My C&p Exam Notes Are In (just As Expected Not Promising)

[TANKERJOE0]

HI,I HAD A COPY OF MY C&P EXAMS PRINTED OUT FOR ME TODAY.

SOME MAY REMBER THE DAY I GOT BACK FROM THE EXAMS AND WAS IRATE,DISGUSTED AND DISSAPOINTED.

WELL JUST AS EXPECTED THE DRS NOTES THAT THEY ARE SENDING TO THE VARO ARE CLEARLY UNTRUE AND UNFOUNDED??

I NEED A SUGGESTION.OR MAYBE A EXPERIENCED HADIT MEMBER WHO WOULD BE WILLING TO ANALYZE MY C&P NOTES AND TELL ME WHAT THEY THINK???

I DONT THINK ITS ADVISABLE TO POST ALL THE NOTES ON THE FORUMS

AS IT WILL TAKE ALOT OF SPACE UP?

IF ANYONE IS WILLING TO HAVE ME FWD YOU THE NOTES VIA EMAIL AND GO OVER THEM WITH ME ID BE FOREVER GREATFUL!!!

THANKS AGAIN FOR ALL THE GREAT ADVICE AND SUPPORT THIS HADIT FAMILY PROVIDES TO ME.

I TRULY FEEL I AM AT WAR WITH THE VA AND EVERYONE ON HERE IS ON THE SAME SIDE AND CAN HELP ME.

OTHER WISE ID BE FIGHTING A MUCH BIGGER ENEMY BY MYSELF!!!

TRYING TO CLEAR THROUGH ALL OF THE OBSTACLES THE VA HAS SET UP TO MAKE IT GUT WRENCHING TO GO THROUGH THIS PROCESS. SO MANY GIVE UP.

I WILL NOT GIVE UP.I AM FURIOUS.

I GAVE UP 17 YRS AGO ON THE VA WHEN I FIRST ARRIVED HOME FROM THE WAR.AFTER THE WAY THEY MADE ME FEEL SO I CONTINUED MY MEDICAL TREATMENTS WITH A PRACTICE OUTSIDE THE VA.

I REFUSE TO GIVE UP THIS TIME.

THE VA HAS NOT FOUND A WAY TO MAKE MY PHYSICAL AND EMOTIONAL PROBLEMS GO AWAY OR EVEN MAKE THEM MANAGABLE.

SO IM GOING TO TRY WITH THE HELP FROM HADIT,MY WIFE AND MYSELF TO FIGHT THIS BATTLE TO THE END.

THANKS FOR ANY ADVICE.

SEMPER FI!

TANKERJOE0

[carlie]

Tanker,

In reading through some of the scans below:

1) Yes, by all means take your father, hysterical mother

and both of your children to a hearing to provide sworn lay testimony

as to the way you were prior to military v the way you are after military.

2) There is a huge demand on the street for anxiety and depression drugs.

3) Your current Mental Health condition is not an undiagnosed illness.

4) Rental gave you good advice concerning your claim and evidence.

jmho,

carlie

[rentalguy1]

This is going to be a long one, so everybody grab your favorite beverage and a snack. You old farts like Pete may want to get your reading glasses, too :D

Joe, first let me say that I sincerely hope that you don't think I was being mean in my response. I was not trying to be a jerk, and was only trying to help another veteran. I completely understand that you have problems, and they need to be addressed and taken care of by the VA. I am trying to set you off in the right direction towards getting that help.

I have read the pm that you sent me, and I think it is the same as the rebuttal that you have posted in this thread. In order to win here, you first need to understand a few things about the VA. First of all is that they are set up in different branches. The Veterans Benefits Administration (VBA) are the folks who decide on and pay our compensation. The Veterans Health Administration (VHA) are the docs and staff at the VA Medical Centers. There are some bad apples in both, but they are the exception, not the rule.

The raters at the VBA do not "pick" the docs at the VHA who give us our C&P exams, as has been said on here recently. The rater is mandated by laws, regulations, and manuals. One of those manuals, M21-1MR, mandates that the rater send a request to the VAMC for a C&P exam. When the C&P section at the VAMC receives this request, they assign the appropriate doc to perform the exam. The docs who perform these exams are not hand picked to deny us our benefits. They volunteer and go through specialized training to be able to do these C&P's. They don't exactly do it out of the goodness of their hearts, though, since they get a slight increase in pay for doing C&P's.

