Need Some Guidance

[mssoup1]

My husband has several claims in to the VARO. Some remands from the BVA, some new claims as a result of the BVA hearing. He had C & P exams set up for all of these claims and he went to each. One of the C & P exam reports was horrendous. Nothing in the report was at all accurate. Wrote the report based on a condition that my husband does not now have or never has had. What happened to what he was supposed to be writing the report on? We can't figure that out. He also had another C & P exam, by the same examiner, whereby he never even bothered to write up a report at all. During the examination, the examiner really seemed to be speaking in our favor, but that is as far as he got. Never wrote anything up. I did get the results of the inadequate C & P exam and discovered that nothing had been written up on the other exam. I sent this information to the VARO and explained in detail to them why these were inadequate exams and should not be used in deciding his claims. I also told them that we did not want this same examiner to redo the exam. Never heard anything. Called the VAMC and talked with someone affiliated with the Directors office in charge of the C & P examiners. I explained the problem and she told me that I would be contacted back by someone in that office. Never heard anything from them. I wanted to file a complaint against this examiner, as this is not the first time he has done this. Well, after several calls to the VARO during the last few weeks to find out where his claims stood, I then sent an e-mail thinking I would get more information. Well, I did, to a degree. Here is what they had to say:

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

Mr. ,

Your remanded appeal is awaiting the processing of your new claims. With one exception, we have received the examination reports for your claimed conditions. The exception is the skin condition. We asked the VAMC for completion of the inadequate examination. They responded that because of your expressed disappointment with the examination, they were asking us to have another VAMC complete the examination. We replied that we had no such authority, that their manual said that this is their responsibility. Their manual says that they must find a facility willing to accept the examination and that you, the veteran, must agree to travel to the other facility. I assume that they will contact you soon on this matter.

Veterans Service Center Manager

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

First, I am upset that I never heard back from the Directors office at the VAMC. Think I will call them again tomorrow and tell them that we want an appointment set up to speak with them. Secondly, since my husband just had another complete knee replacement (NSC), he could in no way be sent to another VAMC in an area that would be that far away. He couldn't make the trip. Also, from the response that I received back from the VARO (as I showed above), neither the VARO or the VAMC knows what they are doing. They assume I will be contacted. When? In the next century. Also, there were two inadequate exams, not one, but according to the reply from the VARO, they only spoke of one. How was the other inadequate exam handled? I am so frustrated with this whole system that I could scream. I have been dealing with some of these claims for over 6 years and those are remands back from the BVA back in February 2005.

Questions for the group:

Should I call the VAMC tomorrow and set up an appointment to speak with the Director over the C & P examiners in order to complain about these inadequate exams being done by this examiner and also about the problem my husband would have in making a long distance trip at this time to go to another VAMC for something that should have been able to adequately been done here?

How do I go about finding out what happened to the exam that was written up, but was considered inadequate based on the fact tht the exam was reporting on a condition my husband doesn't have and was not what the C & P exam was set up for?

Should I get the VARO involved with the problem in sending my husband to another VAMC?

Since my husband would not be able to make the long distance trip, how would he be able to get a new examination and would this go against him in any way? It kinda sounded like in the VARO reply to me that my husband would have to agree to travel the distance to another VAMC for an exam.

We have had other claims held up because of this examiner. He is not out to assist the veteran in any way. In fact, I think he does everything he can to help get the claim denied. We have filed other complaints in the past due to the inadequate exams that this examiner is giving. Why is he still employed there?

Any help or assistance on what direction I should take would be geatly appreciated. I am getting more frustrated and worn down as each day goes by. Trying to cope with my husbands needs with his knee replacement, along with his other problems, taking care of everything else by myself, along with my health problems, I don't need all of this on me as well.

Sorry for the ranting, but where else can you go, except HADIT, to be able to do this and everyone understands what you are going through.

Thanks for any help you can give me.

mssoup

[mssoup1]

Berta,

To answer your questions:

Did we get the results of the C & P exam?

