mwillis71

So as the title says, I've been denied SC for 2 presumptive illnesses that I have medical documentation of and was deployed to the presumptive areas 3 damn times! I was denied ED secondary to PTSD/Anxiety/Bipolar 1 and corresponding meds (when they fricking prescribe me the VIAGRA and diagnosed me)! Finally, denied GERD as a secondary to PTSD/Anxiety/Bipolar 1, corresponding meds and sleep apnea when they diagnosed me as well!  I mean what in the actual F@ck are these fools thinking?! I just got out of 5 days in the hospital for relapsing after 3 years of sobriety, father in law (Gunny Marine Corps) died the day I got out and now this shit!?
1. I will be putting in a supplemental for all 4 denials.
2. I have more medical evidence I can add that I have found since I applied.
3. I can actually tie my GERD back to my military medical records and they related it to sleep apnea! Should I file GERD as a service connected in its own right since they denied the obvious secondary nature of it?!
4. I have been accepted by a law firm to represent me in another case which regards dates and conflicting information on their part for denying and then approving ptsd/anxiety in the past. It's a few 100,000 dollar case if we win. Do you think I should ask them if they'd role all of these cases in as well or do you think they would only be interested in the other? 
 
I'm sooooooo pissssseeddd.

Even though you may meet the criterial and qualifications for a VA service connection disability you may not be able to receive an important formal doctors nexus opinion or DBQ stating your disability is due to your service or another service connected condition because some doctors and their staffs are lazy, indifferent or hostile to vets receiving VA money.
Here is what has worked for me since 1987 to present day.  I have submitted copies of VA, Army, private medical records and other evidence with my numerous claims and appeals with almost 100 percent success and won those claims/appeals without a doctors nexus statement with only one recent exception where the paid for opinion was also successful.  I have been 100% P&T since 98 and now also with SMC-S.  
IF you contact me I can send you a detailed list of the medical and other evidence that has won my claims and appeals.  What has worked for me is no guarantee it will work for you.
It is a disservice IMHO for anyone to discourage a vet from filing a disability claim just because they cannot get some chicken*** doctor to fill out a DBQ or sign a nexus statement as the vet may still have the other medical and non medical evidence in their files or possession to win. 
I encourage vets to seek opinions of others and do their own research as I have done.
Some vets like to brag about their receiving a VA or private doctors nexus opinion free of charge or it was paid for by their insurance or others and I congratulate them on their good fortune.  I have learned and worked the hard way for my benefits and proud of it.
I learned many years ago to in my case to correctly assume the VARO will deny my claim with a BS statement like "NO EVIDENCE" and then I have to appeal to the BVA or higher U.S. CAVC court which I have done on my own successfully.  This has created jealously on part of some other vets.  Too Bad they can still get happy.
My comment is not legal advice as I am not a lawyer, paralegal or VSO representative.

Vets who have suffered from long term service connected PTSD and the use of those PTSD medications usually have easy time of being granted disability pay for ED especially if not having sired any children during that time.  Just saying.
Every time I have successfully filed a disability claim I have on the form and in the cover letter asked the VARO to BOTH adjudicate my claim on a direct service connection basis and also a secondary service connection basis to another SC medical condition.  It works for me.  I also restate this short sentence in my appeals to the BVA.   This is like covering all your bases.  You do not hurt yourself by dong this IMHO.
This comment is not legal advice as I am not a lawyer, paralegal or VSO.

Yep. Looks like what I have experienced repeatedly, both ages ago and in recent years. They make passing mention of the evidence, but completely failed to explain why you got a 0% rating other than saying that's what they assigned you.
Berta recommended calling the White House VA Hotline. While that can be beneficial, when I was in this exact situation they came back and said they could do nothing because a decision had been made. Instead, I was advised to submit a supplemental, HLR, CUE, or go to the BVA with it. I opted for the supplemental/CUE route for two separate issues. They got one right and the other wrong. If you choose to call, I hope you get a better result than I did. 

