Gripe With Nurse Practicianers Doing C&p Exams And

[Rockhound]

Now I know why I am of the opinion that NP do not have the experience or training to give professional medical opinions that even at times, a more qualified MD and/or specialist can get wrong when they don't consider, not only all the patients medical history and problems, or compair what they have found to a differential diagnoses as well.

Case in point, the NP is so convinced that my symptoms are so consistant to Allergic Rhinitis and that it is not, in any way related to my SC nasal fracture and deviated septum, that they made no attempt to add that their where other diifferential diagnosis that could and do have the same type of symptoms. Nor do they deem it necessary to give any mention to those NSC problems that I have, that could explain for one or more of these symptoms.

If I take but one of the symptoms, such as the eye symptoms, these same symptoms can be explained away by the fact that I not only have a Autoimmune disease that is know to cause eye problems, an eye problem with dry eys syndrome, and oh yea, I have mild photophoia/sensitivity to light. These problems are not discused or mention away as to how these conditions have no bearing on their opinion that I have Allergic Rhinitis.

Finally, they are so sure of their opinion that felt it was no even necessary to have any test or such to even show what it was that I was allergic to to cause my symptoms, yet the also opinion that I have a history of Sinusits and also Chronic non Allergic Rhinitis, failing to say how either of these conditions can cause the same sympptoms and/or be present at the same time.

Neither of this matters, when my claim deals with how my fracture nasal bone and deviated septom are causing the problems or if not the cause of my present congestion and obstruction problem, they have made my chronic issues significantly worse than what they would normally be in the course of their disease process. It is shown by a differntial diagnoses, that an acquired structural change of the nasal passage, such as would be in the case of a nsal fracture and a deviated septum, cand and does cause these same symptoms of congestion and can make any one of the problems mentioned, worse than they would normally be, such as to make a non chronic nasal condition to become chronic and/or make the symptoms worse.

All this gives rise to my paranoia, that the VA is not their to help us get what is due us, but that they are their for the government, just to save as much money as they possibly same or keep the claims open long enough, in the hopes that we either drop the ball on the claim or die before we can and usually, do get SC in the end, especially those who do have anyone to carry on the claim who would also has a claim in the matter such as a wife and or child.

I'm left with trying to get, yet another IMO, to add to my DRO request and I suspect another year and maybe more time, before I here on it, and even then it would probably still end up being appealed to the BVA.

The longer this goes on, the worse my mental pictue seems to become. I guess its time to think on getting a few days stay at the VA loony ben again, just so when they adjust my medication, I don't have to worry about who or how I am going to manage to take care of myself.

I guess I better go take my meds like a good boy, I was so out of it, I forgot to take them after dinner tonight and I guess it shows. It goes to show how dependant I am on these meds, to at least keep me on a simblance of an even keel.

Good night all and I hope you all have a nice holiday week end,

Rockhound Rider :D B) :o :o

[Testvet]

Rockhound this is where IMOs from board certified doctors comes in handy, on my cardiac problems the VA used a NP, a radioligist, a regular MD to say my cardiac porblems could NOT be related to my SC PTSD, I had three IMOs from board certified cardioligists and one pyschiatrist that all supported my claim that my PTSD eithe aggravated at the least and if not was the outright cause of the early onset of my severe cardiac problems staring in my early 30s, the BVA Judge looked at my board certified docs and looked at the hodge podge of medicas the VA used and awarded my claim use board certified doctors to refute them, you will win more of then than you will lose

the VA does the same thing over and over and most veterans give up rather than spend the money on valid IMOs.....quitting never lets you win

persistence and evidence and better evidence than they have wins claims

[Notorious Kelly]

On my latest Social Security disability denial, they state that my PCP's opinion doesn't matter cuz she's an NP.

"NP (her name) cannot be given controlling weight due to 1) She is not an AMS..."

AMS = Authorized/Acceptable Medical Source?

So that's weird an NP would be doing C & P's.

[Jayg]

Too often I have heard of VA taking a C&P NP or PA's word over an MD's or a specialist's in an IMO. It's ridiculous.

But really it's moot when they are blatantly falsifying the C&P exam results anyway. A janitor could make the report and what difference would it make? My last exam was a complete farce. Range of motion testing? Push it through and don't stop because I yelled. More than once.

Their report went on to:

Say there's no halus valgus on the radiology report... when there is.

Say there's no callosity on the feet... when there is.

Say there's no tenderness of the feet yet I have been diagnosed with plantar fasciitis. Well, that could be argued not to be "tenderness," that's pain! Oh wait. There's none of that either.

