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Why Does One Need A C&p Examination


Josephine

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  • HadIt.com Elder
You have to remember that the doctors at the VAMC don't service-connect anything, the RVSR (Ratings Veterans Service reperesentive) does this. The doctor can state anything they want, but the decision to grant or deny service-connection lies soley with the regional office.

What good is a C&P Examination?

Josephine

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Jpsephine, That statement is correct to some extent. A C@P is obtaining a medical opinion on a claim. It all depends on how the Examiner writes it up. They must apply a good reason and basis for their opinions as well as use the magic words the Regional Offices are seeking. At least as likely as not related, 50 percent.

Most likely 75 percent sure , was due to, 100 percent sure.

Now the person I spoke to yesterday said that over 600 C@Ps are performed at the facility every year and the RO has not went against an opinion yet.

Now as far as the Rating officials making the determination, Medical evidence and the application of the laws and regulations are what service connects diseases.

In most case the Rating officials that overturn a good C@P examination often lose at the BVA. I believe a Good C@P exam puts claims in relative equipose and should give the benefit of doubt to the Veteran.

But also heed what I have always said before, Some regional offices will not grant anything unless they are forced to by the BVA or Court.

Dont lose faith in the C@P in the system, Paranoia, can cause blindness and not all VA Employees are out to get Vets. There are actually some fine compassionate people who I respect very much and they happen to be C@P examiners.

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The VARO grants precious few awards without a C&P. Don't ask me why its just the way they operate.

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The reason the RO's don't grant many claims without C&P exams done by the VA is 99% of the private doctors out there don't have the first idea how to administer a VA C&P exam i.e. going by the VA's Physician's guide. When the C&P is done according to the Physician's Guide then the exam is generaly sufficient for rating purposes. How often does a veteran have a private doctor that routinely does their write-ups with all of that stuff needed for a sufficient rating? Not very many! I have helped a few veterans with their claims and had their doctors do a write-up in accordance with the VA's Physician's Guide and they were awaded service-connection with out having to see a VA Doctor. I'm not saying this will happen all of the time, but does happen.

The VA isn't trying to purposely dely a claim. There is such a back log, they're tying to crank out decisions as fast as they can. That's probably why some of the craziest errors happen. The quality of the work goes down when they have to try and crank these things out left and right! As far as costing the government money, it doesn't matter when the veteran prevails, the VA still has to pay the same amount. Whether it's a lump some payment or the monthly benefit paid, the amount is the same and the effective date is the same. And they certainly aren't trying to shut any one up. You would be surprised at how many combat veterans work at the regional offices as RVSR's or VSR's working their fellow veterans claims!

Vike 17

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vike 17,

As you have already read my remand and may remember some of it. This is where I am at.

My first C&P was by a PHD Psychologist with a More Likely than Not Anxiety began in service.

My file was transferred to another Regional Office, when the C&P results came in, as my niece is a DRO at that R.O.

She had always told me that she had signed off when I was in the rating board. Not true.

5 months after I was transferred to another R.O for rating. I was send before a Board of Two Psychiatrist, Male and Female.

The C&P was full of lies and slanderous accusations, none to be backed up by any of my Private or Military records. She committed fraud with the intent to deceive.

I will if I have to, turn her in to the Virginia Board Of License.

The male Psychiatrist would not sign the C&P.

Their determination nothing bothered her in service.

The C&P was so full of lies that I sent a rebuttal to the R.O and the Medical Center and requested a new C&P.

I did not receive one.

8 months later, I received by denial.

We place our weight with the Psychiatrist, because they are Psychiatrist.

I had received my Statement of the Case before I received my first C&P with a form 9 to turn in. I did this.

With the form 9 being at the BVA months before my denial, when I received the denial, my time at the BVA was only a couple of months.

I made sure that everyone knew about the legalities of my claim and the slanderous lies written in the C&P and drew a child proof map for the BVA to locate the lies. From Military to Private medical records, to compare with what she had typed.

The remand states -

After the above development has been completed, the veteran's claims file

should returned to the board of VA psychiatrists who participated in the

April 2005 examination for clarification of the provided opinion. They should be

requested to review the record and reconcile their opinion as to etiology in

light of the evidence added since their examination of the veteran, including the

May 2005 statement of Dr. B C. C and the January 2006 statement of

Dr. M P.

The Mangement Center also had the choice to send me for another examination, but they have chosen the fair route.

