Va Examiner Notes Additional Conditions In C&p Examination

[MarkInTexas]

Howdy All,

It's been a while since I've been on here, and I wanted to share that I finally got my C-File copy that I requested way back in February of 2013. I ended up finding the military and civilian medical records of four other individuals tucked inside, about 89 pages worth, and found that a majority of my own SMR's and civilian medical records were missing. I'm working on that through my appellate process, and I'll keep y'all posted. It does look like the C-File is missing most of my separation physical examination testing and report documentation though. I was able to reconstruct a bit with copies that I had and have since forwarded on to the VA, along with a lot of personnel documentation that wasn't in the file either.

However, the thing that intrigued me was that I finally was able to read what my VA examiner, a medical doctor (retired USAF Colonel) working for the contract company Veterans Evaluation Service had provided in my C&P examination report. This particular examination was for service connection for Mononucleosis, incurred while on duty.

I noted that he did service connect the Mononucleosis infection on my DBQ, advising that the first sign occurred while I was on active duty. However, he goes on to state that while I show no "active" signs of Mononucleosis, the resulting Epstein Barr Virus (virus that causes infectious Mononucleosis), has caused residual conditions of Chronic Fatigue and "recurrent viral symptoms and infections".

He even went so far as to add my other claimed condition, Hodgkin's Lymphoma as a secondary condition to the Mononucleosis (I have a NOD already filed on this, along with the Mononucleosis and Epstein Barr Virus residuals.)

I believe the rater probably went with the "no evidence of active Mononucleosis" and denied. On the Hodgkin's Lymphoma and Epstein Barr conditions, the rater stated that there was no record of Mononucleosis in service, which even the VA examiner noted was present. (Which now that I have copies of my SMR's in my C-File, I know that evidence of diagnosis was present and available upon rating.)

I've picked up the football with a medical opinion letter from my oncologist, linking my Hodgkin's Lymphoma condition to Mononucleosis and Epstein Barr infection, so I'm working on that. However, here's my question:

Should I go ahead and file a new application on the Chronic Fatigue and "recurrent viral symptoms and infections" conditions right now? Or wait?

I already have claimed conditions that are in NOD for joint pain, sleeplessness and sinusitis. Would these cancel each other out with a Chronic Fatigue or "recurrent viral symptoms and infections" claim?

Also, because he diagnosed these conditions on my Mononucleosis DBQ, will the VA trash them immediately?

Any thoughts or advice would be deeply appreciated. Have a great weekend!

Mark

Oh yeah....and when people on here say to get your C-File copy first before starting on this adventure......DO IT! I wish I had saved myself the years of waiting and stress by requesting my copy at the onset.

Edited August 3, 2014 by MarkInTexas

[MarkInTexas]

Nobody has had additional conditions identified or diagnosed by a VA examiner during a C&P examination? Here is what was said on the C&P and DBQ:

"Additional Clinician Notes:

2. Medical history

a. Describe the history (including onset and course) of the Veteran's infectious disease condition(s):

Veteran gives a history of contracting Mononucleosis in 1990, he had several bouts of viral illnesses attributable to the Epstein Barr virus then developed Hodgkin's Lymphoma in 1998 undergoing chemotherapy."

"c. Does the Veteran have residuals attributable to disease: #1?

[X] Yes [ ] No

If yes, describe: .

Chronic fatigue, recurrent viral infections"

"7 . Remarks, if any:

There is no evidence of active mononucleosis but he has active recurrent viral symptoms and infections attributable to Epstein Barr virus. All relevant submitted records were reviewed."

"4. Medical opinion for direct service connection

Choose the statement that most closely approximates the etiology of the claimed condition.

a. [X] The claimed condition was at least as likely as not (50 percent or greater probability) incurred in or caused by the claimed in- service injury, event, or illness.

Provide rationale in section c."

"c. Rationale:

Based on veteran's records of having Mononucleosis while stationed in England while on active duty there is evidence that the condition is as least as likely as not to have been incurred while on active duty."

Also, the IMO from my oncologist of the past 16 years reads, "Patient was seen today for follow up office visit from diagnosis of Hodgkin's lymphoma. Mr. XXXXX was exposed to toxic chemicals and diagnosed with Epstein Barr which is also known as the virus

mononucleosis during his time in service. This virus is known to cause Hodgkin's lymphoma and more likely than not is the cause for his diagnosis of Hodgkin's lymphoma. Order Entered 06/19/2014 15:53"

He's a civilian doctor, and has a heavy patient load every day, so this was about as good as I could get from him on the IMO, but I have a good 16 years of examinations/treatments/reports that the VA has from his office on this condition, and he has been my sole oncologist during this entire time.

