Would A C&p Likely Be Required?

[BFR]

Greetings all. I did several searches across hadit but didn't seem to find this specific question so I'll post it here.

I'm a veteran of the first Gulf War back in 1990-1991. Recently IBS (Irritable Bowel Syndrome), CFS (Chronic Fatigue Syndrome), and fibromyalgia have been deemed as presumptive conditions.

Since that ruling came out I was diagnosed as having all three by my private physician, (Endocrinology and Internal Medicine). From what I understand from my research there are no definitive tests for any of these conditions. She wrote a beautiful statement for me to submit with liberal use of the magic phrase "In my opinion this condition is at least as likely as not related to military service" for each disorder. (My thanks to the Travis County Veteran's Commission (Texas) for the heads up on the VA's preferred phrasing!)

I wondering if the VA may use a C&P to counter the private doctor's findings. Any ideas or previous experience with filing based on presumptive conditions documented by a non-VA doctor?

TIA,

BFR

[BFR]

I just located the Gulf War subforum. I'd like to move this post to that area since it seems more appropriate, but I dont know how to remove this post. Neither would I want to double post.

What's the most appropriate action?

[Notorious Kelly]

BFR,

That's great that you got those statements.

I don't know much about presumptives but I'd expect C & P's for any claims with the VA.

[pacmanx1]

It is normal for VA to request a C & P exam. The C & P exam could go either way, the C & P examiner can say that he or she believes that your conditions are related to your military service or the examiner can say that your conditions are not related to your service. The key is to have treatment records showing that you are being treated for these conditions. Currently there are no test that can prove these conditions, the diagnoses are based on the doctors medical opinion and examining you over a period of time. As long as you have a doctor's opinion that these condition are related to your service and the doctor gives a good medical rationale then VA will have to award your claims. Don’t take this the wrong way, VA may deny your claims but eventually award them

Hope the Best

[Berta]

"I wondering if the VA may use a C&P to counter the private doctor's findings"

That happens a lot- if the IMO complies with the IMO criteria (here at hadit) and it sure sounds like it does, then VA weighs any negative VA opinion against a favorable private opinion.

Under the Benefit of Doubt Regs- when the evidence for and against the claim is of equal merit-the veteran's claim should succeed.

Make sure you have proof of mailing for this IMO and make sure the VA considers it.

Pete is right- although this could go smoothly and the C & P sure could support the claim as well-

if VA can ignore strong independent medical evidence they will-

My last claim took 7 years because the RO refused to read my med evidence-to include 3 strong IMOs.

Have you received a VCAA letter yet?

[BFR]

Thanks, Berta and Pete.

The last several times I submitted claims I did it on my own. This time I went with our county's vet rep and filed everything through her. She makes a copy for me, a copy for her archive, and sends a notarized copy to the VA with a cover letter.

I'll have to ask about some of the acronyms used: IMO...is that independent medical opinion? I don't know what the VCCA letter is. I did get one asking if I had more evidence to submit that I answered and mailed back. Soon after that my rep mailed in all my evidence.

For each component of GWS I looked up the VA's criteria and rating schedule. I used that to create a template for my private doctor to use along with the suggested phrasing. She used that to create 7 pages of evidence for me to submit, using VA's terminology where possible. I suspect that the VA is more receptive to this approach than others.

I did an IRIS inquiry and got this response last week:

Our records indicate that your claim opened on August 24, 2010, for Gulf War Syndrome, was made ready for decision on October 25, 2010. All of the requested evidence has been received and your claim file will go to the rating board, the team who reviews evidence and makes decisions, for review. If additional evidence is needed, you will receive a letter from the regional office informing you what is needed. If no additional evidence is needed, we will make a decision.

Unfortunately, we can't provide a time frame in which this will occur as this depends upon their current caseload. Once a decision is made, your claim will then be given to the staff that reviews the information for accuracy and approves the payment, if applicable, which is usually the final step. The rating decision will be sent to you by U.S. mail when the claim is completely finished.

I don't know if this is the step at which a C&P might be requested or if they're ready to make a ruling (when they get to my stack of paper).

[Bravo6]

I don't know if this is the step at which a C&P might be requested or if they're ready to make a ruling (when they get to my stack of paper).

Yes. This is when "they" (VA) will schedule the C&P exam because they see that one was not given for the claim. The VA wants to have their doctors look at your claim before they render a decision!

Best of Luck!

B6

[Berta]

Yes-IMO Independent medical opinion or IME independent medical exam.

The criteria is here under "Getting an Independent Medical Opinion."

It sounds like your IMO doctor gave a very good opinion.

[Testvet]

the VA requires C&P exams if you use VA doctors or private doctors that make the diagnosis the diagnosis is one thing then they have the C&P doc determine how severe it is then a "rater" decides what percentage they want to assign to your claim they may lowball it, they may award it the proper percentage

if they low ball it then you can file a Notice of Disagreement (NOD) and appeal it sometimes a DRO hearing can resolve the issue quicker than the BVA appeal will or you can skip the DRO hearing and go straight to BVA with it, it seems that DRO hearings seem to take about one year while a BVA appeal can be anywhere from 2-4 years before it gets done

nothing is fast with the VA claims process except denials seem to be done quickly

[BFR]

nothing is fast with the VA claims process except denials seem to be done quickly

Boy, don't I know it!