C&p Exam Physicians

[JAMES10902]

Is there a rule or policy about the type of Doctor that performs you C&P exam. Both my claims are related to foot injuries.

Bilateral ankle instability and plantar fasciitis. Yet none of my exams were performed by podiatrist. They were done by

a general medicine PA and a general medicine physician.

[63SIERRA]

why would they need a qualified doctor when the main goal is to deny you? that doesnt take a specialist.

[toddt]

While there are qualifications that should be met to be a C&P examiner there isn't a "rule or policy" that they must be a specialist in the field of your disability. The exception seems to be if you are claiming PTSD. Throughout HADIT you will find many complaints about the C&P examiners and their qualifications. One thing to keep in mind, if you are denied you may always appeal with a NEXUS from a specialist in the field.

[Berta]

You can also challenge the exam if it is too speculative.... In the NOD.

Still, this is one reason why many claims only succeed once the vet gets an opinion from a real, non VA doctor, with expertise in the field of disability..

In 2009 I had a BVA case and the BVA (since I had 3 IMOs in support of my claim, remanded for another C & P exam.I had 2 against the claim and IMos that destrpyed those C & P results with a full medical rationale.

I was remanded for a Cardio opinion.

I got a PA opinion, and got a copy of the negative C & P from him right away and knocked it down, pointing out it was too speculative and I had already proved to VA ( FTCA) that I had more cardio knowledge than the PA did.

I have a podiatrist. My PCP does not understand my foot condition at all.

She doesn't have to.... the podiatrist does.

People do not understand why, although I can clean, do yard work, paint my walls, run a tiller, mower etc, shop etc etc, that I am unable to stand comfortably for more than a few minutes, in lines at stores or for idle chatting, and I cannot stand up for all the singing in church.

I saw a podiatrist on TV once who was the only person other than my own podiatrist, who understood what severe pronation is all about regarding the bio mechanics that affect our whole body due to foot problems.

You could certainly get a favorable C & P result......but that is hard to say.if you will ......

BVA agreed. They awarded the claim.

Edited March 18, 2015 by Berta (see edit history)

[davidlj1958]

In my Pulmonary DBQ C&P exam in Wash DC back in December of 2012 the doctor was not a specialist in that field just a GP diagnosed me as having COPD based off the so called earliest non service exam in 2005 which had no diagnoses what so ever. Big mistake as my current MD Pulmonary specialist diagnosed me back in 1993 five months after my return from Saudi Arabia Oct -Dec 1992 active duty period with asthma

[JAMES10902]

While there are qualifications that should be met to be a C&P examiner there isn't a "rule or policy" that they must be a specialist in the field of your disability. The exception seems to be if you are claiming PTSD. Throughout HADIT you will find many complaints about the C&P examiners and their qualifications. One thing to keep in mind, if you are denied you may always appeal with a NEXUS from a specialist in the field.

What is a NEXUS

[toddt]

Here is what a NEXUS is and what it should contain: http://veteransinfo.tripod.com/nexus2.pdf

[Buck52]

I would ask if the examiner is qualified for this exam?...I mean you don't want a back specialist to comment about your foot?

Here a look at a Nexus Letter!

Source : Untied States Veterans Alliance

Example of a Nexus Letter

DATE ____________

Reference: (Veteran's name) ____________

SS# ____________________ VA File #____________________

To Whom It May Concern,

I am Dr. ____________. I am board certified to practice in my specialty. My credentials are included. I have been asked to write a statement in support of the afore mentioned veterans claim.

I have personally reviewed his medical history. (Name the Documents) I have also reviewed and have noted the circumstances and events of his military service in the years ____________ (Event or Events claimed as the cause of the condition) while he served during his military service. (List dates of service)

Mr. ___________ is a patient under my care since (enter Date). His diagnosis is _____________ (Name the Condition).

I am familiar with his history and have examined Mr.____________ often while he has been under my care. (Specify Lab Work, X-rays, Etc.)

Mr.____________ has no other known risk factors that may have precipitated his current condition.

After a review of the pertinent records it is my professional opinion that it is at least as likely as not that Mr. ____________'s condition is a direct result of his (Event) as due to his military service. (Choose the degree of likelihood with which you can concur - "at least as likely as not", "more than likely", or "highly likely")

In my personal experience and in the medical literature it is known (Give a rationale).

Signed,

Dr. ____________

(List credentials and contact information)

Please understand that the VA often uses credentials to assign probative value to the nexus letter.

While the nexus letter must be brief as possible it should be as detailed and complete as the circumstances dictate.

USVA - 2013

.............Buck!

