One For You Berta As Medical Lay Person

[Rockhound]

Berta: I was a Hospital Corpsman in the Navy. To get their, I had to attend both an A school and B school before being allowed to receive orders to my first duty station as a HN/E2 Hospitalman. At that rank I served at several posts, to include, ward duty with new born infant care and then infant intensive care unit. from their I was transfered to my second posting to ward duty on a proctology surgical recovery ward. This was followed by a posting in the Cardiopalmonary lab as their administrations clerk, also serving as the clerk for the cardiopalmonary lab school. Next duty rotation I served at a Drug Rehab center as an intake physical evaluation clerk. acting as a physicians assistant in giving physicals and assisting the Dr with minor out patient surgical percedures. Upon my request at this time I was transfered from shore duty to Sea duty as a Junior medical officer/ Hospitalman 3rd class aboard a small class DD/Destroyer, where I attended to the medical needs of the enlisted personel aboard ship, this included conducting Sick Call twice a day and any and all emergencies that might arise. One of the duties, of which is of great importants, is that I was also charged with keeping all the medical files of the enlisted men, making entries as needed to show any illness, injuries, and/or treatment that I may note or dispense in the course of my duties. These would be the medical entries that the VA would look at to determine if an injury or illness had occured during service. It was also my duty to keep track of the quality of the potable water aboard ship and the control of any pests or vermin that may have made its way aboard with the use of US Navy regulated pest control chemicals.

Upon my transfer back to shore duty, my temporary duties were at a dispenseries imunisation clinic, dispensing the various shots that are necessary for those personnel who travel to foreign shores. My last duty station was as a Security Personnel at a Navy Hospital as a junior petty office of my post with personnel under my command. At this time I was approved for re-enlistment with approval to attend a Specialty School of my choice and advancement upon its successful completion. This is when I became ill and the time I was injured.

After leaving the service I attended College where I took and passed a class in Human Anatomy and cirtification as a EMT I/ Emergency Medical Technician. As you can see, I have had a varied amount of education and practicle experience in a number of areas, but I note my limited time aboard ship provided the most applicable training and experience of them all, not that the rest didn't have any meaning or cary any less weight in my medical career.

In the course of compiling my claim for my SC nasal fracture and deviated septum and now for secondary issues, I have researched the conditions for which I claiming and find that I probably have or has just as much knowledge about the condition as one would expect of a nurse practitioner except for the surgical aspects of the condition. But for the general knowledge necessary in conducting a physical exam, noting symtoms and their severity and the general knowlege in the basic treatment of these problems, I feel I am just as qualified in my opinion as that of a Nurse Practitioner. However I may have to do some point to point research on lab results and such, and time to update the list of pharmacology used in possible treatments that I would recommend, but on a one to one basis, I think my qualifications as a medical layman should have some weight comparible to that of a NP in this instance.

I know this sounds like a rant to some or most, but my training and experience should have some meaning and cary some weight in this case, at least more than just my word on the matter. What do you say and how do I get my training and experience noted?

Rockhound Rider :)

[broncovet]

Rock

I agree with you. The VA frequently contracts with QTC for VA medical exams performed by persons with LESS than a medical degree, and then use this evidence to deny Veterans claims on a regular basis. If the VA can cite medical opinions of non Doctors to deny claims, then medical opinions less than a MD should be able to be used as evidence to approve Veterans claims as well.

Also, the VA has rating specialists who are rarely qualified in either the medical or legal fields, yet these rating specialists make determinations of a legal and medical nature on a daily basis. Often the rating specialists lack of knowledge in either the medical or legal fields shows up at appeal decisions.

Since the VA uses a layperson's opinion (a rating specialist) to judge the validity of a doctor's opinion on a Veterans condition, why would it not make sense to also consider your lay medical opinion? Your laypersons opinion should be just as valid as a rating specialists laypersons opinion!

The only real answer is for your doctor to rate your claim and give you a rating, and then have a lawyer review it to see if it is legal. The VA does not do this, and instead relies upon the medical and legal opinions of a layperson rating specialist to determine your rating. Therefore, your lapersons opinion is just as valid as a rating specialists opinion, assuming neither of you are lawyers or doctors.

