When To Report This Va Doc To Oig?

[Josephine]

For those of you who have followed my claim, you know that my claim has gone to the AMC and back to the Judge, did get the IME to him in time. My husband says to wait until the Judge makes his decision before reporting her to the OIG?

My question, is when do I turn this Dr. L Lxxxx over to the Office of the Inspector General?

I have now 5 copies of this particular C&P of 2005, to date the records have been altered

The first Copy of the C&P:

COMPENSATION & PENSION EXAMINATION APR. 14, 2005

Filed a comlaint against the C&P to Patient Advocate.

May 16, 2005 Dr. L. Lxxxxx placed this on the C&P

You may not VIEW THIS COMPLETED PRIVACY AMENDMENT NOTE

Addendum Oct. 2006

Does not alter initial conclusion.

Addendum Nov 16, 2007

Priority of exam: Original S.C

-------------------------------

Examining Provider : Dr. Laxxx Lehmxxxx

Examined on: Nov.16, 2007

----------------------------------

Examination Results:

Picked up copy of C&P and Addendums to take to Dr. Crowley:

All of this had been removed from the medical records

You may not VIEW THIS COMPLETED PRIVACY AMENDMENT NOTE

Adddendum of Nov. 16. 2007

Addendum Nov 16, 2007

Priority of exam: Original S.C

-------------------------------

Examining Provider : Dr. Laxxx Lehmxxxx

Examined on: Nov.16, 2007

----------------------------------

Examination Results:

-----------------------------------------------

Dr. Crowley was under the impression, I had a Compensation and Pension Examination Nov. 16, 2007, until I showed him the copy I picked up the day before and everything has been removed from the computer. The Privacy Amendment Note and any mention of a C&P Nov. 16, 2007.

I am so confused.

Thanks,

Betty

[Josephine]

I would file the complain now. I also would be a realist and know that may be or may be not it would have an impact. Tampering with Medical Records is probably a State or Federal Offense.

By the way since you are still pursuing your Claim I would not get to wrapped up in this.

In your complaint be very specific and make your charges as enumerated points so that the investigating authorities have to address your issues. From what you have said on Hadit I am not so sure that there is not also some misdeeds at the AMC.

No matter what happens good luck on your claim

Pete,

I have no ideal of who is changing the medical records, but wanted to try to get the IME to the judge before he made his decision made.

This is and was my only goal. Why a claim would move so fast, I have no ideal.

I had just received the letter of the 8th of January 2008, from Carrie Johnson to tell me it would be some time before my case was decided.

Next thing I know, I receive a call from the Benefits Center ( Carol ) my file has gone to the Judge, this would be January 14th of January, just 6 days after the dated letter from Mrs. Johnson.

Someone is pushing me faster than I can think.

The Judge does have the letter and did wait for the IME.

As for reporting the medical records, not until this is all over.

I needed time from the Judge and I used the best means of getting it.

SSOC from AMC: The Current Credible Diagnosis "Personality Disorder not otherwise Specified" was of April 13, 2005.

Dr. Brain Crowley is January 11, 2008. 300.00 Anxiety Disorder NoS Chronic, Severe,with Depressive Features.

I would think these credentials would over - ride hers.

Present Professional Practice:

Private practice of Psychiatry, Forensic Psychiatry, and Psychoanalysis in Washington, DC

Senior Attending Staff and Past Chairman, Department of Psychiatry,

Suburban Hospital, Bethesda, Maryland

Psychiatrist, Deployment Health Clinical, Department of Defense, at Walter Reed Army Medical Center, Washington, DC.

Thanks a bunch!

Betty

[ruby]

I need to chime in to a point, as I am not an expert on anything dealing with the VA.

As far as reporting this in your inquiry to whomever, you need to start at the top and your questions should be made to what is the creditially process for the VA and who oversees that process, how or why could this happen, and if it happen to you how many other veterans has this happen too.

Hippa laws, you need to look at them also.

While non VA hospitals need to be in compliance with Jacho and AHCA, its not because its the right thing to do, it has to do with MONEY.

