FAXING THIS TO MY VSO IN THE MORNING< ANY FEEDBACK WOULD BE APPRECIATED
Enclosure (1) C&P Exam Report 9/26/06
Enclosure (2) Cervical Spine History
Dear Robert,
On 9/18/2006 I had a C&P Exam conducted at the Detroit VAMC by Doctor XXXXX M.D. My spouse was present for the entire exam. I gave Dr XXXXXX a copy of enclosure (2) which documents the history and associated pain caused by my cervical condition. Dr XXXXX stated he had reviewed my file including MRI reports and the statements of Dr XXXXX and Dr XXXXXX.
Today I received enclosure (1) in the mail. After a review of the report I would like to point out the following items I disagree with.
From the section:
Medical History including current complaints
a. “States Medication seems to help. No side effects.”
Duragesic side effects include fatigue, sweating, weakness and
tiredness. Oxycodone side effects include drowsiness, dizziness, lightheadedness, sweating, and weakness. Both of these medications are narcotics and prevent me from operating a vehicle or place in me in jeopardy of driving under the influence if I were to operate a vehicle.
b. States “no history of flare ups.”
In order for there to be flare ups I would have to be pain free and that never happens.
c. He repeatedly makes the statement “His work is not affected”.
In his opening statement he states, “Has not been employed for the last year and a half.” When in fact I told him I tried delivering pizzas for 12 hours a week for a couple of months but could not handle that.
d. States I am “not taking any medication for the C-Spine and or right arm.”
I am currently prescribed Duragesic 75 mcg/h and Oxycodone for the pain caused by this condition.
e. No History of acute, incapacitating neck pain in the last 12 months.
I am not able to work because of the neck pain, is this not incapacitating? Doctors normally order bed rest to prevent patients from going to work. My Doctors know that I cannot work so there is no reason to order bed rest. Enclosure (2), which was provided to Dr XXXXXX list 18 doctors, visits in 2005 for neck pain, and list 6 doctors visits for neck pain through April of 2006. It also notes I was to have a cervical spinal fusion because of the pain.
f. “He also complains of that sometimes in 1970, he started to experience throbbing pain in his left knee.”
What I stated was in the late 1970s I started having knee problems while stationed in Hawaii. I was not stationed in Hawaii until 1977 or 78.
g. He states “no history of flare ups.”
Prior to that statement he states, “began experiencing right knee pain on prolonged standing and walking.” “Going up and down stairs is difficult due to increased pain.” “Using medication prn, no side effects.” “Activities of daily living are affected.” “Repetitive motion increases the pain without additional loss of motion.”
h. “His left hip is also throbbing with pain at times.” “There is no limitation daily activities.” His work is not affected but his hip is still painful. “No history of flare ups.”
Then he states “Prolonged standing and walking makes him feel week in his left hip.” Again I do not work!
From the section:
Physical Examination
a. He states “there is no evidence of Carpal Tunnel Syndrome.”
Dr XXXXXX’s Letter which Dr XXXXX said he read states an EMG showed evidence of bilateral Carpal Tunnel Syndrome.
b. He states, “There is no crepitation”
Dr XXXXXX’s C&P report of April 8 2005 states, “the patella appeared to track normally bilaterally with crepitus with movement.” My SMR documents plenty of crepitus in my knees.
From the section:
DIAGNOSES
a. “1. Mild cervical spondylosis. 2. Normal both knees without residual of trauma.
3. Normal Left foot. 4. Normal left hip.”
The evidence of record previously submitted oppose the above diagnoses especially that of Mild cervical spondylosis. Mild cervical spondylosis would not warrant prescriptions of Duragesic and Oxycodone, multiple cervical manipulations, approximately 40 doctors visits in the last three years or recommendations of cervical fusion by two neurosurgeons. My SMR document multiple problems and a long history of knee problems with multiple diagnoses of Patellofemoral Pain Syndrome, and Chrondomalacia and regimes of Physical Therapy. X-rays taken at both the Detroit and Ann Arbor VAMC show degenerative changes in my knees and left hip.
b. He states, “There is no evidence of residual strain involving the left hip and left foot. There is no evidence of Incoordination in the right upper extremities. No evidence of bilateral patellofemoral pain syndrome.”
It is quite obvious that Dr XXXXXX did not do a very thorough review of my SMR’s where there is evidence of all of these.
c. The last statement in the report states “No impairment of daily occupational activities.