[BoonDoc]

This reminds me to go take my medicine before I flame someone.

BoonDoc

03:33 AM' post='162592']

Yeah, it does sound like a rant. I'm certainly glad this is only "your opinion" of yourself. You are sadly mistaken to think that the basic and limited training you have even comes close to that of an NP/PA, you have no license. Any idiot can get an EMT card, and corpsman training is limited. The internet for all the good it does, produces people like you who claim to have actual medical knowledge. You are very sadly mistaken to think that "your qualifications as a medical layman" have any weight to that of an NP, you have no qualifications or license. Oh and I love your self proclaimed statement "acting as a Physician Assistant", and I won't even address the "junior medical officer" comment (LOL). Personally, I can't believe that you can begin to buy your own BS, any RO, DRO, or court would laugh at you and your claim to fame. And in case you are wondering, I'm finishing up my NP program in December...

Also, it sounds as if you are suggesting that with your "extensive knowledge" you would be able/willing to give "one on one" recommendations to others on this web site. If so be prepared for prosecution as it is against the law to "practice medicine" without a license.

Next time PM Berta and don't put crap like this out for everyone to read and respond to. I also want to caution other vets, beware of this person and their false claims...

I apologize if i've made anyone else angry by my reply, but I can't ignore this post. It is a personal insult and misleading to others....

Bergie

[Berta]

NVLSP has stated that the VCAA considers "competent lay evidence" "as any evidence not requiring that the proponent have specialized education,training,or experience."

In a few BVA cases the veteran themselves had a medical background which was mentioned in the decision.

NVLSP goes on the state:

"Lay evidence is competent if it is provided by a person who has knowledge of the facts and circumstances and conveys matters that can be observed and described by a lay person."

Lay evidence can also be treatises and probative internet printouts that a lay person can fully associate to the specific clinical record.

I hope I didnt present my situation wrong here.

I won wrongful death claim FTCA and Sec 1151 claim with "competent lay evidence" of a medical nature-

that is- I studied the disabilities my husband had as listed on his death certificate and autopsy and discovered malpractice and took VA step by step as to how the malpractice occurred.

The medical evidence itself was the 'competent' factor- prime facie-

but it took 3 years for those awards.

VA was different to deal with in those days.

I also re-opened my husband's SC claim and provided competent lay evidence of a medical nature. That too was awarded - based on the medical evidence.

I felt when I re-opened the SC death claim 6 years ago- the VA would give the same credence to my submissions of prime facie evidence for that claim.

I was wrong-they never read any of it at all.

Before I contacted Dr. Bash-knowing his fee would be high-I made sure I could give him absolute bonafide evidence for my claim-

I emailed him as to a few specific records and he emailed me back-if you have that-this is a good case.

If a real medical doctor could interpret only a few pieces of my evidence that fast- that just goes to show Rockhound -that the VA has definitely become arbitrary and capricious-by ignoring whatever they chose to ignore.

Ten years ago I could deal directly with the VA Strategic Health Team in DC.

I dont know if I was allowed to do that or not but I contacted them and through them I learned why they had denied the FTCA claim at first.The RO had held back critical evidence from them.When I learned that I faxed it to them and soon thereafter got an award.

Evidence for my 2003 claim however was completely ignored by the RO for 6 years.

This was medical evidence presented to them by a competent lay person-me.Then I got 3 IMOs-competent medical doctors- it was still ignored.

My long point here is that competent lay evidence -whether the claimant has any medical expertise or not- is only as good as the medical evidence they have.

We all send to the VA competent lay evidence of a medical nature every time we rebutt a SOC. Most of us know more about our disabilities than the C & P experts do.

Claims have been won that way.

A C & P exam that denies a claim is our opportunity to rebutt-with medical evidence as a competent lay person-the reasons for denial.

