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C&p And Your Claim File


jlshand

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Had three C&P exams two weeks ago, ALL with MD's contracted by VA.

NOT ONE OF THESE FOLKS HAD MY CLAIMS FILE!!

The Internist who I learned later will actually gather all the results and write the report to the VA, told me that they (MD's contracted by the VA)were not supposed to have my medical records so THAT they (she)

COULD GIVE A TOTALLY INDEPENDENT AND OBJECTIVE EVALUATION!!!!

What do you all think of this B.S?????

I have a pacemaker ( clearly indicated in all my claims paperwork and notede visually by the technician) but they wanted to give me a treadmill stress test!!!

Now, any first year med student will tell you a pacemaker and treadmill test just dont work real well together

The entire Internist face exam took less than ten minutes

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Unless your disability is so obvious by what they have in limited info- then you are right- this IS BS!

I dont get it- the VA sure comes up with some weird stuff- I saw some great IMOs from Dr. Bash and other private doctors knocked down by the RO and even the BVA because the IMO doctor had not 'physically' examined the patient but yet they had all the med recs to prepare the IMOs.

Now they say they dont need the med recs, just 'examine' the patient? for 15 minutes?

It is bull crap- but all you can do is wait for those C & P results-

In some cases I would think the C & P really would not require the whole shibang and the result could still be OK with the vet.

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  • HadIt.com Elder

Like Berta says, wait for the C&P results and then you probably need to wait for the decision. The decision ususally comes quickly after the C&P. Then you see what they have to say and hire your own IMO or regular doctor to specifically dispute the reasons that you were low balled or denied. This is how I would do it because you don't have a decision yet. I know the TIME thing is what gets us down waiting for a decision so you can appeal the exact reasons why you were denied. There are people who visit hadit who may have a different take on it, but this is my idea.

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The claims file is supposed to have already been read by the examiner (a board certified specialist in the area being examined) and physically available during any C & P. This contributes to the requirement for the exam to be thorough and contemporaneous. Anything outside of this I would argue would be grounds for an appeal of an unsatisfactory or incomplete C & P. I had this bookmarked from M21-1. Has it changed?

M21-1, Part VI, CH. 1. PHYSICAL EXAMINATIONS, SOCIAL SURVEYS, AND FIELD EXAMINATIONS

1.07 SUFFICIENCY OF VA EXAMINATION

a. Sufficient Examination Reports. Be sure the examination is as full and complete as possible under existing circumstances. It must include a brief medical and industrial history from the date of discharge, or last examination, to the current date. It should also record subjective complaints and a complete description of objective findings, stated in concrete terms. A diagnosis of all described conditions should be included. The examination should provide the clinical findings required by the Rating Schedule for the evaluation of the specific disability such as the range of motion in degrees when a joint is being examined. A VA examination not meeting those requirements is insufficient. A claim should not be denied, nor an evaluation reduced, based upon an insufficient examination.

b. Insufficient Reports. Return reports that are insufficient in any essential aspect to the clinic, or health care facility Director, with a statement setting forth the deficiencies to be remedied. If known, include the diagnostic code for the disability at issue. Avoid using language that can be construed as adversarial when returning reports for clarification. For example, use the term "insufficient for rating purposes" rather than "inadequate examination." Use AMIE to return an insufficient report to the examining facility if it was requested through AMIE. If necessary, the Adjudication Officer or Veterans Service Center Manager will discuss unusual cases with the health care officials to ensure proper understanding of the issue(s) at hand.

(6) The rating activity may request that the claimant be reexamined by another medical examiner if compelling reasons exist. To request a reexamination, prepare another examination request and annotate it to show that reexamination is necessary. Include the name and VA station of the medical examiner who conducted the prior examination.

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Vicki

The last C&P exam I had the doctor had to look at the chart to find out my name. I know that this person did not look at my medical records before the exam. In fact there was no examination. I was there for DMII. He just looked at the chart and said "You have diabetes all right", and that was it. I then went to the neurologist who did a ten minute exam and she said you have PN in your hands and feet. I know they did not even look at my records because both asked if I had been in Vietnam. One pyschiatrist asked if I had been in Vietnam and when I said Yes he looked through my records until he found my DD214. In other words he figured I was lying to him and knew nothing about me before the exam.

