hypertension A Nexis Type Letter For C&p Examiner.

[Greg88]

Since I have my C&P exam coming up in a few weeks and it seems like no one at the VA has looked at my medical records, I've decided to include a nexus type letter said that the C&P examiner knows what's going on. The VA has decided to look at the areas that they deemed responsible for my hundred percent disability, I've been at 100% for 14.9 years I've been service-connected for the last 36. I know that a nexus letter is usually used to establish service connection, but since I have not used the VA medical system for the last 15 years and no one seems to have looked at my private MDs medical records, I thought this would help speed things up and I have an appointment with my private M.D. a few days before the exams. I received 100% disability because of my diabetes mellitus Type 1 and the associated complication of neuropathy and labile diabetes, my private MDs notes all indicate worsening of my neuropathy and my diabetes which he lists as uncontrolled, but since I was rated 100% other complications of diabetes have popped up, such as hypertension, ED, and depression. I know that a nexus type letter should be short and sweet and by focusing on the things that made them rate me at 100%would help the process, but the VA also included in the letter that they sent me complications that have popped up in my years before ( I used to the VA medical system for 21 years) 1997, they put into my letter that they were looking at proteinuria which I haven't had since 1989 and the VA doctor put me on a low protein diet. I'm just wondering what to put in this letter.

Gregory

[USMC5811]

My two cents...if nothing else adding my comments/questions will bump the post so that other more knowledgeable members might see it and respond.

After reading both M-21-1MR, Part III, Subpart IV, Chapter 3, Section B which explains to VA personnel when an Examination or Reexamination should be conducted/considered AND reading 38CFR 3.327 - Reexamination the only thing that I could come up with for the reason why they might be doing a reexamination after you've been service connected for 36 years and at 100% for 14.9 years is that perhaps because you are using a private physician/health care and according to what I read from you are no longer using (have not for the last 15 years) the Veterans Health System so they don't have access to your medical records (unless you've submitted them) like they would if you were using VA's Healthcare. In 38CFR 3.327 it does state "that reexaminations, including periods of hospital observation, will be requested whenever VA determines there is a need to verify either the continued existence or the current severity of a disability. Reexaminations will be required if it is likely that a disability has improved, or if evidence indicates there has been a material change in a disability or the current rating may be incorrect.

As for the "Nexus letter" that your wanting to write for the C&P examiner to "speed things up". First you need to go to the C&P appointment with the mindset that the C&P examiner might refuse to read your letter as most of them are instructed by the VA as to what the VA wants them to do during the C&P exam = nothing more - nothing less. I had one C&P examiner that was willing to look at what I brought and another that refused to look at anything I had. Usually somewhere on the C&P exam notification that is sent to you - it states not to bring records etc with you. Since your being seen by your private MD a few days before the exam perhaps you could have him/her fill out a few Disability Compensation Questionnaires (DBQ's) for the contentions that VA has said they intend to do the reexaminations for. DBQ's for most contentions can be found here: http://benefits.va.g...abilityexams/ Doing this in my opinion would serve two purposes: 1. You could bring them with you just in case the C&P examiner is willing to look at them - as DBQ's are almost identical to the forms that the C&P examiner will be filling out at the examination and your treating physicians comments/answers might just help "speed things up" 2. If he refuses to look at any info during the C&P exam you will already have them to submit to the VA if they propose a reduction or if you feel that the VA examiner's conclusions do not represent the current severity of your condition.

You stated that proteinuria is something that you no longer suffer from because the VA doctor put you on a low protein diet BUT that you have other complications such as hypertension, ED and depression. I'll assume that your private physician diagnosed the hypertension and ED and is treating you for same so there are medical records for these conditions and he might be willing to do DBQ's for them as well if needed.

Like I said this is just my two cents - hopefully someone else will respond soon.

Edited September 2, 2012 by USMC5811

[Greg88]

USMC5811, the VA sent me a letter saying they were looking at my claim for : Diabetes mellitus with retinitis (diabetics rarely get retinitis, they get retinopathy), neuropathy with muscle weakness of both hands, in truth I have neuropathy of both feet with pain and muscle weakness and last but not least proteinuria. With the VA having 2 out of 4 things wrong, I'm thinking the examiner would like to know whats actually happening. The funny things is I dropped off all my medical records down at the Regional Office and left them with my DAV SO, I'm wondering know if the VA even received them. I'm bringing another copy to the exam, because it say's bring all medical records involved with your claim. In my mind the letter is just a synopsis of what's in the medical records, my MD will not sign anything that not's true, he's one of the top Dr.s in the area where the C&P exam is being done and according to the VA it looks like an NP is doing the exam. For the NP examiner the letter makes life easier, the Diabetes DBQ barely scratches the surface of whats going on with me. There sending me for 2 C&P's one for eyes and the other medical, on both sheets it says bring with you any outside medical records that pertain to your claim. I'm thinking that because I have not used the VA in the 12- 15 years, because the same clinic thats doing the eye exam may have examined my eyes in 1994-2000, they should have those records as a baseline. The VA hospital has been trolling for Pt's for a while, I know there was talk of closing it in the 90's, after hearing the stories about how other VA hospitals are being overwhelmed, it makes me wonder.

