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

[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

[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.