Question
betrayed
FAXING THIS TO MY VSO IN THE MORNING< ANY FEEDBACK WOULD BE APPRECIATED
Enclosure (1) C&P Exam Report 9/26/06
Enclosure (2) Cervical Spine History
Dear Robert,
On 9/18/2006 I had a C&P Exam conducted at the Detroit VAMC by Doctor XXXXX M.D. My spouse was present for the entire exam. I gave Dr XXXXXX a copy of enclosure (2) which documents the history and associated pain caused by my cervical condition. Dr XXXXX stated he had reviewed my file including MRI reports and the statements of Dr XXXXX and Dr XXXXXX.
Today I received enclosure (1) in the mail. After a review of the report I would like to point out the following items I disagree with.
From the section:
Medical History including current complaints
a. “States Medication seems to help. No side effects.”
Duragesic side effects include fatigue, sweating, weakness and
tiredness. Oxycodone side effects include drowsiness, dizziness, lightheadedness, sweating, and weakness. Both of these medications are narcotics and prevent me from operating a vehicle or place in me in jeopardy of driving under the influence if I were to operate a vehicle.
b. States “no history of flare ups.”
In order for there to be flare ups I would have to be pain free and that never happens.
c. He repeatedly makes the statement “His work is not affected”.
In his opening statement he states, “Has not been employed for the last year and a half.” When in fact I told him I tried delivering pizzas for 12 hours a week for a couple of months but could not handle that.
d. States I am “not taking any medication for the C-Spine and or right arm.”
I am currently prescribed Duragesic 75 mcg/h and Oxycodone for the pain caused by this condition.
e. No History of acute, incapacitating neck pain in the last 12 months.
I am not able to work because of the neck pain, is this not incapacitating? Doctors normally order bed rest to prevent patients from going to work. My Doctors know that I cannot work so there is no reason to order bed rest. Enclosure (2), which was provided to Dr XXXXXX list 18 doctors, visits in 2005 for neck pain, and list 6 doctors visits for neck pain through April of 2006. It also notes I was to have a cervical spinal fusion because of the pain.
f. “He also complains of that sometimes in 1970, he started to experience throbbing pain in his left knee.”
What I stated was in the late 1970s I started having knee problems while stationed in Hawaii. I was not stationed in Hawaii until 1977 or 78.
g. He states “no history of flare ups.”
Prior to that statement he states, “began experiencing right knee pain on prolonged standing and walking.” “Going up and down stairs is difficult due to increased pain.” “Using medication prn, no side effects.” “Activities of daily living are affected.” “Repetitive motion increases the pain without additional loss of motion.”
h. “His left hip is also throbbing with pain at times.” “There is no limitation daily activities.” His work is not affected but his hip is still painful. “No history of flare ups.”
Then he states “Prolonged standing and walking makes him feel week in his left hip.” Again I do not work!
From the section:
Physical Examination
a. He states “there is no evidence of Carpal Tunnel Syndrome.”
Dr XXXXXX’s Letter which Dr XXXXX said he read states an EMG showed evidence of bilateral Carpal Tunnel Syndrome.
b. He states, “There is no crepitation”
Dr XXXXXX’s C&P report of April 8 2005 states, “the patella appeared to track normally bilaterally with crepitus with movement.” My SMR documents plenty of crepitus in my knees.
From the section:
DIAGNOSES
a. “1. Mild cervical spondylosis. 2. Normal both knees without residual of trauma.
3. Normal Left foot. 4. Normal left hip.”
The evidence of record previously submitted oppose the above diagnoses especially that of Mild cervical spondylosis. Mild cervical spondylosis would not warrant prescriptions of Duragesic and Oxycodone, multiple cervical manipulations, approximately 40 doctors visits in the last three years or recommendations of cervical fusion by two neurosurgeons. My SMR document multiple problems and a long history of knee problems with multiple diagnoses of Patellofemoral Pain Syndrome, and Chrondomalacia and regimes of Physical Therapy. X-rays taken at both the Detroit and Ann Arbor VAMC show degenerative changes in my knees and left hip.
b. He states, “There is no evidence of residual strain involving the left hip and left foot. There is no evidence of Incoordination in the right upper extremities. No evidence of bilateral patellofemoral pain syndrome.”
It is quite obvious that Dr XXXXXX did not do a very thorough review of my SMR’s where there is evidence of all of these.
c. The last statement in the report states “No impairment of daily occupational activities.
Again I do not work!
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