If you lose JCAHO rating then you lose any government money--You can not take any pt where thier medical care is paid by the governement. PERIOD

NO MONEY, your out of business. So they stay in compliance--with Jcaho they (health care facitities) pay them 200-500,000 to be inspected-do you really think Jacho would close a facility and lose out on that money. NO, they might put thier rating down (I beleive they do pass and fail now), but there not going to close them. They also notify a facility of when they are going to be inspected, they also offer a pre inspection for an additional sum so the facility knows where there deficits are. Thier really a joke. Research them and find out how many clients they have closed down by pulling thier accrediation.

ACHA, on the other hand can and will lock the doors on a facility. A complaint to ACHA with any form of proof can cause SEVERE problems for a facility. Again this is civilan facility's.

How much control does a government facility have over another govt facility?

Do your complaint now start at the top, not locally. Make your concerns in your complaint rationale and clear.

Key words are quality assurance, malpractice, credentially process,hippa violations, who oversees this process, if this happen to you, how many others has it happen to. How can you be assured this will not happen again. How can you ever trust the system again.

If you don't counter thier reponses, they will give you the pat answers to stall. That's the whole purpose of the pat answers to stall a person, to the point they give up.

With a congressional inquiry all they do is type a letter to the organization and say we recieved this, please investigate and respond. That's it, they are a go between, don't give them the opporunity to stall.

If you can counter thier responses before they respond then you will be forcing them to investigate this in greater detail. Otherwise they send to the next person etc, they write we are investigating, your response is a letter we are investigating, they respond with some pat answer, you respond with why that's not correct, they repond with were investigating.

Just like filing for SC, take the dots and connect them, before they can say, oops that dots missing sorry, denied.

I think but am not sure the VA hates, congressional inquiry's and IG inquiry's. Heads usually role.

If it were me and I said I did a CE on a date I didn't do it and got caught, I would say it was an error, that was the date I reviewed my notes and inadvertenly wrote the wrong date. Where does it say you must do a face to face for a psy exam?

Her reaction to this was over the top, whatever, and thats why my I wrote this note that I feel it would be determential to her if she read it.

Do I understand this correctly that you filed a complaint against this person in 2005?

[Josephine]

I need to chime in to a point, as I am not an expert on anything dealing with the VA.

As far as reporting this in your inquiry to whomever, you need to start at the top and your questions should be made to what is the creditially process for the VA and who oversees that process, how or why could this happen, and if it happen to you how many other veterans has this happen too.

Hippa laws, you need to look at them also.

While non VA hospitals need to be in compliance with Jacho and AHCA, its not because its the right thing to do, it has to do with MONEY.

If you lose JCAHO rating then you lose any government money--You can not take any pt where thier medical care is paid by the governement. PERIOD

NO MONEY, your out of business. So they stay in compliance--with Jcaho they (health care facitities) pay them 200-500,000 to be inspected-do you really think Jacho would close a facility and lose out on that money. NO, they might put thier rating down (I beleive they do pass and fail now), but there not going to close them. They also notify a facility of when they are going to be inspected, they also offer a pre inspection for an additional sum so the facility knows where there deficits are. Thier really a joke. Research them and find out how many clients they have closed down by pulling thier accrediation.

ACHA, on the other hand can and will lock the doors on a facility. A complaint to ACHA with any form of proof can cause SEVERE problems for a facility. Again this is civilan facility's.

How much control does a government facility have over another govt facility?

Do your complaint now start at the top, not locally. Make your concerns in your complaint rationale and clear.

Key words are quality assurance, malpractice, credentially process,hippa violations, who oversees this process, if this happen to you, how many others has it happen to. How can you be assured this will not happen again. How can you ever trust the system again.

If you don't counter thier reponses, they will give you the pat answers to stall. That's the whole purpose of the pat answers to stall a person, to the point they give up.

With a congressional inquiry all they do is type a letter to the organization and say we recieved this, please investigate and respond. That's it, they are a go between, don't give them the opporunity to stall.

If you can counter thier responses before they respond then you will be forcing them to investigate this in greater detail. Otherwise they send to the next person etc, they write we are investigating, your response is a letter we are investigating, they respond with some pat answer, you respond with why that's not correct, they repond with were investigating.