OK......so does anybody think that I should file for the additional condition(s) identified as a separate secondary condition claim, or try to get them added into the current one? I've already filed a NOD, so I don't know that I can add at this point. Any thoughts or advice would be deeply appreciated.

Mark

[VetlawUS]

Mark,

One thing I noticed in that private opinion is that the doctor didn't review your C-File. That's one of the reasons that the BVA will "discount" a private medical opinion. Get him a copy of your C-File and have him include the statement: "I reviewed the Veteran's C-File in making this opinion".

It's one of the "Magic Words" that needs to be in a Private Medical Nexus Opinion.

As to your other question, this gets a little trickier.

When a C&P doc identifies a "new" condition that could be related to your military service, but the VA does not address it in a Ratings Decision, you might have what is known as an "Inferred Claim". Generally, an "inferred claim" is one that is not SPECIFICALLY raised by the Veteran, but is "reasonably raised" by the facts in the record.

The VA routinely ignores "inferred claims".

The process allows you to do 2 things, and I do BOTH when representing my clients:

#1: Include the Inferred Claim as part of your current appeal. If you still have time on the 1year clock, even though you have filed a NOD, file what I call a "Supplemental NOD".

#2: File a "new" claim for secondary service connection (or service connection based on aggravation) on the additional condition. That way, if they deny it in the NOD "track", you have a second "track" to continue your claim. You can always argue for the earlier effective date later, too.

Hope this helps. I wanted to give helpful information about the process, without leading you to believe it is legal advice (which is not).

[Mikemmlj]

The more I reD the more I feel vets should avoid private C+P exams.

[silverdollar22]

Mike ,

In reply, we don't get a choice on private C&P'S or VA C&P'S. The Va make that decision for us and we just have to hope that we get a good Doctor taht will be fair. I'm hopeing that is my case right now after going to a Private C&P.

[MarkInTexas]

I should also explain that the VA denied my Mononucleosis claim however, due the small portion of the statement in the remarks section of "There is no active evidence of mononucleosis".....and they disregarded the remainder. I was hoping that my private IMO letter from my oncologist would provide the medical conclusion that Mononucleosis is a result of Epstein Barr Viral Infection. He was able to do that at least hopefully in this IMO. (I agree that I may need to go back and get that language included regarding a review of the military medical records.)

The VA's rater took no notice of the Epstein Barr references, although I have it in a separate claimed condition during the initial rating, even with professional journal information, military records and civilian records. That's why I'm now trying to get as much evidence as possible, such as the IMO from my oncologist (and perhaps another independent C&P) to help me on this NOD process. The VA has recognized the link between Mononucleosis and Epstein Barr, and granted service connection on several appellate cases, so I guess I need to first try to convince my local VARO at this level. Wish me luck.

Part of this is my fault for trying to do it all by myself. I've found I need to clean up areas where I wasn't clear, and thanks to the help of this site, I have a great deal of information available, complete with stories of lessons learned.

Mark

[john999]

Getting a good IME is the best move a veteran can make. You just have to find a doctor who will do one according to the VA rules. I won my TDIU P&T based entirely on a IME done by a doctor who knew how to write, and the rules of the game. Social security lawyers often know doctors who can write an IME/IMO that will stand up. The doctor must at least say he has reviewed your C-File and your SMR's and current medical records. They must be available to him/her. None of the C&P doctors the VA uses actually read a vet's C-File (1000 pages plus). They just sometimes say they do. Often they don't even do that. They just scan your medical records. The VA uses those exams to deny or approve your claim every day. When you get to the BVA or COVA then the knives come out to cut the exam to ribbons. Your good IME doctor can cut it to ribbons if it is not good. That is what my IME doctor's did for me. I remember back in 70's, 80's and 90's the VA would use resident doctors from the medical school next door. All they would do is review the other doctors notes from last C&P and parrot it back. What lazy trash they were then and now sometimes. I met many C&P docs who believed every vet was scamming the system. One told me Vietnam vets get fat on purpose just to get more compensation for DMII. Hey, he gave me a decent exam for what it was worth.

John