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

[Rockhound]

I know I need a good IMO and a better IME also, but I am stuck between Medicare and the VAHC, in that neither will give me or allow payment for these. I can get a basic exam and possibly a diagnosis and a recommendation for treatment, but not an opinion such that which I would need to give a rational and nexus statement showing it to be the result of my SC'd problems. Ijust don't have any other source in which to pay a specialist, or find one that would do it and let me pay for it over time or should I win, pay out of my back pay check.

I haven't been lucky enough yet to find a caring ENT specialist or a general MD for that matter, who will help out a Veteran in claim actions like a Lawyer doing pro-bono work for Veterans.

Rockhound Rider B) <_<

Sorry for the bad news - but it gets worse - the courts have upheld the VA's right to use a NP/PA and call them competent. My advise is to always request the name and title (MD, PA, NP, etc) of the examiner so you can do some research on your own if needed.

My fear is this court ruling will mean the VA can decide that a NP opinion is just as valid or more so than an MD. Scary stuff.

In essence, the Court said that if the VA says their medical expert is a medical expert, then it is so ... unless the veteran can prove otherwise.

Here's the link to the article at vawatchdog.org:

http://www.vawatchdog.org/09/nf09/nfsep09/nf091009-3.htm

I was lucky - I had a young shrink do my C&P exam and she was very clear about nexus ("plenty of evidence" to support sc) that I was 100% ("since first treated in military") but the VA rater just ignored it all (like they did the SMR evidence and military shrinks' letters in the first place when they denied me sc) and assigned me 50%. I appealed for a higher rating, got an IMO who said the same thing the C&P examiner did, and was finally awarded 100% P&T by the DRO on the second appeal. What a hassle. And I had a good C&P exam.

Hang in there, Rockhound, and get a good IMO by a EENT doc to support your claim. It pays for itself years after the fact when they send you your retro check.

Hope this helps,

TS Snave

[dav_marine72]

Hi Rock,

I fully understand the BS about NPs. For years I have complained about my back being examined by a NP. I was rated 20% in 2000 for 3 blown discs with sciatica in both legs. I finally had this decision over turned at the U.S. court after the BVA decided to give me 10% for neurological symptoms in my lower extremities. Don't you love how they group both my legs which should be rated separately under this as just one group.

In my case I was lucky to have worked for 14 years prior to March 2009. My back and mental issues now preclude me from working. Along the way because I had insurance I had letters written by podiatrists, neurosurgeons, orthopedic surgeons, psychiatrists, psychotherapists, and chiropractors. To be quite honest until I just won my case at the U.S. court for my back, testicle, right and left foot no weight has been put on these letters. I even paid Dr. Bash $3000 for two separate letters for my back, testicle pain, and high blood pressure. Not only did the RO discredit his IMOs, the BVA never even mentioned them. Every decision I have had made was based on VA personnel.

Luckily I had a VA examiner service connect my back in 2000. I got out of the Marines in 1995 and problems started in 1997. I have service connected feet that broke in service hence giving a nexus for the back but the examiner still stated he thought it was mainly just the abuse the Marine Corps puts on our bodies. Most recently I just received TDIU permanent and total and mind you we have not received the letter yet but my service officer from the American legion read me over the phone some of the verbiage the RO used in their decision. They seemed to base the most weight on a VA mental health examiner. He stated that my mental condition as a whole was not as least as likely the cause of me not being able to work but when combined with my service connected back they produced a significant disability picture as a whole.

Where I am going with this is even though I got letter after letter and IMOs they did nothing for me. I went from 10% in 96 to 80% in 2008 to 100% TDIU P&T in 2009. I also was denied GERD on this same claim. I had asked my NP to fill out my nexus letter because she herself had said she thought it was from all the medications I am on and she said that's not my job it's comp and pens.

The VA and your conditions are putting stress on you as a whole. I would file a claim if you have not yet for adjustment disorder. If you can get the mental service connected you have a better chance of getting the combined rating you deserve.

It's a long road but just keep appealing and fighting. They denied my mental claim 2 times before connecting me. Then they gave me 30% and I appealed that. I'm a man that doesn't show emotions easily so I finally said screw it. I had another exam with the same psychologist and this time I poured it on. Now mind you none of what i did was lies or untrue, I just showed him what I truly face on a daily basis. I told him I drink 4-5 beers a day and smoke weed along with my 3 oxys, 3 roxis, 3 ativans, 6 buspars, a sleeping pill, and the max 200mg of Zoloft. He looked at me and was like how are you conscious after doing this? LOL. Then I told him oh yeah I drive after I do all of this as well. I started crying like I do everyday because of this chronic pain and the fact I'm 37 and my life is gone as I know it. Next thing you know his report was loaded with everything the RO needs to see. So I get bumped to 50%.

Once I filed TDIU they have to schedule you for an exam that looks at all your service connections. The mental health exam has to be by a mental health PH.D and of course a general exam by the wonderful nurse practitioners. The only reason I got TDIU 6 months after asking for it I believe was the mental health PH.D's statement earlier in my post (They seemed to base the most weight on a VA mental health examiner. He stated that my mental condition as a whole was not as least as likely the cause of me not being able to work but when combined with my service connected back they produced a significant disability picture as a whole.)