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Guest allanopie

>One pyschiatrist asked if I had been in Vietnam and when I said Yes he looked through my records until he found my DD214.

Hello John,

I think they have to verify once a vet claims combat or in-country duty. Special consideration & benefits should be provided. The first thing I would want to look at would be the DD-214. Far to many try to claim benefits of a Vietnam combat vet, & were no where near it. If the DD-214 information is correct, they should take additional steps & evidence considerations to assist "COMBAT" vets. If not. They're complete jerks handling your claim.

I'm a Navy Vet & served during the Vietnam Era. My ship was attached to the 7th fleet. I sailed in international waters, but no where near Vietnam. Researching my service history, i've found several occupational exposures to toxins & tried to discuss it with VA doctors. Since i'm not a "Vietnam" Vet, I couldn't get a referral to the Environmental Exposures Clinic on the coast. I tried several times to show them my service records & research. All I gained from it, was a comment in my medical records from my doctor, claiming I brought in all this stuff, claiming all this stuff when the only problem I had according to my service records, was "jock itch". Dr Bash said it was Multiple Sclerosis he saw in the same records. I'm far from being the sharpist tack in the box, but theres a wide range between those two interpretations of the same records.

When I filed for a reopen for hearing loss & bilateral tinnitus due to artillery injury & nearly 4 years of operating, marine high pressure boilers. My claim was first denied by the VA stating in the denial, I basically lied to the hearing loss examiner by claiming I was a "Boilerman" in the Navy, when my Naval occupation was a "truck driver". My DD-214 doesn't say a #^T$^((_())(%#@# about a truck driver.

I have so much BS the VA sitcks in my records, im determined to leave it all there untill I go to COVA. Then, there will be a "long record" of "intentional fraudulent remarks" by VA personell to present as evidence.

I had one remark show up in my records from an examiner, that he smelled alcohol on my breath & my clothing during the exam. They are liein bandits & I have alot of proof.

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  • HadIt.com Elder

Not having your C File at a C&P means that there was no review prior to your exam and that there is not a chance in hell a competent C&P will come from it. If it was me I would have walked around to the Administrator at the VAMC and filed a complaint right there and than.

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Peter and Allan

The C&P before the one where they did not review my file the doctor had wrote down that he believed I was a fraud because I had a college education with a major in pyschology. I appealed the decision based on the C&P and had it overturned and got a new C&P by another incompetent VA shrink. That is when I came to Hadit and got my own IMO's . Two years later I was P&T. I took a lot of shit because I was employed up until 2001 when I took disability retirement from the Post Office. That is when I got serious about my VA claim. As long as I was working the VA did not enter my mind to a great extent even though I put in for increases. I got it up from 10% to 30% and then hit a wall until I was unemployed and totally disabled. I never went for any kind of treatment at the VA until the late 1990's. The last time I was there in 1972 I ended up in the rubber room for two weeks.

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Again, the examiner is obligated to review the claims file and also have it present during the C & P exam. Complaining to the Patient Advocate on site is a good idea, but the veteran should also immediately file an objection with the VARO.

I'm sorry, but I keep harping on the fact as well that the examiner is supposed to be a specialist in the area being examined. Without those two requirements being met, the C & P is a flawed examination, therefore, arguably invalid for rating purposes. The veteran should immediately file an objection with the VARO in that case, as well. The case below shows the Court of Veterans Appeals denied an appeal for a claim of PTSD because the supporting independent medical opinion was not rendered by a specialist in mental health. If the VA can require that the opinion being rendered comes for a specialist in the condition being claimed, so can the veteran.

The VA is very often not in compliance with these requirements. If you feel therefore that your exam was not "thorough and contemporaneous" for either of the above reasons, challenge it through the VARO.

UNITED STATES COURT OF VETERANS APPEALS

No. 91-1586

Sigmond V. Sklar, Appellant,

v.

Jesse Brown,Secretary of Veterans Affairs, Appellee.

On Appeal from the Board of Veterans' Appeals

and

On Appellee's Motion for Summary Affirmance

(Decided May 18, 1993 )

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Again, the examiner is obligated to review the claims file and also have it present during the C & P exam. Complaining to the Patient Advocate on site is a good idea, but the veteran should also immediately file an objection with the VARO.

