely as not" conclusion. Thanks in advance for any feedback that can be provided. LOCAL TITLE: AMB CARE C&P EXAM STANDARD TITLE: C & P EXAMINATION NOTE STATUS: COMPLETED Peripheral Nerves Conditions (not including Diabetic Sensory-Motor Peripheral Neuropathy) Disability Benefits Questionnaire Indicate method used to obtain medical information to complete this document: [ ] Review of available records (without in-person or video telehealth examination) using the Acceptable Clinical Evidence (ACE) process because the existing medical evidence provided sufficient information on which to prepare the DBQ and such an examination will likely provide no additional relevant evidence. [ ] Review of available records in conjunction with a telephone interview with the Veteran (without in-person or telehealth examination) using the ACE process because the existing medical evidence supplemented with a telephone interview provided sufficient information on which to prepare the DBQ and such an examination would likely provide no additional relevant evidence. [ ] Examination via approved video telehealth [X] In-person examination Evidence review -------------- Was the Veteran's VA claims file reviewed? [X] Yes [ ] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: records If no, check all records reviewed: [ ] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [ ] Department of Defense Form 214 Separation Documents [ ] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [ ] Other: 1. Diagnosis ----------- Does the Veteran have a peripheral nerve condition or peripheral neuropathy? [X] Yes [ ] No Diagnosis #1: myasthenia gravis 2. Medical history ----------------- a. Describe the history (including onset and course) of the Veteran's peripheral nerve condition (brief summary): Mr. X , accompanied by his wife, is scheduled for evaluation of MG. He is service connected for MG at 30%. vet is scheduled for an exam to determine the current level of severity and manifestations of MG. An exam and med opinion are requested for the board of veterans appeals. Vet had previous C&P neuro eval done in 2008. Vet states his sx started in 1998 with double vision and droopy eyelid and generalized weakness. HE was treated with mestinon which did not provide complete relief. He states he has been treated with Prednisone x 15 years. He has tried Cellcept and IVIG with not much relief. HE follows at XXXX and is currently on Mestinon 120 mg Q6H, Imuran 225 mg daily and gets plasmapharesis once a week. he states he had thymectomy twice. SH: married, works part time in IT All: NKDA b. Dominant hand No response provided. 3. Symptoms ---------- a. Does the Veteran have any symptoms attributable to any peripheral nerve conditions? [ ] Yes [X] No Paresthesias and/or dysesthesias 4. Muscle strength testing ------------------------- a. Rate strength according to the following scale: 0/5 No muscle movement 1/5 Palpable or visible muscle contraction, but no joint movement 2/5 Active movement with gravity eliminated 3/5 Active movement against gravity 4/5 Active movement against some resistance 5/5 Normal strength Elbow flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Elbow extension: Right: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Wrist flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Wrist extension: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Grip: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Pinch (thumb to index finger): Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Knee extension: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Ankle plantar flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Ankle dorsiflexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 b. Does the Veteran have muscle atrophy? [ ] Yes [X] No 5. Reflex exam ------------- Rate deep tendon reflexes (DTRs) according to the following scale: 0 Absent 1+ Hypoactive 2+ Normal 3+ Hyperactive without clonus 4+ Hyperactive with clonus Biceps: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Triceps: Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Brachioradialis: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Knee: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Ankle: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ 6. Sensory exam -------------- Indicate results for sensation testing for light touch: Shoulder area (C5): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Inner/outer forearm (C6/T1): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Hand/fingers (C6-8): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Upper anterior thigh (L2): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Thigh/knee (L3/4): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Lower leg/ankle (L4/L5/S1): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Foot/toes (L5): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent 7. Trophic changes ----------------- Does the Veteran have trophic changes (characterized by loss of extremity hair, smooth, shiny skin, etc.) attributable to peripheral neuropathy? [ ] Yes [X] No 8. Gait ------ Is the Veteran's gait normal? [X] Yes [ ] No 9. Special tests for median nerve -------------------------------- Were special tests indicated and performed for median nerve evaluation? [ ] Yes [X] No 10. Nerves Affected: Severity evaluation for upper extremity nerves and radicular groups ---------------------------------------------------------------------- a. Radial nerve (musculospiral nerve) Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis b. Median nerve Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis c. Ulnar nerve Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis d. Musculocutaneous nerve Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis e. Circumflex nerve No response provided. f. Long thoracic nerve No response provided. g. Upper radicular group (5th & 6th cervicals) No response provided. h. Middle radicular group No response provided. i. Lower radicular group No response provided. 