Another Bogus C&p

[Hoppy]

I have been assisting a veteran who was diagnosed with GERD 9 months after discharge. The veteran has continued treatment with the VAMC since discharge and has received diagnoses of GERD and prescribed medication continuously. He has had several Barium swallows and UGI exams showing the presence of reflux. He went to a C&P and the C&P examiner wrote a report saying there was no objective evidence of GERD. His claim was denied based on this bogus C&P. I got involved and wrote a letter in support of the claim and got the C&P thrown out and the BVA remanded for a new C&P. I was disappointed because I thought there was sufficient records to show continuity since discharge. However, it was some progress to get a new C&P.

The remand stated that there was evidence of a current diagnosis of GERD and ask the new exam to address whether or not there was a nexus. The veteran was scheduled two exams. he went to a barium swallow exam then ½ hour later he saw the c&p examiner who was supposed to address a nexus.

The C&P examiner said there was no current diagnosis of GERD “at this moment”. !/2 hour earlier the barium test confirmed the diagnosis of GERD. The C&P examiner failed to address nexus as asked in the remand..

The C&P examiner offered no logic disputing the ongoing diagnoses of GERD provided by treating clinicians. Rather he said that the current subjective symptoms could be caused by a temporary flare of esophagitis.

The fact that he said the current symptoms “Could” be caused by a temporary flair of esophagitis does not sufficiently rebut the established diagnosis of GERD. Additionally, the word could is not sufficient to establish that it is more likely than not that the temporary flare is a dominating symptom pattern.

These doctors are idiots. The inability to establish a diagnosis “at the moment” because the symptoms “could be caused” by a temporary flare of esophagitis is a total cop out. I guess the entire history provided by treating conditions has no weight because this C&P examiner came up with an explanation based on events that “could” be occurring. By the way esophagitis does not show that a symptom is regurgitation. I have been reading a lot of GERD cases where the BVA has been throwing out bogus C&P exams. We are going to try and get another C&P or an IMO.

[USNDW]

After I meet with the Congressman/womans Aid, if I get some positive feedback I will be looking for Veterans in my area who have had similar experiences and documented medical records to prove the C&P examiners ignored their medical history, C file, or what the Veteran relayed to them.

If we can work together showing people in a position to actually make something happen, I do believe we can put a dent in this fraudulant practice.

[Hoppy]

What can be done??

Several years ago I was assisting a veteran who had 17 pages of detailed SMR notes showing the veterans first episode of a “panic attack”. The notes continued showing re-occurring panic attacks for another year and a half before he was diagnosed with a personality disorder and discharged without treatment or benefits. The military doctors said there was no treatment for the condition. The veteran later went to a VAMC and was properly diagnosed as having panic disorder.

The BVA has many cases in which this condition was misdiagnosed as a personality disorder and it was later corrected and the veteran was service connected. Thus, I decided to get involved.

The VA sent the veteran to a contracted “forensic psychiatrist” for a C&P exam.

It is a long story that I have posted before. To sum it up the psychiatrist made statements about etiology that contradicted known medical principals. The C&P examiner invented false evidence about symptom patterns that did not conform to the recorded history.

Basically had this evidence been submitted to a court it would have been considered “extrinsic fraud”.

I decided to try and cause this doctor some problems. This is what I found out.

The VA has internal monitoring of the quality of C&P exams. They had considered allowing veterans too file complaints to this monitoring program. However, the complaint feature was not adopted. The only resolution identified by the service organizations was to file a complaint to the director of the hospital where the exam was scheduled. Thus, remedies are within the discretion of each individual hospital administrator. I found no established policy addressing poor quality C&P exams.

I could not find any requirement that there be any ongoing recording of rejected or discredited C&P exams. Thus, there is no paper trail that would lead to clinicians who make a life time of writing bad exams. In a functional system any clinician who presents incompetent or false information for the purpose of adjudication should be disciplined. More importantly every claim the clinician has submitted evidence on in their entire career should be reviewed.

A system that was required by federal law to monitor the actions of law enforcement officers needs to be adopted and applied to any individual capable of providing evidence under administrative law. Recording of original inadequate or false actions of the clinicians and disciplinary actions needs to be standardized throughout the entire system. Such recordings need to follow the clinician throughout their entire career and be subject to public review. The public review consisted of selected members from the public who had access to the records. Tell this to your congressman.

I have an entire file full of bogus C&P exams

Edited October 13, 2012 by Hoppy

[Hoppy]

It turns out that after closer review of the C&P that the C&P doctor did not read the VAMC treatment notes or a DBQ provided by the veterans primary care doctor. The C&P examiner only noted a review of the SMR and post service endocscopies and blood studies.

Although the veteran had been diagnosed by the VAMC primary care doctor with GERD seven years ago and the veteran has been on omeprazole for many years the C&P examiner failed to check the box indicating a prior diagnosis of GERD.

There is no requirement of the rating schedule that GERD must be confirmed by every single UGI or endoscopy.

[qwiksting]

Thank you Hoppy...I actually might be able to sleep alittle now..

Edited October 13, 2012 by qwiksting