Just like filing for SC, take the dots and connect them, before they can say, oops that dots missing sorry, denied.

I think but am not sure the VA hates, congressional inquiry's and IG inquiry's. Heads usually role.

If it were me and I said I did a CE on a date I didn't do it and got caught, I would say it was an error, that was the date I reviewed my notes and inadvertenly wrote the wrong date. Where does it say you must do a face to face for a psy exam?

Her reaction to this was over the top, whatever, and thats why my I wrote this note that I feel it would be determential to her if she read it.

Do I understand this correctly that you filed a complaint against this person in 2005?

Ruby,

Yes, I did to the Patient Advocate and talked to the General Council and was told to contact the Privacy Amendment Officer, who in turn, took the C&P to the doctor and she chose to not make any changes.

Received a letter from the Director of the VAMC of this decision by the doctor.

I complained to the R. O and in their SSOC they stated, although I thought that C&P was erroneous, it was good enough for rating.

When the file went to the BVA, I sent a letter of complaint to them also.

This is from the remand:

7. After the above development has been

completed, the veteran's claims file

should returned to the board of VA

psychiatrists who participated in the

April 2005 examination for clarification

of the provided opinion. They should be

requested to review the record and

reconcile their opinion as to etiology in

light of the evidence added since their

examination of the veteran, including the

May 2005 statement of Dr. Brian C.

Campion and the January 2006 statement of

Dr. Michael Payne.

I complained to the AMC about this:

The AMC sent the file down to them October 2006 - Does not alter initial conclusion.

The AMC sent the file back to them again Nov. 16, 2007.

Examining Provider: L.L. Lxxxxxx, MD

Examined on : November 16, 2007

Examining Results:

The c-file, including personnel records, Dr. Pxxxxx's letters of 4/5/04, 1/23/06, 4/28/06, and 10/9/07, and Dr. B. Cxxxxx letter of 5/10/2005, was made available to the examiners and was reviewed.

The current request involves consideration of letters by Dr. B. Cxxxxxx and Dr. Pxxxx and " to reconcile their opinion as to etiology".

In our professional opinion, the preponderances of the evidence, including the letters by Dr. Cxxxxx and Pxxxx, supports the initial findings and diagnosis of the examiners and suggest that the etiology of her anxiety appears to have preceded her time in service.

Dr. L. L.

Now that Nov. 16, 2007 addendum makes no mention of this:

Examining Provider: L.L. Lxxxxxx, MD

Examined on : November 16, 2007

Examining Results:

Now the addendum reads:

The c-file, including personnel records, Dr. Pxxxxx's letters of 4/5/04, 1/23/06, 4/28/06, and 10/9/07, and Dr. B. Cxxxxx letter of 5/10/2005, was made available to the examiners and was reviewed.

The current request involves consideration of letters by Dr. B. Cxxxxxx and Dr. Pxxxx and " to reconcile their opinion as to etiology".

In our professional opinion, the preponderances of the evidence, including the letters by Dr. Cxxxxx and Pxxxx, supports the initial findings and diagnosis of the examiners and suggest that the etiology of her anxiety appears to have preceded her time in service.

Dr. L. L.

Ruby, I will give you the date of printing and what each states:

April 15, 2005

TITLE: COMPENSATION & PENSION EXAM

DATE OF NOTE: April 12, 2005@08:00 ENTRY DATE Apr 14, 2005 @ 08:39:47

AUTHOR: LEHMXXXXX LXXXX EXP COSIGNOR

URGENCY STATUS COMPLETED

Printed Sep 26, 2006

TITLE: PRIVACY ACT AMENDEMENT NOTE

DATE OF NOTE: MAY 16, 2005@14:33

ENTRY DATE MAY 16,2005@34:01

AUTHOR LEHXXX LXX PXXX EXP COSIGNOR

URGENCY: STATUS : COMPLETED

YOU MAY NOT VIEW THIS PRIVACY ACT AMENDMENT NOTE.