Please follow my advice in this thread-if you have downloaded  the older decision and the Evidence list- others here can help you determine if a CUE exists- I have another matter taking up my time-
and it involves veterans , of course. And the VA. And others.
A lousy C & P exam, on it's own, is not a CUE basis- however that exam can set up a CUE in many other legal ways-
Others will help-----

I have no time to read thiswhole thread However you said:
 
"I am now in the process of having my private medical professional do a writeup of my symptoms, frequencies, severity and likely cause of the migraines. "
lese make sure they follow the IMO.IME criteria here at hadit.
"My VSO thinks that I should go straight for a judicial review but can't I just submit another supplemental claim with the new evidence? What would you all suggest?"
Your decision might contain a CUE- please scan and attach the decision and the Evidence list here Cover your C file #, name, address, prior to scanning it-
Attach as well any type of Rating sheet they gave you and by all means if you think LHI gave you a lousy C & P exam , contact THEM and raise Hell.
The contact Info is here for LHI, QTC, And VES ,under a search, I posted it many times-
I have been in contact with Secretary Mcdonough on two other issues recently-
and this is the next issue I want him to resolve---- the ridiculous things vets put up with regarding C & P exams, as a widow I also have been victimized by this fact.
But veterans SHOULD be  fighting this crap themselves.......
Call the White House Hot Line 1- 1-347 -237 -4819 to complain.
I was on the phone with them yesterday for almost an hour.It was an involved situation.
 
Make sure you have a clear statement, you have prepared, to give them.
Let us know what the results of that call are.
YOU men and women have more POWER than you know-and only by being aggressive with the VA, in a diplomatic but determined way,  do thumbs get taken out of butts.
I never tell anyone to do something like that without reminding you all I have had to do that myself with VA for almost 30 years, as a claimant.
Graduating with Honors from a  a military university ,as a civilian,  also helped me a lot!
AMU has ads here at hadit- please check us out- they also have Voc Rehab vets and maybe more Chap 35 spouses-I was their first Chapter 35 DEA student.
KNOWLEDGE IS POWER- I think that is our theme here-
 
 
 

You cannot go straight to judicial review that would be the U.S. Court of Veterans Appeals from a VARO denial.  You have to wait until the BVA appeal is a final denial then you can appeal to the CAVC court.
You can submit new and material evidence along the way before then and/or directly to the Board (BVA) if you decide to appeal.  The CAVC court rules will not allow any new and material evidence however I did send new and material evidence to them in 2003 and won my CUE claim with their remand instructions ordering the VARO to adjudicate my TDIU claim that resulted in award of P&T TDIU with back pay of 5 years.  They said this was not CUE but I still got what I wanted.
Never close off your options to submit new and material evidence to the VARO or Board.  HLR request does not allow for new and material evidence ???? .  Supplemental claim allows for new and material evidence.
This comment is not legal advice as I am not a lawyer, paralegal or VSO representative. 

Keep it simple. If you have the supporting documents for a supplemental claim, then just file a 995.  Don't fall into the hype for a BVA hearing, they take forever and you get the same result with solid evidence.

In 30 plus years of handling my own claims, BVA and Court appeals successfully I have never requested a board or VARO personal hearing as not necessary and for me a total waste of time and I did not want to deal with an indifferent could care less VSO. Also adds a great deal time to your BVA appeal before a decision.  But for some it adds to the drama of a hearing with a real live BVA judge.
I have read and heard they use trick questions and even try to read your body language to see if you are truthful in your answers and of course they can make mistakes.
This comment is not legal advice as I am not a lawyer, paralegal or VSO.
 

You posted this with a topic indicating you requested an increase. Are you certain that they deemed you service-connected and simultaneously rated at 0%? I have talked with others who thought they were SC when they saw 0%, but actually were not.
Would you consider posting the reasons and bases section from the decision with any personal or sensitive information redacted? It would be helpful to understand the VA's supposed reasons to rate it at 0%.
Check the evidence listing and reasons and bases section in the decision to confirm that they considered your lay statements and any buddy letters.
 
If the doc deemed you as service-connected for migraines, even if their notes are marked at 0%, the VA is still required under 38 CFR 4.6 to look at all the evidence which includes your lay statements and buddy letters.
Here are the VA's inadequate C&P exam policies where they should send them back to be reworked or clarified:
https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000180517/M21-1,-Part-IV,-Subpart-i,-Chapter-3,-Section-C---Insufficient-Examinations
If a reasonable person reads the lay statements/buddy letters from you and your wife that clearly state the number of times per month and prostrating nature, they should have rated you based solely on those sworn statements.

