C&p Exam Results Not Good

[Rockhound]

I picked up my C&P exam results today and it wasn't good, they said I had all the secondary issues I claimed to have, but the they were less likely than due to my SC condition.

They said I had chronic sinisitis and Rhynitis, but that neither was due to my SC nasal fracture with deviated septum due to trauma, that their was no correlation between the nasal fracture and the deviated septom and that their is no definitive medical rationale to support the cause being the fractured nasal bone and the deviated septom.

I don't understand how they can say that when I gave them supporting medical literature that shows the rationale to be at least as likely as not.

I also applied for painful scars on my nose, but I am not clear as to whether or not they even plan to rate them, since I believe they may be rating the scars under the wrong diagnostic code, but I'll have to wait until the decision to find out.

It appears I am going to have to get a IMO with evidence/research/treatese, that supports the ENT specialist results, I get.

I am not in a very good mood, to say the least. I got the impression from the C&P examiner that her findings would be favorable, boy was I dubt. I'd go an call her out if I didn't think it would get me in deep doodoo or a private room with padded walls.

Got to go, using computor at VA to write this. they have a time limit so others can use it too.

Rockhound Rider :P ;) :(

[Josephine]

Rockhound,

I am so sorry.

Edited June 23, 2009 by Josephine (see edit history)

[Pete53]

Its at this point you need to consider an outside opinion.

Good Luck

[jbasser]

Hamg in there Rock.

[cowgirl]

Rock, you'll get whats due someday. Don't recall if you had supporting documentation in your smr's or not. Ya seen the cat chinup poster that says, 'Hang in there, Fridays coming!'? (made me think of you and yer cat).

Best to ya,

Cg'up2009!

[WHOLESALE]

Rockhound, I feel for ya, I went through the same thing. I didn't have an IMO either but I finally got one, actually two, and they got my claim granted. If you can see if your treating physician will write you an IMO regarded the connection. I handed my C&P exam to my VA doctor and he said, "Hell no" that is wrong what the examiner put in. He was more than willing to contradict the examiners opinion. Hope it works as well for you as it did for me. Good luck, we're all with you.

jay

I picked up my C&P exam results today and it wasn't good, they said I had all the secondary issues I claimed to have, but the they were less likely than due to my SC condition.

They said I had chronic sinisitis and Rhynitis, but that neither was due to my SC nasal fracture with deviated septum due to trauma, that their was no correlation between the nasal fracture and the deviated septom and that their is no definitive medical rationale to support the cause being the fractured nasal bone and the deviated septom.

I don't understand how they can say that when I gave them supporting medical literature that shows the rationale to be at least as likely as not.

I also applied for painful scars on my nose, but I am not clear as to whether or not they even plan to rate them, since I believe they may be rating the scars under the wrong diagnostic code, but I'll have to wait until the decision to find out.

It appears I am going to have to get a IMO with evidence/research/treatese, that supports the ENT specialist results, I get.

I am not in a very good mood, to say the least. I got the impression from the C&P examiner that her findings would be favorable, boy was I dubt. I'd go an call her out if I didn't think it would get me in deep doodoo or a private room with padded walls.

Got to go, using computor at VA to write this. they have a time limit so others can use it too.

Rockhound Rider :P ;) :(

[Alb]

I was recently SC for the same thing. They rated me at Zero Percent, because the examiner did not put down how many episodes of sinus infections per year I had. They also did not give me anything for my facial scar (nose) I don't think they even considered the code (7800-disfigurement) One side of my nostril is bigger and misshaped from the two surgeries they done on me. I think we had the same examiner. She sure seemed that she had everything she need for a complete exam. I too thought the exam went well, then she did not report half the stuff in her examination.

[Rockhound]

Rock, you'll get whats due someday. Don't recall if you had supporting documentation in your smr's or not. Ya seen the cat chinup poster that says, 'Hang in there, Fridays coming!'? (made me think of you and yer cat).

Best to ya,

Cg'up2009!

I thought I had all that was needed. I had my enlistment physical that said everything was normal and my medical history was blank for any sinisitis and rhynitis, and my re-enlistment physical was normal. All this was prior to my receiving the fractured nasal bone and deviated septom due to trauma, which a was found to be SC at 0% until just resently when it was found to be rated at 10%, which is the most you can get for a fractured nasal bone with deviated septom due to trauma like mine.