I gained quite a background in DM II and cardiology and other stuff- up to the level I needed for my claims-

that helped me knock down many C & P results over the years-

but still I am only a lay person -who brought to light in my rebuttals the medical evidence in the clinical record itself-from VA- that revealed the negative C & P exam results were inaccurate medically

so -

it still means that it takes medical evidence to succeed in a claim-

regardless of any medical background we might have-

The C &Ps I knocked down were from VA Endocrinologist, Neuros and 2 Cardiologists.

They were "competent" highly trained medical experts with lots of diplomas on their walls.

Neither any of my psuedo medical expertise nor their real medical expertise won those claims.None of my costly IMOs won the claims.

Medical Evidence won them.

But these days when the VA has a IMO from a real doctor and if they will actually read it-the IMO can bring all of the medical evidence to light with a full 'medical rationale,-and if favorable to the claimant-then the VA rater can justify the award they make because they have the IMO to back up their decision.

[cannoncocker]

I was in Nurses training for 1.5 years befor I enlisted, in an Associate Degree in Nursing Program. I had one Clincial and 1 Microbology class to take the exam and be a registered nurse. Before you say it, Slow car and fast women was my actual major. Actually I was young and quite dumb. But I would absolutely agree, it is all about the experience. Those two classes would have left me as green as a twig. I could have passed the exams but god help the patient i tried to catheterize for instance. Experience,experince, experince. But I suppose they have to use some form of measurement and cut off but you do have training so I see no reason your clinical observation should carry some weight, minus the conflict of interest.

QTC. I have seen some that I would pay to see again on my own. Excellent. Others, if I had an infarction in the waiting room they woud just brush me up and deliver me to the dumpster. But they were all qualified on paper.

Limited experience though, but it is clear who some were working for and clear they knew who they were working for and wanted to continue to do so.

Bottom line, your opinion as a trained care giver should crry more weight than an electrician for example. how that would be implemented?

PS I just saw the Berta post and did in my claim post the NIOSH lifting chart, which in field artillery, was engaged in repetitive lifting of projectiles that weighed more than I do, which is in far of excess of the accepted limits. The VARO giggled and told me to go tell my priest.

Edited August 27, 2009 by cannoncocker (see edit history)

[gp747]

:) i wired a chicken coop one time, does that make me an electrician?

just kidding ,couldnt resist.

Edited August 27, 2009 by skunk (see edit history)

[Berta]

forgot- the NVLSP quote- VBM -2008 Edition page 1401

Also a competent relative can provide VA with medical statements if they have medical background.The BVA has accepted opinions from relatives who had medical expertise.That doesnt mean the opinion made the claim succeed however but added weight to it for the veteran-just like a buddy statement does.

My ex husband is a nurse and said he would provide me with an IMO if needed for my claim.

However- although I appreciated his offer, he did not have the expertise I wanted when I decided to get an IMO-I had MRI results that were critical to my claim and Dr. Bash had the expertise to interpret the MRI and he didnt.He had never read an autopsy either and did not have any specific expertise in diabetes.

He asked if VA would even accept an IMO from an ex husband-but actually they would-

He was listed on my 21-526 as prior marriage and would have stated in the IMO his relationship to me because it didnt matter if he could provide the type of IMO I needed.

I feel terrible every time I suggest to a vet that they should get an IMO.

I have dealt with the VA for over 20 years and unfortunately IMOs are often the only way to succeed these days.

Still persistence can pay off without an IMO-because if the medical evidence is there -persistence will get the VA to consider it at some point properly.

But our enemy is time.VA knows that.

I strongly suggest that a negative C & P exam be rebutted line by line.Use direct references to the clinical records, and quote from Treatises or abstracts or any info well known in the standard medical community that can help rebutt the examiners negative statements.

Raise the rebuttal to a level of doubt for the reader.

Highlight any statement that contains no valid medical reationale.

I even raised the issue that a VA Endocrinologist could not read military time and therefore questioned some glucose readings as to when they were taken.

The clinical record clearly showed the time of readings.

The Endocrinologist did state the "veteran was certainly a risk for diabetes."

I pounced on that with the medical definition of risk and that this VA statement supported the fact that the DMII had been misdiagnosed.

