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sleeper692

C&p Exam For Problems I Did Not Submit Claims For!?!

Question

I got a call today from VBA to schedule another C&P exam. When I asked what the exams were for, he said they were for my requested increases for arthritis and sleep apnea. The funny thing is, I have never filed a claim or an increase for either one of those things. In fact, I've been examined at a previous C&P as well as by a rheumatologist for arthritis (because I have pain that is similar but I lack any signs of inflammation). After both exams and a battery of blood tests, they both reported that there were no findings in my lab reports that indicated I have arthritis.

I have a NOD in for insomnia as a sleep disorder for connection under the Gulf War presumptives. I never mentioned sleep apnea. My neurologist *suggested* I might have sleep apnea and sent me to a sleep study. That was just a few days ago and they said I had very little problem with my breathing during sleep.

In both cases, I have already had recent exams done by specialists and they haven't found arthritis or sleep apnea. I don't understand why I would have another C&P exam for things that they already know are going to be negative since they have full access to my medical records.

Is it normal for the raters to just pull things out of......thin air....and create a claim on my behalf? Am I missing something here???

Edited by sleeper692

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An opinion only.

The rater ordered the C&P because of the medical records and your "general" sleep disorder claim.

The newer medical records from the "specialists" might not have made it into the file when the rater looked at it.

Also, being paranoid, particularly when the VA is involved, I can think of another reason - -

If the rater is planning on a denial, in part or full, and the medical records are "iffy" as to justifying the denial,

a C&P with negative results would be all that is needed to base the denial on. (CYA in other words!)

Edited by Chuck75

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I have kinda the same simliar situation going on, i'm in the middle of an appeal with a Review Officer for cervical and upperback issues which are secondary to lower back issues. I received a letter for a c and p appointment thinking its for my upper back when in fact its for things i'm already service connected for. I spoke to the c and p clinic and the rep. told me that the appointment was for a claim for increase. This really puzzled me because I never put in a claim for increase, I've only put in a claim for an appeal.

I dont know what is going on, but it doesn't really make sense to me, Any insight will be greatly appreciated.

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I have seen the VA do some strange things over the 20 years I have been doing this.

It appears to me that they are misdirecting an appeal and are adjudicating an increase. It may be a plot to mess around with your effective date.

Keep a keen eye on this one. Do you have an attorney, They can usually nip this type of crap in the bud.

Anyway go to the exam because you don't want to miss it. That can be a disaster in the making or at least cost you a couple of years of your time.

J

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I'll definitely go to the exam loaded with lots of my own questions. I don't have an attorney. I do have a VSO but I have not had a response from emailing her yet and will probably have to call her on Monday.

I have a friend that works for a different VARO and he said it sounds like to him that they see something in my medical records and they are trying to give me the increase via the exam to confirm. I don't know, it still doesn't make much sense to me.

I intend to ask the doctor what questions the rater forwarded for the exam so maybe I can leave with some clue as to what is going on. Otherwise I will have to wait until I get my copy of the C&P exam and hope its not to late to figure out what is going on.

I hope my friend is right and they are trying to do something good and not screw with my current IU claim and the increases/NOD's I did file with this trumped up stuff. I have read that the rater can "infer" a claim but I did nothing on my end to cause that. I just can't imagine where they are getting this particularly since I am reasonably sure about how the outcome of the exam is going to go.

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I hope my friend is right and they are trying to do something good and not screw with my current IU claim and the increases/NOD's I did file with this trumped up stuff.

sleeper,

Looks to me like it something that would relate to the following from a BVA decision,

since you filed for an increase and IU.

Just a thought.

http://www.va.gov/vetapp10/Files1/1008621.txt

The increase to 70 percent for the service-connected bipolar

disorder from September 8, 1991 to April 16, 2001 raises an

inferred claim for a total rating for individual

unemployability due to service-connected disability (TDIU).

A TDIU claim is reasonably raised when a claimant whose

schedular rating meets the minimum criteria under 38 C.F.R. §

4.16(a) requests entitlement to an increased rating and there

is evidence of current service-connected unemployability in

the claimant's claims file or in records under VA control.

See Norris v. West, 12 Vet. App. 413, 421 (1999); Rice v.

Shinseki, 22 Vet. App. 447, 453-54 (2009). This matter is

referred to the RO for the appropriate consideratio

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