11. Nerves Affected: Severity evaluation for lower extremity nerves ------------------------------------------------------------------ Sciatic nerve Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis b. External popliteal (common peroneal) nerve Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis c. Musculocutaneous (superficial peroneal) nerve Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis d. Anterior tibial (deep peroneal) nerve Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis e. Internal popliteal (tibial) nerve No response provided. f. Posterior tibial nerve No response provided. g. Anterior crural (femoral) nerve No response provided. h. Internal saphenous nerve No response provided. i. Obturator nerve No response provided. j. External cutaneous nerve of the thigh No response provided. k. Ilio-inguinal nerve No response provided. 12. Assistive devices -------------------- a. Does the Veteran use any assistive devices as a normal mode of locomotion, although occasional locomotion by other methods may be possible? [ ] Yes [X] No 13. Remaining effective function of the extremities -------------------------------------------------- Due to peripheral nerve conditions, is there functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis? (Functions of the upper extremity include grasping, manipulation, etc., while functions for the lower extremity include balance and propulsion, etc.) [ ] Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran. [X] No 14. Other pertinent physical findings, complications, conditions, signs and/or symptoms ---------------------------------------------------------------------- a. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis section above? [X] Yes [ ] No b. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms? [X] Yes [ ] No If yes, describe (brief summary): Gen: well dressed, well groomed MS: AAOx3 Lang: no dysarthria, no aphasia CN: pupils midline, EOMI, weakness of eye closure blt; states he has diplopia with both eyes open as well as with each eye covered (?); facial sensation intact to LT blt, no facial asymmetry, weakness when pt puffs out cheeks; tongue midline Motor strength: 5/5 in blt UE except R triceps 4-/5 and L Triceps is 4/5; blt deltoids 4/5; blt LE 5/5 DTRs: symmetric 2+ blt UE and LE except triceps 1+ blt Coordinato: no dysmetria with FTN Sensory: grossly intact to LT blt Gait: steady 15. Diagnostic testing --------------------- a. Have EMG studies been performed? No response provided. b. Are there any other significant diagnostic test findings and/or results? No response provided. 16. Functional impact -------------------- Does the Veteran's peripheral nerve condition and/or peripheral Neuropathy impact his or her ability to work? [ ] Yes [X] No 17. Remarks, if any: ------------------- No remarks provided. **************************************************************************** Medical Opinion Disability Benefits Questionnaire Name of patient/Veteran: Indicate method used to obtain medical information to complete this document: [ ] Review of available records (without in-person or video telehealth examination) using the Acceptable Clinical Evidence (ACE) process because the existing medical evidence provided sufficient information on which to prepare the DBQ and such an examination will likely provide no additional relevant evidence. [ ] Review of available records in conjunction with a telephone interview with the Veteran (without in-person or telehealth examination) using the ACE process because the existing medical evidence supplemented with a telephone interview provided sufficient information on which to prepare the DBQ and such an examination would likely provide no additional relevant evidence. [ ] Examination via approved video telehealth [X] In-person examination Evidence review -------------- Was the Veteran's VA claims file reviewed? Yes If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: records MEDICAL OPINION SUMMARY ----------------------- RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: Is the veteran able to maintain substantial gainful employment based only on his service connected myasthenia gravis. b. Indicate type of exam for which opinion has been requested: Neurology peripheral nerves. TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] It is at least as likely as not that veteran is able to maintain substantial gainful employment based only on his service connected myasthenia gravis. Vet has complaints about primarily ocular and mild generalized weakness. He currently has a part time job.