I was trying for the secondary problems as a result of the SC issue. I didn't have these problems before I was injured, but I did afterwards. Also I have problems where my glasses rest on my nose that become painfull and ulcerated 4 or more times a year which should be rated under painful scars at 10% for each side, but it looks like they may not rate this under the proper DC. Instead of painfull scars, it appears they are rating them under disfiguring scars and since they are not that large they could try and get away with maybe SC but at 0%. I'll just have to wait and see what the final decision is going to be.

If I have to get a IMO, it will have to include all the evidence the C&P examiner used and listed plus they will have to give a much more indepth rationale in their reason and basis than what the examiner did, in order to overcome the C&P reason and basis. I might have to save up enough money for such a report, because I don't think my medicare will cover such a report, and examination yes, but the opinion I am not so sure of.

I'll have one year to appeal it, but I was hoping for the added income from this claim to help me with my major one dealing with my major depression and cognitive problems with post traumatic organic personality disorder or personality disorder due to a general medical condition.

Rockhound Rider ;)

[broncovet]

Rock...Read it again carefully to make sure.

If it says, "Veterans condition is AT Least as LIKELY AS NOT" related to military service," then this is good..very good.

However, if it says that it is Less likely than not, then that is not so good for you.

[Railroader]

Don't give up. It took 15 years for me to get SC for my allergic conjuntivis. I've also got a claim for allergic Rhinitis and the remand is for the RO to go over it again as one examiner said that is was likely caused by my deviated septum while in the service. I got 29,000 for my conjuntivis. So hang in there and always do the next step and stay busy until you get the surprise in the mail one of these days. Railroader

[john999]

Rock

No connection between nasal fracture and deviated septum????? That is absurd. They are almost the same thing.

[Hoppy]

Rockhound,

This is my take: They are treating these as direct service connection.

What did they say was causing the rhinitis? What evidence did they use to support their etiology for the rhinitis?

If they did not offer any etiology and only made a determination that it was not caused by the deviated septum then their determination that the rhinitis was not caused by the deviated septum is speculative. An arbitrary statement that something was not caused by a specific event should not be considered evidence. There is no objective evidence against the claim. I have seen BVA decisions whereby the BVA has seen through this type of speculative evidence against the claim.

What you need is some evidence that weighs in favor of the claim. They are looking for continuity of symptoms. The literature does not prove continuity of your symptoms.. The RO has become adversarial with this claim or they are just plain incapable of carrying on an intelligent conversation. The decision should state that the evidence against the claim is speculative and there is no evidence that was given weight in favor of the claim. Instead they blow spoke by talking about the negative evidence. If they were to tell you that there is no objective evidence against the claim and that the literature was not given weigh then you might get the bright idea that you need to get a report from a doctor to win the claim. If they were not adversarial they would explain to you that if you could get some evidence of continuity of symptoms the speculative evidence against the claim will wind up in the trash. The case below was denied because there was a 25 year gap between the military and the diagnosis of sinusitis with no record of treatment in between.

CFR

A disorder also may be service connected if the evidence of

record reveals the veteran currently has a disorder that was

chronic in service or, if not chronic, that was seen in

service with continuity of symptomatology demonstrated

thereafter. 38 C.F.R. § 3.303(b)Citation Nr: 9905326

Citation Nr: 9905326

The veteran reports chronic exposure to

welding fumes and dust in military

service (1967 to 1969). This exposure

along with nasal fracture could

theoretically be contributory to

development of chronic rhinitis and

subsequent sinusitis. Regrettably I

didn't find any medical evidence of such

symptoms and treatment for them in the

veteran's [claims] file since trauma in

1968 until 1993 to 1994. For that reason

I cannot establish direct connection

between nasal trauma in 1968 and current

recurrent sinusitis.

Edited June 25, 2009 by Hoppy (see edit history)

[Hoppy]

Rockhound,

I have been reading more of these. It looks like a good old fashioned nexus letter from a doctor would also be favorable.

They would probably schedule a C&P and try to find post service causes that outweigh the potential for post service development based on the original in service injury. After they put you through all those hoops there is a chance you would get SC'd. If you have a record of treatment from the military to present that would be really hard for them to overlook. You have the option of direct SC or secondary.

As of now I do not see any significant evidence against the claim.

Edited June 25, 2009 by Hoppy (see edit history)

[mags1023]

[Berta]

I sure concur that an IMO is needed here.

As costly as they can be, the amount of research and stress they save us is something to consider as well as an eventual award.

The VARO should consider internet printouts but can reject them because they are generalized and not specific to a veteran's own issues.

