wirat

Well this might be late, but I would; 1) Research what each disability is defined as before you claim it and articulate it using those symptoms. I don't think it is a lie, it is what the VA rating terminology is. If you use different words to describe something it is left up to their interpretation. 2) If you got rated 0% on something like a scar that is painful, file for an increase instead of a NOD. This will cause another C&P that will focus on the pain. Now you have the service connected element out of the way. If you file a NOD you will be burning up a challenge on that disability. Save the NOD for when/if the claim for increase fails. It worked for me. For example, I filed for scarring that was painful and got 0% because the examiner put NO on the painful question. (That's another story) When I got the results instead of a NOD I just immediately filed for an increase, got another exam with a VA Dr, and at that appointment I really went over the pain issue which was the focus of the entire exam. He said there was no question and I got 10% for it after that exam. No appeal required. 3) When you go for the C&P make sure you go over the exam results with the provider. Take hand written notes. Ask them what they are going to report, what their measurements are, etc. It helps them too so that they form a mental conclusion in their head. I bring my wife along and have her sit in there so the provider knows there is a witness. I think this may have prevented the issue with my painful scars during the first exam. I have a grade V AC separation from decades ago. Back then they only gave me 10% for arthritis. I was young, dumb and full of."...". I didn't know any better and trusted that must be what you get for this injury. When I later discovered there was a separate disability for the AC injury alone at 20%, I was really shocked and felt betrayed at how they could not have given me that rating from the start. It's a prima facie injury, either you have it or you don't. Like an amputation. That was years ago for me, but now I am learning and trying to get it corrected. I would read over that site Military Disability Made Easy...they have all the ratings in plain English with pictures that make it easy to understand. Go there and write down everything you think applies to you. You may find you are missing something or are claiming something under the wrong disability. I did.

By the way, I created a complaint report regarding the faulty exam I had with the C&P nurse and emailed it to the OAWB email address. They emailed back the next day and said they had reviewed my complaint and said they were forwarding it to the VBA Office of the Under Secretary for Benefits, (aka; file-13 garbage can!) because the OAWB only handles complaints from VA employees or applicants. If I remember correctly the whistle blower programs were designed to protect employees from management retribution if they report fraud, waste and abuse, etc. I am just a civilian not affiliated with the VA, so I suppose their response makes sense. I suppose you could also report misconduct to the VA OIG, but they are going have some high thresholds for financial losses or serious felonies before they will be able take action on it.

VES Phone 1-877-637-8387; https://www.vesservices.com/?page_id=37 Veterans Evaluation Services PO Box 924089 Houston, Texas 77292

I may end up doing this. Just listing what the injury is and ask it be rated at what I think (know) it is. At some point you just have to point out the elephant in the room. I just want to say "why aren't you looking here and giving it this rating?". It's like an amputated foot is an amputated foot. And in my case, it's like the VA won't recognize or acknowledge the amputated foot, but gives 10% for arthritis instead of 40% for what the amputated foot is rated at. This must be an avoidance technique or something. There are successful case appeals, my medical records are complete, it is already service connected. My current injuries all happened on active duty and I was treated in military hospitals. A no-brainier. There is no guessing involved, my only issue is that they failed to rate me with any % a long time ago, and now older and wiser, I see there is a code for the exact same thing and many have been given 20% while they only gave me 0%. Fighting the decision is not my issue, it's getting them to say you claimed "X" disability rating under code XXX, and yes we agree or no we don't and here is why... If I ultimately get rated at the listed disability they originally gave me 0% on I'm going to consider a CUE for back pay because some things, like amputations, detached joints, etc. don't grow back and if it is rateable today it should have been back then.

@Richard1954 - Is this the Dr. Ainse in Florida? If so, where does she work please? I need a Doctor I can go for a consultation to that is a reasonable distance from central Florida.

