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

[free_spirit_etc]

I agree that VSOs can also be part of the problem, especially if they have bad attitudes.

My VSO absolutely ruined my hearing:

** Disclaimer -- I am not saying that ALL VSOs are part of the problem. But some of them are...

Edited October 22, 2013 by free_spirit_etc

[4MR05C]

Lord, that's AWFUL. So sorry you went through that. If it gets that far (and I pray that it doesn't), I'll hire attorneys.

[Chuck75]

"It just infuriates me that any old doctor is "qualified"- - -

The Atlanta VARO often uses VA NPs and PAs to do the C&P exams.

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]

I have been surprised by some of the BVA cases I have read where the remand specifically said the specialty the person needed to write an opinion, and then the RO sends an opinion from someone else - AND the BVA will accept it and note that the RO had knowledge of who had enough experience to write such an opinion -- and they trusted their judgement. Something just seems very wrong with that.

[4MR05C]

Chuck75: I didn't know that the Atlanta VARO uses VAMC NPs & PAs... all of my C&P exams have been with QTC doctors and they've all been doctors.

Free: I guess the BVA is daring the Vet to go to the courts in these cases.... its crazy!

[free_spirit_etc]

"Free: I guess the BVA is daring the Vet to go to the courts in these cases.... its crazy!"

Well.. sometimes they remand it BACK to the RO and say the specifically requested a __ doctor and the remand must be followed. That adds a lot of time to the claim too. So the veteran has to wait while the RO does what they were told to do in the first case. In these cases, I don't understand why if the vet has an IMO they even play that game. If the VA had the stronger opinion, they sure wouldn't put it off another year waiting for the veteran to get a stronger opinion. They would deny it.

To me, remands seem to tangle things up sometimes. As part of my husband's claim when he retired, he asked for ONE TIME dental care. If you didn't get dental treatment within a certain amount of time of your discharge, then they are supposed to provide you with one time dental care AFTER you discharge. So basically, they fix everything one time (that should have been fixed while you were still in the service.)

Believe it or not - he never did get it. The RO kept saying his teeth were not injured in service. He kept saying he wasn't applying for an SC condition - he was applying for his ONE TIME dental treatment. It should have been that easy... But it had to go to the Board. The Board remanded because they said his DD214 wasn't in the record. They couldn't have HIM send ANOTHER copy. They remanded the dang thing, just for that. So that used up another year. When it got back to the Board, he again told them he only wanted the one time TREATMENT he was entitled to. They looked at his records and decided he MIGHT have been injured and their MIGHT be a SC condition - so they remanded back to the RO to develop that. Meanwhile, they didn't approve the treatment (as they hadn't made a decision...). So then he had to go to a dental C&P, which, of course, found no injury (that he never claimed in the first case). So he was denied AGAIN at the RO and had to wait for the case to go to the Board. The Board upheld the denial for SC - and somehow they lost track of the fact that he was just trying to get treatment. Remands can sometimes get crazy because everyone can forget what the claim was for in the first place.

Edited October 23, 2013 by free_spirit_etc