C & P Exam Results

[militarynurse]

I recently had a C & P exam after 16 years for neurology and orthopedic conditions. The results I got back are titled "Confidential AD HOC Summary" . Anyone know what that title means or why the C & P exam is titled like that?

I believe I was scheduled for the C & P exam after 16 years @ 70% because I didn't drop my comp claim at the BVA.

The neurology exam was about 20 seconds long. I was asked to touch my nose with my fingertip and the doctor tapped my arms with a rubber hammer. From that the doctor gathered that my "motor, power, tone and bulk are normal in the upper and lower extremities" and "he has good heel-knee-shin. Gait is normal".

Being that I was in a wheelchair and have a positive EMG for service-connected cervical radiculopathy, I find that neurology exam more than a bit off the mark.

What should I do about it?

Thank you.

[john999]

Get a neurology report from your own private doctor to rebutt this inadequate VA C&P exam. This is the best and fastest way to fight these pathetic C&P exams from quack doctors who are just there to pick up a quick fee from the VA.

[militarynurse]

I wrote a strongly worded letter to the neurologist that she hadn't examined me for many of the things she claimed were tested in her C & P exam. Never got a reply. On the plus side, I did get a white envelope today notifying me that my various ratings would continue unchanged as a result of the C & P exam. Naturally, I believe they are rated too low and will appeal after the dust settles.

Meanwhile can anyone offer advice on if Major Depressive Disorder ( MDD - GAF 50 ) can cause or affect obstructive speep apnea? Can a respiratory disorder, ( i.e., fibrosis and atelectasis lower lobes ), cause or affect sleep apnea?

Thanks to all. The info posted on hadit helps very much.

Get a neurology report from your own private doctor to rebutt this inadequate VA C&P exam. This is the best and fastest way to fight these pathetic C&P exams from quack doctors who are just there to pick up a quick fee from the VA.

[Vike17]

Militarynurse,

If the C&P exam went as you stated, I would file a Notice of Disagreement (NOD) and state what you just did in that NOD. Ask to have your claim handled by a Decision Review Officer (DRO), otherwise known as a DRO review. The DRO, with the info you stated here, will probably schedule you with another C&P exam.

As far as your Major Deppresive Disorder, are you already service-connected for this? If not, you need to establish service-connection for this before anything else. If you are already servcie-connected, then you need to have your doctor state that your MDD is the cause of your sleep apnea. There is medical litrature out there that support this in general, but the VA needs a statement from your doctor who states that your MDD is the cause of your sleep apnea. The Doctor should then reference the general medical litrature to support his opinion. Just submitting general medical litrature without any specific reference to the veteran isn't going to do the veteran's claim any good.

Same goes for the respiratory disorder. Are you already service-connected for it?

Hope this helps!

Vike 17

Edited September 27, 2006 by Vike17 (see edit history)

[john999]

If you got a GAF of 50 for MDD you should be able to get 70% for that alone. 50 is the magic number on the GAF scale. Anything below is ususally 100% and above is 50-30%. How did they rate the MDD? A GAF of 50 means you have serious symptoms. As we all know a GAF score is not all there is but it is significant and corresponds with a host of symptoms that would incapacitate most from work.

[Guest jstacy]

Can a respiratory disorder, ( i.e., fibrosis and atelectasis lower lobes ), cause or affect sleep apnea?

Both can be be a result of Sleep Apnea. With Sleep Apnea, you stop breathing at night.

All you need is a Nexus opinion from a good Pulmonary Fellow.

Atelectasis is a condition where the lung has lost its elasticity a small collapse.

[militarynurse]

Thanks for the tip. I am rated 0% for a respiratory disorder, ( atelectasis from a bout of pneumonia in 1990) as secondary to spinal injury. A few months ago, out of the blue over a decade later and without any C & P exam, I got a letter I was SC'd for the respiratory disorder - and I sure need that respiratory SC now. This was a very weak claim which was mysteriously granted while what is in my opinion much stronger claims I submitted remain denied...including the one for depression.

Had a C & P last week on a request for an increase on the Respiratory disorder as I was diagnosed with pulmonary embolism, ( PE ), this past May. The doctor/examiner I found on the Internet to have a speciality in OB-GYN, not pulmonary as one might have expected expect. She said my respiratory disorder aggravated the PE but didn't cause it.

