Three C&p's Scheduled, Two Ortho, One Psych.

[LarryJ]

I mean, the VA Medical Center has been taking care of me since the first of the year, and they have diagnosed Major Depression Disorder (that's the psych claim, secondary to pain resulting from my SC'd condition). So, they have been prescribing medication for my MDD, and it makes me better, as long as I take it regulary.

Should I take it, and show up at my psych C&P appearing relatively "normal"?

Then, the Ortho C&P's, same thing....the VAMC has been providing me with codiene and some other stuff (makes me better, takes away most of my pain, I can sleep 2 - 3 hours a night now).

Same question, should I take my pain meds and show up at my Ortho C&P's "numb"? Or show up like I would be IF I didn't have the VA's meds "on board"?

I mean, I can really see them saying "claimant did NOT appear to be in any pain......yada, yada", and do NOT think for a second that they wouldn't do just exactly THAT.

Which, of course, brings up ANOTHER silly question:

Why can't they just accept THEIR OWN DOCTOR'S previous dianosis? Why even HAVE a C&P?

[Guest morgan]

The issue is always how much any condition affects one's ability to work. If medication can relieve pain, thus restore range of motion, enough to work, then medication should be taken as directed to show actual improvement with treatment. But the other issue would be pain medications that affect operating a vehicle. I talked with a lady a few months ago who was arrested for driving under the influence of prescription drugs. She said she was weaving all over the road on her way to work and didn't realize it.

So how does it affect the veteran's ability to stay gainfully employed if he or she can't drive to work, and public transportation isn't available?

I think it would be helpful to point out the level of medication needed to control the condition--in case the examiner doesn't notice--and that the veteran is unable to drive to work because of medication side effects, if that is the case. (Don't expect that to fly if you drive yourself to the exam.) :)

That said, I see no logic in encouraging veterans to stop taking medications before an exam. In fact, doing so could cause dire circumstance in some cases. For instance, hypertension usually can be managed with medication and diet, and both (thank goodness) can effectively lower the blood pressure readings. And the ratings criteria is based on need for medication and specific readings taken multiple times and sometimes over multiple days.

To those who have compensable hypertension, it's clear what happens when the medication is missed and the diet is not followed, and most know the risk of stroke if daily medication is not taken as directed. So to say any veteran should not take medications before an exam could encourage or cause serious circumstance regarding certain medical conditions. IMO, if the advice doesn't apply to all conditions, then it doesn't

apply for any.

We need to remember that it's common for working people to be taking regular medications to manage medical conditions. However, it certainly becomes a disabling factor if certain medications make driving risky or even dangerous.

[vaf]

Larry, don't be sorry one bit. This is an excellent question. You have the right to a "thorough and contemporaneous" C & P exam, one that accurately and thoroughly measures the symptoms of the condition being rated. If you are in remission, or the symptoms of your condition are not active at the time you are examined, your exam would not be "thorough" and you not only have the right, but I believe the obligation to reschedule it at the time your symptoms were in full-blown active state. If your meds mask your symptoms, there is no way an examiner could objectively measure the extent and severity of those symptoms, which is necessary to gauging them to a rating contained in 38 CFR Part 4. If that means you need to have someone basically take custody of you and accompany you to the exam, then that's what you have to do. Implying or insinuating that the veteran is being dishonest or fraudulent in not taking his meds prior to a C & P, in an ill-intentioned attempt to fool the examiner is just plain dumb, and even worse, insensitive. In many cases, the examiner can't measure what he can't observe, like a rash or ROM. Let's keep in mind the true purpose of a C & P exam, which is to measure and not to treat the condition being rated.

The C & P process is flawed, it's a snapshot at one moment in time of conditions that more than likely have existed for years. The purpose for which it's designed mandates that the veteran present himself with the condition in full-blown measurable state. Granted, it's terribly hard on the veteran to have to withstand the end result of going without meds, but they didn't design this system. They have to do whatever is necessary to show the true, unmedicated, natural state of the injury or disease to the examiner, which is the sole intent of a C & P exam.

[LarryJ]

That is correct, when speaking of a medication such as hypertension meds.

However, in a situation such as mine (destroyed ankle, no cartilage in the ankle and about 1/2 of my foot, as the surgeon states "a total bone-on-bone situation" where I have to take SOMETHING to alleviate the pain) then your hypothesis doesn't hold true. For one thing, I can do without my pain medication WITHOUT causing any more damage to my joints, unlike hypertension medication which actually makes a condition better or at least keeps it from getting worse.

In my case you see, in the CFR addressing the points that the examiner should notice and follow to come to a rating decision, the examiner is expressly instructed to note the effects of pain, etc.

If I may be allowed a quote from the applicable CFR:

"The

intent of the schedule is to recognize painful motion with joint or

periarticular pathology as productive of disability. It is the intention

to recognize actually painful, unstable, or malaligned joints, due to

healed injury, as entitled to at least the minimum compensable rating

for the joint."

And, if anyone says that pain is not important or not considered when rating a disability, let me point out that pain, itself, will, as the above states, entitle you to "at least the minimum compensable rating for the joint".

So, what does this do for you, when you show up for the exam, unable to show pain (without faking it) due to the narcotics you have on board?

[vaf]

By the way, I know others will disagree with what I've said. But my comments are based on our own experiences, and the way things really worked for us, not the way they should have worked for us. How many vets went without meds during the time they were initially applying for disability benefits? No one worried about their condition then, so I'm sorry, I'm for rating the true picture of the disease or injury, whenever possible. Otherwise, you're inviting a lowball rating or outright denial.