Hi all, I need some advice from those who know what I am seeking clarification on. How do I claim for what I already know is a rated condition? I have been looking for go-bys and have found lots of instructions, but not really sure how to go about the descriptive wording to articulate what the claimed item is. For example, the samples on the claim form and the instructions say to "describe the disability", by symptoms, not by the scheduled diagnosis of the disability. Let's take code 6604 Chronic obstructive pulmonary disease (COPD) as an example. The way I read the claim instructions, you would claim "difficulty breathing" or "pulmonary disease" or something like that rather than "6604 COPD". I understand the concept behind this is for the C&P exam/medical side and the VA to rate what the final diagnosed condition is, however, what if you already know you have COPD from extensive medical testing? Why should you have to beat around the bush and let the VA classify it when they may classify it as something else, in error, for less compensation, or whatever? Can't you simply claim what you have the evidence to show it is, and make them say yes or no? Another example for instance, code 5203 shoulder AC separation, where the clavicle is dislocated from the scapula, can't you just put that rather than "shoulder injury", etc., if you already know what it is from a Dr's diagnosis? So instead of them trying to say you have arthritis, or some other disability, how do you force them to address what you know is the correct rating classification for the injury? For the VA I think it would be more of a verification issue than a diagnostic one. Thanks for helping me understand a basic, yet confusing part of this process.

I could not agree more! I was inexperienced and trusting of the VA (geez!) when I first got off active duty and learned later how I was bamboozled. Partly my fault for not perusing everything, but mostly because I trusted the system. The recent faulty C&P exam for my scars was a real eye opener for me and it mortified me in a way because reading that report was an assault on my integrity and it lowered my faith in the entire VA system. I'm on guard from here on out though, I will tell everyone from this day on, the VA is NOT going to act in your best interest, you must research everything, save every record, only provide copies, memorialize everything, take notes, bring a witness to your C&P exams if you can (yesterday I brought my wife in there), research the providers they send you to before you go, and lastly, DON'T BE AFRAID TO *TACTFULLY* ASK QUESTIONS/CLARIFY DURING THE EXAM AND VERIFY WHAT THE DOCTOR IS GOING TO REPORT. Speak up - it's the only chance you will have to communicate findings with the provider. *Remember this = Once you leave that room, it will be the VA cube dwellers falling back on what the practitioner wrote in the exam, and personally, I don't want to find out two months later that I thought he/she would report "X" when it turns out they reported "Y" instead. I see now a system compartmentalized like this not only separates functions to provide impartiality, but more often allows the VA to practice willful blindness by falling back on the practitioners report as tying their hands. I think if you can have a witness present (just for support) it may change the demeanor of the C&P exam because now the practitioner is aware there is someone else in the room witnessing everything. I felt this way with my wife present. Personally, I believe every C&P exam should be audio recorded. It would protect the integrity of the process for both sides, keep everyone honest, and create a memorandum of record that could be reviewed later to resolve disputes. It is done in all sorts of legal proceedings, court, depositions, etc. this is no different. A C&P exam may be a medical related event, but it is merely a step in a regulatory/legal discovery process and as such should be treated as evidence.

FYI, I think my issue will be resolved. I posted earlier that I went for a C&P exam for a scar with this male nurse (contractor) wearing a gown with "Dr." stitched in it. He measured the scar, I went over how it was painful and he examined it and acknowledged. Two months later I get the rating of service connected, but 0%. I look at his exam report and he checks "NO" in the painful question. I complained through LHI the contract company this must be an admin error, and he flat out denied there was any pain associated with the scar even though I brought it up during the exam in detail and checking for pain is part of the exam anyway. I immediately filed for an increase for painful scar since it was at least rated as service connected now (it would be difficult for him to not determine that since this was all done in a military hospital while on active duty). Today I had the increase C&P exam with a real VA doctor at a VA clinic and had my wife present in the room. He measured and did the same exam, I told him the same issues with the pain and he agreed. I asked and clarified what he would report. He gave me his measurements and I made sure to ask about the painful scar reporting part and he said yes, it will be rated as a painful scar there is no question. So hopefully in two months or so I will see it rated properly and go from there. I would expect it to be rated at 10% now because that is what it should have been if the 1st quack they sent me to was ethical.

