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Claims Without C&p Exam?

rpowell01

Asked by rpowell01,

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rpowell01 Mentor

rpowell01

Posted
Posted (edited)

Okay I have a NOD by DRO actively at the RO. I also have new claims in at the RO. I had a IMO from Dr. Bash that basically put everything together for the NOD by DRO and it linked current issues on the new claims.

On ebenefits it shows my claim status is at Review of Evidence and that means they have received all evidence. I also haven't had any C&P Exam for these new claims and one of them is IU. Is it possible that since my last C&P exam was in 2011 or Dr. Bash's IMO will trump any C&P Exam that there is no need for a C&P Exam? Has anybody ever filed a claim and never had a C&P exam because they used the IMO in lieu of the C&P Exam?

Just wondering and I am curiuous.

BTW the IMO stated I can't go back to work and I know my Voc Rehab Counselor told me she felt I could go back to work. I think he is still letting me use Voc Rehab has therapy. She is the best Voc Rehab Counselor anybody can have.

Edited by rpowell01 (see edit history)
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TLaff Collaborator

TLaff

Posted
Posted
On 3/25/2013 at 4:14 PM, rpowell01 said:

Okay I have a NOD by DRO actively at the RO. I also have new claims in at the RO. I had a IMO from Dr. Bash that basically put everything together for the NOD by DRO and it linked current issues on the new claims.

 

On ebenefits it shows my claim status is at Review of Evidence and that means they have received all evidence. I also haven't had any C&P Exam for these new claims and one of them is IU. Is it possible that since my last C&P exam was in 2011 or Dr. Bash's IMO will trump any C&P Exam that there is no need for a C&P Exam? Has anybody ever filed a claim and never had a C&P exam because they used the IMO in lieu of the C&P Exam?

 

Just wondering and I am curiuous.

 

BTW the IMO stated I can't go back to work and I know my Voc Rehab Counselor told me she felt I could go back to work. I think he is still letting me use Voc Rehab has therapy. She is the best Voc Rehab Counselor anybody can have.

Dont want to bust your bubble but the VA totally ignored Dr. Bash's IMO with all my claims as if they just threw it in the trash. Maybe you will get better understanding rater than I but even with NOD's and DRO Review they all ignored his IMO.

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broncovet Grand Master

broncovet

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There are at least 2 reasons why Va will go ahead and rate a claim with no c and p exam:

1.  There is already enough evidence in the file for a favorable result.  That is, nothing is missing, you have all 3 caluza elements present, as well as applicable symptoms for rating.  

2.  There is not enough evidence, but a c and p exam wont fix it.  One example of this is if you apply for benefits, but dont have the requite service or discharge.  The c and p exam wont fix a dishonorable discharge, for example, so there is no need.  

The VA is supposed to order an exam when there is not enough evidence, but you otherwise would qualify for benefits.  Now, you can not count on VA always doing as they are supposed to do.  

ALSO, in reference to Tlaff's post, which stated, 

Quote

...(the VA) totally ignored Dr. Bash's IMO with all my claims as if they just threw it in the trash.

I agree this happens, and it happens frequently.  Berta often says "VA can not read".  They deny us, even when there is evidence to award because they dont read it.  

This is what appeals and Cue is for:  When VA ignores evidence.  The VA CAN deny, even with favorable evidence, but they must state in the reasons and bases as to why this favorable evidence did not manifest itself in a favorable result.  

VA did this in my own claim:  They stated that, even tho, DR. xxx opined that my sc condition prevented substantial gainful employment, that statement was in conflict with the rest of the evidence.  They went on to cite an 2001 voc rehab exam that reached a different conclusion than Dr. XXX.  

So, what did my attorney do?  She could not appeal on a "reasons and bases", so she appealed on something else, got a CAVC remand, and submitted "new evidence", that is a Voc rehab experts opinion refuting the 2001 voc rehab exam.  

If VA "ignores" your Dr. Bash exam, then you could/should appeal that unless they give a reasons and bases as to why this exam was ignored.  "Reasons and bases" appeals are a no brainer for attorney's.  They virtually ALWAYs result in at least a remand, and that enables the Veteran or his representative, to submit new evidence and have it considered since the beginning of the appeal period.  See 38 cfr 3.156 "b" on pending claims.  

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Berta Grand Master

Berta

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Posted

Broncovet  -you gave a superb reply to this vet........!!!!