I have seen claims won with internet printouts alone but they are few and far between.

My first claims were won with medical treatises and stuff but these days the ROs are either not reading them or as my remand mentioned - listing them as evidence but not opining on them at all.

I dont know what rating you could expect and that is something that needs to factor in when you seek an IMO.

If any private doctor ever treated you-perhaps they would provide an IMO for a very small fee.

I got a free one from a former VA doctor who treated my husband.

It was really only two sentences in an email reply to me but the BVA gave it considerable weight in their recent award letter as it corroborated my other IMOs from Dr. Bash and all of my lay medical evidence.

[Berta]

In some cases lawyers at NOVA (National Organization of Veterans)had advanced IMO costs that came out of the retro.

This is unusual but it would be great if all vets lawyers did that.

One can never determine exactly what an IMO will produce.Sometimes there is no possibility of an IMO supporting a claim.

On the other hand, an IMO doctor is going to read your records more carefully than VA doctors do.They are going to access medical texts that a C & P doc might never have heard of and will be by far more thorough in medical rationale then any assessment you get from the VA.

In my BVA award the board took note of how thorough my IMOs from Dr. Bash were as to the veteran's entire clinical record.

His Agent Orange malpraciced disability went back to evidence and documentation I found in 1988 in his VA medical records. The IMOs concurred with that.

The proper diagnosis of my husband's catastropic disabilities and death due to DMII came first from me and then came from a real doctor.VA never diagnosed him correctly as patient and every C & P on his death (there were plenty)was completely wrong.

No one at VA is going to assess medical records in their entirety like an IMO doctor will. or even as thorough as we claimants do ourselves.

But a favorable IMO depends on the medical evidence.Not every IMO is favorable.

I have local vet who had to get 3 IMos from the same private doctor- who by this time-was pretty ticked off at us.

Then to make matters worse he got mad because the vet showed him copy of his Healthgrades report-which I paid for and got on the internet-

I had to explain that this was what we needed to knock down numerous C & P reports- to show his credential far outweighed the VA doctors.

An IMO doctor must follow the criteria that VA wants.This doctor had never been asked for an IMO before.And never had dealt with VA.I had to prepare the nexus info based on the veteran's SMRs and do lots of other research to support this IMO.

The vet's claim was finally awarded with a good EED (but we filed NOD right away however as they low balled him)

based on the final IMO.

The doctor never charged him a fee at all.But it was a difficult and time consuming rigamorale for a claim that could have been awarded a decade before it was-The vet had ever been to the CAVC twice.

It was finally awarded by the same RO I deal with.

Private doctors, unless they are familiar with IMos for the VA need to know the IMO criteria posted here at hadit, exactly what the opinion is needed to prove, and all med recs and critical documents that can help them such as copies of past C & P exams, etc., any relevant SSA records or awards etc, and anything at all that will help them provide full and complete medical rationale for their opinion.

I suggest when a doctor asks for the entire clinical record that a claimant should prepare a cover letter detailing the citical evidence and then tabbing copies of those specific records. The IMO doc will read it all but this will help them focus on what the specific opinion entails.

[Rockhound]

This is the rationale that the C&P examiner gave. I did not tell her that I had sneezing with my chronic rhinitis and she gives no rationale what so ever for my claim chronic sinusitis. I did present a paper giving the different causes of chronic rhinitis which listed nasal fractures and deviated septum as part of a list of issues that can be the cause, chronic sinusitis was also a problem arising from these two issues. I guess I will have to find another IMO with a good rationale to counter this, in my opinion, bogus rationale.

Rationale: Pathogenesis of nonallergic rhinitis--There is no single unifying theory of pathogenesis for chronic nonallergic rhinitis and it may represent a group of incompletely-defined disorders. However, nonallergic rhinitis can be broadly divided into noninflamatory and inflamatory forms; wit the inflamatory form being further divided into cases that are either eosinopnilic or non-eosinophilic processes. With all forms of chronic non-allergic rhinitis, there is also a variable component of autonomic dysregulation. In the non -inflamatory form, there is no evidence in the medical literature indicating that a deviated septum/nasal fracture causes non-allergic rhinitis.

Clinical features of non-allergic rhinitis which is constant with this veteran includes perenial sysmptoms with prominent nasal congestion and postnasal drainage in contrast with eye symtoms, sneezing and rhinorrhea that are more prominent with allergic rhinitis.

Rockhound Rider B) :( :)

Rockhound,

I have been reading more of these. It looks like a good old fashioned nexus letter from a doctor would also be favorable.