Edited March 19, 2015 by Buck52 (see edit history)

[davidlj1958]

Interesting the doctor stated in my Dec 2012 DBQ C&P Exam that 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.

Rationale was that there are multiple references in the veteran’s service record of medical visits for lower back pain and sciatic type numbness in the right leg. The problem is the logical extension of those problems.

Diagnosis Lumbar spinal arthritis ICD code 724.4, Intervertebral disc syndrome (IVDS) and incapacitating episodes Date of diagnosis: 12.28.2012 that I had incapacitating episodes over the past 12 months due to IVDS which the doctor remarked as being yes of at least 2 weeks but less than 4 weeks.

Furthermore the doctor stated that "This veteran developed lower back pain while in service and sought medical attention which included physical therapy, medications and bed rest.

He was SIQ and was limited duty several times while in service. After leaving the service, he mentioned the problem to his physician in the 1990's and underwent physical therapy but more recently, for 10+ years he has only taken aspirin and done the exercises provided by the former physical therapist.

He was absent from work for 2 weeks in the past 12 months and did not seek medical advice. In addition, he develops leg numbness, usually on the right and at times on the left" .

That my thoracolumbar spine (back) condition impacted on his ability to work that the condition impacted on his ability to work and that his job requires being up and about and during a flare-up, he needs to sit.

I was denied of having any back issues and sciatica

Over all the exam did not go the best at the start as the doctor refused to exam the MRI from Dec 1995 but settled down. If I had known better I would not have pushed myself and stopped right when the pain started. At least he had read most of my service medical records. The doctor who did my pulmonary had not and I found foul ups all over in the report wrong references to dates, Not referring to some service PFT's at all nor the fact that I had failed a fire fighter physical (PFT) not even six months from my return from Saudi Arabia in Dec 82 (The FF exam had been May 93). Nor was the MD a specialist in pulmonary care and diagnosed me from a 2005 exam as having COPD which was strange as my 93 to present pulmonary doctor said all along Asthma.

[Berta]

Can you scan and post their Reasons and Bases part of the denial here as an attach ment, along with the evidence list.

Cover the C file number, name, address prior to scanning.

I just got email from VACO, they have my files and are reviewing the bogus examine I got for my claim last week.

I hate to repeat this (I am livid about it)

some medical person they did not identify "reviewed" my 1151 issue at my RO, and wrote an opinion that goes against an opinion from a Cardio specalist at VACO, that was part of my successful FTCA case.

Even though the VA cardio doc's credentials were outstanding, I also never got any statement as to why I was denied Relative Equipoise.

When vets start really raising Hell about these ridiculous C & Ps that can control the rest of their lives in a negative way, then

the VA will do something about it.

The reason the VA continues to pull this conflict of interest crap , when a doctor, paid by the VA, can say just about anything they want, in some cases, for the sole purpose to deny the claim, is because vets have not complained enough about it.

In my opinion

[georgiapapa]

James,

With the exception of mental disorder claims and hearing loss claims, I believe most VA C & P exams are performed by PAs and NPs. They are given a computerized checklist of questions to ask during the exam.

I had a C & P exam for Multiple Myeloma which is a blood Cancer in the bone marrow. The NP who performed my exam had no knowledge of Multiple Myeloma and admitted she thought my claim was for Melanoma skin cancer when she first saw the exam info. Fortunately I brought my medical documentation to my C & P exam and the NP used the info from my records to complete most of the answers on the checklist and prepare her report. I did win my claim.

I believe the VA uses NPs and PAs because it saves the VA money. Is it fair to vets? No, but fairness to veterans takes a back seat if the VA can save a dollar. JMO

Good luck to you.

GP

[63SIERRA]

the CP exams are WAY too important to let under qualified, often disgruntaled people make these decisions/. How is it that a person can be in the medical field for 20 years and not become a full fledged MD., Yet they act as MD s under MD s supposedly direct supervision. If a MD has the time to thouroughly review the file and supervise, and quality check the NP s work, then why dont they have time to examine the vet themselves.

It should be just the opposite, the NPs should be doing the day to day healthcare for minor stuff and the MD s doing CP exams.

I myself have had very elementary errors on CP exams such as having the wrong box checked,

yes or no, and no being checked when it should have been yes, according to the description that the examiner themselves wrote. well guess what the m 21 reads,, the checkboxes.. coinicidence??? I doubt it.

Edited March 22, 2015 by 63SIERRA (see edit history)

[SeattleShay]

Seattle RO used to use an American Lake GP for all female C&P's (she was a female).

In one C&P she did a pelvic and then the examined my back and ankle.....

Lot of denials back in those days for female vets..