[LarryJ]

Thank you vaf.

and your post got posted as I was replying to morgan's post.

[luvHIM]

I just wanted to jump back in and reply to "sixthscents." First let me state to "oneshot" that I just respectfully disagree that ALL conditions can be likened to cancer or ever do go in remission. For instance, I have already indicated that my conditons are service connected. I'm not battling that anymore. The radiographic evidence stands alone and shows the damage to be irreversible. That is not being argued either.

However, medications do not make me better. They are prescribed to help me "manage" my pain. That's it. My conditon is incurable and due to the spinal damage there is no remission. However, I told the examiner that I DO NOT take my meds when I have to drive.

I also told him that I had not taken one of my meds prescribed by an outside the VAMC physician because there was a delay in refilling the RX.

I told him that, not because he asked, just because I thought it was relative.

To "sixthscent:" I have been studying BVA archive cases, as they relate to my own claim, and I have seen so many times where the BVA granted claims based on the fact that they applied the laws, provisions and regulations a lot more liberally than the rating specialist. In cases where the meds were helping a veteran, the BVA noted that were it not for the meds the veteran would be at a certain percentage. It was not that the VARO rating specialist did not do their job correctly. It was that BVA saw the disability picture differently based on the medical evidence and the report of the VA medical examiner.

I was just beginning to take medications at my first three C&P exams. Each exam I was increased to a higher dosage or my RX had been changed to something else altogether. So, I have actually never even been on the SAME medications at any of my C&P exams. I just began Enbrel injections (which was the RX that got delayed in its refilling), which the Veterans Benefits Administration does recognize as an immunosuppress drug for "ACTIVE" disease. But I can assure you that many rating specialists probably do not know that. For those who do, it is taken into account. But the idea that all of these RO's are operating under the SAME exact mentality is ludicrous.

I think, personally, that it becomes a questionable move (not taking meds before an exam) in a PTSD claim situation. I think someone else already pointed out that stopping those meds can lead to endangering someone else, if not the veteran him/her self.

But most meds prescribed for a musculoskeletal condition are for pain management only. Radiographic evidence is not going to lie and if the x-rays, mri, ct scan, bone scan, what have you, doesn't show anything remarkable or of significance then a veteran is probably not going to present with a lot of pain and a rating examiner would indeed know that.

But as LarryJ has mentioned. Sometimes the TRUE pain threshold is not presented. I am on some pretty "powerful" drugs. There is no way I can take these drugs on a day that I have a VA appointment or have to be somewhere that I would have to drive to. However, for the benefit of "onestop" this is thoroughly noted throughout my VAMR, which the rating examiner admitted that he had NOT reviewed.

As far as veterans having their benefits decreased because they are "feeling" better, I think is absurd. It doesn't mean the condition is eradicated. It simply means the medications enable them to function a little better throughout the course of their day. I am considered 100% totally and permanently disabled and receive SSD as a result. But my conditiion is the result of my service in the Armed Forces.

If "onestop" honestly believes that every veteran should have their benefits decreased if they are "feeling" better than why are half of us who come to this forum still fighting for 100% service connection? Why are people receiving 70-100% service connect disability for PTSD and other like disorders on this forum who articulate themselves better than I do? In fact, how are any of us sitting at a computer typing our comments in this forum?

I'll tell you why...because as it has been described throughout the VBA regulations, it is not what someone (a veteran) is able to do sometimes...but what he/she is able to do ALL the time. I can walk to the corner of my street with a cane. But I cannot do it without my cane. I cannot lay in a prone or supine position...but it doesn't mean I don't go to sleep. I cannot sit or stand for periods that exceed 20-30 minutes at a time and am constantly having to shift or re-position myself...but at least I can recline when necessary and take my meds as prescribed. Do I "feel" better afterward? Absolutely! Does that mean I can go back into the economy and pull a nine to five. Absolutely NOT! Do rating specialists always see or read between the lines of a rating examination in that manner? NO! And they are the ones who seem to have the determining say in a veterans claim, until we appeal the unsatisfactory decision. To me that is more ridiculous than choosing to not take my "pain" meds in order for the examiner to assess the disability with accuracy.

LarryJ, I'm not sorry that you asked this question. I think it raises awareness to just how sad it is that veterans even think they have to not take their meds because they don't get a "fair and just" depiction of their disability(s).

However, I do believe there should be wisdom and caution exercised on all fronts. I don't know what meds people take for PTSD or like conditions. But I would think those would be meds to continue taking no matter what.

Lastly, I know that there are some who would like to believe that all RO's, medical examiners, and rating specialists are functioning and operating the same. But that is simply not true. It is not happening that way across the board. I read a thread on Hadit.com where it was pointed out, in fact, that rating specialists are not doctors and do not have the medical knowledge to always know how a conditiion might be related to another. It has to be pointed out to them. This is why there are rating exams.

Well, if that is the case, there is not going to be any reading between the lines. If the medical examiner states that there is "moderate pain on motion, but the veteran is on many prescribed drugs for pain which is most likely the reason that the pain is only moderate," why in the world would a rating specialist deduce that the veteran is only "slightly impaired by pain due impart to his/her medications." The statement from the medical examiner doesn't say that at all. But that is what ends up happening when left to the interpretation of a rating specialist. Yet, it is certainly not accurate and these misinterpretations is what many claims end up in appeal over.