I'm sorry, but I keep harping on the fact as well that the examiner is supposed to be a specialist in the area being examined. Without those two requirements being met, the C & P is a flawed examination, therefore, arguably invalid for rating purposes. The veteran should immediately file an objection with the VARO in that case, as well. The case below shows the Court of Veterans Appeals denied an appeal for a claim of PTSD because the supporting independent medical opinion was not rendered by a specialist in mental health. If the VA can require that the opinion being rendered comes from a specialist in the condition being claimed, so can the veteran.

The VA is very often not in compliance with these requirements. If you feel therefore that your exam was not "thorough and contemporaneous" for either of the above reasons, challenge it through the VARO.

UNITED STATES COURT OF VETERANS APPEALS

No. 91-1586

Sigmond V. Sklar, Appellant,

v.

Jesse Brown,Secretary of Veterans Affairs, Appellee.

On Appeal from the Board of Veterans' Appeals

and

On Appellee's Motion for Summary Affirmance

(Decided May 18, 1993 )

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Vicki

When you challenge your C&P exam as being inadequate how exactly do you do it? I did it via an NOD. This ultimately led to the BVA two years later. That was a long wait.

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Guest allanopie

>I'm sorry, but I keep harping on the fact as well that the examiner is supposed to be a specialist in the area being examined.

>If the VA can require that the opinion being rendered comes for a specialist in the condition being claimed, so can the veteran.

Hello Vicki,

With a diagnoses of 'neuromuscular dosorder of unknown cause" the VA left me with when they granted NSC-pension(around 1995), I requested an MRI & to be examined by a specialist, in writing, "prior" to the exam.

The C&P dept at the nearest VAMC, provided a "NP" for the first examination.

I complained due to the fact that she refused to view current xrays or labs & include it in her report. I was then givin a PA for the C&P examination. He found all issues service connected in his opinion. The VARO concealed this opinion & contacted an "internal" medicine MD on the staff payroll. The VARO said they wouldn't use the favorable opinion because the PA wasn't "experienced" enough to provide the opinion.

The "Internal" medicine MD at another VAMC, denied SC by claiming I had no health complaints untill the 90's

It took 4 yrs to get a hearing with the BVA. During that time I recieved help through some very kind hadit members & was able to get a Writ sent in. This spured a request from COVA or the BVA,(don't recall) for a specialist in "Orthopeadics" to examine my spine.

I was sent to the local C&P dept again, this time I got another "Internal medicine" MD.

This jerk decided to put an end to it & stated I may be "MALINGERING".

I've "never" seen a "C&P" specialist for any issue except for hearing loss. The only specialist since I first filed in 1975, that has ever took the time to give my records a therough evaluation was Dr Bash .

The VARO, BVA, COVA & the Vet can request for decades, a complete evaluation of their records.

What vets get is what the VA is alowed to choose.

And that is anyone they want to "train" for the evaluations or pay for. That may be the janitor willing to come in on his days off.

Or the Iranian Peadiatrician going to school at the VAMC in another sate, that will deny SC, almost word for word as the other non-specialized VA whores.

This may have changed, but the way I understand it is, the VAMC facility decides who will provide the C&P examination based on the funding they recieve for it or choose to spend on it.

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The point to challenging an inadequate C & P exam is to attempt to get an adequate one, defined by the two conditions we discussed previously in this thread. Filing an NOD through the VARO is the first step to challenging an exam that isn't "thorough and contemporaneous. If you don't get a response within 90 days, I would consider filing a Writ of Mandamus to force the issue. Cite Sklar v. Brown if the issue is the fact that the examiner isn't a specialist. Cite the M21-1 reference, if the issue is the fact that the examiner never reviewed or didn't have the claims file present during the C & P.

When the Board remands a claim back to the VARO, and the VARO does not comply with the Board's instructions, you have grounds to file for a writ of mandamus to force the issue. The VA decides a lot of issues that are out of compliance with the law, so don't let that stop you from throwing the BS flag when you see a violation. The point of this board is to provide us with a means of educating ourselves so we recognize when the VA is out of compliance and we know how to call them on it.

