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]

Thanks, Berta -- yes, that's almost word for word. I assumed that this was part of their deny-at-first approach, and so my reconsideration tried to very strongly rebut that statement of theirs and their omission of relevant SMRs. If nothing else, I thought that the new documentation might help if the reconsideration doesn't work, and it has to be laid out in front of a DRO reviewer. I'm inexperienced, since this was my first rating decision and now my first reconsideration request, but your thoughts on benefit of the doubt matched mine.

[desertstormvet]

hey buddy, if you get denied again ask for a de novo review. Those DRO's have some power and are technnical specialists. The DRO will review everything from scratch as if your claim was neve rated. He won't even look at the reason for denial.

i had good succes at DRO levell. These guys or gals have power. They are required to be at least a GS 12 and usually work under direct control with tha VSCM.

Bud, I hope your granted but this is anotherr avanue if denied. Some of these raters or rater "helpers" willl just deni for stupefd reasons.

the Dro will go strictle by the regs, hence techical specialistt

[Pete53]

Its definitely not a C&P that is what you want but the benefit of doubt and your outside medical opinion should prevail.Don't forget to ask for it. Point out that your opinion is by a neurologist an expert and the VA C&P was done by a less qualified Doc. If you are not awarded you should consider asking for a Hearing.

Good Luck