Morale of the story here, mental health is still directed by the VA to have you examined by a true PH.D mental health professional. I want to make sure you understand that I am seriously disabled and have been for years. I'm 50% mental, 50% back (2 surgeries), 30% asthma, 10% right foot, 0% left foot, 0% high blood pressure, 0% chronic right testicle pain, 0% eczema, and 0% residuals of an appendectomy. I don't know your history or severity of conditions. However, I believe anyone that deals with the VA for disability should immediately be granted a minimum of 10% for stress <_<

I just wanted to share my story as a possible way for you to get what you deserve.

[tssnave]

Rockhound,

Have you tried to find out about any local free medical clinics? How about your local county social services mental/physical health clinics?

The reason I ask is that our paper just ran an article on two free medical clinics and I didn't realize how many services they offered. They don't check to see if you're illegal or not and look simply to help the patient. I mention that because it speaks of an attitude of simply helping when help is needed and not looking at extemporaneous stuff other than what the patient needs. You may find a sympathetic doc at a free clinic.

Also, have you tried your local county mental/medical services? I have used them in the past when I was between insurance and while it rivals Army sick call on a holiday weekend, they also have very helpful folks who work there once you actually get past the waiting room and into a treatment room.

Have you contacted your local DAV, VFW, other vet orgs to ask them if they have anyone they know of who's willing to help?

Have you called local churches and asked if they have a military ministry and if so do they know of any local docs that would help?

Do you have a non gov't assitance center (we have a huge one here that is community run but not gov't run) like a community center or a church resource center that could help?

The phone and phone book may be your best friend right now. At every turn, ask whoever you're talking to if they have any ideas or other places they can think of that you could call. You'd be surprised how plugged in some of these folks are.

Lastly, have you contacted your local paper and asked if they could write a story about your situation and in doing so request assistance from a local physician who could help?

Have you written and/or called all the ENTs in your area asking if they would see you and accept small payments until your claim is determined? Ask to speak to the office managers and see if someone will give you a break.

I know how frustrating it is to be in your position - I had to call over half a dozen shrinks before I found one who had the ability and willingness to write an IMO for my psych claim. It was spendy but paid for itself after 2 months at 100%. If the VA had read their own C&P report it would have saved me lots of $$, time, and frustration but we all know the VA could give a rip about my time, money, or frustration.

I believe in IMOs and hope you will continue to try to get one.

Good luck and keep us posted.

TS Snave

[tssnave]

DAV Marine 72,

Much as I wish you were correct when you write "mental health is still directed by the VA to have you examined by a true PH.D mental health professional," you are not entirely correct. While an initial exam needs to be done by either a PhD or soon to be PdD, a review exam does not. This is true whether you have a mental disorder or PTSD. So, you could have a NP or PA or even a social worker do your review mental/PTSD exams.

Here's the link and info from the mental health exam:

http://www.vba.va.gov/bln/21/Benefits/exams/disexm37.htm

The following health care providers can perform initial examinations for Mental Disorders:

board-certified or board "eligible" psychiatrist;

a licensed doctorate-level psychologist;

a doctorate-level mental health provider under the close supervision of a board-certified or board eligible psychiatrist or licensed doctorate-level psychologist;

a psychiatry resident under close supervision of a board-certified or board eligible psychiatrist or or licensed doctorate-level psychologist; or

a clinical or counseling psychologist completing a one-year internship or residency (for purposes of a doctorate-level degree) under close supervision of a board-certified or eligible psychiatrist or licensed doctorate-level psychologist.

The following health care providers can perform review examinations for Mental Disorders:

a board-certified psychiatrist or board "eligible" psychiatrist;

a licensed doctorate-level psychologist;

a doctorate-level mental health provider under close supervision of a board-certified or board eligible psychiatrist or licensed doctorate-level psychologist;

a psychiatry resident under close supervision of a board-certified or board eligible psychiatrist or licensed doctorate-level psychologist;

a clinical or counseling psychologist completing a one-year internship or residency (for purposes of a doctorate-level degree) under close supervision of a board-certified or board eligible psychiatrist or licensed doctorate-level psychologist;

a licensed clinical social worker (LCSW);

a nurse practitioner, a clinical nurse specialist or physician assistant, if they are clinically privileged to perform activities required for C&P mental disorder examinations, under the close supervision of a board-certified or board eligible psychiatrist or licensed doctorate-level psychologist.

Thanks,

TS Snave

[Testvet]

Rockhound I have a few friends around the country who know a few docs that help what area are you in and do you need a mental, or physical type doc or a more specialized one (hardeer to get, but not impossible)

hell my lawyer paid for my last IMO 600 and I paid her back when I got the back pay and she did my case pro bono so there are people who care and will help if you aren't comfortable putting it here send it to me in an e mail privately testvet@aol.com this will be done thru friends of friends so if you make a promise please keep it it won't only bite me but may keep future veterans from getting help from these same people...always pay it forward

[blanco63]

on 9/13 i posted on a topic, c&p problems, that i believe that 75% of c&p's are done by pa's(np's) and people thought my figure was too high and me insane or something. now i see this topic. is 75% too high or too low ? 3 of my 3 were done by pa's and all were negative, but i did not get upset.i just sent in a recon with a positive letter from my doctor and Increase quickly. doctor's weight over pa's weight = increase(well in my claims anyway). i have another c&p this month and truthfully, i do not know which would be better, pa or doctor. <_<