Unfortunately, anything going to the Board or the Court involves a long wait. I've been at this for 13 years, many of us have been at this far longer. We do what we have to do, for as long as it takes.

By the way, when you have an examiner whose command of English is so poor that you feel he/she does not understand you, and you do not understand them, that is also grounds to challenge the C & P exam.

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It took 4 yrs to get a hearing with the BVA. During that time I recieved help through some very kind hadit members & was able to get a Writ sent in. This spured a request from COVA or the BVA,(don't recall) for a specialist in "Orthopeadics" to examine my spine.

I was sent to the local C&P dept again, this time I got another "Internal medicine" MD.

This jerk decided to put an end to it & stated I may be "MALINGERING".

Allanopie, if this is the way the VARO handled the original writ, I would file another one based on the internal medicine doctor not being an orthopeadics specialist. The VARO did not follow the instructions of the Court. If Dr. Bash gave you the IMO for the condition for which you've been accused of "malingering," that would be evidentiary support that you are doing no such thing.

You know, I've gotta tell you. If someone accused my husband of that, I don't care how long it took or how much of my time it required to deal with them, I'd get my rear in gear and go for their jugular. I wouldn't let that go unaddressed, and I wouldn't let the "jerk" who called you a malingerer think he put an end to the whole issue, not by a longshot.

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I probably have the record for the number of complaints filed for inadequate C & P exams. Our local VAMC has one general physician who does most of the C & P exams, even ones which should have been done by a specialist. I have been fortunate enough in the past that I was able to get a copy of the C & P exams shortly after they were entered into the system. If they were inadequate, I did not wait for a denial from the VARO, which would have only caused a longer wait. I would immediately write a letter stating the specific errors in the report and also send a copy of the report along with it. I highlighted all of the areas which were in error. I then requested that my husband be given a new C & P exam, and that the same examiner not be the one doing this exam. In all but one case, this was done and the claim proceeded on. On the one that a new C & P exam was requested and not given and the claim denied, I plan to again appeal based on the fact that a new C & P exam was requested and not given. I will also have a letter from one of my husbands physicians who can also address some of the incorrect information in the exam.

I understand that the VARO does not like veterans being able to get copies of their C & P exams before a decision is made on their claim. To me, I feel that this would save time in the process, since you can catch mistakes before a decision is made which can have an impact on the outcome of your claim.

mssoup1

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Could have added to my earlier report on my three C@ps that although I am claiming PN in both a hand and foot, and this is clearly acknowledged on paperwork from the VA, no questions or tests about these conditions were conducted.

Now ,I guess there could be another round of exams in store for me but the scheduler contracted by the VA seemed to think I am done.

I had in mind at least the prospect of walking out when the MD's had no records of mine but in reality since the prospects for delay and denial are so strong I really did figure I'd at least consider taking the exams then a step in an ultimate direction as well as potentially more, valid criticism of how these cases are handled.

After the stolen records scandal and the possible contaminated flu instruments debacle where are the legitimate voices out there for an entire overhaul of this incompetent ,criminally mismanaged organization ?

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I wouldn't advise walking out of a C & P exam for any reason. Take it, and then challenge it. Or take it, complain to the Patient Advocate, and then challenge it.

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Guest allanopie

>If Dr. Bash gave you the IMO for the condition for which you've been accused of "malingering," that would be evidentiary support that you are doing no such thing.

Hello Vicki,

it knocked the wind out of me a bit. I was over medicated at the time with 3 different antidepressents from a VAMC dr's treatment, so I wasn't up to fighting back very well. Asked an SO to assist, but just got laughed off. When I heard about Dr Bash from Berta, I thought it was the best way to resolve the matter & set the record straight on who's full of BS, my medical records, me or the VA. Ever since, i've been accused on the web & through emails that I hired the big guns & PAID Bash to write what "I" wanted.

Good Lord. What kind of fool do these folks think I am that I wouldn't have medicals records to back up my claims.

I don't let these jerks bother me anymore. My happiness doesn't depend on what a fool working for a thief has to say. Both will get caught in the cookie jar in the end.

Since this internist said I may be milingering, a VA Neurologist said I had a "Brain Injury" and Dr Bash agreed with the PA C&P examiner back in 97 and a Local Dr I started seeing back in the 70's when I first moved to WA state, that my current neuromuscular disorder, spinal sclerosis, stenosis, DJD, DDD, etc was service connected.

