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Sick & Tired Of Va Second Guessing Imo's


Rockhound
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Question

I always thought if their was sufficient evidence of record, IMO's, private medical records, etc. to prove onset in service or within the time limit after service, a current diagnosis, and a quantifiable nexus statement, then a C&P exam isn't necessary.

It seems the VARO is using its porogitive, or right, in deciding if a C&P exam is necessary in way to many claims. That they are then using these exams, which tend to be most unfavorable to a Veterans claim, to then use them to deny an otherwise legitimate claim, causing the Veteran to spend countless time and effort in appeals, remands, and even as much as taking their claims all the way to the courts, only to spend more time in directed remands and the likes.

If an IMO is insufficient for rating purposes, then why doesn't the VARO return their reports for the necessary requirements, instead of sending the Veteran to a C&P exam that has to start from page one, when most of the information necessary for the Veterans claim has already been done or covered in the IMO?

If I wasn't already slightly right of paranoid, I would be thinking conspericy or at the very least, colution with the C&P Examiners to give directed opinion in such a manner unfavorable to Veterans.

It's kind of like the chicken house being guarded by the Fox.

It just doesn't make sense any other way. It is quite apparent to me at least that many C&P exams are less than addequate for rating purposes, even to go as far as to not provide the Veteran with necessary tests, exams, specialist reviews and other requirements for a proper opinion, relying more on their own views and what little they deam probative from existing records, non of which comes from sources not controled in some way, shape, or fashion by the VA claims process.

Something stinks and the smell isn't hard to notice from which direction it is coming from.

Rockhound Rider :P :( :P :P :o :o

Edited by Rockhound
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Rockhound, If they assign you a C and P exam and the evidence is already there, there is a rule against the VA Dr Shopping for a negative opinion.

her eis a CAVC case where the VA docs out opinioned Civillian doctors and the VA was accused of the same. MD Shoppers.http://www.warms.vba.va.gov/cova/dads/2000dads/prejean.doc

J

Edited by jbasser
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My opinion:

1. Requesting a C&P is a quick way for the RO to record an action and throw your claim back into the awaiting action pile.

2. A C&P is often given by someone that really does not have the the medical qualifications to make a proper judgment, yet the VA will attempt to use such a C&P to refute or nullify a MO from a properly qualified doctor (even a VA doctor).

3. A C&P may be used in an attempt to counter other favorable evidence.

4. Repeated C&P's may be used in some cases to attempt to reduce or deny further compensation. (They did this to my father, a WWII veteran, many years ago.)

5. We all suspect (and wish there was a way to prove) that C&P examiners are somehow evaluated on the number of unfavorable C&P's, and instructed on ways to minimize medical problems, thus producing an unfavorable judgment or at least reducing the amount of an award.

In my case, the VA tried to schedule a C&P with tests that are precluded by my medical condition and VA regs. They did not provide written notice of the C&P, just had the C&P section call me.

When I protested the lack of a written notice, I also asked what tests were scheduled, and who was going to preform the exam. I was told that an "actual doctor" was assigned, instead of the usual RN or NP. When they mentioned the tests to be taken, I pointed out that I was under a doctors care, and due to the severity of my medical problems, the doctor would have to approve the tests. They included a stress test (treadmill) that is not to be given in my situation (By VA reg).

When I stated my objections and concerns, and said that aside, I was willing to drive a hundred miles to the C&P location, and had cleared the date to do so, I was told that the C&P was canceled. I never received anything in writing from the VA concerning the whole incident.

In actual fact, a C&P by a qualified specialist (As called for by VA regs) would likely result in award of about $85 a month more due to a "special schedule" claim and allowance.

There is more than enough medical evidence in my VA file (assuming it did not disappear) to document the medical problems. Further current authoritative medical references, including those used used by the VA, can be used to SC my more severe medical problems. Not to mention a favorable MO from a treating VA doctor as well as IMO's.

I always thought if their was sufficient evidence of record, IMO's, private medical records, etc. to prove onset in service or within the time limit after service, a current diagnosis, and a quantifiable nexus statement, then a C&P exam isn't necessary.

It seems the VARO is using its porogitive, or right, in deciding if a C&P exam is necessary in way to many claims. That they are then using these exams, which tend to be most unfavorable to a Veterans claim, to then use them to deny an otherwise legitimate claim, causing the Veteran to spend countless time and effort in appeals, remands, and even as much as taking their claims all the way to the courts, only to spend more time in directed remands and the likes.

If an IMO is insufficient for rating purposes, then why doesn't the VARO return their reports for the necessary requirements, instead of sending the Veteran to a C&P exam that has to start from page one, when most of the information necessary for the Veterans claim has already been done or covered in the IMO?