I fill this is victory for me.

Now my file is back at The Medical Center on the desk of the Male Psychiatrist. He has had it since Tuesday.

I was told by the BVA that my examination is the first one to be send back to the Psychiatrist to explain why they did what they did in 25 years.

I know that he refused to sign it the first time, what can I expect from him this time? Will I be allowed to pick up a copy of his write- up at the Medical Center.

I will not allow that lady psychiatrist tell me that the medical records state that I have 3 children, but that I claim to have only 2. That is a dern lie. I have two daughters and my medical records state this.

Eating disorder is severe diabetic.

Self - Inflicted wounds- never.

I know that the board has disagreed with my doctor of 29 years being a Board Certified Internist, but he knows me better than they do in their 45 minutes.

I will not let that lady lie about me and my character.

The BVA wants to know" What was the reason for her early discharge of 13 months"? I was taking Librium for my nerves and Caffergot for headaches.

I have a letter from the commanding Officer that only states Unsuitability ( No reason).

I know that I filed in 1978 and again in 2002 and received a pension of being 100% disabled as of 1983. The Va never secured my Psychiatric Records from the Archives, I did this myself in 2004.

My DD214 Code 460

Does it appear that my claim is finally getting on the right track?

Thanks,

Josephine

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Vike, Please dont take this the wrong way.

I also think the RO's do not purposly deny claims, But, Can someone explain to me why there is a 4 percent approval rate, Or why is there a major backlog at the flollowing levels, DRO / VBA / Veterans court?

The claims are being denied somewhere. I guess the intention is not to deny claims, But what are intentions. I intended to 20 years in the Navy until I almost got Killed.

As I have stated in the past and I will not budge for I have personal proof that they do deny claims just for Kicks. The first response is a denial and maybe the fool will go away. This is not published for it is illegal, But, we never know what goes on behing closed doors.

In reading the BVA records I cam across a case where a Regional office employee was caught destroying a Veterans evidence. ( Why).

Not everyone gets the treatment at the VARO level, But a lot of us do. It is best for any vet who is considering filing a claim or has filed a claim be aware of the possibilities that can occur. As they all know, Delays are Common, If you contact Congress, Then it is another 60 days, Lord help contacting the Inspector General.

The main reasons that there are denials are this.

Insufficient claims processing Quality Control.

Not evaluating the entire evidence. Ignoring evidence. ( Ignored my smr for 9 years)

Leading the C@P examiners to find a negative opinion. ( I can show a C@P exam with this one)

Making their own medical diagnoses up out of thin air. ( read the VBA cases on that issue)

Every Regional Office is different. But if you start handing out too much money, someone in accounting is going to pull the plug and that is the bottom line.It all Boils down to budget.

John

Edited by jstacy (see edit history)
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I hate to break it to you Vike but many of the C&P's ordered by the VARO are done by has beens and quacks who can't make it in the real world.

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I was seen by a shrink at the VA in 1972. The shrink was middle aged. In 2002 I saw the same shrink at the VA. He was now a consultant to the VA. He was in his 80's pushing 90.

A claims examiner who does Fee Base claims purposely destroyed my claim for dental work. The VA minor boss in charge of Fee Base admitted this to me one on one with the understanding that he was very sorry and that my claim would get priority henceforth. All I wanted was my money so I did not raise a fuss.

I had one decent C&P exam over the last 30 years. The rest were half-ass efforts that should be objects of shame. 10-15 minute affairs in which the last exam was simply re-written and a few things added or subtracted.

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jstacy,

Many, many, many cases at the BVA and Court are eventually granted because of new evidence that came about after the first deciion was made. If that new evidence was available the first go around, maybe the claim would have been granted then? Yes, there are those claims that go before the BVA and Court that are granted based upon the previous evidence. However, I'm willing to bet that if one were to read all of the BVA cases for instance, the majority were granted because of new evidence after the initial decision was made.