If VA Ignores an IMO, that is a violation of 38 CFR 4.6 (CUE) but often they do not ignore the IMO, they just state the opinion  of the C & P examiner had more weight.

Dr Bash has quite a lengthy Curriculum Vitae he often sends with his IMOs and even though he is a Neuro Radiologist, he has expertise to opine on many types of claims. In an IMO he did for me( claim for direct SC death due to untreated, misdiagnosed DMII due to AO, he stated in the opinion he had personally dealt with thousands of diabetics and their MRIs, etc etc etc.

If they list the IMO/IME in the evidence list and then do not even mention it at all, that is a CUE as much as if they didnt list it.

If you can scan and attach it here that will help more to determine what they did. (cover C file # prior to scanning it)

 

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Guest L

Guest L

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Posted

rpowell01 I recently had a IMO by Dr Vallett and was scheduled for a C & P exam -( the same week they called me)  The quick processing of these c&p exams is making it faster to get one, so you may have not been notified yet. Most people I have spoken with recently got a call, ask if they would accept an appointment in that week or the next. You have nothing to worry about sounds like you are the master of your claim.:) 

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MikeHunt Rising Star

MikeHunt

Posted
Posted

In general terms, the VA can ask for an ACE exam so as not to actually examine you. The situation would be where you are processing a claim for prostrate cancer;

The Veteran has:

1. Vietnam Boots on ground evidence in his eFolder

2. VAMC records show 'Prostrate Cancer' in CAPRI 'current Problems' list.

(prostrate is presumptive to Boots on ground Veterans, so there's no need for a medical opinion)

Since it's either- or; That is, there's no degree of prostrate cancer to rate, the examiner can simply review CAPRI records, private clinic records or you can include a  VA Form 21-4142 and see if the VA can get the private records for you.

Otherwise, for other disabilities, you need some type exam to determine percentage/degree of disability- Range of motion, psychological/social impairment, percentage of scarring- You get the idea.

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Chuck75 Grand Master

Chuck75

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I filed the first "simple" single issue claim about 8 years ago. Supporting evidence was in my VA medical records, as well as private records.

No C&P was ever called for, and the claim was awarded about nine months later. (And then the fights began!)

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rpowell01 Mentor

rpowell01

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I'm just curious John if the VA has enough evidence that there is no need of a C&P....They should only do it per the VA Policy only if they don't have evidence to support the claim...

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jbasser Grand Master

jbasser

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It is on very rare occasion the veteran will get rated without a C and P exam. They have to have a current level of disability so you will get an exam. I can guarantee it especially with cervical and lumbar issues based on ROM.

J

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rpowell01 Mentor

rpowell01

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So on Ebennys where it shows

What Did We Not Receive?

This is a list of items that have never been received from you and that have been closed.

Request for Examination 12/21/2012 03/21/2013

Maybe they wanted a C&P Exam but never got around to scheduling it? This is what I am thinking...That or some rater has been acting like they have been doing their job when they are actually behind...LOL

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bhoward422 Enthusiast

bhoward422

Posted
Posted

Okay I have a NOD by DRO actively at the RO. I also have new claims in at the RO. I had a IMO from Dr. Bash that basically put everything together for the NOD by DRO and it linked current issues on the new claims.

On ebenefits it shows my claim status is at Review of Evidence and that means they have received all evidence. I also haven't had any C&P Exam for these new claims and one of them is IU. Is it possible that since my last C&P exam was in 2011 or Dr. Bash's IMO will trump any C&P Exam that there is no need for a C&P Exam? Has anybody ever filed a claim and never had a C&P exam because they used the IMO in lieu of the C&P Exam?

Just wondering and I am curiuous.

BTW the IMO stated I can't go back to work and I know my Voc Rehab Counselor told me she felt I could go back to work. I think he is still letting me use Voc Rehab has therapy. She is the best Voc Rehab Counselor anybody can have.

Yes I have a claim in for my back and it's at the pending decision phase and I haven't had any C&P exam as of yet I am curious also

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bhoward422 Enthusiast

bhoward422

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Posted

I'm just curious John if the VA has enough evidence that there is no need of a C&P....They should only do it per the VA Policy only if they don't have evidence to support the claim...

This is my reply it makes sense my VSR called me on 09/11/13 she stated that she has all require evidence to send the claim forward to preparation for decision phase I haven't been contacted as of yet.

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