Rockhound

Is requesting a C&P exam the same as Dr. Shopping if there is sufficent medical evidence to support SC or even if a C&P examiners opinion differs from the other medical evidence in support, does it mean that the evidence is in relative equipoise, provided they do not find the prior medical opinion was made in error? Rockhound Rider

Reno Nevada: I looked up what was in the phone book and printed out a list off the Internet, so I hope this will be enough. I just hope I don't end up having to go to California to find one, should there not be one here that takes their fee schedule. Thanks all, will be calling around today, will let you knpw how it goes. Rockhound Rider

I believe I have residuals of schizophrenia, at least enough symptoms that are mentioned in the DSMIV, but apparently not enough and/or exact enough for my VA Psychiatrists to opinion the diagnosis for residuals of schizophrenia. I'm hoping that by the time I meet with my new/or Psychiatrist, I will be able to show and/or demonstrate to her that all or most of my problems had their begining from my psychotic episode while in service, also that the C&P diagnosed personality disorder was the result of my head injury while in service. My new/old Psychiatrist was my psychiatrist from 2003, who took time off to have a kid and the VA wouldn't let her come back part time, so she waited until her kid was older and she could then come back full time. Now she is coming back and I have made arrangements to be reassigned to her since my current psychiatrist will be rotating out after our next visit. Not to mention that since her, all my psychiatrists have been interns and about every year they would rotate out and I would get a new psychiatrist to take over my care. I'll finally be getting a full fledged psychiatrist again and one I have had a good history with and a better understanding of my full medical history. Rockhound Rider

Most of my evidence is only suggestive of a problem and will need a forensic IMO to compare it all to the minimal amount of actual medical evidence I have from then till now. Reminder here is that the head injury went untreated after being transfered to the VA hospital and untill recently I had no concrete evidence that their were any problems associated with the head injury. I had been assuming that my psychiatric problems stemmed from my psychiatric problem I had while in the service, that was until I was able to get my VA Psychiatrist to have neuropsychiatric testing done after she told me I could probably more easily prove that my problems were the result of the head injury instead. The results showed cognitive dysfunctions or as you stated, functional impairment, that were probably the result of trauma to the brain. I'm hoping the upcoming MRI and EEG results will help bare this out, but not holding my breath. Anyway, with the Neuropsychiatric tests done and the results that they show, my psychiatrist is now going to have to make a determination along with my Neurologist, whether my current psychological problems/conditions are caused by a psychiatric disorder or if they are the result of the head injury and since I have not been in any accident that resulted in an additional head injury since the one I had in service, then it must be as a result of that injury and thusly SC'd. although any subsequent head injury would only exacerbate the problems associated with the original one while in service. I also got one of my psychiatrists to opinion that at the time, having evaluated me over a period of time, that she saw that I did not exibit any personality disorder as discribed by the standards set by the DSM IV. So If I don't have a personality disorder now, then I could not possibly have had a personality disorder for which the VA used, to not only change my prior diagnosis, but also for which I was denied SC for. With this new evidence, it could be shown that the personality disorder the VA C&P examiner saw at that time, could well have been residual effects of the head injury nine months earlier. I just feel, IMHO, all I need to do is wrap this all up together with a nice IMO, maybe a treatise or two, and a nexus letter to put a pretty bow on top, before I send this claim to the VA. Rockhound Rider

No such luck for me, not one name or number and/or suggestion who I could contact.

In 1973 while still in the service, I was hospitalized for an unrelated psychiatric condition, I sustained a fall, due to a fainting spell, believed to have been caused by the psych drugs I was on at the time. The result of this fall was a Fractured Nasal Bone and a minor cerebral concussion or closed brain injury of the frontal lobe of the brain. Further testing done shortly after the injury confermed this fact. Later the Fracture Nasal Bone was SC, yet the minor cerebral concussion was not. Today, such head injuries are handled much differently and are more likely than not, with the similiar medical evidence I had back in 1973, the minor cerebral concussion would have also been SC, even if secondary to the actual skeletal injury. My question is this, how would I use the new liberalized VA Rules, Regulations, and Laws to my best advantage to reopen and support a claim for the cerebral concussion/TBI, possibly secondary to the Nasal Bone Fracture, which caused the cerebral concussion? Rockhound Rider