When we go to the VAMC for treatment, the docs are there to take care of us and help us to get better. When we go for a C&P exam, the docs aren't there to make us better. They are there to determine our present level of disability. Nothing more, nothing less. They have examination sheets that must be adhered to in order to determine this. This is one reason for the lack of a bedside manner from these docs. They most likely have had to spend a great deal of time pouring over our C-files and medical records, and probably have several other vets to see that day. They will never see us again, so there is no need to establish a rapport with us. They also have to weed out the malingerers. Believe it or not, some vets actually lie in a attempt to get benefits that they do not deserve. This is especially true when it comes to mental conditions and PTSD in particular. You can't take this so personally. It's absolutely no different than when we took our entrance physical at a MEPS station, and we were inpersonally hearded through the line of docs like cattle.

These C&P docs all have years of training, and several volumes of medical literature at their disposal. They are expected as professionals to use all of it. Just the same way that you were expected to use all the tools of knowledge and literature at your disposal while operating a tank in the Corps. Now, you wouldn't expect a doc to know how to operate that tank, and no one expects you to know how to do the docs job. But, when you enter their world for a C&P exam, it would be wise to learn as much about your condition as possible, right? That means you need to know certain things like: what is the diagnostic criteria for my condition(s), what is the rating criteria for my condition(s), and what is on the exam sheet(s) for my condition(s).

I can't stress enough that the VA is a war of words. If you don't have the correct words, then you lose a battle. If you lose enough battles, then you lose the war, or even worse; you end up in a VA stale-mate that can drag out for a decade. You have to educate yourself as to the words needed to win the battles. If you think you are not capable of learning the words needed, then seek help. If you have to seek help, then accept the help you are given. It is not wise to get upset with the help you receive simply because you don't like what the helper had to say. Take the advice at face value and get the words that you need to win the war.

Now, concerning your rebuttal; you've written a very long argument against these C&P's. That generally isn't advisable, especially with only three issues at hand. It's not that these folks are stupid, incoherent, or even lazy. The system is dealing with a 800,000 claim backlog. They simply do not have the time necessary to read through a eight or ten page letter from a vet that disagrees with the exams they were given. The rater's best option here is to deny, and let the veteran appeal the claim to someone who has the time to sift through all of it. I know this sounds like a horrible practice, and it is, but it is a fact that we all have to deal with. If you must send in a disagreement with these exams, please shorten it to two pages (at the very most) and be very direct and to the point. Be aware that your feelings about the exam don't matter at all. They do not care about how the exam made you feel, because that has no bearing on the outcome of the claim.

Dealing with the audiology: When you enetered service you had hearing that was within normal limits. When you left the service, you had hearing that was within normal limits. STOP! That is about as far as this will ever go. You are almost two decades out of the military. You cannot go back and claim normal hearing loss on something that happened that long ago. The only hope you can have here is if there was a noticable loss of hearing on the exit physical. It can still say within normal limits when you left the service, but you are looking for a numerical drop in puretone averages, speech recognition scores, or both from the time you went in to the time you left the Corps. That is the only way you will ever tie your current loss to the service.

If you did go back and look at your entrance and exit exams and found what I am talking about, and they did service connect the hearing loss, you would get a rating of zero percent. Like I sad before, the VA is a war of words, and raters are mandated by laws, regs, and manuals. The regulation for ratings is 38 CFR 4. In that reg, there are tables that tell the rater exactly what percentage to assign a veteran for specific puretone and speech recognition scores. When your audiogram scores are applied to these tables, the percentage returned is zero. It does not matter if they assigned you a TV amplifier and told you that you could get hearing aids. It would not even matter if the audiologist wrote in the medical records that you were completely deaf and gave you megaphones for hearing aids. The audiogram scores are all that matters when assigning a percentage.

For the tinnitus you have brought up a very excellent point when you said (paraphrasing) "what if I am one of the seldom who gets tinnitus without hearing loss?" There are two problems here, though. Foremost, you are not a audiologist, and therefore when you make this statement it holds absolutely no weight. That is precisely why I told you to get a IMO from a audiologist that can make this statement. If you do this, it will put the evidence in relative equipose and the benefit of the doubt rule will apply. The second problem is that if you use this argument, you as much as admit that you have no hearing loss. If you are going to admit it, then why persue the hearing loss claim? That really doesn't matter, though, because your current audiogram shows your hearing to be within normal limits. Also know that if you do get the tinnitus service connected, it is a ten percent rating. That is the only percentage allowed in the regulation.