Say he began falling because of work in 2008 when I have been falling much longer (fall risk noted in records) and I haven't worked since 2008.(EDIT- since 2004)

The list goes on, and on, and onnn. I rebutted that C&P with some 30 pages of contradicting records from my medical files that they alleged to have examined. I don't know if a DRO or anybody else will read my rebuttal, but they sure as heck will read that C&P exam report! :o

A janitor, heck! A monkey could have given that report.

I need to go soak my head in a bucket I'm so mad again right now....

Edited September 18, 2009 by Jayg (see edit history)

[john999]

I had a PA do my heart C&P. She was training another PA to do exams. Her exam was a joke. She just estimated things like METS. I read the sheet for the exam and she had just ignored the requirements for stress testing etc. I appealed it. What they do it to get the PA or NP to do the exam and a doctor signs off on it. This is just to save money at the vet's expense. I don't know what they pay these PA's and NP's. I know it is all about money. It is a nice way for a doctor to get paid and really never treat patients or have to pay any malpractice insurance.

[Testvet]

On my latest Social Security disability denial, they state that my PCP's opinion doesn't matter cuz she's an NP.

"NP (her name) cannot be given controlling weight due to 1) She is not an AMS..."

AMS = Authorized/Acceptable Medical Source?

So that's weird an NP would be doing C & P's.

Social Security won't accept many things the VA does, nor will the VA normally recognize SSD decisons my cardiac problems were approved by SSD in April 2003 based only on VA records in June 2009 after a BVA award the RO awarded me 60% based on the same reports I was awarded SSD which is a total disability grant go figure 2 government agencies with 2 different standards.....

Edited September 5, 2009 by Testvet (see edit history)

[Rockhound]

The rationale that the C&P Examiner, a NP used, was from the Internet Web site called, "UpToDate". She quoted in her opinion directly from a report, that supposedly supports her opinion, but in this same report it hints at differential diagnosises that may have the same syptomalogy for the problem I am seeking SC for. She relied on a report for Chronic Non-Allergic Rhinitis, then going on to say my symtoms were more consistant with Allergic Rhinitis and that the available literature does not support that Allergic Rhinitis is less likely as not caused by my SC fractured nose and deviated septom due to trauma.

What she failes to state, is that from this same source, UpToDate, a report discusses the differential diagnosis for Structural causes of nasal symptoms, which shows how acquired abnormalities, such as a deviated septum, alter the natural air flow through the nasal air ways and concomitant diseases, such as discribed by the C&P examiner may potentiate/make worse the obstruction caused by the deviated septom. Meaning that a mild deviated septom along with one of these concomitant diseases can otherwise make a mild obstructed nasal air way much worse, more so than it would otherwise have been.

I'm hoping to offer this observation with an ENT IMO hoping after they have had time to study my case, will agree and offer this apposing opinion showing how the C&P Examiner failed to consider all the medical evidence when giving their opinion and medical diagnosis. A diagnosis Allergic Rhinitis, with out any tests to conclusively make a diagnosis, nor anything other than her unsupported opinion, that the problems that I suffer from, chronic sinisitis, chonic non-allergic rhinitis, and/or rhinitis are not directly either the cause of or that they cause these problems to be worse than they would otherwise be.

Also I hate it when the C&P Rating officer makes a medical opinion, such as when they state that they know conclusively where the tip of my nose is located and to what extent the fracture was, when their was only the one brief statement that the fracture occured at the tip of the nose, expecially when, even after a couple of CT scans and an Xray, haven't been able to show the brake, nor have any opinion from the reports on these exams, made any statement as to the fractures location.

I'm just in a sour mood and can't seem to get myself out of it. I may be predudical in my opinion, but what I read from my research thus far, appears to bear my opinion out, that opinion being that it is at least as likely as not that my fractured nasal bone and deviated septom are what is causing my symptoms of Rhinitis and at time sinusitis to not only be chronic, but worse that they would otherwise be, had I not fractured my nasal bone and developed a deviated septom as a result of that trauma.

I do believe I should get, in addition to my 10% SC'd fractured nasal bone with a deviated septum due to trauma, I should be award as secondary, my chronic sinusitis, non-allergic rhinitis, and/or allergic rhinitis, or at the very least, for aggrivation of these NSC problems as if they were SC, as determined by the symptoms, a 10% rating as well.