A C & P exam is what justifies either an award or a denial-unless it is so insufficient the VA has it re done, but that most often occurs only when the veteran, not the VA, raises hell- meaning they complain directly to QTC, LHI, or VES ( I put their contact numbers here  available under a search)- and/or  the veteran calls the White House Veterans Hot Line:
1-855-948-2311 
I am still gathering info/evidence  for a letter almost ready to be sent to VA Secretary McDonough to see why veterans cannot have their C & P exam results sooner than later.
It has taken me longer that I thought it would, -but that is because I want it to be as good as my last letter to former Secretary Shulkin. I had raised a 'good cause' legal argument,with evidence, to Dr Shulkin.  And that letter got great results.
 
 
 
 
 
 

My BVA Judge's de novo review found the attached previously unprocessed "request consideration for additional compensation" got me an EED for TDIU from 2009 back to 1985 based upon my record.
If your record supports it, you should put in the special request.  There are numerous references in 38 CFR for submission of a requesting consideration for additional compensation, including being poverty stricken even, to the Director Compensation Services.  I am also attaching a redacted copy of the Director's letter that got the DRO to make the EED TDIU award.
It appears to me this is the best way to address EED issues.  The director can specify the date the records show the disability.  That would include family, employers' or teachers' statements about your addiction.  It took 8 days from the Director's opinion to the DRO Decision.  Another 3 months to payment because it entailed going back to schedules that were no longer online in the accounting department.
Note:  The date went back 2 years before the claim and therefore I presume an EED is established by the Director according to the record.  A Central Office DRO has to do due diligence in sending the file up to the Director's office.  No mistake will be made because the decision is appealable, and the Director does not like to lose appeals.
3711 19870624 TDIU claim_Redacted.pdf 20200408 - TDIU Review - Admin Opinion_Redacted.pdf

Let's cut to the chase. There is no CUE here. A subcontractor/clinician from QTC/VES/LHI has been trained to ask you when you come in for a c&p : "How are you today?" Most folks will answer neutrally or say something to the effect that they are "Fine, and you?" This is a pleasantry normal people exchange with one another. VA, however, will always weaponize it to extrapolate it to mean you are stating you are fine and denying anything is wrong with you. I've been watching this phenomenon ever since it happened to me in 1989. VA has a finite bag of tricks to deny with. They can legally say that you went to a psych c&p and no diagnosis was rendered of a mental disorder or your claimed disability of ________________ (fill in the blank). Right there at that point if you had obtained a private nexus letter (IMO) from a shrink saying you had bent brain syndrome, you would have prevailed. Ditto right foot pain.
But, as you say, you did not know how the dog and pony show worked back then. Most Vets didn't and still don't. You didn't appeal and that was fatal to revisiting this denial now in 2022. As Berta pointed out, you can never argue how the evidence was decided in CUE. As for §3.156(c), do you have relevant medical records which show a real, bonafide dx of MDD while in service which has never been made a matter of record? If not, that theory goes down the drain. 
Anxiety/GAD/ PTSD/MST/Bipolar etc. are a group of major depressive disorders (MDD) adjudicated under §4.130. Pyramiding prevents an award for each one. There are 31 different forms of MDD. As with all claims, I almost always find that someone "diagnosed" a Vet w/ MDD in-say 2005. But the diagnosis was done by someone with a MHS (mental health specialist) "degree" after their name. No dice. It has to be a psychologist with a real degree in psychotherapy-not a six month degree out of a Crackerjacks box. They'll have Psy.D after their name. 
I think everyone reading this knows you got screwed. The repair order is extremely limited. You say you got the 70% in 2015. Unless you're still litigating that as an active justiciable appeal, it, too, is a final decision which could only be overturned by a clear and  unmistakable error of law. I've had claimants say at a c&p that they think they got Hep. C from a jetgun. Bad idea. You are not a doctor so that is off limits. But what you will often see is the clinician state that you admitted to a history of illicit drug use and that explains it. Of course you didn't say that but how do you negate that statement? It's too late. Sure, VA is not allowed to do it but they do. That's why Theresa invented this gig. We teach you how not to step on your necktie. In your case, I think that ship has already sailed but without a review of the claims file, it's impossible to say with any certainty.
One trick I've learned to reopen these as a §3.156(c) claim is to go back to the NPRC and ask for any "inpatient records" if you were ever admitted to a military hospital. These records are kept separate in another building at NPRC and are almost never included in any SF 180 request. I went back three times and got a new tranche of records each time. If any of these are pertinent to your 2005 claims, then you can get a can opener into an earlier effective date. It's perfectly legal to get a retrospective IMO and have a dr. opine as to what  your mental state was back then when you're doing a §3.156(c) claim.  
Best of luck.
 