If I wasn't already slightly right of paranoid, I would be thinking conspericy or at the very least, colution with the C&P Examiners to give directed opinion in such a manner unfavorable to Veterans.

It's kind of like the chicken house being guarded by the Fox.

It just doesn't make sense any other way. It is quite apparent to me at least that many C&P exams are less than adequate for rating purposes, even to go as far as to not provide the Veteran with necessary tests, exams, specialist reviews and other requirements for a proper opinion, relying more on their own views and what little they deam probative from existing records, non of which comes from sources not controled in some way, shape, or fashion by the VA claims process.

Something stinks and the smell isn't hard to notice from which direction it is coming from.

Rockhound Rider :P :( :P :P :o :o

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Rockhound - I agree with you. Last year I sent a very detailed letter to the house committee on this issue. It provided basically what you have covered in that if a veteran is being treated for a supposed service connected issue by a specialist who prepares a detailed summary of the diagnosis, reason for the diagnosis and an accepted reason as to why it is service connected then a c&P is a simple waste of money not to mention the time attached to the claims process.

Never heard from them. The only thing I can assume is that if a vet prepares his claim in accordance with the regulation and presents detailed undoubtable medical information the C&P exam is order to simply move the claim and credit can be taken for that move. And as we all know many, many times the one time look over C&P from a NP outweighs an medical information the vets submitts from a TREATING specialist. I can understand their actions if a vet goes doc shopping and comes up with a well documented IMO from Doc Abu when it is well know that for 400 bucks doc Abu will write anything. However, if the medical evidence is submitted by your TREATING doc then it should be accepted as is without any other requirement cause we all are told day in and day out that the rater can not make his on medical diagnosis - bull crap that is the primary reason the C&P is conducted. These guys have too much authority and wiggle room with a vets medical information submitted with a claim. Funny that when it comes to medical issues he/she are nothing more than laypersons but boy they sure can influence the weight of the medical information. I bet no one has ever seed where the rater listed in the rating decision that the C&P doc's medical opinion was not within the accepted standards of the medical community. sorry for the rant. Oops forgot the C&P exam is part of the duty to assist so you would never be able to prove that they were using it for doc shopping in order to deny a claim. All the rater would have to say is that the medical information submitted by you 45 year board certified neuro was inadequate so he scheduled you with a VA 4 year NP to maked a decision on your rare neuro problem which is listed on the medical communities list of Rare Disorders and affects only about 1 out of every 10 million people!!!!! Sad but true.

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If there is sufficient evidence of record, medical records that show treatment / diagnosis during service, and qualified IMO provides a nexus that the current disability is related to service, then a VA exam may not be warranted. However, the C&P is strictly structured to comform with the rating schedule. If the person providing the opinion is qualified and provides enough information--the claim can be evaluated without a VA exam. However, this is rare. Therefore, even when a case can be completed based on an IMO, raters are so accustomed to requesting exams that they may not know it.

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Oh they know it, they just ignore it as they please. Claims would move a lot faster and probably be awarded more often and sooner than being awarded after a NOD and appeals. It's like some Veterans believe, the stall as long as they can in hopes that the Veteran either gives up in frustration or dies and you which the VA prefers.

Rockhound Rider :o

p.s. Why else would a claim finally get awarded after 35 plus years or in at least one claim I know of, after 40 plus years?

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Since my retirement some 22 plus years ago I have had to indure many C/p exams. I must be one of the few fortunate veterns who's C/P's usually resulted in a positive outcome. Mind you I don't like driving 100 miles or staying in a hotel over night just so some va quak can examine me for 5 minutes just to tell me what I already know. But I still think there are some valid reasons for C/P exams. A good example for the need of a C/P exam would be when a vet's medical records contain more than one diagnoses, or adverse opinions. The C/P exam is required to confirm either for or against what is in the medical record. In some cases, a clear diagnoses was not made, then the c/p serves to determine what the diagnoses is based on the symptons in the medical chart. I have also seen veterans who try to beat the system, one such veteran I met on the way to a c/p exam. My wife and I stopped to get some coffee and doughnuts on our way to the exam, while in the resturant a man walked in ordered coffee and left. About an hour latter we met this man again, this time he was sitting in a wheelchair at the VA clinic waiting for a c/p exam. I sincerely hope that he was found out because vets like him make it harder for those of us who are honest and only trying to get what we have earned.....

The bottom line, the va does many thinks we do not agree with, but one think is for sure if you don't show at your C/P you screw yourself out of any compensation you might be due.

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