I won't even go into anything now, about what I see and my PCP see as painfull scar tissue on each side of my nose at this time. I need some time to consider whether or not it will be worth the additional 10% for each side, by seeking an IMO opinion from a Dermatologist specialist or Plastic surgion, who is familiar with scar tissue and can give an opinion that supports that it is indeed, scar tissue and is in part due to my fractured nasal bone and or deviated septom.

Got to go, Tammi says it's time for her Mid Night snack and won't stop bugging me. LoL

Rockhound Rider :o :o

[Pete53]

The only way a claimant can overcome a bad C&P is with a good medical opinion that rebukes it. Concentrate less on who did it but what was wrong with it.

Good Luck

[halos2]

Rock I feel your frustration all the way!! I had the Nurse Practitioner who was fired from ever doing C & P exams and the DRO took her ridiculous half-assed exam results, which were non-sensical, and needed clarification to the DRO to understand what she even wrote... rather than 2 separate physicians IMO's. Go figure right. So my case went to BVA...and sits and gathers dust.

Who am I gonna call?? Ghost busters?? No it is not a joke how us vets get fu*ked by bogus exams, and non-qualified people, and these results determine basically if we live or just exist! The doctors do have to sign off on the exams done by np's. They could just as easily sign off for the janitor cleaning the toilet, and yet the job IS DONE CORRECTLY WITH THE TOILET!!

Now I know why I am of the opinion that NP do not have the experience or training to give professional medical opinions that even at times, a more qualified MD and/or specialist can get wrong when they don't consider, not only all the patients medical history and problems, or compair what they have found to a differential diagnoses as well.

Case in point, the NP is so convinced that my symptoms are so consistant to Allergic Rhinitis and that it is not, in any way related to my SC nasal fracture and deviated septum, that they made no attempt to add that their where other diifferential diagnosis that could and do have the same type of symptoms. Nor do they deem it necessary to give any mention to those NSC problems that I have, that could explain for one or more of these symptoms.

If I take but one of the symptoms, such as the eye symptoms, these same symptoms can be explained away by the fact that I not only have a Autoimmune disease that is know to cause eye problems, an eye problem with dry eys syndrome, and oh yea, I have mild photophoia/sensitivity to light. These problems are not discused or mention away as to how these conditions have no bearing on their opinion that I have Allergic Rhinitis.

Finally, they are so sure of their opinion that felt it was no even necessary to have any test or such to even show what it was that I was allergic to to cause my symptoms, yet the also opinion that I have a history of Sinusits and also Chronic non Allergic Rhinitis, failing to say how either of these conditions can cause the same sympptoms and/or be present at the same time.

Neither of this matters, when my claim deals with how my fracture nasal bone and deviated septom are causing the problems or if not the cause of my present congestion and obstruction problem, they have made my chronic issues significantly worse than what they would normally be in the course of their disease process. It is shown by a differntial diagnoses, that an acquired structural change of the nasal passage, such as would be in the case of a nsal fracture and a deviated septum, cand and does cause these same symptoms of congestion and can make any one of the problems mentioned, worse than they would normally be, such as to make a non chronic nasal condition to become chronic and/or make the symptoms worse.

All this gives rise to my paranoia, that the VA is not their to help us get what is due us, but that they are their for the government, just to save as much money as they possibly same or keep the claims open long enough, in the hopes that we either drop the ball on the claim or die before we can and usually, do get SC in the end, especially those who do have anyone to carry on the claim who would also has a claim in the matter such as a wife and or child.

I'm left with trying to get, yet another IMO, to add to my DRO request and I suspect another year and maybe more time, before I here on it, and even then it would probably still end up being appealed to the BVA.

The longer this goes on, the worse my mental pictue seems to become. I guess its time to think on getting a few days stay at the VA loony ben again, just so when they adjust my medication, I don't have to worry about who or how I am going to manage to take care of myself.

I guess I better go take my meds like a good boy, I was so out of it, I forgot to take them after dinner tonight and I guess it shows. It goes to show how dependant I am on these meds, to at least keep me on a simblance of an even keel.

Good night all and I hope you all have a nice holiday week end,

Rockhound Rider :) :) B) :D

[MikeR]

Had a MD do the first C&P on the foot, and then the VA sent me to the NP for a second one. Both agreed that the foot was messed up and SC'd, neither put it in writing. Denied by the AMC, went to the BVA. Meanwhile my Board Certified Orthopedics Chief OSU foot surgeon composed a 2 page letter showing service connection etiology, and nexus. I sent an appellants brief with it so the BVA attorney had to remand to the AMC, they sent for opine at the clinic and is now back with the AMC "development" team. We shall see what they do. My next stop is CAVC.