Berta is correct.  A C and P exam is "presumed correct" absent your challenge to the competency of the examiner. 
Source:  https://attigcurransteel.com/veterans-law-updates/va-medical-examiners-competence-presumption-rizzo/#:~:text=See how that worked%3F,opine on a particular issue.
CCK law explains how to challenge a c and p exam:  https://cck-law.com/blog/how-to-challenge-va-cp-exam/
A veteran (unless he is a medical professional) is not competent to refute medical evidence with lay evidence.  It takes medical evidence to refute medical evidence, not lay evidence.  
So, its not CUE, because your opinion is insufficient to overturn the evidence of a medical professional in matters of medial nature.   CUE is a very specific kind of error, and not all mistakes are CUE.   Instead, to refute the doc exam, you would need another doc to supply a more favorable exam.  Its not Cue because the decision makers based their decision on the medical evidence at the time.  You cant add "new evidence" to make something CUE.  It has to be an error, based on the evidence before the VA.  
Of course, you can refute an exam in dispute, with more medical evidence, that is, an IMO or IME.  
But, you still have to keep in mind the claim finality, and the difficulting in overcoming a denial when you dont appeal or reopen inside the one year period.  
BUT, before you jump to conclusions, Get your cfile and READ it.  Did you submit new evidence within a year of the decision?  
VARO often ignores that this should reopen the claim with new and material (relevant) evidence, and they never readjuticate the reopened claim.  This prevents the claim from becoming final, because, an unadjuticated claim is "pending".  
There has been a "liberalizing" law of 38 CFR 3.156 (new evidence).  In pertinet part, VA formerly used "new and MATERIAL" evidence. but this has been liberalized with new and RELEVANT evidence.  
The difference between "Material" and "Relevant" can be a deal maker/deal breaker.  
"Material" means that evidence, alone, changes the outcome.  
"Relevant" means, well, this evidence "when combined with other evidence" can change the outcome.  
    They used to deny 3.156 often stating "the new evidence submitted" was insufficient to change the outcome.  
However, now, you may have had some or even many OTHER exams which corroborate the "new relevant" evidence you submitted, rendering it, when combined with the other evidence changes the outcome (favorably).  
    Lets try hypothetical example, which may well apply.  Lets say you are at the doc, and he notices a fracture on your leg, and, that it has been healed up, suggesting it may have happended some time ago, while you were in service.  This is probably "relevant" evidence on your knee claim, but it may not be "material" evidence.  
    However, if you get an IMO/IME, along with a buddy letter, who testifies he was with you when you jumped out of airplanes and witnessed you grabbing your knee, wincing in pain, on one or more jumps.  Next, you may need an IMO/IME to supply a nexus linking your old knee fracture to your current knee issue diagnosis.
    Now, when you combine the new evidence from your doc noticing the old fracture, along with the buddy letter rendering an opinion he saw your in service event (jump from airplane), and the doc's nexus, this can be a deal maker.  
     On the other hand, a documented old knee fracture may be insufficient to establish service connection, and thus not "material" by itself, without the aforementioned corroboration that your current injuries are a result of military service.  (Service connected). 
    With the more liberal "new and relevant evidence" you may be able to add additional evidence to support your appeal, while the old material evidence would not cut it.  
    Fortunately, the way I interpret VA regulations you should get "the more favorable" of the old "material evidecne" or newer "relevant evidence".  So, you should, with some effort, get your benefits in the above hypothetical example.  
 

I have a hearing coming up on re-opening my PTSD claim in 1984.  The 1985 C&P examiner diagnosed PTSD.  The Chief of Psychiatry wrote a note on the exam, "not PTSD, no numbing" though the symptoms of numbing are listed in the C&P but not the specific listing of them as numbing.  Seems some of the VA medical personnel diminish as much as possible the disabling affects.  I am going to prove that by comparing an MRI read by the Radiology Department of the University of Colorado Medical School to one only a month later by the VA Radiology Group.  Guess which one was very benign.  The problem is the reports are considered to be accurate, so one must have an opposing vies by a higher medical authority.
Employment history is a good rebuttal.  Get your Social Security CAVES Report if it will help and statements from employers about time off for medical care of these issues.  My CAVES Report and my VA clinical appoints give evidence to the degree PTSD was affecting my life.