I got a letter from the VA Fee Basis Office at my VA Hospital and am somewhat confused about how they are handling a MRI I requested and was approved for. Since I am a large person and the local VA Hospital's MRI machine is to small, they are refering me outside the system, but they are telling me that I have to locate a provider that will accept what VA Fee Basis is willing to accept. They say that is on the line of what Medicare would pay. Talk about passing the buck, even though I didn't make any request for Fee Basis. I don't know what I will do if I can't find a facility that will accept what the VA will pay. I don't want to just forget about it, It may make it more difficult in the future if I should request something they will have to refer outside the system. Anyone have any insight and/or suggestions on how I should handle this situation? Rockhound Rider

Hoppy: Something to think about. A Dr. who treats a patient for a diagnosed illness, must also consider and document the causation of that illnes and must also consider the duration in which the patient has had the illness. To do so IMHO is tantamount to negligence. My resoning is thus; the treatment of a disease process in it's begining stages is quite different from that of a disease process that has gone undiagnosed or misdiagnosed for a period of time and has probably caused additional harm to the patient in the process. For a Dr to not consider these aspects of a patient's illness/disease, then he may well neglect to treat the patient properly and sufficiently, so that these other problems or conditions are taken care of as well. Also their neglect to consider the inservice diagnosis and as to whether it was the correct diagnosis or whether the patients illness/disease process may have had it begining during his time in service could lead the Dr to misjudge how far along the illness/disease process has gone on. If the illness/disease process is further along than the Dr's believes, the patient might not being treated properly and could lead to worsening of his present condition down the road. I would try writing a letter to the VA Hospitals director explaining your position that you feel he is being, not only unfairly treated, but also that the current level of treatment borders on malpractice for his Dr's failure to evaluate his SMR and a possible misdiagnosis at that time and a connection with the symptomotology of his current diagnosis and to the length and extent of his current diagnosis. That if nothing is done to correct these inadequecies of diagnostic procedures and treatment, you will be force to formally file a claim of grevence with the Secretary of Veteran Affairs or should it be shown that the Veteran has been harmed in any way for the inadequacies of diagnostic procedures and/or treatment, that a 1151/malpractive suite may be his only recourse to force the VA Hospital and it's Dr's to do the right thing and for what the VA hospital is chartered to do. IMHO if its worth anything, doing what I suggested could well get you nowhere also, it's just a more direct and in your face option with a little poker added. Rockhound Rider

I found the redicules letter they just sent me, according to the date of the letter, it took a day better than a week to be mailed and for it to reach me. Take in mind it was mailed in the same county and city. This is the first paragraph: "We are still processing your application for COMPENSATION. We apologize for the delay. You will be notified upon completion of processing. If you need to contact us, be sure to show the file number and full name of the veteran." The rest just talks about any change of address and how to contact them by using their 1-800 number. I wonder if a letter like this could just as well have been sent via E-mail and saved a few trees in the process. If they wanted to let me know anything, they could have sent me a letter saying my claim has been finished being developt and was now being forwarded to the Rating stage. Movement of the claim like that would mean more to me than an apology for taking so long when we already know they haven't been able to process a claim in a timely manner since the very begining of VA claims processing from times long ago. Rockhound Rider

I know for a fact that they cancelled a previously scheduled C&P exam. They made a mistake when they made their request and did not ask for the proper exam or rather they forgot to request a complete exam that covered each aspect of my new claim. Now they are probably waiting for a medical opinion of my medical evidence, prior C&P exam that was less than a year ago, and the current evidence I sent in with my claim. Once that medical opinion is issued, then my claim can be forwarded to the Rater. That is IMHO and the fact that they Holidays have also slowed things down to a snail crawl. I'm looking for three 10% ratings, but even if they disallow the chronic sinusitis/rhynitis, I cannot see how they can disallow the two painful scars. Untouched photos do not lie and the pain is subjective, in that if I say they are painfull, it would be very difficult for the VA to prove they weren't. Either way, I should end up with a combined 30% VA math, which is OK for me. Each higher percentage I can get, gives me room and funds to seek out additional SC conditions that the VA has denied me in the past. It's a slow process, but now that I know how and what is needed, gives me the strength and patients to follow through until I get all that I believe I deserve. I just wish they would realize, that I am not going to go away like I did in the past, so they might as well stop trying to delay things and get on with the process. Rockhound Rider

Current claim for secondary issues associated to SC nasal fracture with deviated septum due to trauma. Secondary issues are Chronic Sinusitis/Rhynitis due to deviated septum causing at least 50% nasal passage obstruction and/or at times 100% obstruction to one or both nasal passages and painful scars to each side of nose bridge due to fracture nasal bone. Received letter from the VARO appologizing for the delay in my claims process and that they are proceding with my claim. The basic, don't call us, we'll call you letter. The claim is so basic and all the evidence is in and a new C&P exam was found to not be necessary, So I can't understand the delay, this claim should have been at the Raters at least by now, but apparently it is somewhere between the collection of all evidence and being sent on to a Rater. If it follows the same time table of my last claim, I have at least five to six more months to go before I know what the decision will be. But I am not going to hold my breath on that assumption. Rockhound Rider