For PTSD I completely believe that you have it. There is no question in my mind. The problem is that I am not a doctor, and my belief doesn't mean a damn thing, just like your belief doesn't mean a damn thing. Nobody, short of a medical professional, can have a bearing on the diagnosis of PTSD. I have already explained why you were not given a diagnosis of PTSD in this exam. There are certain criteria laid out in the DSM-IV. You either meet it, or you don't. In this exam you did not meet the criteria. That is not to say that you didn't meet the criteria in the past, or that you didn't meet the criteria an hour after the exam, but during the exam you didn't meet the criteria. That's all that matters.

Now you have to combat this exam. Don't worry about the "possible drug seeker," and "r/o possible exaggeration of symptoms" comments. They don't mean squat. Don't worry about the "manipulative" attitude towards the examiner. That would only mean something if he outright called you a malingerer, which he did not do. You are getting hung up on little things in the exam that don't mean anything to the rater. Don't fall into this trap. What you have to do first is prove you have PTSD, and then prove that it is severe enough to be compensable.

You have medical records saying you are receiving treatment for PTSD. Hell, it even says so in the C&P exam. I hate to tell you this, but that doesn't matter. We may be able to make it matter, though. You need to get a complete copy of your medical records and scour them for the exact point where you got a diagnosis of PTSD. Then it will also need to make comments about your symptoms and how they match up with the guidelines in the DSM-IV. If you do not have this in your records, you are going to have to get it. That means a Independent Medical Opinion. You only missed the diagnosis by one single criteria. I am positive that you have at least one more symptom of avoidance, but the way the questions were asked, you were not able to convey that symptom. Had you looked over those symptoms before going into the exam, you would have been better prepared. It is easy to look over the symptoms with someone close to you (like your wife) and figure out exactly which ones you suffer from. That makes it easier to let the examiner know what's going on with you. Like I told you before, you'll have to have a copy of all of your medical records and your C-file for a IMO doc to review in order for that opinion to be considered equal to that of the C&P examiner.

Now, you need to be able to show that your PTSD is severe enough to warrant a rating. As it is right now, I think you would get a ten percent rating.You need to study the rating criteria set our in 38 CFR 4 and figure out which of these symptoms you suffer from. Then you have to get them across to your doc. One biggie is the panic attacks. I know you say in your rebuttal that you suffer from them, and again, I believe you. Almost all of us that have this type of condition have this symptom universally. The point is that you need medical evidence proving this. That means that you will need notations in medical records stating that you have panic attacks. If you get a IMO, and it states that you have them, then it still will not matter. The rater will say that this is the first mention of this symptom, and there is no track record of sustained panic attacks. The same holds true for suicidal/homicidal ideations. The same holds true for the remainder of the criteria set forth in the regs. If you do not have a track record of these symptoms, then they might as well not be in there at all. This is most likely why the C&P examiner stated that you do not have these symptoms; because they are not mentioned in your medical records.

You were also worried about the statement on total occupational and social impairment. You said that his answer of no is a bold faced lie. I understand how you feel, but again, how you feel doesn't mean squat in this situation. If you have a job, then you cannot be totally occupationally impaired. If you were totally occupationally impaired, you would not be able to concentrate enough to hold a job. If you have a wife of 13 years, and a relationship with any single person, you cannot be totally socially impaired. To be totally occupationally and socially impaired would mean that at best you stay locked in your house almost 24/7 with no job, and no familial or friendly relationships at all. At worst you would be institutionalized. I don't think you want the label of total occupational and social impairment.

Again, I am not trying to be a jerk. I am not trying to be mean or talk down to you. I want to help you, just like I would want to help any other vet that I come in contact with. This is a process, and you have to be aware of how the process works, and willing to work within the guidelines of the process in order to win. Remember the VA sale-mate that can last for a decade that I mentioned earlier? If you send in this rebuttal, you will have taken your first step in that direction. Not only that, but you will be standing in the way of another veteran who has a well-grounded claim. You will spend your time going around in circles while the next guy in line behind you has to wait for you to get off the merry-go-round. You are at the very early stages of the process. Take the time now to get a copy of your C-file, and the rest of the evidence that I have told you. It may add a few months to your claim, but that is much better than a few years of being in the appeals process. We're all on your side, and we have your six :D

[rentalguy1]

How do they give him a C&P looking for a diagnosis when he has already been diagnosed as having PTSD? How can you claim it if you haven't been told you have it?

In the initial C&P exam for PTSD they are looking for information to confirm the stressor and the diagnosis. They readily accept his stressor, and he only missed the diagnosis by one avoidance criteria. Like I said before, I am certain that he has many more avoidance issues, but he didn't know what they were, and therefore couldn't convey them to the doc.