__________________________________________________

TITLE: COMPENSATION & PENSION EXAM

DATE OF NOTE: April 12, 2005@08:00 ENTRY DATE Apr 14, 2005 @ 08:39:47

AUTHOR: LEHMXXXXX LXXXX EXP COSIGNOR

URGENCY STATUS COMPLETED

Printed Jan. 11, 2008

TITLE: COMPENSATION & PENSION EXAM

DATE OF NOTE: April 12, 2005@08:00 ENTRY DATE Apr 14, 2005 @ 08:39:47

AUTHOR: LEHMXXXXX LXXXX EXP COSIGNOR

URGENCY STATUS COMPLETED

_________________________________________________________

Ruby, this printing the PRIVACY ACT AMENDMENT NOTE - IT IS NOT ON THIS COPY OF THE SAME C&P.

_______________________________________________________________

SAME FOR THE ADDENDUMS.

Betty

Edited January 21, 2008 by Josephine

[ruby]

Anything I say is based on civilian knowledge and some VA experience-I worked as contract nurse at the VA, I know some of the rules and how they react to inquiry's. They shake in thier boots if you do it right.

The VA system is very political. When it comes time for promotions at any level they don't want any black marks.

I haven't followed all your threads regarding this matter so,please forgive me and tell me the following.

You had a CE in 05 as a result of this CE you filed a NOD (or whatever)

What did you complain about and when (original complaint)

Who did you see, is the person that did the exam one and the same or did you see someone else and this Doc co signed the notes.

If the amendment is now gone, go to the VA and ask for that specific date if you can. Don't know about psy notes.

Was your complaint, that she made a statement you could not view this note?

AUTHOR: LEHMXXXXX LXXXX EXP COSIGNOR

What does EXP COSIGNOR mean?

What did she exam? Your notes? Did she imply she examined you one on one?

Are they required to exam the person or just the file?

Those of some of the questions you need answers too.

Before you file any complaints to anyone, you want to make it look professional and your concerns are real and that you are not some wacko person trying to discredit someone you disagree with.

If they did make an entry that implied they interviewed you one on one and you can get those notes, you gottem.

If you can show that those notes disappeared--its enough to cause someone a really big problem.

If they removed the addendum saying you couldn't view after review of your complaint they simply did as you ask.

[Josephine]

Anything I say is based on civilian knowledge and some VA experience-I worked as contract nurse at the VA, I know some of the rules and how they react to inquiry's. They shake in thier boots if you do it right.

The VA system is very political. When it comes time for promotions at any level they don't want any black marks.

I haven't followed all your threads regarding this matter so,please forgive me and tell me the following.

You had a CE in 05 as a result of this CE you filed a NOD (or whatever)

Ruby, I actually had two C&P's examinations within 5 months of each other.

The first C&P was correct diagnosis of Anxiety Disorder not otherwise Specified with depression, with a " More Likely than not this veterans anxiety began in service." This one was October 18, 2004 at the same VAMC.

I had the second C&P five months later same VAMC, April 12, 2005. AXIS 1 - Anxiety not otherwise Specified:

Axis 11 - Personality Disorder not Otherswise Specified with borderline, historian and dependent traits.

It appears this veterans symptoms are those of a personality disorder and it does not appear she had an " acquired pscyhiatric disorder in service".

What did you complain about and when (original complaint)

Ruby, My original complaint was the fact my husband was not allowed to go back with me. I complained about her slanderous remarks. Such as she denies any self-inflicted injuries, " So she says." Things like one medical record states she is a gravida 3 para 3, " but she claims to have only two children." According to her".

The report from Dr. Smith is as plain as day and it states, she is a Gravida 3 para 2. The slander goes on and on.

I complained to the R. O to the Patient Advocate and the Privacy Amendment Officer in formal writing.

There was not one shred of truth in the complete examination.

Who did you see, is the person that did the exam one and the same or did you see someone else and this Doc co signed the notes.

Dr. L and Dr. Bxxx were both in the room. She did not do any talking only he did. This would be Dr. Bxxxx.

Dr. Bxxxx only acknowledged the C&P.

If the amendment is now gone, go to the VA and ask for that specific date if you can. Don't know about psy notes.

I have a letter from the Director of the VAMC stating the doctors did not wish to change anything.

