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C&p Exams From Contract Doctors

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Hoppy

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  • HadIt.com Elder

To those concerned folks who have an opinion about QTC exams.

My training as an insurance investigator that specialized in disability compensation claims that were filed under labor law (Workers Compensation) occurred ten years before my battle with the VA. As a result of my training I developed opinions on the subject matter of C&P exams that I started posting on hadit over ten years ago. The focus of my posts was that I thought that any exam that was written by a doctor would favor the party who paid for the exam fee.

The idea that a doctor would favor the party paying the exam fee was the dominating attitude within the workers comp system. As such no plaintiff attorney would ever allow a case to go to court with opinions written only by the employer’s doctors. Even if the opinions appeared to be favorable the attorney would only know if the reports were fully favorable by obtaining an opinion from a doctor who had established a commitment to supporting plaintiffs. This commitment to the plaintiff was so strong that the plaintiff attorneys who I worked with would only get reports from doctors who did plaintiff evaluations only.

We were told in school to choose sides when entering the profession. Either you worked for defense attorneys or plaintiff attorneys. Flip flopping was not recommended. The attorneys who represented me in my workers comp claims did not do defenses. The entire office represented workers only.

When I was at a DRO hearing the DRO told me that he was going to schedule a C&P exam with a contract doctor. My gut reaction was to immediately object and ask for an exam by a VA clinician. I was afraid that the contract doctor might be of the opinion that he needed to write reports that were favorable to the party paying him. I am not saying that the VA has told these doctors to write denials. I am saying that the doctors might have the misconception that they needed to have a VA bias to keep getting referrals.

The VA runs a non adversarial system that has shown over the years that were individuals within the system who were in fact adversarial. As such the DAV and other service organizations were able to get rating procedures changed to protect veterans from maverick adjudicators who had become adversarial. As of yet I have seen no specific steps to protect veterans from what I call “anti-compensation doctors”.

I ran into several of these doctors at VA clinics when advancing my claims for compensation. I interpreted their lack of interest in my claim and their less than factual opinions as adversarial. The fact that I won my claim based on one doctor’s report proved that there were three doctors who were “anti-compensation” doctors who failed to assist me with my claim. I have read many BVA decisions whereby VA C&P examiners who were so bent on denying benefits that the BVA had to explain in their decision that the doctor had over stepped their authority. In one sense this shows that veterans who have the determination to get IMO’s and appeal to the BVA have a chance. However, the VA has the cart before the horse. More needs to be done on the front end to get good C&P reports for the veterans.

There is no question that these “anti-compensation” doctors not only perform C&P exams they work in clinics at the VA hospitals. I have a very wide definition of an “anti-compensation: doctor. An anti-compensation doctor is one who fails to take extraordinary steps to diagnoses and research all avenues available to assist a veteran with a claim. Any doctor who under diagnoses fails to diagnosis or who has otherwise been rebutted or written a single report that was found to be deficient in any level of adjudication within the VA system should be identified on a public board with the specifics of the report made available to any veteran with an active claim for benefits with the VA. The VA seems to think that internal self policing is adequate. I have disagreed for over ten years and have suggested that public releases of information would be necessary to allow veterans to take the steps necessary to protect their interest in VA claims.

In my case, I was able to convince the DRO to schedule the exam with a VA clinician. I would rather take my chances with a doctor who got paid to show up to work whether or not he wrote reports favorable to the VA. As it turned out the C&P exam was written by a VA clinician who had worked at the VA for over twenty years. He was the head of the clinic. I really do not feel he was afraid of losing any pay for writing a report favorable to a veteran. As it turned out it worked in my favor.

The idea of basing a VA compensation claim on a doctor chosen at random by the VA or by a veteran who thinks he found a doctor at a VA clinic who is willing to help makes me want to hurl. The best solution is to have a pool of doctors that is known by the advocates for veterans to write favorable and thorough reports on behalf of the veterans. Good plaintiff attorneys have such a pool.

Hoppy

100% for Angioedema with secondary conditions.

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  • HadIt.com Elder

Its pretty rough beating the VA when their clerks are making Medical Decisions.

If the VA deny's you have to get an IMO. I agree with most of what you said.

Veterans deserve real choice for their health care.

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Its pretty rough beating the VA when their clerks are making Medical Decisions.

If the VA deny's you have to get an IMO. I agree with most of what you said.

I am in the middle of my claim for an increase in my Disability rating. The paperwork was just submitted by my VSO. I am wondering if I should get an IME from an outside doctor only if I am turned down and need to appeal? Getting an IME is very very expensive. Plus I had to literally search the Internet dor docotrs that do IME's. And they seem to have never done Veteran IME's only for civilain companies.

is it better if I se ehow the firs tclaim come sout before I go through with an IME. in other words if I lose my first application, the get an IME? Or get the IME for the first claim?

