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

[sleeper692]

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 October 14, 2011 by sleeper692

[jbasser]

You are absolutely right, this could be a way of not paying me the retro i'm owed. My retro would have to go back to the original claim date of March of 2006. That would be a lot of retro owed, and I know I have all my statements and IMO's in order to win the appeal. At what point would you consider getting an attorney?? I have thought about obtaining one if my appeal didn't go through this time with the review officer. Thanks for bringing this point up too me, it will definitely keep my eyes open.

You have a denial letter on a claim and you are appealing. Attorney time is any time after you receive a denial letter.

When selecting an attorney, It is imparative you find one who deals with VA claims. I think you would better situated with doing that.

Bergman-Moore is one I would personally recommend since VA is all they do and they are very well versed on Veterans claims issues.

J

[sleeper692]

I just had a thought (a scary thing, I know): In my case, since a lot of my filings are tied to the Gulf War presumptives, I wonder if this is the rater's way of trying to get the doc to find an actual diagnosis on my hand pain so they can deny it. Under the Gulf War presumptives, if something like joint pain can be given a definitive diagnosis, then it can't be rated under the presumptives and must be service connected under normal conditions.

That still doesn't explain the sleep apnea exam but I'm past worrying about it. I'll figure it out soon enough and follow up with what transpires at the exam.

[sleeper692]

I just had a thought (a scary thing, I know): In my case, since a lot of my filings are tied to the Gulf War presumptives, I wonder if this is the rater's way of trying to get the doc to find an actual diagnosis on my hand pain so they can deny it. Under the Gulf War presumptives, if something like joint pain can be given a definitive diagnosis, then it can't be rated under the presumptives and must be service connected under normal conditions.

That still doesn't explain the sleep apnea exam but I'm past worrying about it. I'll figure it out soon enough and follow up with what transpires at the exam.

This was my fourth C&P exam today and definitely the least "exam-like" of any of them. Today's exam was for sleep apnea and arthritis. As I mentioned in my original post, I had not personally requested a claim or request for increase for either one of these ailments.

So here is how this exam went. I got called into the doctor's office. No vital signs were taken. No physical exam was done. I was asked about how I sleep, if other people say anything about my sleeping (searching for "snoring" and "stopping breathing" complaints), and if I feel tired or fall asleep during the day. I confirmed I sleep better with meds but still don't feel rested, people tell me I snore and occasionally stop breathing, that I never feel rested and that I frequently wake up with headaches. During all this, the doc didn't type or write a note. In fact, he hardly ever glanced at my chart.

Then he asked me to tell him about my arthritis. I told him I had just went to the rheumatologist and they could find no signs of anything in the form of inflammatory arthritis. He then elaborated that he had reviewed the findings of that exam and agreed. I explained to him all the types of pains I have in my hands (sounds like osteoarthritis to me) and he nodded. Then he asked me if I had any questions.

That was it!! No touchy-feely with my hands. No x-rays, no blood work (not that he needed to repeat that again), no nothing. No questions about when did it start, what makes it better, what makes it worse, how long does it last, etc. He either had all the information he needed, he didn't care or it didn't matter.

So I started asking questions. It seems that a sleep specialist doctor hasn't even reviewed my sleep study yet so there has been no official opinion entered into my medical records beyond the notes of the sleep technician. (He would not elaborate on what the sleep tech wrote in my records.) When he told me that, I asked how that was going to affect his report to my rater. He said it wouldn't be a problem, that he already had his prognosis. Unfortunately it was so early in the morning and I was still groggy that I didn't have the presence of mind to ask what that prognosis was. Then again, I had the distinct impression that the doc was done with the conversation and ready to move me out of his office.

My impression of the whole "exam" is this: for what information the doctor decided he needed to hear from me, he could have probably conducted a phone interview. Maybe setting eyes on the patient is a requirement. I had the distinct impression that, as I had suspected would happen, the doctor pretty much had his conclusions drawn from his review of my medical records before I ever walked in the door and I simply confirmed his diagnosis.

I don't know if it ends up working in my favor or not once it gets back to the regional office and everything melts together with my IU claim but it sure seems like a funny way to drag things out. First someone, whether its was my VSO or my rater, created claims I'm not aware of. Then I'm sent on exams for these phantom claims that are merely reviews of my medical records or based on conjecture of exams that haven't been expounded upon by medical specialists.

On one hand, if they are trying to give me increases for stuff they see that I didn't claim out of the kindness of their heart, then I am blessed. On the other hand, if they are trying to stick a diagnosis on my "medically unexplained chronic multisymptom illness" claims under the Gulf War presumptives so they can deny my claims, then shame on them.

Either way, I'm still in the dark as to what in the hell is going on.

[Ryguy]

Wow, I hope that this works out in your favor, and that the increase is granted. I think i'm falling into the same category, I am going in the morning for my C and P Examination with a Physician Assistant, I dont know what to make of this either, I didn't request this increase, but you really scared me after reading your post. I'll most definitely let you know how my appointment goes in the morning. I have two appointments, and i'm not feeling all that great, so my patience will be very much on edge if they are wasting my time.

[sleeper692]

Wow, I hope that this works out in your favor, and that the increase is granted. I think i'm falling into the same category, I am going in the morning for my C and P Examination with a Physician Assistant, I dont know what to make of this either, I didn't request this increase, but you really scared me after reading your post. I'll most definitely let you know how my appointment goes in the morning. I have two appointments, and i'm not feeling all that great, so my patience will be very much on edge if they are wasting my time.

Ryguy,

I feel your pain. I had to get up at 5:30am to get ready to go clear across town for my 8am appointment. I assure you that I was cranky from lack of sleep on top of being wary and defensive going into my exam. My doc sensed my attitude pretty quick and started in with the "what are your questions, siiiiirrrrrrr!" crap, showing me he wasn't exactly thrilled with my questioning his or the VA's authority. I bit my lip pretty hard at that point to try to remain civil and I strongly urge you to do the same. Keep in mind that these docs have your claim in their hands. While they might not get away in the long run with derailing your claim when you actually deserve the benefit, they can certainly derail it and throw your claim into years of appeals if you piss them off sufficiently. Besides, you might get one of the good guys that is actually trying to help you out.

If you have someone that can go with you, all the better.

Just remember, don't poop where ya eat and just because everyone is out to get you doesn't necessarily mean you're paranoid. Good luck tomorrow!

[Ryguy]

Ok, thanks for the tips, I dont have anyone to go with me, as everyone is working that time of day, but I should be ok. The drive isn't that far and I always show respect to the doctors, I just try to remain calm and let them know how my health is concerning the issue, and in the past its always gotten positive results. I'm seeing a Physician Assistant, so this should be very interesting.. Thanks