"They acknowledged my anxiety/depression in 2016 and rated me 70%. I feel like that should be retroed back to 2006 though. "
I assume they gave you retro back to the date of the re-opened claim.
As Mr CUE said, there are only two options, 38CFR 3.156 or CUE , or both?
3.156 is explained here:
https://www.law.cornell.edu/cfr/text/38/3.156
CUE is explained ad finitum in our CUE forum.
But I disagree with this statement Mr CUE said:
"An base it on inadequate medical opinion and that your service records were never address."
A faulty C & P exam, standing alone, is not a basis for a valid CUE.
However a lousy C & P exam  can cause the wrong diagnostic code etc, as well as a denial based on other legal errors the VA made.
I feel they will use your words against you- 
 "they claimed that I denied having the conditions anymore so they denied me based on the assumption that they weren't chronic." an that would be a Valid VA reason to deny-
However- do you have a copy of ALL of the C & P exams, because, I now this personally- the VA can manipulate the words of n examiner and also withhold from them probative evidence.
I am still poed that they did this to me in around 1996-the claimant, my husband, was dead and I was the claimant on 2 issues pending that he had when he died.
VA did this to me also when I filed FTCA for wrongful death=he RO deliberately withheld his 6 page autopsy from VACO and the VA OGC.
I raised Hell , and sent DC the autopsy, and then I  settled for the wrongful death and also VA awarded the 1151 DIC claim, that the manipulated C & P exam that hd denied the 1151 claim, ( I called the doctor and we had quite a talk- he was stunned that they never gave him probative evidence (the autopsy) and said his opinion would have been far different id he had it.
Do you have any treatment records at all-VA or private doctors, that would prove the anxiety/depression were Chronic in the years before the awarded EED?
The good part is this!!!!!!
Obviously the re open worked!!!!!-maybe they have enough to determine a better EED now but it will require a claim as indicated above. 
I dont think 3.156 would do it because they obviously had your SMRs for the re- open ( I think).And they saw the nexus in them.*
Do you have a POA to help you?
*They might have made a CUE under 38  CFR 4.6, in the Evidence list of the past denials,if they did not obtain the SMRS or even if they did, they obviously did not see the nexus-
NOTHING is impossible and many here have gotten more retro under 3.156 or CUE.
Can you scan and attach here their last denials prior to the award?
We need to see their rationale and the Evidence List they used.
Cover your C file #, name, address prior to scanning them.
 
 
 
 

It is very possible but really don’t know what records where in your file, you can also research Clemons V. Shinseki.
Clemons v Shinseki is way more than just mental health disorders - VA Disability Compensation Benefits Claims Research Forum - VA Disability Compensation Benefits Forums - HadIt.com Veterans
 

To me it all mental health.
I wouldn't worry about that. 
U just have to use the law not your evidence to win the cue.
 
So I would start by get all the law that address this type of case.
Because they had to service connect you. Using sometpye of service records 2016
 

Yes I understand that.
But the only way to get the 2005 decision open is to cue it because it is final.
The cue must be based in the law you don't think they followed.
1. Inadequate medical exam is one issue.
2. You were granted the condition later what did they use or service records or evidence did that use to granted it later. 2016.
There are other law you should use to do the cue.
You can't use new evidence.
To prove they cue
 but you can use the granted of the issue later to show the error.
That I would handle it.
Other my feel different

You should wait to appeal "exactly" as long as you want to wait to get paid (retro).  Appeal sooner = get it settled sooner.  
                            Appeal later = get it settled later. 
I would not wait.  Start with the evidence you have.  Specifically the decision.  
What portion(s) of the VARO decision are you in dispute?  Why?  Do you have evidence to support your position?  
File a NOD, disputing every aspect of the decision you dispute:
The percentage,
Denial of SC
Effective date(s) etc.  
Combining 2 into one etc.  