Was your complaint, that she made a statement you could not view this note?

No, I complained about the way the C&P was conducted and its' contents. I have a statement from the nurse on duty who had to see me afterwards and called me the next day at home, for I could not remeember anything after their examination. I thought I had had a stroke. [

b]Dr. Lxxxx placed this "Privacy Act Amendment Note, YOU MAY NOT VIEW"

30 days after I placed the formal complaint. She did not place it on the Original C&P Write-up!

AUTHOR: LEHMXXXXX LXXXX EXP COSIGNOR

What does EXP COSIGNOR mean?

He was in the room, but only means he read or signed as her Superior.

What did she exam? Your notes? Did she imply she examined you one on one?

I saw those two nuts one time only April 2005, the second was typed up as a review and the second time the AMC sent it to them

Examiner: Dr. L . Lxxxx

Examined on: Nov. 16, 2007

Examination Results :

Are they required to exam the person or just the file?

I have no ideal of what the AMC ask them to do the second time, as they did not send me a notice.

Those of some of the questions you need answers too.

Before you file any complaints to anyone, you want to make it look professional and your concerns are real and that you are not some wacko person trying to discredit someone you disagree with.

If they did make an entry that implied they interviewed you one on one and you can get those notes, you gottem.

I have a copy of the addendum that states:

Examiner: Dr. L. Lxxxx

Examined on: Nov. 16, 2007

Examination Results:

If you can show that those notes disappeared--its enough to cause someone a really big problem.

I have a copy I picked up January 10, 2008 to take to Dr. Crowley and it has disappeared.

Dr. Crowley ask me if they did an examination? I told him no!

If they removed the addendum saying you couldn't view after review of your complaint they simply did as you ask.

I never placed any complaint of the Privacy Amendment Note to anyone but the AMC. I said it was not very professional for a doctor to allow a patient a copy of a C&P examination and then when they filed a formal complaint then go in and place the Privacy Act Amendement.

Sure hope this makes sense to you.

Betty

[free_spirit_etc]

So the difference is - they took off the part where it says you were examined - and left the opinion.

This might seem like a SMALL thing to some people, and I'm sure the VA will try to say it was an innocent error, which was corrected.

However, I think it is important BECAUSE:

1. You do NOT "correct" a medical record by deleting something. You correct it by stating the correction. They could have simply stated - The previous entry is in error. This was not an examination. It was merely a follow up report by ___"

To DELETE something usually indicates you are trying to cover something up...make an error go away.

That is not to say they INTENDED to cover it up. They may have merely been trying to correct it. Sometimes they don't have a clue. But they need to GET a clue - if they are working with medical records.

2. They told you it affected your case. And then the evidence that it was ever THERE disappeared. Again, they may NOT have done this with the INTENT to harm. But again, that is why rules are in place.

If you had not SAVED a copy of the OLD report - you would have been told that thinking it was an exam affected your case - you would have started complaining about how it said you had and exam when you didn't - and ALL the EVIDENCE would been GONE - and the BVA would have thought you were just being a NUT.

No matter how much you complained - you wouldn't have been able to PROVE it - as they had destroyed the evidence.

Again, I wouldn't so much say they deleted it in order to destroy the evidence. But reguardless of their intent, it had the same outcome.

Luckily, you have a copy of the OLD one.

3. This calling opinions exams is NOT unique to your case. It happens to MANY vets The VA is aware of the fact that if something is called an exam - people will think it was one. The VA is constantly seeking both exams and opinions - and though they have a zillion forms - it has not seemed to occur to them to create a different form for a doctor to report an opinion than to report an exam.

To say EXAM indicates you were EXAMINED. To use the term is totally misleading if it is a medical opinion. I bet if you turned something in to THEM that SAID EXAM, when you had NOT been examined - they would throw it right out.

They need to get their stuff straight and stop calling reports and opinions exams - as it is most likely affecting many veterans.

Here is an EXCERPT from the letter we sent them about my husband's NON-exam they called an exam:

I consider the examination report of March 2002, by Mxxxx, at XXX VA Center, (Attachment 7-1c in my evidence packet) regarding my lung cancer to be totally inadequate for the following reasons and request that it not be used as a basis in determining my case.