Greg

Semper Fi

[USMC5811]

Hey Greg that IS definitely a plus that for this reexamination they ask that you bring the medical records with you - I'd bombard them with medical records in that case.

I'm leary of what some Service Rep say they have done....and what they have actually done, so I hear ya where that is concerned - the VA probably never received them. I mean really given how many years you've been service connected, how many years you've been 100% and IF they received the medical records you gave the DAV rep not to mention that your contentions are not going to disappear unless a miracle happens - it makes no sense at all, at least to me, that they would do a reexam - but the VA process and reasoning does not make much sense as a whole.

I'm wondering since they stated they want your medical records at the C&P if you might be able to separate copies of the documentation for each contention/secondary, place them in chronologically order (most recent med report to oldest ) and then use stickies or index tabs to mark what you believe should be specifically reviewed by the C&P doctor (ie., attachment 1, 2 etc) and then provide that "Nexus Letter" or synopsis and refer to the attachments in the letter: Ie., Neuropathy - explain your current symptoms, their severity in regards to your daily living etc and the medical treatment/meds your receiving and then write something like see attachment 1 - which refers to all or whatever treatment records you have in regards to this contention. Heck I'd even give each contention and secondary their own folder or soft binder so that you or the examiner does not have to wade through the paperwork to find each one.

Seeing how you said an NP is doing this exam - you might want to add in the letter who your doctor is and what his background/experience is if you know that info. I just looked my private doctors up on-line and was amazed at how much info pertaining to their medical education/experience etc came up. I added that info to my cover letter to dispute a C&P examination.

Wishing the best for you devil dog - Semper Fi

[Greg88]

USMC, it's funny you mention the SO, when I went down to the RO to visit him he gave me his usual "don't worry about it" but try to get him on the phone or any other modern communication device and nothing. At this point they reassure me this exam is nothing to worry about, but so far I have seen nothing to impress me. The DAV SO I had in the 90's who got me the 60 and 100% was diligent and on the ball, he know sits on the VA Ratings board in Houston. My doctor looks puzzled when I tell him that the VA says (since your Diabetes Mellitus condition is not considered permanent) he replies "thats just stupid". The funny thing is that the complications they list on the letter they sent me and the ones in the DBQ (not even mentioned) are not the worst part of the Diabetes, the main problem is I just pass out because of the time with disease, as time goes by our bodies adjust to hypoglycemia (low blood sugar) normal start to sweat and become disorientated when there sugar drops below 70, I can be at 35 and seem reasonable and then I hit the floor. The thing is most MDs know this and know that the disease kill's you slowly, piece by piece. According to everything I have read I think they want see if I've been given a cure and that I'm also 25 years years younger LOL. But I think the timing plays a big role in this I turned 56 in August and with everything thats in the CFR 3.327 I meet all the requirements of not being bothered again, but this is the VA and who know what there thinking.

Greg

[john999]

If I was you I would use the VA for at least the twice yearly physicals and blood work. If you can get your meds from the VA that is a plus. This way you create in their own backyard a mountain of records.Keep using the private doctor you trust, but include the VA in the loop. I have been TDIU for eleven years and no one questions it at the VA except for yearly document I send them saying I still can't work.

[Greg88]

John, the problem I have with VA is continuity of care, when I was using the system through the 70s, 80s, and 90s, I had the same Dr. he retired from the VA in 94 or 95 and then all I got were Endo residents that thought they would cure things (in their own minds), and then they start prescibing new meds and insulin and bang I'm passed out somewhere. In 1987 my Doctor had to take a leave of abscence from the VA (his mother was dying in Italy) a resident took over for the 6 months he was gone, she thought it would be a good idea to try me on a new invention the "Insulin pump". I tried it and and after 3 weeks one day I ended up 100 miles from home in the passenger seat (I was driving) pump torn out and laying on the floor, p*ssed my pants and my clothes drenched with sweat. A lot of VAs are associtated with teaching hospitals and the veterans end up being lab rats for these students (even if their doctors) their still students. The VA used to be great at R&D, they had MDs that stayed for years and years, but from what I've been hearing the Doctors don't hang around as long, actually thats not true, the psychologists and psychiatrists seem to stay a long time. Because of my condition I test my sugar 12 times a day and the VA is real cheap about test strips, they start moaning and requiring all kinds of approvals if you test more than 5 times, talk about pennywise and pound foolish. I do have to include that I use Tricare for all my medical right now and it's been very good, it just occured to me that the VA can see all prescripitions through Tricare if they want to.

Greg