Need Help With Increase And C&p Exam

Bound4heaven · November 29, 2005

Greetings,

I contacted my local RO over a year ago to ask if I could get a letter stating that I am T&P (I am currently rated at 90%IU with T&P with Chapter 35 benefits and no future exams) The ro informed my that I was not T&P (I was but was unaware at that time) and I would have to apply for increase. I do file for increase and I was sent to my 5th C&P exam. The examiner was a N.P and extremely rude to me. She asked me questions that had nothing to do with my exam (Why do my wife and I adopt special needs children, and was I drinking I havn't drank in over 10 years) I informed her that was not while I was there. I have many bi-lateral foot issues and she asked me to stand on my toes and I informed her I could not and she became furious at me telling me I was combatant and she would make sure that was known. I knew after that exam last July it ewas not going to go well.

I got a copy of the C&P exam from the mnedical records and I was floored with the distorations and lies that were in the exam. She said in the final report that I was missed dignosed and my disabilities were not as severe as my other doctors in the VA. She went on to say that I was able to stand on my toes so by doing that I had no foot problems. I files 7 complaints with the patients advocate at the VA Medical Center. I even met the pwrson in charge of the C&P exams. I sent all information to the RO. I also receive SSD. The question I have is because of her comments on the C&P reports will I loose the increase? However the big issue I have is will they reduce my current benefits I now receive?

I have one last issue. With this increase I brought into play secondary disabilities from side effects I now endure from the 21 different medications I now take. I had a medication evulation done outside the VA and all the current side effects I thought were due to my disabilities were because of my meds. I submitted this report to the RO. I also had a IME done by Dr. Bash , however he is not done with it as of yet. My American Leigon cso wants the RO to make a decison asap, and use the IME for an appeal if necessary. Can anyone give me some advice? God bless you all.

Bound4heaven · November 30, 2005

Oh, I missed that it was an NP. There's NO WAY the RO should take a general NP diagnosis over your past doctor's opinion. In fact, the RO should know better then to send someone with specialized disorders to a general NP for an overall evaluation. As a nurse I can etll you that an NP is in now way traianed to deal with the issues you mentioned...they are, essentially, for medications and routine common problems like flu, colds and other common everyday disorders...in fact, an NP cannot even officially diagnose anything without the signature of a supervising MD.

Dear Jay,

I do thank you so much for your response. I have learned more from fellow veterans from this web site in 2 days then my entire expirence with my Americam L. Service officer. I have found out that dealing with the VA. It is the Veteran that must make and stay on top of the entire process. A veteran cannot rely on anyone else to the fact of making sure the RO gets all necessary information. I am very very dissapointed with my cso. I currently have a IME performed my DR. Bash who has a heart for veterans and their issues. My CSO did not even reccommened him to me till after I informed him I was using DR, Bash, and he knew (MY cso ) THat I needed an IME and I told him I was unable to find one until another CSO from a different origization informed me of DR. Bash.

Why do the RO send Veterans to NP at C&P exams? if they have such limits placed upon them why are they there? my expirence with this C&P examinier is on the line of incompentence, and she was no way able to address all my issues and then be able to make a decsion (Which they have not the medical knowledge of education). Many veterans don't know this and are again and again given wrong decisions which will effect them and their famlies for years on appeals. I asked this question to the RO when I started my complaints againt my C&P examiner and he had no response, and I informed him that was not good enough. It was then because of his disinterest on my complaints that I turned to the Medical Center patients advocates, and contacted all my senators, abd all reps both state and federal. It was time consuming, however I not only wanted attention to my case but to all veterans who feel they have no voice aginst a system (NOt all) but most of the time against them.

Majority of workers at the RO at college grads who never knew a veteran, and have little clue the issues we face and therefore have no sympthmy towads us. (I am not complainer at all, however justice is what I am after) I appriciate all you help Jay. God bless you.

mssoup1 · November 30, 2005

Thanks so much for your responses back to me. First, ouir Patient Advocate is of no help. Been that route before. She tells you to first try and resolve the problems yourself. When we told her that is why we were there speaking to her, because we couldn't resolve the problem, she basically said go away and try again. So much for their help.

As far as the question someone else had concerning PA's doing C & P's, our VAMC has one. She does the C & P, writes up the notes, gives her opinion and then states that it has ben reviewed by the C & P doctor and he agrees with her opinion. I think this is basically how they get around using PA's for C & P's. As long as the PA has a doctor who claims they reviewed what they did, the VARO accepts their opinion.

Also, I am giving the office of the Chief of Staff at the VAMC time to respond back to me before I contact them again. I just recently called them so they may be getting documentation together for a meeting. I explained quite a bit over the phone to them. They also stated that it was possible the Diretor himself may want to be involved in this issue.

I hope I haven't overstepped some bounds with this issue, but it is time that someone does something aboujt this doctor. When we walked into the exam my husband made a comment to him about he had heard that he was going to retire. His comment was that they would like to get rid of him, but he wasn't going anywhere and besides they had no one to replace him with.

As I stated before, we don't want anything that my husband is not entitled to. But his exams rquired by the VARO could at least be as honest and accurate as possible. It appears that this doctor goes out of his way to write up opinions which will automatically guarantee a denial at the VARO, regardless of what he has to put in them. That is not right for the veterans who are fighting so hard for what they rightfully deserve. Give an honest opinion and then let this and the evidence make or break your case.

