Success !

[Hoppy]

This is a success story. However, I am posting in claims and research because I have a lot more to say about the process than just a statement that we won. Also before I get started and bury a question I have in what will be a long post I will ask the question now.

Does anyone know of the process for having a compensation and pension examiner reprimanded or barred from performing compensation and pension examinations? The compensation and pension examiner wrote a report that was adversarial. He wrote an opinion that stated that the veteran's symptoms in the military were caused by a nonservice connectable condition that predated service. His opinion directly contradicted as existing opinion of record. More importantly it is an accepted medical principle that the cause of the veteran symptoms in the military cannot be attributed any single etiology. There were other errors and presumptions made by the clinician.

The fact that a veteran has the ability to rebut or otherwise present evidence in support of the claim does not excuse an individual who is bound by professional standards of doing a professional job. A labor law attorney I previously worked with presented this argument against a professional involved in a workers compensation law suit. I am very interested in pursuing a complaint against the clinician. If you have any ideas please advise me. If this were a workers compensation claim or civil claim the complaint will be filed with presiding judge.

Now for the success story and how the long battle unfolded.

When I first met the veteran he was homeless and living in his car. I tried to get them to go to the VA hospital and see a social worker. As time went on I realized that he was diagnosed in the military under the DSM II with a non-service connectable personality disorder. After reading the service medical records it was obvious to me that under the DSM-IV he would have been diagnosed with a service connectable panic disorder. For the purpose of obtaining a compensation and pension examination we obtained an opinion from the primary care Dr. The primary care Dr. reviewed the service medical records and determined that his current diagnosis of panic disorder was related to the symptoms in the military. This should have been sufficient to get a compensation and pension examination. Unfortunately, the claim was denied without any exam. This forced me to obtain a report from another clinician. I wrote a brief summary of the history of the claim and sent it to a qualified specialist who worked as a staff clinician at a VA hospital. Fortunately this clinician became interested in the case and reviewed all the records. The clinician wrote a very favorable and strong report.

The new report did in fact cause the regional office to schedule a C&P exam. Unfortunately, the C&P examiner made some wild guesses about the nature of the veteran's lifetime battle with panic disorder. What is most bothersome is the report took advantage of speculative theories and flawed conclusions based on invalid experimental designs. The report ignored any symptoms that could be explained by individual differences of symptoms that are known to occur in service connectable conditions that had been diagnosed by treating clinicians and are a matter of record. The most apparent aberration was the problem of assigning a single etiology to the veteran symptoms. Had the etiology been correct the condition would have been considered to have existed prior to entry into the military. The manner in which this was stated gave the false representation that an unconfirmed theory had somehow been validated. I'm of the opinion the examiner did everything he could to write an adversarial report that would result in a loss of benefits. It appears that the DRO gave weight to the opinion of the examiner who was the staff clinician at a VA hospital rather than the C&P examiner.

The good news is that a DRO service connected the veteran at 50%. I have not seen the decision yet. However, I am very sure that the award was based on the report I obtained from the VAMC staff clinician. We do plan to file for an upgrade. The veteran has not worked in four years and has been receiving Social Security for the panic disorder for the last two years.

Edited June 1, 2010 by Hoppy

[MikeR]

Hoppy,

Other than reporting them to the VA IG it is difficult to make a case against these people, many who are contractors trying to make Hay with the VA in order to get a new contract and are in fact working with quotas for denials given to them by the VA. At this point I put nothing past them. The 2009 BVA decision in my case claims that I had a Teleconference with the Cleveland RO in April 2008. I had to call my lawyer and point this out this morning. I never had any Teleconference.....

[*Bergie*]

This is a success story. However, I am posting in claims and research because I have a lot more to say about the process than just a statement that we won. Also before I get started and bury a question I have in what will be a long post I will ask the question now.

Does anyone know of the process for having a compensation and pension examiner reprimanded or barred from performing compensation and pension examinations? The compensation and pension examiner wrote a report that was adversarial. He wrote an opinion that stated that the veteran's symptoms in the military were caused by a nonservice connectable condition that predated service. His opinion directly contradicted as existing opinion of record. More importantly it is an accepted medical principle that the cause of the veteran symptoms in the military cannot be attributed any single etiology. There were other errors and presumptions made by the clinician.