According to the C&P Service Clinician’s Guide § 4.2 “1.11 If an examination report does not contain sufficient details to adequately support the diagnoses (unless the diagnosis is already well established) or sufficient information about the current findings and effects on functioning, the RVSR will return the report as inadequate for rating purposes. (38 CFR 4.2)

1. The examiner did not examine me.

Though the report is labeled as an examination, the examiner never met with me. The examiner indicated in his report that he was requested to offer an opinion after review of the medical records whether there is a relationship between my currently detected lung cancer and exposure to asbestos in the service, or to give an opinion as to any other etiology.

There is nothing in the examiner’s report which indicates he even talked to me, let alone examined me. The VA examiner issued his report / opinion after a review of some of my records. However, issuing such a report as a “Respiratory Diseases, Miscellaneous Exam” is misleading, and could be mistaken for an actual examination under the VA Clinical Guidelines, which it is not.

2. The fact the examiner stated I had no shortness of breath, and did not have any apparent residuals of the lung cancer I was treated for without even examining me raises a legitimate question as to the credibility of his report.

My pulmonary function tests done at the same VA facility on March 19, 2002 (the same day the VA examiner indicated he reviewed my medical records – and five days before he signed the report) noted that I had dyspnea on hills and stairs, frequent wheezing, and decreased FVC (73% predicted) and decreased FEV1 (69% predicted)

According to § 4.97 Schedule of ratings—respiratory system.Restrictive Lung Disease - 6844 Post-surgical residual (lobectomy, pneumonectomy, etc.).

FEV-1 of 56- to 70-percent predicted should be rated at 30%

The examiner did not even mention my pulmonary function tests done that day, yet he declared I did not have any apparent residuals of the lung cancer. Though it is part of my medical record, it is not clear whether the examiner realized that I had a left lung lower lobectomy before he issued his opinion on my residuals, as he failed to mention it in the report.

My DLCO was 51% on my pulmonary tests at xxxx in xxx. These were also part of my medical record. According to § 4.97 Schedule of ratings—respiratory system.Restrictive Lung Disease - 6844 Post-surgical residual (lobectomy, pneumonectomy, etc.).DLCO (SB) of 40- to 55-percent predicted should be rated at 60%.

I am not saying for certain that my residuals should have necessarily been rated as a 30% or 60% disability, but I am saying that the decreased levels on the PFTs, which were CLEARLY of record, indicate that that a determination should NOT have been made that I did not appear to have ANY residuals without so much as mentioning the PFT levels, let alone articulating medical reasoning to support such a conclusion. This is especially important in light of the fact the examiner did not even provide me with a physical examination prior to issuing his opinion on the lack of residuals from my cancer.

The C&P Service Clinician’s Guide 6.1 d) 4. states “If the DLCO test is not included as part of pulmonary function testing, the examiner should determine whether or not it would provide useful information about the severity of pulmonary functioning in a particular case. If it was not done as part of the routine testing, and would not be useful, the examiner should explain why, e.g., by explaining that the DLCO would not be valid in this particular case because of the decreased lung volumes. Unless an explanation for its omission is provided, the DLCO should be done.”

Though my DLCO’s of record were low, no DLCO was done as part of my pulmonary functioning testing. Nor was there any explanation as to why a DLCO was not done prior to his determination that I had no residuals from lung cancer. Again, I question the adequacy of his report.

As I also have resected ribs, an 11 inch long depressed scar spanning from my scapula to under my arm, etc. I question the ethical soundness of a physician making a determination that I had no residuals of lung cancer merely from reviewing some of my medical records, without so much as seeing me, and without articulating sound medical reasons for doing so.

Yep. They need to STOP calling NON-exams Exams. I couldn't get over my husband's SOC going on and on about "You TOLD the doctor this and you TOLD the doctor THAT - because they THOUGHT he had SEEN the doctor.

Free

Ruby,

Yes, I did to the Patient Advocate and talked to the General Council and was told to contact the Privacy Amendment Officer, who in turn, took the C&P to the doctor and she chose to not make any changes.