Yes. In fact, I get copies of all of his VAMC exam records shortly after he has been at the VAMC. This was another thing that I think the VARO got upset about was because we got the reports on these exams before a decision was made and I quickly responded back to the VARO about them being inadeuate. There are two C & P exans that we are complaining about. One was for ED. The examiner performing the exam is not a Urologist, just your run of the milll C & P examiner who handles non specialized exams, like skin problems, hypertension, etc. When my husband had these exams, there was no one else in the waiting room waiting to have a C & P exam done. We were the only ones there. We spoke to the doctor in his office about the ED. This is when he really jumped my case. Was really beligerent to me. Didn't want to hear anything I had to say about his problem. I'm married to him, I should know. Even his doctor that has prescirbed the medications for his PTSD stated in his records that those meds could cause ED. They even gave him prescriptions for Viagra, which didn't help. After the meeting in his office, we went into the hall, the examiner hugged me and apoligized to me for treating me the way he did. He then took my husband into the examining room and we were then sent on our way. I got the results of the exam. The only thing he had correct in his exam was the name of one of the medications he is currently on. He quoted that this medication was being given by a male doctor in the Urology Department. His psychiatrist prescribed this medication, is a she not a he, and he has never been to the urology Department. He also stated that this medication was being given for a prostrate gland problem. My husband does not and never has had a prostrate gland problem. This medication was being given to him for his PTSD. He even gave a quote that he said was from the Urology Department records. How could that be since he has never seen anyone in the Urology Department. So, this examiner stated that his ED problem was a result of this medication being given for his prostrate gland problem. Nothing contained in the report about our claim being for this medication being given by his psychiatrist and this was the result of his ED. But, with all of this being said, the examiner did state that the medication would cause ED. He just had everything else messed up. We are wondering which veterans folder he used to write this exam report besides my husband. Nothing in the exam report was anywhere close to being accurate.

The second exam he had was for an increase in his skin condition. Again, we went into his office and tried to explain how bad my husbands problems were. Instead of starting out listening to us, he told us that my husband should be glad that he didn't have the poblems that some veterans had with cancer all over their body. Well, my husband may not have cancer, thank God, but he has severe problems with his skin. He listens to us for a few minutes, then takes him into the examining room where my husband strips for him, The first thing the examiner says is Well you do have that crud all over your body. He proceeds to write down percentages on his paper he had and then tells my husband that he does have this on more than 60% of his body. This was what we needed to get my husband an increase since the laws changes on skin conditions. We left with a good feeling on this. Well, the only thing that ever showed up concerning this exam was one sentence in his ED exam report that the veteran also had a claim in for his skin condition. No actual exam report was ever written up on his skin exam. The examiner was in a hurry after the exam to leave town for vacation or something, so I guess this is why the reports ended up so screwed up. But now we suffer over this.

This is not the first time this examiner has given inadequate exams. He has done it to us before. He even did it to a friend who I was helping on his claim. At what point do they take some action on giving these inadequate exam reports? If we are being done this way, how many other veterans are having their claims denied due to this? This examiner also gives you the feeling that a lot of veterans coming to him are only wanting a handout.

My husband did get several bad C & P exams and he cannot travel a long distance to another VAMC due to his recent surgery. We have a VAMC here and the exam should have been performed correctly here without having to go somewhere else.

Do you think it would be the right route to take to go to the Director of the VAMC and talk to him about this situation. I intend to take the evidence with me. Has anyone else gone this route and got any results or would we be spinning our wheels?

We need to speak with someone about this before they set up an appointment miles away from us that my husband will not be able to keep. This would then throw his claim in the waste can if he says he cannot go.

On another note, when my husband went into the examiners office, he made a comment about the fact that he had heard that he was retiring. My husband has seen this examiner a few times before, so he knew him. The examiners reply was that they, the VAMC, would like to see him retire, but that he was not going to and they didn't have anyone to replace him with anyway. I thought this was most inappropriate for him to say, but that was my take on it.

I hope that this gives you a little better insight on where we stand at this point. My husband has had other exams done by specialist for other claims he has in and they went really well. We only have problems with this one examiner and it could cost my husband an approval on these claims.

By the way, this examiner is a doctor, not a physicans assistant or nurse practticioner. (SP?) Also, you said that the IG did not get involved with the VARO or the process, but do they get involved with the VAMC and inadequate exam reporting by their doctors?

Any additional thoughts would be appreciated.

Thanks

mssoup

[Guest Berta]

"Do you think it would be the right route to take to go to the Director of the VAMC and talk to him about this situation. I intend to take the evidence with me."

Yes- I think that is a good idea-I bought VA med recs with me whenever I talked to the VAMC director here-

and made him enter in the medical records what we discussed.