I hate to break the bad news, but far too many claims are filed with the VA that are not well prepared, shakey to begin with as far as being legitimate, or just down right absurd. Who is at fault? The majority of the fault lies with the veteran or their SO for submitting half assed claims with only a portion of the needed evidence, or just sending a claim in with the hope of getting one by the VA. VA disbility is not a lottery with which a veteran just files a claim to see what happens and hopes to win something. This also goes for the appeals portion of a claim. Many (I'm not saying all of them) appeals filed with the appeals Team, BVA and Court are either lacking the evidence to be granted or are just baseless. One example of this is a while back veteran I was helping filed a NOD with his regional office. A couple of weeks later he received an envelope from the Appeals Team acknowledging his issues on appeal. However, enclosed with his letter was a similar letter to another veteran acknowledging their issues on appeal too. I about lost it when I read the other letter; the veteran was appealing a 0% rating for residuals of a lost fingernail! This isn't a joke!! I'm willing to bet that when the DRO further denied the veteran's appeal for an increase, they'll piss and moan that he/she got "screwed." I'm not saying all appeals are like this but with that letter in mind and some of the cases before the BVA and Court, it makes one wonder a bit.

I've even had a couple of instances where a veterans have asked me to help them with their claims because they wanted to "get that good, easy VA disability." Needless to say, I about went through the roof. I even had a member of Hadit send me a message a while back in which he stated that he has seen a few times where he had been in PTSD counseling at the local vet center or VAMC, and there were wannebes trying to pick up things from the real PTSDers in order to prevail in there bogus claim! This just pisses me off to no end! :(

As far as the VA employee destroying medical records, evidence and anythng else in a C-file, sure that has happended, and is down right disgraceful. When that employee is caught, they are fired and to the appropriate extent are prosecuted. I'm sure this has happened at the Social Security Administration also, but you don't hear nearly as much bitching as you do with the VA. The vast majority of VA employees are honest and hard working, and to a large extent veterans like you and me. Like I've said before, are there the few bad apples in the barrel, or just that plain moron that doesn't have a clue to what they are doing, you bet there is. But it say this is a common practice at the VA is just a little stretch.

The 4% approval rate with VA was dicussed a couple of years ago on the old board and I have to say this is one of the more absurd things I have heard about the VA. The countless claims I have helped with (and were with different regional offices too) would contradict this. If I were to go back and look at all of the claims that I have done, I think I would probably be right around the 90%-95% approval rate. For the veterans that are hell bent on the idea that the VA only approves 4% of all claims is basically saying that the Dept. of Veterans Affairs is able to keep over 200,000 employees quiet on this conspiracy. I don't buy it!

Pete,

Every VAMC doctor possess a valid license with the state in which their VAMC is located.

The botom line is the VA isn't the big, bad, evil empire as everyone thinks it is.

Vike 17

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Vike, Maybe in time I can gain the confidence you have with the VARO's. Im not saying they are all bad either, Now if Congress passes the representation bill, ( I heard it is in committee whwere it will probally die) I believe majority of the sloppiniss of claims will cease to exist.

With the Vets that I help, I put it straight forward on what they must submit to the VA as evidence.

I know 200.000 VA employees are all not in conspiracy, However I also know that certain GS grades are not authorized to make decisons unless you are above a certain grade. Most of the employees are development people who process the information on claims. The management and rating officers are the ones who actually make the decisions. The 200.000 figure is about 90 percent too high.

The Current backlog is not really a backlog at all, I call it a bottleneck. The raters get in to bit of a rush trying to rate claims and do not take the time necessary to do a complete Job. It is not their fault, It is the fault of the system which is designed to do this,

Leading C@P examiners in examinations:

When I was a child, I fractured my clavicle, It was cracked. It healed by the time I was 11 years old. I am service connected for a Neck Injury with Radiculpathy to the C6 nerve root and the RO sent a direct request to the Examiner to ask for an opinion that the Fractured Clavicle was responsible for my left deltoid muscle innervation. The Examiner about lost it. The statement was replied to as the Fractured CLavicle was not associated with any injury in service.

What does this tell Veterans? ( They are looking for reasons to deny claims)

Attitude of rating officers.

I received a statement of case denying My neck in 1998 when I applied to reopen on the basis of SMR being received.

It said the Veteran was struck on the left side of the neck by an unknow object( Perhaps a Fist.)

I had included the Boats Master at Arms log and a Medical report from the Medical Department that the Object was a Battle Lantern.

Vike, you are correct , Eventually a Vet will get Service Connection if the Evidence is there. A vet just has to out live the system.