The nice thing about having memory problems, you don't have to wait for apologies, there a given, since I can't remember what the apology is for in the first place. LoL LoL LoL :D :) Rockhound Rider B)

My Neurologist is not of the school of thought where by if their is no indications on the MRI or EEG that their is no injury, He feels the the neuropsychiatric test are more indicative of functional impairment and he says he usually relies on these tests more so than any other exams and/or tests. If I don't have these tests done, the VARO may request them as part of a C&P exam. I am covering all my bases so that the VARO will not have any room the intergect their own findings. I prefer to seek my own findings outside the claims process as much as possible, VA Drs' seem to be more cooperative to right positive or rather more helpfull statements in your records when they feel they are not being asked to go up against the VARO and/or C&P exam dept. I hope I have explained my process for getting probative evidence from my VA DRs' makes sense. If I told them it was for a claim, they would be less likely to offer any help. This way they think they are helping me to understand the why for and causation of my cognitive dysfunction to rule out an organic and/or psychiatric reason for it. Rockhound Rider

The answer to this is a resounding big negative. No I am not going to give it up. I am hoping to use the cognitive dysfunction due to head trauma to prove that any personality disorder I have or had, was the result or residual effect of the head trauma/cerebral concusssion. Having then disproved the VA's previous finding that my personality disorder was preexisting I can then seek SC for my inservice mental disorder. However, if I am able to also get my current adjustment disorder with depression and anxiety SC combined with my cognitive dysfunction and/or SC for a cognitive personality disorder/syndrome and/or cognitive depression disorder SC, If all or part are SC to such a degree that gives me either TDIU or 100% scheduler, then seeking any further mental disabilities may be a mute subject. Only time and results witll tell. Rockhound Rider

yelloownumber5: Mild/moderate deviation and/or obstruction are relative terms, you must get a determination of the amount of the obstruction the deviated septum causes, the ENT medical opinion must state and use the criteria, at least 50% obstruction of both nasal passages or at least 100% of one nasal passage, otherwise your claim will be denied before you get anywhere. Secondly, you will have to get the ENT specialist, whether it be from a IMO or the VA, that the rather than correcting the deviated septum like it was first believed, it in fact made the condition worse. An IMO would more likely be more inclined to see it your way, but they must support their findings with some sound medical reasoning. Such as the auto accident that showed indication of facial trauma that was such that the truma to the nasal structure went unnoticed until the deviated septum was accessed and currective surgery was done, which was inicially thought to have corrected the problem, but in fact was only temperary, since the deviation returned and was now more severe and causing breathing difficulties due to the obstructed nasal passages by at least 50% of each nasal passage, and further that your sleep apnea difficulties are being directly affected by the obstructed nasal passages due to the deviated septum and the failure to access the extent of the trauma to the nasal structure when the injury to the facial area occured. Something on this order, but the ENT can put in better in medical terms. Otherwise it does not appear you have any evidence to counter any of the medical evidence thus far you have provided. Look up the C&P examination for ENT and the one for Sleep Apnea, also the CFR rating schedule for these conditions, you will have a better understanding the criteria for which the VA rater must follow in his determination and what evidence you must provide to support your claim. You'll find links on this forum to all these sources. Rockhound Rider