You can claim anything whether or not you've been diagnosed. Send in the paperwork for some crazy claim and see if they won't look into it. They may not send you for a C&P if you don't have something in your records, though. In this case he had something in the records pertaining to PTSD. But like I said, they seek to confirm the diagnosis in the exam.

They actually seek to confirm the diagnosis in any C&P exam, not just the initial PTSD exam.

[carlie]

rentals post at 10:51 am is excellent.

carlie

[Quint7]

Tankerjoe and Rentalguy, that was a really good, honest post by Shane (Rentalguy). A good way to explain the VA system to Tankerjoe.

I agree with Rental in that post Tanker. Forget that you had the exam. Start gettng records together for your appeal. The important thing is not the compensation, it is getting help. I agree that you need a copy of ALL treatment records at the VA, a copy of your C-file, a copy of your service medical records (SMR's) and service record book (SRB) if you don't have them.

Once you have all of that, you can go through page by page and document statements, etc. that confirm not only that you have and have been diagnosed with PTSD, but that you also meet a certain rating criteria. As Rental said, they have rules that they have to follow and if you can prove to them that they ignored or misapplied those rules than you win. I agree with Shane too that you need to print out the exam and rating criteria and sit down and do an honest assesment of your situation with your wife and family.

When I started going for help I had a social worker named Frank who was fantastic. He didn't ask me questions, he gave me situations and said would you do a, b, c, or d. That really opened up my view of why I act and react why I do. When I finished the 3-4 week assessment with him he sent me of to what was supposed to be my fulltime councilor, I almost lost it. The new guy literally just had flashcard type things and would just hand me printouts for "anger control" and stuf like that. No conversation, no input, just him sitting there with me trembling wanting to smash his face. I stopped in Franks office after 3 visits with the new guy and told him I was quitting... that the new guy was an idiot who just gave me handouts. He told me that he understood, that the new guy had a different approach... but the he told me maybe I should go up to the Vet Center by my house. I did and the guy I meet with there is a Vietnam vet, has a masters, lost a big chunk of his leg from a gunshot wound and calls me out on stuff. He doesn't follow charts or give me papers, he talks to me and questions my decisions. He doesn't put them down, he just asks me to explain why I made them and then sometimes says "well look at it from this point of view".

My point in that is that I didn't go to VA for money for this. I went for help. Did I go to VA for money for my knee and am I still fighting them for money for my back? Damn straight....... they broke me and they are gonna pay me. But as far as the PTSD goes, it wasn't about cash or benefits, it was because I had come to terms with the fact that I was seriously going to hurt myself and/or others and was doing a lotta self-destructive stuff. After I went and finally told my family I was getting help (I'm single, never married), my whole family opened up and told me all of the things they had noticed over the years since I got outta the Corps. I know that I will wake up with a soaking wet pillowcase 2 or 3 nights a week for the rest of my life. I also know that it hsa gotten a little better than it has been in a long time. Remember, it isn't like breaking a bone.... it doesn't go away. It is a change in the way your brain operates. You can't undo it.

The best advice I have been given on how to manage day to day is: "don't react, respond". They guy that told me that said that responding takes 1 second longer than reacting, but makes all of the difference. Reaction is immediate, responding gives you that second to "think" about what you are going to do. He said "do you think that people would think differently of a newpaper headline said "police react to unruly crowd with nightsticks" vs. "police respond to unruly crowd with nightsticks". The first one makes it sound like the cops jumped outta cars and started beating people, the second brings to mind visions of a line of police holding back until they had to use force.

Semper Fi brother.

[poolguy11550]

I DISAGREE AND HERE IS WHY???

THIS IS MY TAKE AND REBUTTAL ON THE C&P EXAM!!!

I ALSO PLAN ON LATER SCANNING IN MY ORIGINAL DRS NOTES FROM MY VAMC CONCERNING

MY DIAGNOSIS AND CONDITIONS AND TREATMENT PLANS FOR PTSD.

Tankerjoe-

I read one page of your rebuttal and I had to stop- I simply could not read on. You made medical opinions after medical opinions and even counterdicted yourself on several points- this stuff simply will not fly. Please don't send it to the R/O, instead set down and write out anthor four pages of your veiws and gather all these pages up- thus to burn them in sacifice to the adjudication gods.

Take a time out and review just what exactly what you doing with your claim and take the advice here under heavy concideration. Rentalguy has been honest with you and from my own expirence- honest advice is the best advice. The last thing that you need is is bunch of people telling you how good all your claims are just so that they can put that "nice guy bagde" on.

Edited January 29, 2009 by poolguy11550