Confused With Latest C&p Exam

[4MR05C]

Hi all,

I'm new to this website as a member; but I've been here many times to read up on stuff in regards to my claim. I have a question that I'm hoping some of the more experienced members here can help me with, because I'm concerned that my last exam, which was yesterday (yes, a Saturday) was not done correctly, or by a competent doctor.

A little background first.... I have filed my first claim (since separating from the Army in 1984) in May of 2012. There has yet to be any decision on my case.

I have been to 5 previous C&P, none of which have been on a Saturday. This was at the local QTC offices here in Atlanta. This exam was for my claim for a secondary condition of my ankles (they are painful and occasionally, I limp from not being able to put a lot of weight on them.) The primary condition is that I had a shattered sesamoid bone totally removed from my right foot (its like a ball bearing at the big toe joint) which was not replaced with anything. Over the years, I have developed a way of walking that takes the pressure off that joint by walking on the OUTSIDE of my foot and shifting my weight to the other foot whenever possible, which I contend has caused my ankle problems on both sides.

Now, on to yesterday's exam: First problem: I brought in a pair of flip flops that I have been using this summer to walk in, she refused to exam them, saying that "those are going to do that." Well, no, cause it shows a clear wear pattern on the outside of my shoe.

Second problem, she wanted to see the shoes I had just taken off, well, these shoes are relatively new as I bought them last winter/spring and have not worn them much, she looked at them (entirely disregarding me saying "I haven't worn those much" and said "There's no wear pattern here." Well, duh, I haven't worn them much!

Third problem: When she asked if I had been to doctors about this, I forgot that I had been to see the podiatrist at the VA, for my foot issues (I don't think he made any notations on my ankles, he was more interested in coming up with a custom prosthetic for the bottom of my foot.) that when she asked me if I had gone to the doctor to see about my ankle, I said "No." to which she repeatedly said to me "So they hurt but not enough to go to the doctor?" (in an incredulous tone). My ankles have an ache damn near constantly, but not sharp stabbing pains all the time AND I have a VERY high pain threshold... (I had stitches put in my hand last year and the doctor hadn't numbed my my hand properly, so for at least a couple stitches, I felt the needle go in...and out and in and out - I didn't punch the doctor or anything.. I just gritted my teeth and let him finish. He even said that he was impressed that I could tolerate such pain). so, back to the lady doctor, she rudely cut me off when i tried to tell her that I have a high pain threshold and started scribbling on her notes (my medical records were NOWHERE in sight, btw) while I was trying to talk to her.

Fourth problem: She used her hands to rotate my bare feet around and around, and kept saying "give them to me" to which I explained that she was hurting me so I was resisting her), she just kept insisting that I ""give them" to her and didn't stop trying to twist my feet around.

Fifth problem, Now, I don't know what "repetitve use test" really is, but she never asked me to do any lifting of my heels or standing on my tip toes, she just asked me to walk about 6 feet from the chair I was sitting in to the wall of the exam room and back (three trips total chair to wall, turn, back to chair, and then back to the wall). That as the extent of the repetitive use exam.

Sixth problem, she eyeballed my feet/ankles when she asked me to push them down, wasn't there supposed to be a measurement taken?

Seventh problem: She looked at my feet from the back... while I still had my shoes ON. (isn't there supposed to be an exam from the back with shoes off?

Eighth problem: She did take out the goniometer and measure when she asked me to pull my feet up, and when I did, she asked (again in an incredulous tone) "Can't you get them to go higher?" To which I said "No." Also when she was doing the measuring, (the one and only time that she actually measured anything) she measured my left foot from the outside ankle bone and the right foot from the INSIDE (with out adjusting the alignment goniometer).

Ninth problem: She asked me how my ankles affected my work to which I relied that I was a student and ddn't stand on my feet all day but I had to walk arcross campus and that I had stairs to climb, but I also said, most of the day, I sit (which is the truth). Then she asked "Well, how did it affect your previous job" to which I said "Well, I was a paralegal" and she jumped in with a "So, you sat then too." And I saw her mark a BIG "O:" with a line through it (I'm assuming this was for how my ankles affected my ability to work).

Tenth problem: She's a gynecologist!!!! How is a gynecologist supposed to rate an orthopedic problem (and no, she has never been qualified as an expert witness or anything like that for ortho, I checked on-line.)