The VA has only been treating my MS symptoms & spinal issues since 1993. So maybe it's to short of notice for a C&P examiner in 2003 to view VA diagnoses, xays, MRI's, cat scans & lab reports accumulated for a decade, backed by nearly two decades of private treatment records showing progression & service records showing direct service connection. Malingering? With the records I have, I doubt the VA will deny it again, based on the internists eagerness to kiss their butts over his paycheck.

I should recieve word from the BVA on the medical opinions DR Bash has sent in for the spinal issues, & Multiple Sclerosis any day now.

With my blood pressure running 157 over 134, im trying to be careful of what I get worked up over. This rainy season has me focused on nothing but pain right now & sleepless nights while I wait for "another" letter.

allan

********************************************************************************

****

It took 4 yrs to get a hearing with the BVA. During that time I recieved help through some very kind hadit members & was able to get a Writ sent in. This spured a request from COVA or the BVA,(don't recall) for a specialist in "Orthopeadics" to examine my spine.

I was sent to the local C&P dept again, this time I got another "Internal medicine" MD.

This jerk decided to put an end to it & stated I may be "MALINGERING".

Allanopie, if this is the way the VARO handled the original writ, I would file another one based on the internal medicine doctor not being an orthopeadics specialist. The VARO did not follow the instructions of the Court. If Dr. Bash gave you the IMO for the condition for which you've been accused of "malingering," that would be evidentiary support that you are doing no such thing.

You know, I've gotta tell you. If someone accused my husband of that, I don't care how long it took or how much of my time it required to deal with them, I'd get my rear in gear and go for their jugular. I wouldn't let that go unaddressed, and I wouldn't let the "jerk" who called you a malingerer think he put an end to the whole issue, not by a longshot.

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I understand, Allan. My husband's got hypertension as a by-product of medication he's taking for a service connected disability. That's why I got involved in his claims, so he wouldn't get upset about all this. I can get angry and not let it affect my health, whereas he can't. I have to laugh to myself when I read here that veterans actually go to their respective VARO's in person to discuss problems and drop off their claims. He can't go near the VARO here, I wouldn't know what to expect and don't want to find out.

I want to suggest to you not to expect too much from the Board. They made a passing mention of Dr. Bash's IMO's issued on behalf of my husband, just citing them in a list of other evidence, without giving the required reasons or bases as to why his opinions were ignored and the claim denied. We now have a Court appeal pending, and I'm cautiously optimistic that we'll have better luck there.

I hope everything works out for you.

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Vicki

The VA ignored my clinical pyschologist for years when he said I was unemployable back in the early 1970's. They gave me 10% disability.

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Could have added to my earlier report on my three C@ps that although I am claiming PN in both a hand and foot, and this is clearly acknowledged on paperwork from the VA, no questions or tests about these conditions were conducted.

Now ,I guess there could be another round of exams in store for me but the scheduler contracted by the VA seemed to think I am done.

I had in mind at least the prospect of walking out when the MD's had no records of mine but in reality since the prospects for delay and denial are so strong I really did figure I'd at least consider taking the exams then a step in an ultimate direction as well as potentially more, valid criticism of how these cases are handled.

After the stolen records scandal and the possible contaminated flu instruments debacle where are the legitimate voices out there for an entire overhaul of this incompetent ,criminally mismanaged organization ?

You are absolutely right when you say they dont like our getting copies of the C&P report before a decision is made. That would tend to spee the process up a bit and screw up their delay tactic. Besides , the houston VAro took FOUR MONTHS to send me my service medical records and that was AFTER they told me these records were IRRETRIEVABLE!!!! THe whole process is sad joke which could only be sustained with the implicit support of the CONGRESS and administration

I dont believe for an instance that a determined congressional investigation and or administration ( both present and/or former , intent to change things , wouldnt clear things up.

This is an implicitly supported "arrangement" to keep expenses for Vets strung out, while paying for pet pork projects and administration favored programs.

The truth is as with too many situations where there just isnt enuf political punch, we Vets are just not powerful enough a force!!!

Its a rich mans war and a poor mans fight once again!!!!

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