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C%p Notes, Can I Expect A Denial?


ddj6969
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Question

The patient stated he was seen in 2000 for the n/t in his arms. There are notes that appear to be EOBs that support his claim that a neurologist and radiologist in (state x) billed the insurance for visits on 5/18/2000 and 5/25/2000 for brachial neuritis and cervical ddd, respectively. However, there are some inconsistencies in the history. It seems unusual that a patient would be seen by a specialist and have an mri done just a few days before their separation exam

from the military and then it did not appear to be mentioned in the separation exam; however, the report of medical history that often accompanies enlistment and separation exams was not present in the strs either which is often where that would be reported. Nonetheless, a problem necessitating an mri and specialty consultation a few days prior would have been expected to be mentioned by the

patient to/by the provider on the separation exam, even if the neuro exam at the time was normal. As noted in the prior c and p exam, there is no informatino in the strs about the neck or arm symptoms. This va examiner interpreted the patient

to say that his records from the base there in (state x) were destroyed; however,his separation exam was in the strs - how is it that all other records except the separation exam were destroyed from that location? Unfortunately, Dr. (x) (neurology) office does delete records after 7 years- as reported by the patient and verified with the clinic staff at that office by this va examiner. Unfortunately, the mri center (where Dr. (x) works) has films back to 2005 and has written rad reports back to 2000 but they did not have a report or evidence

of the patient being there in 2000-- but the patient's name showed up in the system at their office. Even though there is substantial evidence he was seen for something related to brachial neuritis in 2000, there is no objective evidence in any medical record to indicate what the symptoms were exactly- if they were unilateral or bilateral. Regarding the mri, there is no objective evidence to indicate the specifics about the cervical ddd without having a medical record or rad report regarding the exact findings. The veteran currently has symptoms in the c8-T1 dermatome. In 2013, he informed the c and p examiner that the symptoms were in his entire arms and hands. The emg in 2013 was normal. Though emg/ncv studies can be normal in presence of radiculopathy, more often than not, these studies identify an abnormality when present, especially if present for so many

years as reported. The cervical spine xray revealed mild degen changes of the cervical spine and narrowing at the right C4-C5 neural foramen. Based on all the above factors taken into consideration, there is insufficient medical evidence to determine a nexus between the symptoms reported in 2000 and the current symptoms.

The symptoms even changed some since the last c and p exam in 2013. Therefore, it is less likely as not that the Veteran's cervical spine disability with bilateral neuritis of the upper extremities was incurred in or caused by military service.

I like the part where I am basically called a liar.

I have not got the response from the DRO yet but I expect a denial. What would be my next step?

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This was what the DRO sent to the C&P:

Note 1: The Veteran's complete original service records are not available for review and the only available copies of record do not show neck problems while on active duty. However, the veteran has submitted copies of medical bills showing a consultation with Dr. (x). D on 5/18/2000 and subsequent MRI of the neck on 5/25/2000. Although the results of the MRI nor the actual treatment reports are available, for purposes of this opinion request, please consider as though the Veteran did report complaints/symptoms involving his neck and/or upper extremities while on active duty.

Note 2: The Veteran is claiming "neuritis/radiculitis" of the upper extremities related to his cervical spine disability. Please specifically examine for and report the presence or absence of an upper extremity diagnosis such as radiculopathy or neuritis and comment on whether or not it is attributable to his claimed neck disability.

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That is one tough C and P report. You have an uphill climb but I wish you the best.

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I think you might need an IMO from a real doctor, like Dr Bash.

As a NeuroRadiologist, he is very familiar with interpreting MRI results and X rays..

"Although the results of the MRI nor the actual treatment reports are available, for purposes of this opinion request, please consider as though the Veteran did report complaints/symptoms involving his neck and/or upper extremities while on active duty."

Why were these records Not available?

And I sure wonder what kind of doctor did this C & P exam......as to their expertise.

Do you have a copy of the MRI results? DId You or the VA attempt to get them?

Any IMO doctor will sure need them.

I took a 2 page Neuro MRI result and matched it up with a copy of a photograph of an autopsied brain for my 1151/FTCA claim, and highlighted it , showing VA exactly what damage they had caused and where the damage was ,due to a severe misdiagnosis of my husbands TIAs and stroke.

I also matched it up with the findingsin his autopsy of the brain damage.

MRIs are a wonderful thing and can save lives .They can also be critical medical evidence.

.

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The MRI exam and the consultation visit in 2000 were done with doctors who were not military. They only keep those records for 7 years. I did not even know I could be compensated by the VA until 2008. By that time the records were destroyed. I made every possible effort to get the records and so did the C&P examiner.

I am still holding out hope. If I do get denied Dr. Bash will be my next step.

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How long ago was the exam on the MRI's?

Go get copies of all your exams MRI's countsulations ect,,ect,,and check on your military records also. if denied or rated unfairly

File NOD if you haven't yet!

Call Dr Bash As Ms Berta mention, He is very good with veterans claims and will get this straighten out for ya Buddy!

Be sure and make copies of Notes 1.& 2. from the DRO.

A good IMO from just a Regular MD or even a specialist would not be much help if they don't use the VA Guidelines or have the medical evidence!

JMO

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