As a side note, the VA radiologist who read the initial CT diagnosing my PE flip flopped and not states he doesn't know if I had PE. Huh?? Can he read a CT scan or not?

Now I can't hardly breathe, yet the VA wouldn't give me home oxygen, yet they are hounding me to take a neuropsych exam to see if I can count backwards from 10. Typical VA logic.

Recent EEG showed encephalopathy with cerebral dysfunction. I am already SC'd @10% for post concussion syndrome.

Thanks again.

Militarynurse,

If the C&P exam went as you stated, I would file a Notice of Disagreement (NOD) and state what you just did in that NOD. Ask to have your claim handled by a Decision Review Officer (DRO), otherwise known as a DRO review. The DRO, with the info you stated here, will probably schedule you with another C&P exam.

As far as your Major Deppresive Disorder, are you already service-connected for this? If not, you need to establish service-connection for this before anything else. If you are already servcie-connected, then you need to have your doctor state that your MDD is the cause of your sleep apnea. There is medical litrature out there that support this in general, but the VA needs a statement from your doctor who states that your MDD is the cause of your sleep apnea. The Doctor should then reference the general medical litrature to support his opinion. Just submitting general medical litrature without any specific reference to the veteran isn't going to do the veteran's claim any good.

Same goes for the respiratory disorder. Are you already service-connected for it?

Hope this helps!

Vike 17

[timetowinarace]

I strongly recomend the neuro-psych exam to see if you can count backword from 10. (there is much more to it than that) The VA is right on to request it.

You cannot be rated any more than 10% for post cunncusive syndrome without a diagnoses of multi infarct dementia. This is most often proven with neuro-psych testing. Or unless your arms, hand leg, or other neurological muscular functioning is obviously impaired. Simular to stroke. Your C&P didn't show that though. That is what they were looking for.

As for the multi-infarct dementia, this does not mean you get lost going to the store as it does for old age. It means there are damaged brain cells due to trauma.

My neuro-psych testing discovered things I did not know was happening from my post cuncussive syndrom. It got me the rating I deserve.

Time

[betrayed]

If you got a GAF of 50 for MDD you should be able to get 70% for that alone. 50 is the magic number on the GAF scale. Anything below is ususally 100% and above is 50-30%. How did they rate the MDD? A GAF of 50 means you have serious symptoms. As we all know a GAF score is not all there is but it is significant and corresponds with a host of symptoms that would incapacitate most from work.

Would be nice if true, I have GAF scores from 35 to 45 and get 30% for MDD :D

[john999]

Bro, if you got a GAF of 35-40 and only got 30% then you were low balled in a most serious way. Did you appeal that rating? It is complete nonsense. The GAF of someone with a score of 35 points to a person who is actively psychotic. A person with MDD and a GAF of 35 is probably in the midst of a deep and severe depression. Just read the symptomology of a person with a GAF of 35. It is horrendous. I am just saying you were screwed on this and if your GAF is still that low you need to be 100%. You know I am not critical of you and what you say, but I think you were done an injustice.

[Berta]

John -I agree with you 100% and Military nurse- are you working? If not here is a TDIU form attachment-I suggest to refer to this in your NOD and tell them you present a severe disability profile due to your clinical record and service and ask them to consider you for TDIU.

TDIU is the 100% rate---single vet $2,393 a month.

Under Remarks attach a separate page and tell them how the meds affect your ability to work- dont take and drink, causes confusionstuff like that- and if I were you I wuld apply for SSA too.

Edited September 27, 2006 by Berta (see edit history)

[Berta]

Forgot it- here it is

[timetowinarace]

While it's true that a GAF of 35 is low and the criteria to get it would be simular to a 70-100% rating by the rating scale for mental disorders, GAF is not the sole determining factor in ratings.

While I agree that a 30% rating is low for a GAF of 35, the GAF is fluid. Meaning it changes by the hour. Up and down. Where the rating scale is is determined by functioning ability over a period of time.

Not trying to be contrarian. Just that we shouldn't rely so heavily on a GAF score. Obviously the raters don't. To get to the elusive 70-100% and/or IU we need to hear the key word from the mental health pro, examiner or treating, - - - unemployable.

Time

[Berta]

Forgot it- here it is-John is right on all points- my husband's gaf was 26 or 34 or maybe both -his PTSD was deemed as catastrophic.