I just received notice that I have been scheduled for another C&P exam for the same condition and by the same Neurologist that performed the first C&P exam. Is it normal to have 2 C&P exams for the same condition and with the same doctor within a 9 month period? Forgive me for being pessimistic, but I think the VA is trying to cook up something and it wont be to my benefit. Let me know you guys thoughts on the matter. BTW, the first exam was somewhat in my favor for an increase.

-----------UPDATE----------- I just received notice that I have been scheduled for another C&P exam for the same condition and by the same Neurologist that performed the first C&P exam. Is it normal to have 2 C&P exams for the same condition and with the same doctor within a 9 month period? Forgive me for being pessimistic, but I think the VA is trying to cook up something and it wont be to my benefit. Let me know you guys thoughts on the matter.

Does anyone know of a doctor near NY/NJ, that familiar with the VA system, that can provide me with an Independent Medical Exam (IME)?

Thanks for the response Vync. It helps to clear up the VA jargon.

I have had very bad experiences with the VA health care system: I was told that I have anemia and needed a colonoscopy/endoscopy procedure do to determine if I was losing blood internally. After the test was done, I went in for the results and the doctor told me that they found nothing. About 1.5 years later, at an unrelated appointment, another doc asked me how my Celiac disease was doing. I told him I didnt have Celiac. He said yes you do, they found out that you have it when they did the endoscopy 1.5 years ago. Surprise. I went to the ER numerous times for the pericarditis they created while cutting open my chest to remove a gland to help my ""mild"" myasthenia gravis weakness. Everytime I went to the ER I was told they didnt find anything specific on the X-rays or lab work and that they were going to assume that it was pericarditis because the symptoms matched that diagnosis. I reviewed my record recently and found out that everytime I went to the ER they found something was wrong and never told me. For example: suspected atrial injury, left ventricular dysfunction w/ more than 50 percent ejection fraction which is actually associated with sudden cardiac death, EKG readings that specifically pinpointed pericarditis, elevated cardiac enzyme and the list goes on. This stuff cant be legal I went into a myasthenic crisis while on vacation and had to be hospitalized for 3 days. My neuro at the VA actually coordinated everything and got me admitted to a private hospital in that state and had the VA pick up the tab. I was praising the ground he walked on until I read my medical record recently. His notes stated "I got into trouble with my myasthenia while on vacation, however, my symptoms improved with rest." REALLY??? How can the VA get away with blatantly false statements? My previous C&P exam was right after this crisis. I walked into the exam not being able to talk due to severe slurred speech and a drooping soft palate, choking on my own saliva because I couldnt swallow due to throat muscle weakness, limping due to calf muscle weakness, and one eye closed due to eye muscle weakness. However, the C&P examiner stated in his notes "my speech was coherent and intact",even though he had to ask me to repeat myself numerous time to understand anything I was saying, and that my upper extremity strength was a 4/5 and everything else was normal. WOW. I was actually readmitted to the hospital 2 days later. However, being that I have had two thoracic surgeries, been through mestinon, cellcept, prednisone, immuran, IVIG, and am now receiving plasma exchange, similar to dialysis, once a week on top of immuran and im about to move up to rituximab. How are they justified in saying that I'm fine and only suffer from ""mild"" weakness. Mild weakness is not treated with plasma exchange once a week! Sorry for the long winded post. I'm frustrated. I just need to formulate my next plan of action to overcome this BS C&P exam. Also, doesn't the " It is at least as likely as not that veteran is able to maintain substantial gainful employment" rule on behalf of the veteran when it comes to TDIU?

Hello Everyone, I am new to the forum and this is my first time posting. I find many of your stories sadly familiar to mine. I am currently service connected for Myasthenia Gravis and recently Pericarditis, got this from allowing the VA doctors to operate on me. I got my C&P results this week from my C&P exam for Myasthenia Gravis, a neuromuscular disorder. Of course the C&P doctor stated that I was fine despite all the apparent signs and symptoms of my disease. BTW, the examiner was 1 hour and 45 minutes late due to car problems, the exam only lasted 7 minutes, the doc did not touch me and told me I was free to go and did not perform and exam until I insisted. However, that is not why I am posting. I requested an increase to extreme muscle weakness in my triceps, double vision and calf muscle weakness. I seems like the doctor basically copied my neurologist notes and passed them on as her findings as there really was no exam done. In the header of the C&P exam results it stated that she only used the physical exam to come to her conclusions, but that's not possible. The docs notes basically stated that I was fine with only mild weakness noted. However, the last section of the docs notes are the " MEDICAL OPINION SUMMARY " which stated: MEDICAL OPINION SUMMARY ---------------------- RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: Is the veteran able to maintain substantial gainful employment based only on his service connected myasthenia gravis. b. Indicate type of exam for which opinion has been requested: Neurology peripheral nerves. TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] It is at least as likely as not that veteran is able to maintain substantial gainful employment based only on his service connected myasthenia gravis. Vet has complaints about primarily ocular and mild generalized weakness. So if I am doing so fine, Why is it "at least as likely as not that veteran is able to maintain substantial gainful employment based only on his service connected myasthenia gravis." I dont get these people. They are so underhanded and contradictary. I also looked in my medical record for the first time, my mistake, and noticed that my neuro was telling me one thing and notating another. Things like "oh you are really weak" but his notes would say my overall strength was 4/5. However, I digress. So what do you guys think is going to happen next in regards to this C&P exam. BTW, I never requested TDIU.