I do believe that this doctor thinks that unless you are terminal or close to it, then you don't deserve anything.

Sorry for the ranting, but I do think it helps other veterans who are working their claims to see what other veterans are having to experience with their claims through the process. Of course, no two will be the same, but it doesn't hurt to know what others are experiencing.

Thanks

Jay Johnson · November 30, 2005

NPs and PA's have, basically, the same level of training. They cannot, officially, diagnose anyone with anything unless they get authorization from a surpervisor (MD). The reason the VA uses them is quite simple, they are cheap! Also, most self-respecting doctors will not work under the contraints of the VA....no MD is going to make medical decisions based on "saving the VA money", but NP's/PA's are more willing to sell their soles (so to speek).

With that said, I hope you keep in mind that RO's are notorious for not following the regulations and you may be in for a long battle regardless of any favorable IMEs and/or outside help from senators, supervisors, etc.......It is still in your best interest to contact the people you have and prepare your case as best as you can, but be prepared for a war if/when the time comes.

You are 100% correct in that it is up to the VETERAN to WIN a claim and the vet MUST stay on top of things or he/she can easily be low-balled/denied. You should treat your case like a lawyer would presenting evidence in court......gether ALL the evidence you can from as many experts as you can and use the regulations to your advantage (here is a link to a website with the full list of regulations - VA REGS ). Also, try to highlite everything in your claim that best supports your percentage....in other words, present the case like your trying to talk to a 3 yr old. Make it as easy as possible for them to get the best picture in support of your claim.

mssoup1 · November 30, 2005

Jay,

Thanks for your response. I have responded back to the RO with a detailed letter I wrote up, cited the regs that applied to what I was talking about, sent them copies of these with the areas highlighted, copies of his medical records with the appropriate areas highlighted, along with copies of anything else which pertained to his case and highlighted those areas as well. Any 3 year old could have fully comprehended what I sent in, but they still cannot read or comprehend what you are trying to state. Then again, it may be that they just are not even bothering to read the evidence you send to them. Takes them too much time. Something is wrong when you get a denial and it doesn't come anywhere to making sense, based on the evidence that was sent in.

As to inadequate C & P exams, per another posting I had, you would think the BVA and Court of Veterans Appeals would get tired of remanding claims back based on inadequate exams being given. I think that they should weigh the other evidence that you have presented and if that pretty much gives them what they need to approve a claim, then they should be doing that. Instead, they remand it back so the veteran can undergo another inadequate C & P exam. No wonder there is such a backlog in the claims process. But then again, I guess this makes too much sense.

Again, thanks for your response.

Mssoup1

Jay Johnson · November 30, 2005

As to inadequate C & P exams, per another posting I had, you would think the BVA and Court of Veterans Appeals would get tired of remanding claims back based on inadequate exams being given. I think that they should weigh the other evidence that you have presented and if that pretty much gives them what they need to approve a claim, then they should be doing that. Instead, they remand it back so the veteran can undergo another inadequate C & P exam. No wonder there is such a backlog in the claims process. But then again, I guess this makes too much sense.

Again, thanks for your response.
Mssoup1

Well, what they are hoping for is that the veteran will NOT appeal in the first place. Or that the veteran will not go above and beyond and get their own sources of medical evidence...this is where the IMEs help a bunch in my opinion. The VA is supposed to weigh evidence and rate based on a "preponderence" of the evidence (though RO's tend to go with the lower eval. regardless, the BVA and CoVA tend to follow the letter of the law). It's all a big circle in the hope that a veteran will either give up or die trying....I know it sounds horrible, but it is the truth. The VA puts up as many roadblocks as they legally can (or illegally...not like they have any oversight).

P.S. - If you already haven't, be sure to copy everything you send and ALL of your medical evidence...the VAROs are known to "misplace" key evidence in your favor:-)

Bound4heaven · December 1, 2005

NPs and PA's have, basically, the same level of training. They cannot, officially, diagnose anyone with anything unless they get authorization from a surpervisor (MD). The reason the VA uses them is quite simple, they are cheap! Also, most self-respecting doctors will not work under the contraints of the VA....no MD is going to make medical decisions based on "saving the VA money", but NP's/PA's are more willing to sell their soles (so to speek).

With that said, I hope you keep in mind that RO's are notorious for not following the regulations and you may be in for a long battle regardless of any favorable IMEs and/or outside help from senators, supervisors, etc.......It is still in your best interest to contact the people you have and prepare your case as best as you can, but be prepared for a war if/when the time comes.

You are 100% correct in that it is up to the VETERAN to WIN a claim and the vet MUST stay on top of things or he/she can easily be low-balled/denied. You should treat your case like a lawyer would presenting evidence in court......gether ALL the evidence you can from as many experts as you can and use the regulations to your advantage (here is a link to a website with the full list of regulations - VA REGS ). Also, try to highlite everything in your claim that best supports your percentage....in other words, present the case like your trying to talk to a 3 yr old. Make it as easy as possible for them to get the best picture in support of your claim.

Jay,

Thank you again so much for your help. Can you ever considered helping out at a vet center? you have knowledge that many veterans need, and will not receive. God bless you.