[buickx]

Had an NP write a letter in support for a claim....Had a meeting with the va rep, who upon reading it, said " this letter holes no weight, she is an NP. if it were written by a MD, then it would hold weight.....Get a letter from your doctor.....in other words

an c/p exam by a NP is useless....

Edited September 9, 2009 by buickx (see edit history)

[jbasser]

A NP and PA both have a license to practice medicine.

We dont like it but that is t he way it is.

Their opinions hold a probative value and when challenged the challenger often loses.

The only way to rebut a NP or a PA is to get a Medical opinion from a MD who specializes in a particular modality of medicine.

I have had bad and good experiences with NP's.

When an opinion offsets another then the wheels start to turn, It may uaually take a third opinion to balance things.

J

[john999]

You know the VA can hire plenty of NP's and PA's for the salary of one doctor. It is just about cost. My experience with a PA doing a C&P was pretty awful. Of course, some of the MD's at the VA were pretty awful as well.

[poolguy11550]

Every state has different laws about such but generally the PA's must be working under a licensed doctor. A good fight against a poor C&P would be to request the supervising doctor to confirm the PA's findings. Hence, its impossible without a re-examination.

A NP and PA both have a license to practice medicine.

[Pete53]

Every state has different laws about such but generally the PA's must be working under a licensed doctor. A good fight against a poor C&P would be to request the supervising doctor to confirm the PA's findings. Hence, its impossible without a re-examination.

Thanks Poolguy glad to see you back.

[rdnkjeeper]

I have had the samethings happen....Just reviewed my last C&P....he murdered the exam.....Like Pete said concentrate on what is wrong with the exam....helping me stay focused!

[darkhorse]

The last exam had that my chronic diarrhea was having a "moderate" effect on my daily functioning. I let her know I was having 3 -4 diarrhea episodes every day with nausea and stomach pain so severe I would be hunched over in pain in the bathroom. I even had to go to the bathroom in the middle of the exam. My VA medical records also backed all this up. Then she puts "moderate." Three to four diarrhea episodes a day with pain and nausea isn't moderate but severe in my opinion. She said my C-file wasn't available for review. This was for an increase. It's VA medical records so has the medical history right there in front of her on the computer. Why wouldn't she have my file anyway. It had been two months this exam had been sheduled. She didn't even want to look at my VA doctors opinion I handed her.

DH

Too often I have heard of VA taking a C&P NP or PA's word over an MD's or a specialist's in an IMO. It's ridiculous.

But really it's moot when they are blatantly falsifying the C&P exam results anyway. A janitor could make the report and what difference would it make? My last exam was a complete farce. Range of motion testing? Push it through and don't stop because I yelled. More than once.

There report went on to:

Say there's no halus valgus on the radiology report... when there is.

Say there's no callosity on the feet... when there is.

Say there's no tenderness of the feet yet I have been diagnosed with plantar fasciitis. Well, that could be argued not to be "tenderness," that's pain! Oh wait. There's none of that either.

Say he began falling because of work in 2008 when I have been falling much longer (fall risk noted in records) and I haven't worked since 2008....

The list goes on, and on, and onnn. I rebutted that C&P with some 30 pages of contradicting records from my medical files that they alleged to have examined. I don't know if a DRO or anybody else will read my rebuttal, but they sure as heck will read that C&P exam report! :P

A janitor, heck! A monkey could have given that report.

I need to go soak my head in a bucket I'm so mad again right now....

[Testvet]

my advice is to get all of the doctors or NPs medical baord records from the state and it lists what their specialties are in my case the VA had used a NP, a radiologist, a regular MD and their regular C&P doctor as "cardiac specialists" to opine that my coronary problmes were not in any way related to my PTSD, I had a board certified pyschiatrist and a Professor at UCLA who wrote an IMO stating he felt my PTSD had either caused or aggravated my cardiac and hypertension and then I had 3 board certified cardiologists IMO's that stated the same thing so when the BVA Judge saw the print outs on the VA experts he was impressed that my homework was so thorough I love openness in government you can find VA doctors listed thru the state boards as well one of their quacks the x ray doc moved from Columbia to Savanah South Carolina listed it all for me their experts are usually NOT experts

[Notorious Kelly]

Good idea to research the docs.

I noticed Social Security doc who denied me is only licensed for "administrative" medical in Oregon.

Further research on the folks who drink our blood might be revealing.

[rdnkjeeper]

How do you search the Drs? How do you find it?

Thanks

[Testvet]

http://search.aol.com/aol/search?query=sta...eyword_rollover

from there try your state