The last C & P I got was by a PA.

I rippped that one apart.

and reminded the BVA that I had succeeded as a "competent lay" person with proving my FTCA and other claims- and I knew more about DMII then this guy did and then stated all the medical errors he had made in the opinion that were not consistent with known medical principles in the standard medical community.

BVA rejected the PA opinion and gave it no weight at all.

The C & P exam results are what controls our claims.

They should attach the actual C & P results to any denial letters.

What they say in the SOC might be quite different from the actual exam results.

Some reps dont even suggest a response to the SOC. I never accepted a single SOC I ever got (got many too) without a full blown attack on the C & P results.

[cannoncocker]

Was it part of an apprentice program, the chicken coop bit? Seems the order of posts got switched. Anyway quite funny but the end.

Edited August 27, 2009 by cannoncocker (see edit history)

[gp747]

Was it part of an apprentice program, the chicken coop bit? Seems the order of posts got switched. Anyway quite funny but the end.

did not work out as i wound up with some broilers

[cannoncocker]

To Berta's post:

"I feel terrible every time I suggest to a vet that they should get an IMO.

I have dealt with the VA for over 20 years and unfortunately IMOs are often the only way to succeed these days."

I did exactly what you suggested, taking the denial line by line. They ignored that completely. They took the new evidence and deleted/cut and pasted/misrepresented in complete contradiction to their own VA Neurologists hand written notes.

Who do you go crying to then. All I can determine that:

a. Get it out of that reviewers hands

b. IMO (one in my area the ambulance chasers use)

Your opinion holds sway with me and as distateful as going into your own pocket to counter the VA's lies and misrepresentations what choice do you have. I could go on to the BVA with the same evidence but with the time this will take I feel it is good advise to get the IMO/new evidence up front after gathering the MRI discs etc. and having it all ready to hand to the specialist.

I wish there was someone to goto in the VARO that was unbiased and would look at this with new eyes but I don't see that option.

Sad but true IMHO.

[gp747]

Berta: I was a Hospital Corpsman in the Navy. To get their, I had to attend both an A school and B school before being allowed to receive orders to my first duty station as a HN/E2 Hospitalman. At that rank I served at several posts, to include, ward duty with new born infant care and then infant intensive care unit. from their I was transfered to my second posting to ward duty on a proctology surgical recovery ward. This was followed by a posting in the Cardiopalmonary lab as their administrations clerk, also serving as the clerk for the cardiopalmonary lab school. Next duty rotation I served at a Drug Rehab center as an intake physical evaluation clerk. acting as a physicians assistant in giving physicals and assisting the Dr with minor out patient surgical percedures. Upon my request at this time I was transfered from shore duty to Sea duty as a Junior medical officer/ Hospitalman 3rd class aboard a small class DD/Destroyer, where I attended to the medical needs of the enlisted personel aboard ship, this included conducting Sick Call twice a day and any and all emergencies that might arise. One of the duties, of which is of great importants, is that I was also charged with keeping all the medical files of the enlisted men, making entries as needed to show any illness, injuries, and/or treatment that I may note or dispense in the course of my duties. These would be the medical entries that the VA would look at to determine if an injury or illness had occured during service. It was also my duty to keep track of the quality of the potable water aboard ship and the control of any pests or vermin that may have made its way aboard with the use of US Navy regulated pest control chemicals.

Upon my transfer back to shore duty, my temporary duties were at a dispenseries imunisation clinic, dispensing the various shots that are necessary for those personnel who travel to foreign shores. My last duty station was as a Security Personnel at a Navy Hospital as a junior petty office of my post with personnel under my command. At this time I was approved for re-enlistment with approval to attend a Specialty School of my choice and advancement upon its successful completion. This is when I became ill and the time I was injured.

After leaving the service I attended College where I took and passed a class in Human Anatomy and cirtification as a EMT I/ Emergency Medical Technician. As you can see, I have had a varied amount of education and practicle experience in a number of areas, but I note my limited time aboard ship provided the most applicable training and experience of them all, not that the rest didn't have any meaning or cary any less weight in my medical career.