They would probably schedule a C&P and try to find post service causes that outweigh the potential for post service development based on the original in service injury. After they put you through all those hoops there is a chance you would get SC'd. If you have a record of treatment from the military to present that would be really hard for them to overlook. You have the option of direct SC or secondary.

As of now I do not see any significant evidence against the claim.

[Rockhound]

Re-read it and it didn't change any, less likey than (less than 50/50 related to SC nasal fracture and deviated septum)

Rockhound Rider :) :(

Rock...Read it again carefully to make sure.

If it says, "Veterans condition is AT Least as LIKELY AS NOT" related to military service," then this is good..very good.

However, if it says that it is Less likely than not, then that is not so good for you.

[Rockhound]

I did a quick search on the causes of Allergic and Non-Allergic Rhinitis. Of the three groups mentioned, two listed structural abnormalities which included deviated septum.

Since 1998, three expert panels1-3 have published reviews of rhinitis. The first report1 was created by the American Academy of Allergy, Asthma, and Immunology (AAAAI) as a complete guideline for the diagnosis and management of rhinitis.

The second report,3 coordinated by the World Health Organization (WHO), focuses on allergic rhinitis and asthma but includes an extensive section on the differential diagnosis of rhinitis. This report is intended to be a complete evidence-based guideline on the diagnosis and management of allergic rhinitis and asthma.

Without a diffinitive test for allergens, it is impossible to differentiate between Allergic Rhinitis and Non Allergic Rhinitis and they both show causes that can be caused by structural abnormalities such as a deviated septum.

Since there was no history of chronic rhinitis or sinusitis prior to and during my time in service and that the problems associated with Chronic Rhinitis and Sinusitis began after the nasal fracture and deviated septum, the evidence appears to be in equipose or 50/50, the examiner should have have deferred it as at least as likely as not instead of less likely than.

So I guess it's to be a battle of a favorable ENT specialist IMO, against the opinion of the C&P Examining Dr.

Rockhound Rider :(

[Hoppy]

Rock,

I remember from research I did years ago that vasomotor rhinitis was caused by a pre-frontal head trauma that injured the nerve conduction to the nose. If you keep searching I am sure you can find more on this. If you had no pre injury symptoms a doctor would need to address the likely hood that your symptoms are related to an injury. How frequently do people without any history of head injury develop this condition mid life? It sounds like allergic rhinitis has not been identified in your case.

http://www.brookwoodent.com/vasomotor.html

The cause of vasomotor rhinitis remains obscure despite its recognition for many years. We do know that the lining inside an affected nose overreacts to anything that irritates it. Blood vessels enlarge (vasodilate) and this results in chronic swelling and nasal obstruction. There is some evidence that individuals with vasomotor rhinitis have an imbalance in the nerve supply to the nose which leads to the dilated blood vessels.

[Rockhound]

As I try to reply to this post from Hoppy, my new house member is getting in the way, so if my typing seems a bit irratict, blame it on a fisty 9 week old kitten named Tammy. LoL I hope to have some pictures to post as soon as I can find a white bed sheet for a contrasting back drop to her brown and gray tabby markings.

My own research has come up with a number of different types of Rhinitis and it seems that any number of these types can either be caused by truama or by a deviated septom and even if their is an allergic response type Rhinitis, it doesn't exclude any of the others from occuring at or with the the allergic Rhinitis. So as I said before, their is no definitive way to differentiate which is caused by the trauma, the deviated septum, or from an allergy.

The C&P Examiner should have found it as likely as not instead of less than likely as. The evidence for or against SC should have been shown to be equal and their fore SC'ble.

Rockhound Rider :D

Rock,

I remember from research I did years ago that vasomotor rhinitis was caused by a pre-frontal head trauma that injured the nerve conduction to the nose. If you keep searching I am sure you can find more on this. If you had no pre injury symptoms a doctor would need to address the likely hood that your symptoms are related to an injury. How frequently do people without any history of head injury develop this condition mid life? It sounds like allergic rhinitis has not been identified in your case.

http://www.brookwoodent.com/vasomotor.html

The cause of vasomotor rhinitis remains obscure despite its recognition for many years. We do know that the lining inside an affected nose overreacts to anything that irritates it. Blood vessels enlarge (vasodilate) and this results in chronic swelling and nasal obstruction. There is some evidence that individuals with vasomotor rhinitis have an imbalance in the nerve supply to the nose which leads to the dilated blood vessels.