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C%p Notes, Can I Expect A Denial?
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ddj6969
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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