C&p - "mere Speculation"

[kaykay]

If any of the experts would be so kind as to comment on this, I would really appreciate hearing what impact this exam could have on my claim. Does it seem that this examiner who is a GP is simply deferring to the opinion supplied by my neurologist? How much of an impact might this exam have on my claim for service connection?

Despite the C&P examiner telling me there was no doubt as to onset in service, here is how her opinion is worded:

PERTINENT EVIDENCE: Note from Dr. _____, specialist, stating it is his opinion that the initial headaches in services were the onsetting symptoms of MS. He said that patient was recommended for discharge due to the headaches, and that the current literature clearly support that headaches are a clinical feature and can be the onsetting symptom of multiple sclerosis.

"I cannot resolve this issue without resort to mere speculation if it is continuation of headaches in service

RATIONALE FOR OPINION GIVEN: This is a very difficult case, being Multiple Sclerosis is a reslapsing/remitting disease with a variable and impredictable course which behaves differently in different patients. In Ms. ______ case, based on the evidence, I would say it could be that the severe headaches that motivated the discharge of this veteran were the onset symptom of the MS. She continued having symptoms of MS on/off, over years, and finally in 2006 diagnosis was made, and this could be the case of a patient with MS. According to the expert opinion of the specialist, and the evidence of the literature (see below), headache alone, although unusual, can be the primary manifestation of MS, even in the preclinical patient. Unfortunately, we do not have medical information on this patient for a long period of time, which could be due to the same nature o fthe disease, remitting/relapsing, but leave to speculation any objective opinion.

OTHER COMMENT: Neurol Sci (2009) (remainder of citation omitted): Headache and multiple sclerosis. Clinical and therapeutic correlations. "....Headaches has been also described as "unusal primary manifestation...in 20 out of 30 preclinical MS patients ..."

[Thad]

Different condition for me, but my C&P examiner said it would be "mere speculation" on his part to conclude that my left knee was associated with my right knee SC. Then the rating decision said that my private doc's IMO which said that left knee "was" SC had to be eliminated, since it did not agree with the C&P examiner's statement that such a conclusion would be "mere speculation."

I've sent in more documentation and SMRs for a reconsideration and am waiting to hear back, but JMHO:

Assume that this is something that you want or need to overcome; might be better to submit more now rather than wait till after an unfavorable rating decision is sent.

I'll look forward to hearing what others will say. That VA attitude sure doesn't seem to represent the benefit of the doubt between 2 docs one of whom says they can conclude and one of whom says they can't, but I hoped to avoid having to go to appeal where the private doc's IMO might get more respect.

[kaykay]

Different condition for me, but my C&P examiner said it would be "mere speculation" on his part to conclude that my left knee was associated with my right knee SC. Then the rating decision said that my private doc's IMO which said that left knee "was" SC had to be eliminated, since it did not agree with the C&P examiner's statement that such a conclusion would be "mere speculation."

I've sent in more documentation and SMRs for a reconsideration and am waiting to hear back, but JMHO:

Assume that this is something that you want or need to overcome; might be better to submit more now rather than wait till after an unfavorable rating decision is sent.

I'll look forward to hearing what others will say. That VA attitude sure doesn't seem to represent the benefit of the doubt between 2 docs one of whom says they can conclude and one of whom says they can't, but I hoped to avoid having to go to appeal where the private doc's IMO might get more respect.

You've got to be kidding! Your Dr.'s opinion was thrown out because it didn't agree with the C&P examiner's opinion? And they say that the claims process is non-adversarial. I wonder if the fact that my Dr. is a VA specialist will hold more weight.

[desertstormvet]

oh man, mere speculation was in my first opinion and I was denied. Likely as not is what you want buddy.

[kaykay]

Before having the C&P, I already submitted a likely as not opinion from my neurologist.

[Thad]

>You've got to be kidding! Your Dr.'s opinion was thrown out because it didn't agree with the C&P examiner's opinion? And they say that the claims process is non-adversarial. I wonder if the fact that my Dr. is a VA specialist will hold more weight.

My private IMO doc was previous military, board certified orthopedic surgeon, military journal reviewer, etc, etc.

To make matters worse, the VA decision also said that his IMO was disqualified since he'd referred to on-duty decline over 3 or 4 in-service visits, but that "wasn't supported by the SMRs" where they said they only saw 1 visit. So my reconsideration sends all the SMRs my doc referred to, with all the incidents highlighted that they "didn't see."

What I really wanted to tell them was that since they think that a poor review of the SMRs is disqualifying, that they should disqualify their own C&P dr and rating team who ignored the visits that were clearly in the SMRs.

[Berta]

This is odd info here-as to how these C & Ps are being presented-

"Different condition for me, but my C&P examiner said it would be "mere speculation" on his part to conclude that my left knee was associated with my right knee SC. Then the rating decision said that my private doc's IMO which said that left knee "was" SC had to be eliminated, since it did not agree with the C&P examiner's statement that such a conclusion would be "mere speculation." Is that exactly how the VA put it?

One opinion for and one against (assuming both opinions had medical rationale ) means Benefit of DOubt-and award under Relative Equipoise.

After BVA ordered a cardio opinion from the VA on my claim (I had 3 IMOs) I got a VA PA's opinion,instead, and rebutted it.

I also ordered a private cardio docs opinion too-

The PA used 'speculation' as the reason they could not opine favorably on the extensive evidence I had.I rebutted their opinion word for word as the medical evidence clearly established disability beyond level of any speculation.

I also rebutted and had an IMO specifically to rebut another prior VA opinion.

BVA rejected the VA PA's opinion and was left with another VA doc's opinion and my 3 IMos and my rebuttals based on competent lay medical evidence.The cardio doc I paid had not even prepared the 4th IMO yet.I won under Relative Equipoise.

I hope you attacked this decision well in a strong rebuttal.

Edited February 28, 2010 by Berta