Cowgirl: The TBI screening clinic exam is specific to Irac and Afganistan soldiers who have been subjected to blast concussion from such devices as car bombs, close by exploding ordinance, suiside bombers, etc. The way he made it sound, if you were hurt in a fall or a vehicular accident, or physically assalted or just about anything along these lines, or even in a training exercise with dummy ordinance, then you don't qualify, expecially if it was outside a combat zone or if it was in a combat zone, then it must have been the result of a concussion blast. Otherwise it is considered under a different criteria as a simple cuncussion to major concussion and or open head injury. Even a bullet wound to the head would not qualify for the TBI Screening. It would be an open head injury even though similiar tests would be given to determine the residual effects of the head truama. Also PTSD is a part of this exam since the Veteran was subject to real threat of dying, being that close to a consussion blast. Since I wasn't in Irac or Afganistan, I didn't meet the first and foremost requirement, so Idid not qualify on those grounds alone to be screened for a TBI. Nor did I meet the concussion blast criteria while in a combat zone either. Like I noted, I did however get the Neurolgist to authorize/schedule a MRI and a EEG test. The EEG test is to be conducted while I have been sleep deprived for eight hours. I just got a call today that scheduled my EEG for Jan 08,09 at 0800 in the morning. I'm supposed to stay awake from Midnight until the exam. I doubt this will be a problem, since all I have to do is not take my medicine for sleep and I am assured of no sleep easily for that amount of time. I'm still waiting on my MRI appointment and If I do not hear from the scheduling clerk after the New Year, I'll be calling him to see why they are taking their time. Once these tests are complete and I see what is written up about them, I will have a better working knowledge on what else I will need to support my claim to SC my concussion/TBI secondary to my SC nasal fracture and deviated septum due to trauma, or to have it SC on it's own merits causing cognitive brain dysfunction. Or rather just as soon as my current claims are accessed and hopefully, not have to appeal them. Well, past my bed time again as usuall. Rockhound Rider

Question? Is their any medical evidence that can possibly show that your original Deviated Septum was exacerbated/made worse by the surgery you had in the service? If you can show this, then you may be able to SC it as having been made worse by the military Dr's beyound what would have been normally expected for such a condition/injury/or congenital malformation. That is so long as the deviated septum results in an obstruction of the nazel passages of at least 50% or at 100% of one side. Your IMO would have to specify that the deviated septum meets this criteria and that the results of the surgery made it at least as likely as not, this bad, That you would have been just as likely as not better off, with a deviated septum causing less of an obstruction without the surgery. Get my meaning? The best you can probably get, would be a 10% rating, even though the deviated septum's severity was due to a bad surgical procedure, the VA would probably look at it as due to trauma. IMHO If you can SC the deviated septum, you can then consider it as a contributing factor to your sleep apnea condition then, if your ENT IMO agrees with my logic, that is. Good luck. Rockhound Rider

I am SC for a fractured nasal bone and deviated septum due to trauma, the Obstruction is at least 50% obstruted on both sides, yet I only have very mild symptoms of sleep apnea. so mild it is hardly worth mentioning. A deviated septum can be a contributing factor or it may not be a factor at all in someone who has sleep apnea. An ENT specialist in sleep apnea can make a determination as to what is the cause of your sleep apnea and how much your deviated septum plays in to it. I would try to pin down the major cause of your sleep apnea before I make a claim for it. Then if your deviated septum is not that much of a factor or a factor at all, you will then have an argument against the VA should they denie on the sole basis of your deviated septum. An ENT IMO is in your best interest if your looking for documentation in your favor. Rockhound Rider

The BVA Judge awarded me service connection back to 1992. This would have been in 2008. I don't agree with the decision of 10% for 1992 - 1997 1998- 2004 - 50% 2005 - 2008 TDIU 2008 100% P&T. I would not waste my time trying to figure out how the VA came up with your EED and/or stepped rating, I would concentrate on what EED you can prove and what percentage of disability at the time of the EED you can prove and appeal on those grounds. If you feel strongly that the VA has made an error in their rating, then all you need to do is figure out what you can prove as I stated above and appeal their ruling. You'll go crazy trying to figure out how they came up with their ruling and or dates. We all know the VA is not going to give you anymore than they have to and making stepped ratings is their way of not paying you your full intitlement. They are just hoping you will take what they give you and go away. Rockhound Rider