Here is the Kicker: I applied in 1994 for Migraines and Hypertension, I stated the Service record and the reserve record showed both as being treated in service. I got the post service records myself and summarized them along with the criteria from the Directives on Hypertension and Migraines. I got a reply that the service records were negative for any treatment, complaints, Diagnosis of Headaches and Hypertension. I felt dejected and DID not appeal. Well in 2005 I was told by someone to file a claim for the Headaches and HTN. I got a C@P exam and the Examiner went straight to the service medical record and Guess what the exmainer found. They were both on the same page. The Next day I handed a CUE claim to my VSO. I also mailed a copy to the RO along with a statement from the Doctor who treated me in the first post service year, He only confirmed the record I had sent before.

I recently had another C@ P for Hypertension and Cad secondary to Hypertension. The Examiner could not understand why I had the Exam. He felt I should have been service connected years ago.

Vike, I can apreciate your experience respect you a lot. Please dont take this negative, But as you can see, I have treated pretty bad and I am a little Bitter. Now things are getting Better and I hope sooon it will all be Good.

Thank you for the advice.

John

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jstacy,

Even if the government is only asking 10% of the VA employees (the decision makers), which would be about 20,000 workers according to your figures, to apporove only 4% of all claims, that's still one hell of a lot of people that have to keep their mouths shut. I still don't buy it.

I still don't think the RO's are deliberately leading the C&P examiners to make an opinion in one direction or another. One has to remember that RVSR's are not doctors and cannot, by law, make medical determinations. In your case, for example, let's say I'm a rating specialist and don't know diddly about human anatomy. The only thing I know is that the collar bone is attached in some way, shape, or form to the deltoid muscle. It would be my job to see if that broken collar bone was somehow the cause of your other problem. That may sound ridiculas to the doctor or someone with a little knowledge of medicine when a rating specialist poses such a question, but they have to to find out what the actual cause of the disability is. Would you want the VA to grant service-connection for disabilities that aren't related to a veterans service? Remember, RVSR's aren't doctors. Now, as stated before, there might be that rater out there that is just a plain jack ass and pulls some of his shinanigans, but this isn't the norm.

As far as the backlog, I guess when I think about it, you would be correct to say that it is a bottle neck. That wouldn't be the VA's fault as you said. The fault is with congress and the administration for under funding the agency, which in turn prohibits the VA from hiring additional decision workers to handle the case load. Then when management applies production quotas to chip away at the backlog to try and speed up thing, you have raters and DRO's working so fast to meet those quotas that things as effective dates or treatment of a condition in the veteran's SMR's get screwed up.

A while back I was helping a veteran re-open his claim from 1994. We requested his C-file to see what was what. About 6 weeks after the request we received his stuff. I almost had a stroke. His C-file was over two feet thick and the VA had to send the stuff in a small box! Now imagine you being a rater having to go through all of that to rate let's say five disabilities, and you have six other C-files you must complete that day that are just as thick to make your production quota! I would probably make just as many mistakes!

I'm not taking your post negatively or anything, just trying to have veterans look at the whole picture of why some things happen. You may have gotten the short end of the stick with VA in your initial dealings with them, but I can speak from experience that the whole system isn't set up to purposely deny and dely a veteran's claim from the VA's standpoint.

1968 Army vv,

Having a claim being well-grounded went out the window in 2000 with the VCAA. Having said that, wouldn't you want to submit a well-grounded claim from your standpoint to the VA? You want to suceed don't you?

Vike 17

Edited by Vike17 (see edit history)
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All you have to do Vike is read the success stories here on hadit. There aint a whole heck of a lot of them.

The reason behind my post is not to be negative, It is a learning tool that should be considered.

Thanks for the assist and I will not be as negative in the future.

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Vike, I just left a job working with hospital resident doctors. Some of them work at the VAMC on rotation or as part-time outside employment. I discovered their medical licenses were expired, one guy was out of compliance since last February.

No one at the VA checked any of this before they agreed to employ them to do C & P exams on veterans.

So what you say about doctors having licenses in the state in which the VAMC may be true, but it's irrelevant if they don't keep them current.

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Vike, I just left a job working with hospital resident doctors. Some of them work at the VAMC on rotation or as part-time outside employment. I discovered their medical licenses were expired, one guy was out of compliance since last February.

No one at the VA checked any of this before they agreed to employ them to do C & P exams on veterans.

So what you say about doctors having licenses in the state in which the VAMC may be true, but it's irrelevant if they don't keep them current.

The Veterans claims assistance act of 2000 removed the terminology of well grounded from the VA.

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