If I wait and see how the claim comes out their cards will be laid out on the table. As it is now, I am confident I can at least go from my 50% to at least 70% but I am shooting for a full 100%.

Also, I still can't find any recommendations for doctors that do these exams and write a Nexus letter, close to me as well. I did find this Dr. Bash through these froums, but he doe snot answer e-mails and he is 3,000 miles away. And the doctors I did find in Southern California were just grabbed off the Internet, with no recommendation or knowledge about them. Plus they seem to have no experience with Veterans.

The firs time I got my 50% Disability rating, int he 1990's I did not need an IME. But I did expect more than 50%. The 50% did save my life. But I am fully 100% with al my serious problems. I am also on SSDI.

Not in appeals, since I got 100%, and some of it was winning an 1151 negligence, which the VA turns out does not give ful benefits if you win 1151 negligence they squirm and legal loophhole you and your family out of many benefits, really crapp nasty bunch running the va benefits, they wil backstab and scre wyou even if you win you lose. May 2021.

01-01-11_My_Medical_Records2.jpg

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  • HadIt.com Elder

Did you use a lawyer with SSD? If you did they can probably help you find a Doc and you should also inform the VA that you have SSD that could help your claim.

Edited by Pete53
typo

Veterans deserve real choice for their health care.

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I just got a denial based upon a contract doctor's C&P exam. I have not yet received a copy of the exam report but based upon comments made within the denial, it sounds as if the exam was at least outwardly objective. The denial was based upon a reported absense of ankylosis and numbers obtained in rom testing. I'm waiting for a copy of the actual report before proceeding.

However, my last VA hosp rendered C&P exam was horrific. It was utterly damning and, entirely false. They lied about statements made, they lied about records and only referred to records supporting denial omitting many more records counter to those. They falsified statements made and in records. They far exceeded the object of the exam to sabotage my entire claim.

Now I have to go back for another exam there and they won't even tell me what the exam is for. It took them 5 weeks to generate a report on my exam which was flagged to expedite for hardship. They didn't get it flagged this time. It's been 3 months since my DRO hearing, it may be another 6-8 weeks or more until the report of this next exam, not due until the 14th, is released. My DRO has been tasked to give classes and will not be working his cases until that is completed and nobody seems to know when that will be... but I digress.

I am really dreading this one since it is clear they will say and do any and everything to drag me down. :D

I'll go back to that contract doc any time!

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Good Post, Hoppy, and I agree. Even a dog understands, "you dont bite the hand that feeds you."

QTC C and P examiners are very well paid for their work..on the order of $500 per hour.

It is very easy for the VA to simply hire the C and P examiners that write medical opinions to support their position. The VA's position is that all Veterans are crooked and are trying to get benefits they do not deserve. A Veterans own words mean nothing. Even Veterans words spoken to his doctor are not beleived by the VA. In most cases, a Veteran telling his doctor something does not result in benefits..the Veterans words have to be verified about sixteen different ways. Blood Tests, past medical history, DD214's, X rays, MRI's, buddy statements, C and P exams (the medical examiner is selected by the VA..not the Veteran), prescription records, military history, etc, etc, all has to be consistent with the Veterans statements before the Veteran is believed, and, even then, often the Veteran is not given the benefit of the doubt, as required by regulations. Then, the Veterans C and P exams are often lost, shredded, or misinterpreted and which is almost never in the Veterans favor.

There is no requirement that the VA follow its own regulations, because there is simply no penalty when they do not. With the VA's "zero enforcement of regulations" policy, VARO's are free to violate regulations, and there are no penalties for not doing so..not even wrist slaps. The Veteran pays the price when the VA violates regulations...even when the Veteran successfully appeals, the VA has gotten an interest free loan from the Veteran for his retro.

In order to "regulate" C and P examiners, the VA simply flexes the $ muscle. The C and P examiner will simply not be given future examinations if the VA feels they are too lenient with the Veteran in offering medical opinions which award benefits, and, instead, hire an examiner in line with their own agenda.

With the VA in complete control of C and P exams, the Veteran looses.

Almost everyone understands that you dont mess with the guy who signs your checks.

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Good Post, Hoppy, and I agree. Even a dog understands, "you dont bite the hand that feeds you."

QTC C and P examiners are very well paid for their work..on the order of $500 per hour.

This link regarding payment was sent to me by broncovet.

http://www.vawatchdog.org/old%20newsflashe...5-10-2006-9.htm

carlie

Carlie passed away in November 2015 she is missed.

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