In the course of compiling my claim for my SC nasal fracture and deviated septum and now for secondary issues, I have researched the conditions for which I claiming and find that I probably have or has just as much knowledge about the condition as one would expect of a nurse practitioner except for the surgical aspects of the condition. But for the general knowledge necessary in conducting a physical exam, noting symtoms and their severity and the general knowlege in the basic treatment of these problems, I feel I am just as qualified in my opinion as that of a Nurse Practitioner. However I may have to do some point to point research on lab results and such, and time to update the list of pharmacology used in possible treatments that I would recommend, but on a one to one basis, I think my qualifications as a medical layman should have some weight comparible to that of a NP in this instance.

I know this sounds like a rant to some or most, but my training and experience should have some meaning and cary some weight in this case, at least more than just my word on the matter. What do you say and how do I get my training and experience noted?

Rockhound Rider :)

just to let you know i know nothing about what you are describing and i in no way was trying to put you down with my chicken coop joke. i have no opinion on what you are describing and was just trying to have a little humor and have the highest respect for you rock and berta. so please do not take offense to my corny joke and forgive me if i have given you the wrong impression. love you guys and girls. feel free to take a shot at me when the opportunity comes along.

[cannoncocker]

just to let you know i know nothing about what you are describing and i in no way was trying to put you down with my chicken coop joke. i have no opinion on what you are describing and was just trying to have a little humor and have the highest respect for you rock and berta. so please do not take offense to my corny joke and forgive me if i have given you the wrong impression. love you guys and girls. feel free to take a shot at me when the opportunity comes along.

I thought that joke was directed at me and thought it was funny. This doesn't have to be all doom and gloom. I appreciate you injecting a little humour. I certainly took no offense.

So we're all good and back to the topic.

[carlie]

Berta: I was a Hospital Corpsman in the Navy.

I know this sounds like a rant to some or most, but my training and experience should have some meaning and cary some weight in this case, at least more than just my word on the matter. What do you say and how do I get my training and experience noted?

Rockhound Rider B)

rock,

If you have any type of certificates or credentials from medical training

you could include copies of those to VA to help substantiate your medical training

and professional knowledge. If you are able to do this then VA may have to give

some extra weight to your statements about your conditions.

I have a buddy that is a licensed RN and VA has to give some extra weight to their

statements due to this.

jmho,

carlie

[militarynurse]

rock,

If you have any type of certificates or credentials from medical training

you could include copies of those to VA to help substantiate your medical training

and professional knowledge. If you are able to do this then VA may have to give

some extra weight to your statements about your conditions.

I have a buddy that is a licensed RN and VA has to give some extra weight to their

statements due to this.

jmho,

carlie

As an R.N., I've yet to see that on any of my claims. If you know where a (non-nurse practioner's) R.N's opinion meant anything in a claim, please advise.

[jbasser]

As long as you are a certified professional your statement cannot be ignored as in Ponds V Brown.

http://www.warms.vba.va.gov/cova/dads/99dads/pond.doc

Hope this helps.

John

Edited August 28, 2009 by jbasser (see edit history)

[carlie]

Listed somewhere in M21-1MR is instruction for decision makers on how

they are to consider medical evidence submitted by the claimant on theirown

behalf,due to they themselves being a medical professional.

Perhaps someone will pull it up and post it.

carlie

[Josephine]

I have pasted this directly from my BVA claim granting service Connection for Chronic Anxiety.

I was also a Hospital Corspman in the Navy with extensive training.

Factual Background

In numerous statements of record, the veteran asserts that

her mental illness had its inception during active military

service. She relates her inservice psychiatric complaints,

not to a personality disorder, but to stressors of service to

include numerous instances (associated with training) where

she almost drowned. She also reported that she knew another

soldier named "[redacted]" who she thought might have drowned.

She did not recall her last name and when asked through

correspondence to provide more details as to the approximate

date and location of the alleged drowning, she did not

respond with such.