In my case with a painful scar the C&P examiner failed to note that it was painful although I told him it was twice. I was subsequently rated as service connected but at 0%. So instead of filing a NOD, or any kind of flaw/error complaint, I immediately filed another claim on Ebenefits for an increase because the scar is painful. Literally put "painful scar" in writing on the claim for increase and submitted the same medical evidence as for the initial claim. The next day, my new claim for increase was gone and merged into my current claim in progress along with other shoulder issues I have. So it seems they got the message and I assume will schedule another appointment for a C&P exam just to cover the painfulness of the scar for an increase. At least this way (immediately filing for an increase) I will not have to go through and burn up time on an appeal (NOD), I will not have to go out and pay for my own IMO at this time to fight it, and will hopefully get the proper rating. Oh - and since they merged it, the date of claim for the increase is not two months later, but the date of my original claim. That surprised me. If they consider what I have and still get 0% then fine, but I at least want all the symptoms considered in the rating which is what the 1st exam did not allow.

Yes, I am organizing information that I have for a complaint I posted about here, but not sure it if would do any good in the end because it's going to come down to a "he said, he said" situation.

Hi, I'm new to this board and the C&P exam process. I was injured many decades ago and was treated in military hospitals, I kept every record I could. I was initially given 10% for arthritis in my right shoulder although my entire shoulder was broken apart on active duty. Funny, I never questioned what the VA gave and assumed (I was young) that they were acting in good faith. Fast forward to today and now I have issues with range of motion, scaring pain, etc. I have filed a claim for an increase. Went to a C&P exam with an LHI contract "provider". Everything went well during exam, friendly, he measured scar, I told him how it was painful, he acknowledged it TWICE and looked at it, etc. Two months go by and I get the results. He says service it's connected (of course) but on his exam he checks NOT painful. Confused, I try to get in touch with him via LHI and cannot. I tell LHI it must be an admin error since there is only a YES or NO box he checks off. He must have made a mistake. LHI calls me back and states they contacted the provider and he swears there was no mention of any pain during the exam! Well, if painful YES or NO is on his exam checklist, what do they think I would have said if he even covered that part during the exam? He never asked nor had to because I brought it up. So I look in to this "provider" and it turns out he is a nurse. He was wearing a frock that had "Dr." stitched on it when he did the exam. The exam was conducted at a clinic near me. I called the clinic and they said he did not work there, only used an exam room there. So I checked the Internet for this guy and every clinic I found he was associated with I called and they said he did not work there and they did not know who he was! When I called LHI a service rep there told me they used contract providers to be "fair and unbiased" for the veteran! I then checked his state license and he has a nursing license, but the address listed is like a shell of an office at some strange store location. Basically a PO box service for mobile physicians. From what I can see, this nurse is just a shill for the VA, has no means of contact, no regular office location, goes around wearing a doctors gown and then when he does the exam and you disagree there is no recourse? I currently have another exam scheduled for next week. Now I have my guard up from the 1st experience. This time it is with a physician through VES. I checked that Dr.s' name and same thing, no office, no contact number, and only her history is in Indiana while I am in Florida and the exam will be here in Florida. I checked the Florida Department of Health for a physician's license and she is not listed as having one in Florida. You need to check up on these "practitioners" they are scheduling you with. I think you might be surprised to see these flags; 1) No regular office or contact information. 2) Listed at several clinics or locations on the Internet. 3) Not licensed to practice medicine in your state. (Not sure yet, but I think Florida may allow this if only for a consultation) 4) Using a leased or rented exam room to do C&P exams at a clinic where they don't have a regular office. 5) Their sole source of income, primarily all they do is C&P exams as contractors for medical service companies. My finding is that this is all put on by the VA under the guise to make the C&P exams appear to be "fair and impartial" when basically you are being seen by a contract practitioner who is really nothing more than a straw man (or woman) VA employee. That way, they can meet you for the exam, send in the results, and when you finally see it two months later and it is not favorable or is deficient, you have no means to contact them to correct it. Then the VA can turn a blind eye and say they are only going off medical information provided to them by an independent medical practitioner, when they know very well it was essentially a VA paid agent who did the exam under these circumstances. What is the recourse under these circumstances? Can you request another exam? It seems you can file a NOD but then you are burning up an appeal when you should not have to appeal it in the first place.