Template: Complaining About C&p Examiner

[fanaticbooks]

New Rough Draft of the C&P Examiner Evaluation Report. Again, very rough, but better than first.

Date

To: C&P Director

VBA

Chairman – VA Senate

Chairman – VA House

CPEP

VARO

From:

Name

Address

Phone

Claim Number

C&P Examination

Date

Time

Place/address

Reason/Disability

Actual Amount of Time Involved

Name of Examiner

Title (PCP, NP, Psych, ?)

Qualifications?

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

Original Claim or Appeal (circle one)

Date of Original claim (mo/yr)

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

Give details as necessary for the following:

Did the examiner—

- Treat you with courtesy and compassion?

- Use the exam worksheet as the guide?

- Have a working knowledge of previous medical records?

- Perform all required tests necessary to diagnose this disability and its impact(s) on you?

- Perform physical exam as necessary?

- Display informed knowledge of the disability to be diagnosed?

- Speak and question consistent with requirements of the exam?

- Write the report noting what was actually performed/discussed in the exam? If not, describe any—

--factual errors,

--omissions,

--discrepancies between the actual exam and the report,

--incomplete diagnose,

--other comments not pertinent to the examination

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

What documentation can you provide to augment your statement?

C&P Worksheet for guidance

C&P report

List Medical,

In My Opinion letters

Dates/doctors/diagnoses, private

OR other such stuff.

Edited March 30, 2011 by fanaticbooks

[Hoppy]

It looks pretty good to me. I tried to find the form that CPEP was developing a couple years ago. However, I had no luck. I wanted to see what type of info CPEP was asking for. It appears they dropped the veterans survey program. I have not heard anything new from them. You might consider a congressional inquiry to see what happened to their program.

Edited March 29, 2011 by Hoppy

[fanaticbooks]

I need some questions that concern mental evaluations. I do not know what to ask.

Anyone out there who could offer suggestions?

Also I forgot to put in about if the examiner looked at any medical records. Will do that once I dwell on it a little. :)

Edited March 29, 2011 by fanaticbooks

[Pete53]

The biggest problem in my opinion is the instructions or lack of them given to the examiner. I also think that the examiner should be told that there opinion should be fair and impartial no more than an honest assessment that addresses a diagnosis, a link to service yes or no and the impact on the Veteran.

[john999]

I had a NP do my cardiac exam. The NP did an awful job. She was teaching another NP how to do cardiac exams. This is inexcusable in my opinion. I have never had a really good C&P exam. I won all my claims on appeals after suffering through these awful and incompetent exams. That is why I have said that the best way to deal with these exams is to have your own IMO doctors. I did spend 18 months going to the BVA to get another exam and I ended up with another one just as bad. The C&P exam is another hurdle we have to get over. I do wish anyone luck on getting this system changed for the better.

[Berta]

"I need some questions that concern mental evaluations. I do not know what to ask."

If C & P examiner decides to state that the veteran is incompetent for VA purposes they should have to give a complete documented medical rationale on that- like how do they know if the veteran pays his/her own bills,cannot write a legible check, cannot comprehend how to handle his/her money etc etc.

When a VA doc declares a vet incompetent and unable to handle their own funds, in some cases this is true and a blessing to the veteran if the vet has a trusted fiduciary-preferably their spouse.

But one only has to read the Fiduciary mess at VA WatchdogToday to see that there is no concern or accountability at all from the VA if VA appoints a fiduciary who squanders the veteran's compensation.

Even if they propose incompetency (and they only do this when it looks like large retro is eminent for MH claims,it takes months for VA to even accept a spouse as the fiduciary-holding up for months more- the veteran's aswarded compensation.

I don't see how any C & P examiner can even determine in any way at all if a veteran cannot handle their own funds except maybe in certain cases.

There is nothing to require a vet to bring copies of their paid bills or their check book to any MH C & P exam.How the heck can they really determine competency ata C & P exam?

I dont get it. VA declared my husband -with catastrophic mental disabilities -as competent- yet I handled all the money and he couldn't tell denominations on bills so hardly carried any cash on him and at some point could not write a check legibly.

But SSA told hm they declared him incompetent due to the level of his PTSD and told him he had right to appeal that but he said he liked it.

The only bill we had that caused us any stress after he became 100% disabled was his student loan.He only owed a small amount a few hundred bucks - and a vet rep told him not to pay it after his date of total disability because he could get a waiver (and he did get one from the VA)

But the student loan people started calling here relentlessly over the Student Loan -knowing he was totally disabled and the waiver was pending.

He was thrilled after SSA called him to tell the Student Loan people he was not only 100% nuts (PTSD SSA) and also had 100% significant brain damage from his stroke but he also was just declared incompetent by SSA so they might as well stop calling him because he was basically a mental basket case anyhow.

I think that stopped their harrassing calls right away and soon he got letter that the loan had been written off the books.It didnt affect our credit either.

[Hoppy]

The idea of using templates specific to advancing any claim as well as

disputing a C&P for a particular condition is a really good idea. These

templates could be specific to each type of disability. They could be used

as a guide to assist in the development of a claim rather than viewed as the

only way to develop a claim. When I was in Private Investigator School and

when I worked with attorneys they called these types of devices "GO BYs".I

feel this type of "GO BY" data base would be a big help to veterans. Use

any information I pass along for your templates. I will probably come up

with one for getting a proper rating for back disabilities in the future.