In support of the veteran's claim, numerous statements were

submitted by family members and others (e.g., her husband,

daughters, and reverend) which attest to the change in her

behavior after discharge from service. Clearly, these

statements infer that she incurred a psychiatric disorder

during service. An October 2004 statement from a fellow

soldier attests to the fact that the veteran was on

medication during service for psychiatric complaints. The

soldier served as a nurse with the veteran and recalled that

they were often mistreated by superiors. She also recalled

that the veteran and "[redacted]" were especially poor swimmers

and that the veteran almost drowned on numerous occasions.

She said that the veteran was finally separated from service

due to her physical and mental problems.

Betty

Edited August 28, 2009 by Josephine (see edit history)

[carlie]

Betty,

It's nice to see a veteran that finally won their claim

and returns to Hadit to help other's.

carlie

[Rockhound]

For the general information to all. To equate what a medic does while in the field or aboard ship to that which a NP might be tasked with, is only seperated by the rules, regulations, and laws that govern them.

I will agree to only one stipulation, If I did quite a few of the medical procedures I was not only trained to do, but was required to do as a part of my duty while a Hospital Corpsman in a civilain setting, I would be tried for practicing medicine without a license, but that is how it is, if you are in the field or aboard ship. Your the medical officer that the serviceman/women turns to first when needed. In the field or on board a small ship, who doesn't have an actual Dr. there. This responsiblity falls on the medic or Corpsman to handle the case. That's how it was when I was in the service.

Out in civilian life, I couldn't do nearly one percent of what I did while in the service, that only being because the civilain regulators had no way of quantifying the training and experiences that the medic/corpsman had during his time in service.

I drew blood in the service, out in civilain life, I would still have to go back and start my training all over again. I did symple surgical procedures, conducted physicals, examined, diagnosed, treated and/or dispensed medications. I even analized blood and urine specimans, drawing the blood myself.

I could go on and on about the different things I did as a hospital corpsman in the Navy that I could not do as a civilian without the so called proper schooling, training, and licensing.

I'm sorry, but my training and experience should have more meaning than it does, even after military service, than being a glorified nurses aid who even now, needs to show they have the proper schooling, training, and licensing these days.

Rockhound Rider :)

[deltaj]

This reminds me to go take my medicine before I flame someone.

BoonDoc

03:33 AM' post='162592']

Yeah, it does sound like a rant. I'm certainly glad this is only "your opinion" of yourself. You are sadly mistaken to think that the basic and limited training you have even comes close to that of an NP/PA, you have no license. Any idiot can get an EMT card, and corpsman training is limited. The internet for all the good it does, produces people like you who claim to have actual medical knowledge. You are very sadly mistaken to think that "your qualifications as a medical layman" have any weight to that of an NP, you have no qualifications or license. Oh and I love your self proclaimed statement "acting as a Physician Assistant", and I won't even address the "junior medical officer" comment (LOL). Personally, I can't believe that you can begin to buy your own BS, any RO, DRO, or court would laugh at you and your claim to fame. And in case you are wondering, I'm finishing up my NP program in December...

Also, it sounds as if you are suggesting that with your "extensive knowledge" you would be able/willing to give "one on one" recommendations to others on this web site. If so be prepared for prosecution as it is against the law to "practice medicine" without a license.

Next time PM Berta and don't put crap like this out for everyone to read and respond to. I also want to caution other vets, beware of this person and their false claims...

I apologize if i've made anyone else angry by my reply, but I can't ignore this post. It is a personal insult and misleading to others....

Bergie

You are finishing an NP program. Is that a neuropsychiatric program? With regard to your post I think I read somewhere that California allows former medical corpsmen to take the state exam to be licensed as LPNs. (Or was that LVNs?).

[Bonzai]

NP stands for Nurse Practitioner, who is a registered nurse who is prepared, through advanced education and clinical training, to provide a wide range of preventive and acute health care services to individuals of all ages.

PA stands for Physician's Assistant, who is a a mid-level medical practitioner who works under the supervision of a licensed doctor (an MD) or osteopathic physician (a DO).