mwillis71 That's the spirit. You don't lose until you quit trying!
You can submit an appeal, supplemental, HLR etc. the next day but I would suggest that you should have 1) your decision letter in hand (sounds like you have it.) And 2) a copy of the C&P exam. You may be able to get it from your RO at the Release of Info office. You also could request thru a FOIA request as well.You want to keep the time-line going certainly so back-pay is still in play. Lookup the requirements for migraines, diagnostic code 8100 to understand what you need for the higher rating. If for example, you do have to shut everything down and lay in a dark room until the headaches go away, then get that info in a letter from your doc and submit. Include a log of your headaches duration date time etc. for a month or 2. Some use Migrain Buddy, but it isn't necessary. Do you take meds for it, including aspirin etc.; if so, include that in your doctor's notes. Have a Statement in support of the claim and include how the headaches effects your work, or social life, interactions with others, etc.  If they are rating your headaches at 0%, then it is a separate disability and it should be rated higher. Lastly, use the disability rating calculator and figure out if an increase from 0% to 10 or 30% will move your overall combined rating. If it doesn't, you may not want to appeal as you are already rated, I believe, at 0%. That is a consideration the veteran has tor consider as well.

We have discussed this before and hopefully we don’t get into another debate, but prostrating is not a normal or typical word that is commonly used with migraines. I typically file a NOD as soon as I can, I keep all the documents I send the VA and whenever I fill out a new form, I save it on adobe on my computer and on a removable disc drive just in case the VA contacts me and tell me they lost my forms.  Who goes to their doctor and say that their headaches/migraines are so severe that the headache or migraines leaves them prostrating? No, we go to the doctor and say that our headaches or migraines are so severe that we/they have to lay down or we/they had to lie down. Who wife/spouse think of mentioning prostrating headaches? No, the most they will say is that your migraines or headaches are so bad that you have to lay/lie down in a dark room or take a nap and medication. The VA has this in their DBQ evaluations but many veterans are not even ask this question and the other issue is that a veteran can explain to his/her doctor and examiner that they have multiple headaches per month but it seems that they get a rating of 30% or lower even though the regulation seems to show at least two or more migraines a month for several month can be rated at 50% but a veteran would have to appeal to get that/this rating percentage. Be sure to include how long your headaches or migraines last. If you have to leave work or can’t go to work. Yes, you can include a migraine or headache log.
50% – with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 
30% – with characteristic prostrating attacks occurring on an average of once a month over the last several months. 
10% – with characteristic prostrating attacks averaging one in two months over the last several months.
0% – with less frequent attacks. 
Migraine - Symptoms and causes - Mayo Clinic
Headache Symptoms: Migraine, Cluster, Tension, Sinus (webmd.com)

What YOU DO need for secondary is a doctor statement that says your "condition applied for" is at least as likely as not due to (current sc condition).  THAT is what is required by VA laws.  
By the way, skip part of this.  No regulations require you parse out and understand primary, secondary, presumptives, or other sc methods.  Just apply, let VA figure it all out.  
My advice is stat on the form:
I want to apply for sleep apnea, both primary and secondary to my other secondary conditions, as a doctor shall so determine.  
You need not even use the term "secondary".  Just apply for SC.  
    I dont want VA to know I understand primary, secondary presumptive, 1151, etc.  I would rather my opponent underestimate me.  Go Bengals!!!!!!!

PS, if you are obtaining an IMO/IME it is best to let the doctor know of any oher possible  theories of entitlement- but a good IMO/IME doctor would probably consider that anyhow- if they have lots of VA claim experience.
They also would seek (I hope) any compensable  issue you have that might fall under Section 1151, 38 USC. If so a formal claim should be filed with their IMO/IME on that aspet as well, in addition to the secondaries.
 
 
This is the sort of attention to your full medical record, that you will never get from a C & P examiner.
 
 
 

I am also SC'd on PTSD (among other things).  I had a diagnosis of GERD in my record.  All I did was submit it as secondary to PTSD and included the diagnosis/treatment records supporting the level of impact to me along with a Medical Article I downloaded from the Mayo Clinic stating how it can be "worsened" or "caused" by Stress.  It was approved..no big deal. 
The thing to keep in mind is that the "medical opinion" you submit doesn't have to be about "you".  It can be something that is "Common Knowledge" in the medical community.  The P&T exam will be the medical opinion they use "about you".  If they decide something that goes against Commonly Accepted Medical Knowledge...then, you have the ability to fight that by getting a different opinion if you want..but most of the time you won't have to.