I did have x-rays taken and the x-ray tech asked me if I had had a recent injury to my ankles because they looked swollen to her, and I said, "No, that's just the way they are, all the time."

So, now that you've read this small book... what can I do to make sure my claim is done correctly and that I am examined fairly? (Which I do not feel happened here.)

Do I even have grounds for a complaint? Should I complain now or wait until I get a decision of some sort? Any help would be greatly appreciated. Thanks!

Btw, I found this online as a guide on how to test ROm in ankles: https://www.med.unc.edu/surclerk/medselect/resources/suggested-readings-for-subspecialty-clinics/rheumatology/Foot%20exam%20reivew_11-4-09.pdf

Edited October 20, 2013 by 4MR05C

[4MR05C]

QTC did most of them, and they said I'd have to get them from the VA... drives me nuts!

The only C&P I can access is a DBQ where the VA had a doctor who never talked to me "review" records (and lives in ILLINOIS - I live in GEORGIA) recommend denial of my hearing issues, so No.. it was NOT favorable.

[free_spirit_etc]

I am not sure I would just focus on the sesamoid bone removal either. I would broaden it out to foot injury. With the claim that you injured your foot in service -- to include shattering your sesamoid bone, it broadens it out a bit to include any other way your foot was injured. I would try to keep the focus on "I injured my foot in service, since then I have had an abnormal gait, my abnormal gait has effected my ankles, knees, hips, etc." If you let them stay very narrow, I am sure they can find all kinds of things that say the sesamoid bone doesn't effect the hip."

[free_spirit_etc]

This is the kind of stuff you can be up against with the VA:

http://www.va.gov/vetapp13/Files2/1313673.txt

"The physician also concluded that the Veteran's left foot pain was not related to any problem or injury to the right foot, to include any treatment therefor. The physician noted that, from his 35 years of experience and a review of the medical literature during that time, he has never seen even a suggestion that an injury to one foot would be expected to cause a problem with the other foot. The physician stated that even patients with a lower extremity amputation who do not use an artificial limb do not report having a problem with their other feet."

By the way... thank you for your service! (The VA might forget to tell you that..)

[4MR05C]

Trust me, when I go and get the private doctor's opinion it WILL be with a highly specialized and highly respected orthopedist who I will insist look at the ENTIRE issue, and submit nexus letters to that effect.

The same goes with the audiologist ENT.

It just infuriates me that any old doctor is "qualified" in the VA's opinion to give their opinion on things outside their specialty.

No thanks needed, just doing what my Dad and Uncle had done before me. (And my brother has done along with me and my nephew is going to do come this November 18th!)

[free_spirit_etc]

"The only C&P I can access is a DBQ where the VA had a doctor who never talked to me "review" records (and lives in ILLINOIS - I live in GEORGIA) recommend denial of my hearing issues, so No.. it was NOT favorable."

Ugh! The VA examiner did not even examine my husband before opining that he had no apparent residuals from his lung cancer surgery. He specifically noted my husband had no shortness of breath, despite the fact the pulmonary function tests done at the same facility the same day reported he had dyspnea on hills and stairs and frequent wheezing.

It is definitely starting to look like you might need an IMO. One good thing is that many of the VA examiners don't take the time to really explain things well (because that would require them to not only look things up, but to also actually find something that supports what they are saying) and so a doctor that practices real medicine can often blow them out of the water will real medicine type stuff.

It is aggravating though - because when a vet claims a lot of things when they get out -- they are milking the system. When a vet tolerates stuff until they can't tolerate it any more -- then "they first complained of pain MANY years after service."

It is a real Catch-22.

But it looks like you might not be able to count on the VA to take care of you on this one, and might have to build your case yourself. It often helps to view BVA cases on similar conditions and see what they said and why they were granted or denied. Many times it is because the VA examiners give unfavorable opinions and the vet just has their own word (which never counts) or a couple of journal articles with no opinion to back them.

Do you mind sharing what the C&P examiner said? You can remove any personal info.

[free_spirit_etc]

Be sure and tell you nephew to make sure every little thing gets documented (because you never know what might come back and bite you in the butt later) and to get copies of everything...

I am sure you know that now...