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]

Blanco I am sure if you look closely at your C&P exams that were done by NPs they had MDs that reviewed them and signed off on the reports that give the C&Ps credibility the challenge has to be of the MD and his or her medical credentials We used this to our advantage at the BVA level as all of my IMOs 4 of them were by board certified specialists they used non board certified doctors and NP doctors that weren't even practicing primamry care doctors how can they expect anyone to accept a radiologists opinion on cardiac conditions when that is his specialty and the VARO tries to pass him off as an expert on cardiology the BVA Judge was laughing when we handed him the state medical board records I love the internet he did not dismiss them as internet garbage as the VARO does all the time heck they dismiss reports from the NCPTSD which is a VA owned site as internet garbage.... they hire to many idiots

[blanco63]

Blanco I am sure if you look closely at your C&P exams that were done by NPs they had MDs that reviewed them and signed off on the reports that give the C&Ps credibility the challenge has to be of the MD and his or her medical credentials We used this to our advantage at the BVA level as all of my IMOs 4 of them were by board certified specialists they used non board certified doctors and NP doctors that weren't even practicing primamry care doctors how can they expect anyone to accept a radiologists opinion on cardiac conditions when that is his specialty and the VARO tries to pass him off as an expert on cardiology the BVA Judge was laughing when we handed him the state medical board records I love the internet he did not dismiss them as internet garbage as the VARO does all the time heck they dismiss reports from the NCPTSD which is a VA owned site as internet garbage.... they hire to many idiots

tv and all - i have seen where the md's signed off but i sometimes i ask myself, did they review them, because those pa's and np's write some strange often made up things. i picture an office in my head where an office clerk hands a stack of forms to his boss and says, can you quick sign these, they're right, all in order and the boss signs about 30 forms in 30 seconds.i may be going too far in what i say next but sometimes i wonder if and think that it possibly could happen. you are at your c&p for acne or something and you have a heart attack and they revive you or god forbid you die, the pa says patient does not meet criteria for say 10% acne ,gives his results/findings to the doc and he signs it. this may be somewhat extreme but i bet similar things have happened and the veteran was given bad results and doc signed. it just seems strange that 3 of my 3 done by pa's and 3 of my friend's 4 done by pa's were against us/pro-va and doctor signs off. that is why i have my doubts. i am so glad my doc never agrees with the pa's. thanks for listening.

[Jayg]

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.

Heh. I know that's right. I went to emergency one late evening when I fell & wrenched my knee pretty badly. I was seen by a very nice but utterly clueless foreign "doctor" who twice commented that I should have come during the day when "the people who know about these things are here"?! :)

Basically, I told this "doctor" what the symptoms indicated and what the treatment should be and that's what he wrote down and did. <_<

(paraphrasing classic 'Star Trek') "Dang it Jim, I'm a machinist, not a doctor! " B) But at least even I know how to treat a wrenched knee. B)

Edited September 18, 2009 by Jayg

[deltaj]

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.

It sounds like you need to go see a doctor outside V.A. who specializes in treatment of chronic pain. Have you applied for Social Security Disability yet? If not, you need to do this immediately while you still have enough work credits on the computer to be eligible for this benefit. When you apply for Social Security don't forget to submit certified copies of your DD214 military discharge because there are military wage credits available. Also since you were at a lower rating in 2008 before you got your 100% rating from V.A. in 2009, you nearly certainly have a potential claim for clear and unmistakable error concerning new and material evidence, a V.A. examination, received during the appeal period of the prior V.A. decision under 38 CFR 3.400 (q) and 38 CFR 3.105. Did you appeal that earlier decision which granted you 80%? Please discuss your earlier entitlement to a 100% rating under these regulations with your appointed representative. Also when you are talking with him please discuss the applicability of 38 CFR 3.400 (o) (2) to your case. Do you have any dependents? If so you are now eligible for additional compensation for dependents. If you have dependents this benefit must be applied for through V.A. and certified copies of marriage certificates, divorce papers, and birth certificates on children should be attached to the application.

Edited September 19, 2009 by deltaj

[deltaj]

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

I READ SOMEWHERE ON HADIT THAT ALL MENTAL HEALTH EXAMS HAVE TO BE SIGNED BY A DOCTOR AND THAT THIS PHRASE IS FOUND IN V.A. REGULATIONS. DOES ANYONE KNOW WHAT REGULATION NUMBER THIS IS FOUND IN? MY HUSBAND'S FILE HAD A LCSW WHO DID A SOCIAL SURVEY (HOME VISIT) WITH THE VETERAN IN 1974 AND HE WAS GIVEN AN INCREASE FROM 10% THE 30%. The exam notes showed he told the examiner he lived on unemployment compensation but there was no discussion of how long he had been out of work. I think the social survey or the supporting notes stated he might be able to work with constant support. He didn't appeal and lived in poverty with marginal employment for many years. Somehow he managed to get enough work credits together to get Social Security Disability beginning in 1986.

Edited September 19, 2009 by deltaj

[dav_marine72]

Hey Delta,

Just when I thought one piece of the system had some integrity LOL. I was basing my statement on the NP who did my general exam saying she couldn't do a mental exam and the fact at the CT RO it's always the same PH.D examiner. I know because I have seen him 5 times LOL. Thanks for the clarification. Next we'll see that a VA janitor is qualified to give spine exams B)