This URL for the Department of Homeland Security shows how extensive

"GO Bys" are used.

http://www.forwardedge2.usss.gov/fieldGuide/formsAndGoBys.aspx

As you requested regarding mental conditions, consider the following:

A really big ongoing problem with VA shrinks is that they misuse a

personality disorder diagnosis to deny service connection or reduce

benefits. They reduce benefits by attributing the most severe symptoms of

the veteran's mental condition to the personality disorder. I have read

many claims were PTSD was awarded at 50% even though the veteran

was not employable. The shrink says the unemployability is due to the

personality disorder. It appears they are cutting and pasting. Their logic

specific to each individual claim is not developed. The problem that I see

when I read these claims is that the personality disorder diagnosis was not

properly established and the BVA just accepts it as fact.

I have assisted quite a few veterans here on hadit getting the PD diagnosis

rebutted and trashed. The questions I address later in this response are

the things I look for in a report involving a mental health claim involving a

Personality Disorder Diagnosis. Just knowing what to look for can get

veterans pointed in the right direction. The actual plan of attacking a bogus

personality disorder diagnosis does vary on a case by case basis.I can provide

you with excerpts from reports written by clinicians I used to

rebut the personality disorder diagnosis. This would be the type of

information that could go into a template on advancing a claim rather than

reporting a bogus C&P.

There will be a continuing problems because veterans are

put in a position to use doctors chosen at random and there will be clinicians who have

hidden agendas such as they do not feel that mental disabilities should be

compensated for by the VA or that the symptoms of mood disorders or

anxiety disorders are not severe and that unemployability in these cases is

due to personality disorder. I have dealt with three such clinicians in the last

year. As far as your form goes maybe a section when a personality disorder

diagnosis was used to deny or reduce benefits could show that proper

protocol was not used when the diagnosis of personality was made. It could

start with a built in reference to the DSM IV protocol then followed

by the veterans identification of what protocols were not followed.

SAMPLE FORM

Answering "NO" to any of the following questions indicates an inadequate

exam.

CROSS SECTIONAL SYMPTOMS

Page 688 of the DSM IV TR states "The clinician must be cautious in

diagnosing Personality disorders during an episode of a mood disorder or

an anxiety disorder because these conditions may have cross-sectional

symptom features that mimic personality traits and may make it more

difficult to evaluate retrospectively the individuals long term patters of

functioning".

Does the report indicate that the clinician provided an adequate explanation

as to how cross-sectional symptoms were isolated when making a

retrospective diagnosis of personality disorder?

Yes

NO

STABILITY OF SYMPTOMS OVER TIME

The DSM IV TR states on page 686 "The clinician should asses the stability

of personality traits over time and across different situations". The DSM IV TR

states "A personality disorder should be diagnosed when symptoms are typical

of the individual's long term functioning, and do not occur exclusively during an

episode of an Axis I disorder". Does the record show that the veteran provided

the clinician with a complete and verifiable history showing long term functioning?

YES

NO

Does the record show that symptoms of personality disorder occurred

exclusively during a time period when an axis 1 diagnosis was not

applicable?

YES

NO

DIFFERENTIAL DIAGNOSIS

The protocol that a differential diagnosis between anxiety disorders and

personality disorders would involve consideration as to whether or not

symptoms are ego dystonic V. ego systonic. This protocol is well

established in the literature and the DSM IV TR. Page 686 of the DSM IV

TR states that personality disorders often involve ego systonic symptoms.

In addition, the literature clarifies that "personality features are typically

ego-syntonic and involve characteristics that the person has come to

accept as an integral part of the self". Most Axis I disorders, like most

medical disorders, are experienced by persons as conditions or syndromes

that come upon them. Personality disorders, in contrast, will often concern

the way persons consider themselves to be. With an Axis I disorder the

problems and difficulties they experience are unacceptable, objectionable,

and alien to the self. In contrast, the problems experienced by a person

with a personality disorder are often perceived as "ego- syntonic":

acceptable, unobjectionable, and part of the self. Many people with

personality disorders do not even think there is nothing wrong with them

and they do not seek help.

Does the record show that the symptoms associated with the diagnosis of

personality disorder are "more likely than not" ego systonic?

YES

NO

UNEMPLOYABILITY ATTRIBUTED TO SYMPTOMS OF

PERSONALITY DISORDER

Did the record show that unemployability was acceptable to the veteran's

self image? That is, was the veteran satisfied with being unemployable

due to his symptoms of any mental condition?

YES

NO

PSYCHOMETRIC TESTING

Attention is directed to the outline of personality disorders in the APA

manual. Formal psychometric tests are essential in the diagnosis of mental

deficiency.

Was psychometric testing used to establish all diagnoses?

YES

NO

It is recommended if "psychometric testing" was not used to make the

diagnosis, either get another opinion based on psychometric testing, or if

the veteran does not have the resources to pay for an IMO, send a demand

to the RO for psychometric testing. It should be noted that psychometric

testing is cross sectional and makes a current diagnosis only.

ISOLATION OF SYMPTOMS

If psychometric testing shows any current axis 1 diagnosis and a diagnosis

of a personality disorders or if the multiple diagnoses of service

connectable axis 1 disorders and a personality is reached by any other

means, request an interpretation of the results showing how the symptoms

were isolated for the purpose of establishing severity of each separate

condition. These symptoms must be distinguishable. If the report does

not state the symptoms were distinguishable, the full disability should be

attributed to the service connectable condition.

Did the report specifically state that the symptoms of personality disorder

were more likely than not distinguishable from an axis 1 condition?

YES

NO

Did the clinicians use adequate supporting logic showing how the severity

was attributed to each diagnosed mental condition?

YES

NO

Edited March 29, 2011 by Hoppy