Received a letter from the Director of the VAMC of this decision by the doctor.

I complained to the R. O and in their SSOC they stated, although I thought that C&P was erroneous, it was good enough for rating.

When the file went to the BVA, I sent a letter of complaint to them also.

This is from the remand:

7. After the above development has been

completed, the veteran's claims file

should returned to the board of VA

psychiatrists who participated in the

April 2005 examination for clarification

of the provided opinion. They should be

requested to review the record and

reconcile their opinion as to etiology in

light of the evidence added since their

examination of the veteran, including the

May 2005 statement of Dr. Brian C.

Campion and the January 2006 statement of

Dr. Michael Payne.

I complained to the AMC about this:

The AMC sent the file down to them October 2006 - Does not alter initial conclusion.

The AMC sent the file back to them again Nov. 16, 2007.

Examining Provider: L.L. Lxxxxxx, MD

Examined on : November 16, 2007

Examining Results:

The c-file, including personnel records, Dr. Pxxxxx's letters of 4/5/04, 1/23/06, 4/28/06, and 10/9/07, and Dr. B. Cxxxxx letter of 5/10/2005, was made available to the examiners and was reviewed.

The current request involves consideration of letters by Dr. B. Cxxxxxx and Dr. Pxxxx and " to reconcile their opinion as to etiology".

In our professional opinion, the preponderances of the evidence, including the letters by Dr. Cxxxxx and Pxxxx, supports the initial findings and diagnosis of the examiners and suggest that the etiology of her anxiety appears to have preceded her time in service.

Dr. L. L.

Now that Nov. 16, 2007 addendum makes no mention of this:

Examining Provider: L.L. Lxxxxxx, MD

Examined on : November 16, 2007

Examining Results:

Now the addendum reads:

The c-file, including personnel records, Dr. Pxxxxx's letters of 4/5/04, 1/23/06, 4/28/06, and 10/9/07, and Dr. B. Cxxxxx letter of 5/10/2005, was made available to the examiners and was reviewed.

The current request involves consideration of letters by Dr. B. Cxxxxxx and Dr. Pxxxx and " to reconcile their opinion as to etiology".

In our professional opinion, the preponderances of the evidence, including the letters by Dr. Cxxxxx and Pxxxx, supports the initial findings and diagnosis of the examiners and suggest that the etiology of her anxiety appears to have preceded her time in service.

Dr. L. L.

Ruby, I will give you the date of printing and what each states:

April 15, 2005

TITLE: COMPENSATION & PENSION EXAM

DATE OF NOTE: April 12, 2005@08:00 ENTRY DATE Apr 14, 2005 @ 08:39:47

AUTHOR: LEHMXXXXX LXXXX EXP COSIGNOR

URGENCY STATUS COMPLETED

Printed Sep 26, 2006

TITLE: PRIVACY ACT AMENDEMENT NOTE

DATE OF NOTE: MAY 16, 2005@14:33

ENTRY DATE MAY 16,2005@34:01

AUTHOR LEHXXX LXX PXXX EXP COSIGNOR

URGENCY: STATUS : COMPLETED

YOU MAY NOT VIEW THIS PRIVACY ACT AMENDMENT NOTE.

__________________________________________________

TITLE: COMPENSATION & PENSION EXAM

DATE OF NOTE: April 12, 2005@08:00 ENTRY DATE Apr 14, 2005 @ 08:39:47

AUTHOR: LEHMXXXXX LXXXX EXP COSIGNOR

URGENCY STATUS COMPLETED

Printed Jan. 11, 2008

TITLE: COMPENSATION & PENSION EXAM

DATE OF NOTE: April 12, 2005@08:00 ENTRY DATE Apr 14, 2005 @ 08:39:47

AUTHOR: LEHMXXXXX LXXXX EXP COSIGNOR

URGENCY STATUS COMPLETED

_________________________________________________________

Ruby, this printing the PRIVACY ACT AMENDMENT NOTE - IT IS NOT ON THIS COPY OF THE SAME C&P.

_______________________________________________________________

SAME FOR THE ADDENDUMS.

Betty