The only other thing would be to get an IMO- an expense, I know, but maybe it could come from a doctor close to your locale and it could stave off these inadequate C & Ps.

It would need to be from a specialist in this type of disability-someone with the expertise and rationale that would be greater than the VA's so-called 'medical' opinions.

The IG-

When I wrote to them I asked specifically what their jurisdiction was over the VAROs ,as this legal criteria is not on their web site,so that I could shape a complaint against the VARO to fit into that jurisdiction.

(they say something to affect that they do not get involved with RO claims problems)-

But then I stated my entire complaint anyhow and how I felt it WAS within their jurisdiction-based on their mission statement. (It was- I have an usual situation and that letter got their attention real fast) Within days- the IG got in touch with them and they suddenly started doing a lot with my claims.

In this case, however, there are things you can still do locally without the IG-

I do suggest putting pressure on that director first-

Also have you contacted the patient's advocate?

Letters to the IG have helped claimants -in some limited situations-but you really should exhaust every other way you can to get the matter resolved.

Does this VAMC have a medical Chief of Staff? or is it the same person-as the Director?

It is not unusual for a bad C & P exam to be re-scheduled elsewhere at another facility-

isn't it possible that-if you can get to a different VA examiner, the C & P results might be better?

But then again a good independent medical opinion would probably resolve this.Unfortunately, I feel any doctor would need to see your husband face to face for that-

so no matter how you look at it- this might involve taking him somewhere else.

Why is he unable to travel to another VAMC?

Edited February 23, 2006 by Berta

[mssoup1]

Berta,

He had a total knee replacement and cannot drive a locng distance in a vehicle. We would have to stop every 15 minutes to let him get out and move around, then start again. Would be too much for him.

mssoup

[mssoup1]

Berta,

I called the Directors office at the VAMC this morning. The person who handles the 8 Regional VAMC's around our area called me back a little while ago. She asked if my husband would see a nurse practioner for his C & P exam for his skin. I told her that as long as he was given a valid C & P exam, we didn't have a problem with that. They don't have a Dermatology Department at our local VAMC, so there is no Dermatologist to do it. But that is okay. The dermatologists that he has seen in the past when they did have this department were no good at all. In fact, most of them never even wanted to touch my husband or never even asked that he strip so they could see his entire body. How can you do an exam when they don't even look at your body? I only hope that this Nurse Practioner knows that we filed the complaint and will be a little better at giving him his exam.

I also asked her why the VARO didn't mention anything about the ED exam being inadequate. I explained the inadequacies in the entire report. She said that the VARO never requested another exam for this, even though we told them that the one he got was inadequate. She is supposed to get with the VARO and ask them about this. She is going to see if she can get him another exam with the Urology Department. She also told me that psychiatric research has shown that medications being given for PTSD only cause a temporary problem with ED, therefore, would not be compensable. Is there information I can obtain to prove this wrong?

I also explained to her that these exams are holding up my husbands claims with the VARO. She said she would try and get appointments set up for him ASAP.

I will keep you posted as this chapter of my book unfolds. But any information you can give me on the effects of ED secondary to PTSD meds would be appreciated.

Thanks,

mssoup

[Guest Berta]

Mssoup -what meds does he get for PTSD?

Best thing to do is attempt to find at least one good printput from a good medical website to show

ED as a potential lasting side affect of any of his PTSD meds.

That info could rebutt this statement:

"She also told me that psychiatric research has shown that medications being given for PTSD only cause a temporary problem with ED, therefore, would not be compensable. Is there information I can obtain to prove this wrong?"

I wonder what her source was for that.

This article refers to some medications that can cause ED.

http://www.aafp.org/afp/990915ap/1159.html

[10thFO]

So does one file for ED secondary to PTSD medications? I also have some neuropathy at the lower levels of my lumbar and starting into my S spine. I am on 60mg of Prozac and 50 mg of Amitryptilene. How do they test for ED anyway? Does my wife have to give a "buddy" statement. All I know is at 36 my rather active sex life with my wife is no more. and she gets upset that I don't want to have sex, of course I don't want to because I know I have issues of softness. trying to be delicate with the wording here.

Also I had a prescription for Cialis, but my doctor told me I had to pay for that, even though the side effects of my medication are lack of sex drive they told me the VA won't pay for it. All I know is it's expensive, and doesn't necessarily work. Only way it will work is if I go off my meds for a couple days. Of course then I fight with my wife so much, she doens't want any part of it.