The fact that a veteran has the ability to rebut or otherwise present evidence in support of the claim does not excuse an individual who is bound by professional standards of doing a professional job. A labor law attorney I previously worked with presented this argument against a professional involved in a workers compensation law suit. I am very interested in pursuing a complaint against the clinician. If you have any ideas please advise me. If this were a workers compensation claim or civil claim the complaint will be filed with presiding judge.

Now for the success story and how the long battle unfolded.

When I first met the veteran he was homeless and living in his car. I tried to get them to go to the VA hospital and see a social worker. As time went on I realized that he was diagnosed in the military under the DSM II with a non-service connectable personality disorder. After reading the service medical records it was obvious to me that under the DSM-IV he would have been diagnosed with a service connectable panic disorder. For the purpose of obtaining a compensation and pension examination we obtained an opinion from the primary care Dr. The primary care Dr. reviewed the service medical records and determined that his current diagnosis of panic disorder was related to the symptoms in the military. This should have been sufficient to get a compensation and pension examination. Unfortunately, the claim was denied without any exam. This forced me to obtain a report from another clinician. I wrote a brief summary of the history of the claim and sent it to a qualified specialist who worked as a staff clinician at a VA hospital. Fortunately this clinician became interested in the case and reviewed all the records. The clinician wrote a very favorable and strong report.

The new report did in fact cause the regional office to schedule a C&P exam. Unfortunately, the C&P examiner made some wild guesses about the nature of the veteran's lifetime battle with panic disorder. What is most bothersome is the report took advantage of speculative theories and flawed conclusions based on invalid experimental designs. The report ignored any symptoms that could be explained by individual differences of symptoms that are known to occur in service connectable conditions that had been diagnosed by treating clinicians and are a matter of record. The most apparent aberration was the problem of assigning a single etiology to the veteran symptoms. Had the etiology been correct the condition would have been considered to have existed prior to entry into the military. The manner in which this was stated gave the false representation that an unconfirmed theory had somehow been validated. I'm of the opinion the examiner did everything he could to write an adversarial report that would result in a loss of benefits. It appears that the DRO gave weight to the opinion of the examiner who was the staff clinician at a VA hospital rather than the C&P examiner.

The good news is that a DRO service connected the veteran at 50%. I have not seen the decision yet. However, I am very sure that the award was based on the report I obtained from the VAMC staff clinician. We do plan to file for an upgrade. The veteran has not worked in four years and has been receiving Social Security for the panic disorder for the last two years.

Hoppy,

You can file a complaint with the state medical board if the individual is a doctor. If they are a nurse practitioner file with the board of nursing. The hard part will be finding what state they are licensed in, since VA employees can work in other states without being licensed in the state of employment. Most VARO doctors are local, so check the states medical board.

Hope this helps,

Bergie

[dav_marine72]

Good work hoppy,

I commend you for your help with Veterans!

[MikeR]

BTW You are the Man!

[Berta]

Wonderful work Hoppy!!!!

I am of the opinion that a lousy C & P report that fails to consider the evidence properly borders on downright malpractice.

If we had the same rights as anyone involved in civil litigation-the practice of lousy C & P exams,to save VA money ,would be called to task- by thousands of us I am sure.

The very fact that real doctor's IM0s overrule so many of these C & P reports proves my point---they are tainted reports to begin with in many if not m,ost cases- just to give lip service to a denial that has probably already been determined.

Is the SSDI exactly for what is now SC? If so I suggest you ask them to reconsider and send them the SSA award letter. (They should have had that already)

[Pete53]

Hoppy:

Congrats that poor Vet would still be stuck in the middle of nowhere with nothing more than Social Security. Its pretty easy to get 50% Panic up to 100% and don't forget SMC for agoraphobia.

If it were me I would write a detailed letter and attach evidence and send it to The Director of the VAMC and copy whoever is the chief Doc at the VAMC yes they all have such an elf who Veterans never see. I saw one once when I was told that although I should be able to get Fee Service I would not cause it might make it something other Veterans wanted.

Its gotten better but many of the C&P Docs are retired and feel they owe their check to finding not in favor of the Veterans.