Good news, bad news: Bad news first, I went to my TBI screening appointment on time and was kept waiting for an extra half hour, only to find out what I was afraid of about the TBI screening. It urned out as I feared, to only be for battle type TBI caused by explosive concussion by some type of explosive device. If what the Neurologist told me was what I was hearing, even a person with a head injury due to an accident and not otherwise from an explosion, even in a battle zone does not qualify for the TBI screening. So I did not get any type of exam that could be used to substantiate my neuropsychiatric exam results that I was hoping to get. I how ever did get an MRI approved and also a type of EEG test call a sleep deprived EEG. Of course these two tests could come up showing nothing, but there worth shot anyway. A negative result is still not conclusive that there is no brain damage or cognitive dysfunction but it would sure help if it did show something to help support the neuropsychiatric test results. The Neurologist said that they pretty much go by what the neuropsychiatric tests indicate since they know from studies and tests, that MRI's and EEG's are poor indicators of the extent of head injury and there lasting effects on the injured persons cognitive functioning. Since I have no other head injuries since my time in service and their is no other indications as to the cause of my cognitive dysfunction my claim that my TBI/Concussion was the cause, stands in equipose. 50/50 with the benefit of the doubt in my favor I will wait for my MRI and Sleep deprived EEG results and to see if my Neurologist will concur and/or defer to the results of my neuropsychiatrict test results before I submit my new claim. I will then hopefully have more than the neuropsychiatric tests results to submit as new and material evidence to reopen my claim for residuals of my TBI/Concussion and hoping also by then, that my current claim for secondary issues to my SC Fractured Nasal Bone and Deviated Septum will be decided in my favor making it unnecessary for me to spend additional time in the appeal process. That's it for now, back to waiting for the VARO to do their thing and also the VAHospital to do their thing. I just hope my newly found ulcers don't eat a hole in my esofiguse, intestines, and/or colon before then. It's back to a bland diet, since what I have been eating over the holidays is causing my ulcers to act up and I don't want to end up with another four days hooked up to IV's and drinking banna flavored bari fluid for more from the top and from the bottom exams to check the status of my ulcers again. Night all, hope your Exmas was uneventfull and joyful and hears hoping the coming new year is more of the same. Rockhound Rider p.s. the sile is for you, the weird smerk is for how my stomach is feeling right now. Not bad, but not good either.

I'm still alive and kicking, barely. I just spent some quality time at the expence of the VA at my local VA Hospital. Once again I had a turn with some stomach ailment that turned out to be Ulcers. above and below my stomach. They believe it may have been the result of one of my medications, which was to harsh for my system to tallerate. But I am OK now, but a bit weak from my ordeal. Home once again. Wednesday I go in for my TBI screening appointment, so I will post about it after Xmas, So all have a VERY MERRY XMAS and I'll be posting again later. Rockhound Rider B) :D :) :D

B. Present Medical History (Subjective Complaints): Please comment whether etiology for any of these subjective complaints is unrelated to claimed disability. Please, anyone correct me if I am wrong, but isn't it against the regulations or USC's, that the VA is not allowed to direct the C&P examiner to make such a finding as stated above? I thought I read someplace,, where by it stated that although the Rating Officer can request a C&P exam, if they feel the evidence or lack of it, is needed to determine SC, but they can only ask for an opinion of the condition for which SC is claimed. That their request must be neutral in form so that it does not appear that they are asking the C&P examiner to make an opinion unfavorable to the Veteran. IMHO-It appears that the statement above is directing the C&P examiner to write an opinion, stating only those findings that he believes are not related to the Veterans SC condition and saying nothing about which ones are. It seems to me that this statement should also include the following B. Present Medical History (Subjective Complaints): Please comment whether etiology for any of these subjective complaints are unrelated to and which ones are related to the claimed disability Rockhound Rider

My VSO is a little old lady type and I don't have to go thru a metal detector to get in to see her either. although, and I'm only speaking from my experience, I've had to wait in line to get in to see her and because she is so busy, it can sometimes take her a few days to a week, to return my call. She also has to take time away from her office to file claims, attend staff meetings, training sessions, attend AMVET club meetings, and oh yea, somewhere in there, she has her won life to live. Not to mention that my phone calls and claims are not the only ones she has on her agenda. If your not satified with the service you are getting and you can not seem to resolve your issues with them, fire them and find someone else, I did and for the first time, I finally got someone who helped me win at least one claim, by making sure that all my paperwork was hand delivered by her to the VARO and that any and all paperwork was turned in and/or signed on time in the process. As far as my looks, I won't win any beuty contests, but I might make a good extra in a movie that has Trolls in it. LoL Rockhound Rider

If this is evidence to support a new claim not already before the rater, It will probably slow down the processing and rating of your present claim before the rater now. If it is additional evidence to help support a current claim before the rater, then by all means submit the additional evidence in support of that claim. Rockhound Rider B)

I too had the chemical test, I was to heavy and out of shape to get a good reading on the tread mill. I had very little discomfort and like some here, I only had one person conducting the test. The results showed I had severe eschemia of the heart and sent me to San Francisco from Reno NV to have a catherization done. What they found surprised everyone and made me very happy. The chemical test was a false positive. Other than minor pulmonary hypertension, my heart was in very good shape considering my weight, HBP, DMII, and other problems If you can do the treadmill, do it, your less likely to have a false positive reading and there are usually more than one person present during the test. Don't forget to ask for a spotter to catch you should you stumble and fall. LoL A catherization is really the best way I know of, which doesn't mean the only way, to test for any heart blockage. The tread mill check also gives you that, in your face, how out of shape you really are. Rockhound Rider B)