Any mental illness in that range is certainly a critical illness and they should compensate you properly for it.

I am thinking that if one of your SCs gets to 100% or TDIU and then the others get to 60% or more- they would kick in SMC "S" or higher- more comp there-

Also I see the "0" rating for the respiratory condition that they finally SCed-

did I get that right?

What about the SC rating for the injury that caused this SC respiratory condition? Is that the post concussion syndrome?

Veteran -did they ever give you a brain MRI and do you have those results?

Are you in a wheelchair because of the SC spinal injury?

God- that is Loss of use of lower extremities-are they comping you for that as a SMC payment?

TDIU_form.pdf

Edited September 27, 2006 by Berta (see edit history)

[betrayed]

Bro, if you got a GAF of 35-40 and only got 30% then you were low balled in a most serious way. Did you appeal that rating? It is complete nonsense. The GAF of someone with a score of 35 points to a person who is actively psychotic. A person with MDD and a GAF of 35 is probably in the midst of a deep and severe depression. Just read the symptomology of a person with a GAF of 35. It is horrendous. I am just saying you were screwed on this and if your GAF is still that low you need to be 100%. You know I am not critical of you and what you say, but I think you were done an injustice.

4 different GAFs, by 4 diff Docs in the last year, lowest 35, highest 45..........ya I know I got screwed, story of my experience with the VA. Dont worry i didnt take it as being critical.

[militarynurse]

I am still working part-time. Sedentary job. However, it requires I speak and as I am quite short of breath, I don't know for how much longer I can do it.

I am SC'd 40% for the C-Spine disorder namely several disc herniations. EMG done on right arm showed "cervical radiculopathy". Naturally, the VA granted me the SC for my left arm and no SC on my right arm. ???

Thanks all

John -I agree with you 100% and Military nurse- are you working? If not here is a TDIU form attachment-I suggest to refer to this in your NOD and tell them you present a severe disability profile due to your clinical record and service and ask them to consider you for TDIU.

TDIU is the 100% rate---single vet $2,393 a month.

Under Remarks attach a separate page and tell them how the meds affect your ability to work- dont take and drink, causes confusionstuff like that- and if I were you I wuld apply for SSA too.

[Bound4heaven]

Greetings,

In regards to your C&P exam. I would file a dispute with your VAMC Patients Advoicates office and the Medical Director of your VAMC or clinic and demand not only a new C&p exam (list all issues) but a new examiner. Send a copy of this to the VARO in charge of your case. Do not accept the results. The VAMC with the VARO will grant you a new C&P exam if your case is strong, and it appears it is. The person who gave you the C&P in question. Were they a PA, NP, or MD? it appears the examiner was not a specialist in the field of your disabilities. God bless you.

Bound4Heaven

[militarynurse]

Update: Just got the rating results based on my recent C & P exams. Ratings were kept the same at 70%. While I am no worse off, I was hoping to get at least one bumped up since my problems increased in severity.

Also my request for the BVA to reconsider my denied claims was shot down. I really thought I had a chance on at least one.

Greetings,

In regards to your C&P exam. I would file a dispute with your VAMC Patients Advoicates office and the Medical Director of your VAMC or clinic and demand not only a new C&p exam (list all issues) but a new examiner. Send a copy of this to the VARO in charge of your case. Do not accept the results. The VAMC with the VARO will grant you a new C&P exam if your case is strong, and it appears it is. The person who gave you the C&P in question. Were they a PA, NP, or MD? it appears the examiner was not a specialist in the field of your disabilities. God bless you.

Bound4Heaven

[john999]

If you have 70% then if you retire from work due to disability you should be able to get IU. You have the rating so when you can't work file the TDIU form.

[militarynurse]

Just had another appointment with the VA psychiatrist. My new assessment is: Axis I: Major depressive disorder recurrent R/O major depression due to general medical condition. Axis V: GAF 50

Does the diagnosis "Major depressive disorder recurrent" versus "Major depression due to generalized medical condition" make any difference in getting SC'd granted for depression?

[militarynurse]

What is an "inferred claim"?

Is that the same as an "inferred issue"?

Would "inferred issue" apply to filing for service connection for a related medical condition not claimed however found during medical testing?

Appreciate any info on this.