I Was Just Scheduled A Second C&p For The Same Condition With The Same Doctor? What Gives

[magnolia_318]

I just received notice that I have been scheduled for another C&P exam for the same condition and by the same Neurologist that performed the first C&P exam. Is it normal to have 2 C&P exams for the same condition and with the same doctor within a 9 month period? Forgive me for being pessimistic, but I think the VA is trying to cook up something and it wont be to my benefit. Let me know you guys thoughts on the matter. BTW, the first exam was somewhat in my favor for an increase.

[Berta]

Do you have a copy of the first C & P?

Perhaps there was something the neuro needed to clarify in it.

"BTW, the first exam was somewhat in my favor for an increase."

Can you scan and attach it here? (cover C file number, name and address first)

It might be a more favorable exam then the first one but I think you are right on point, that they might be cooking up something to go against you with..

I have been a victim of their contaminated 'cooking' many times, like many here have been , but I fought back until I succeeded.

[magnolia_318]

Thank you so much for the quick response, Bertha. I pasted the findings from my C&P in July below. Its confusing that the examiner stated that my strength was 4/5 and 5/5, my VA doc rates me at a 2/5, yet still comes to the "it is at least as likely as not" conclusion. Thanks in advance for any feedback that can be provided.

LOCAL TITLE: AMB CARE C&P EXAM

STANDARD TITLE: C & P EXAMINATION NOTE

STATUS: COMPLETED

Peripheral Nerves Conditions

(not including Diabetic Sensory-Motor Peripheral Neuropathy)

Disability Benefits Questionnaire

Indicate method used to obtain medical information to complete this

document:

[ ] Review of available records (without in-person or video telehealth

examination) using the Acceptable Clinical Evidence (ACE) process

because the existing medical evidence provided sufficient information on which

to prepare the DBQ and such an examination will likely provide no

additional relevant evidence.

[ ] Review of available records in conjunction with a telephone interview

with the Veteran (without in-person or telehealth examination) using the

ACE process because the existing medical evidence supplemented with a

telephone interview provided sufficient information on which to prepare

the DBQ and such an examination would likely provide no additional

relevant evidence.

[ ] Examination via approved video telehealth

[X] In-person examination

Evidence review

--------------

Was the Veteran's VA claims file reviewed?

[X] Yes [ ] No

If yes, list any records that were reviewed but were not included in the

Veteran's VA claims file:

records

If no, check all records reviewed:

[ ] Military service treatment records

[ ] Military service personnel records

[ ] Military enlistment examination

[ ] Military separation examination

[ ] Military post-deployment questionnaire

[ ] Department of Defense Form 214 Separation Documents

[ ] Veterans Health Administration medical records (VA treatment

records)

[ ] Civilian medical records

[ ] Interviews with collateral witnesses (family and others who have

known the Veteran before and after military service)

[ ] No records were reviewed

[ ] Other:

1. Diagnosis

-----------

Does the Veteran have a peripheral nerve condition or peripheral neuropathy?

[X] Yes [ ] No

Diagnosis #1: myasthenia gravis

2. Medical history

-----------------

a. Describe the history (including onset and course) of the Veteran's

peripheral nerve condition (brief summary):

Mr. X , accompanied by his wife, is scheduled for evaluation of

MG.

He is service connected for MG at 30%.

vet is scheduled for an exam to determine the current level of severity

and manifestations of MG. An exam and med opinion are requested for the

board of veterans appeals.

Vet had previous C&P neuro eval done in 2008.

Vet states his sx started in 1998 with double vision and droopy eyelid

and generalized weakness. HE was treated with mestinon which did not

provide complete relief. He states he has been treated with Prednisone

x

15 years. He has tried Cellcept and IVIG with not much relief. HE

follows at XXXX and is currently on Mestinon 120 mg Q6H, Imuran 225

mg daily and gets plasmapharesis once a week.

he states he had thymectomy twice.

SH: married, works part time in IT

All: NKDA

b. Dominant hand

No response provided.

3. Symptoms

----------

a. Does the Veteran have any symptoms attributable to any peripheral nerve

conditions?

[ ] Yes [X] No

Paresthesias and/or dysesthesias

4. Muscle strength testing

-------------------------

a. Rate strength according to the following scale:

0/5 No muscle movement

1/5 Palpable or visible muscle contraction, but no joint movement

2/5 Active movement with gravity eliminated

3/5 Active movement against gravity

4/5 Active movement against some resistance

5/5 Normal strength

Elbow flexion:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Elbow extension:

Right: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Wrist flexion:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Wrist extension:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Grip:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Pinch (thumb to index finger):

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Knee extension:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Ankle plantar flexion:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Ankle dorsiflexion:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

b. Does the Veteran have muscle atrophy?

[ ] Yes [X] No

5. Reflex exam

-------------

Rate deep tendon reflexes (DTRs) according to the following scale:

0 Absent

1+ Hypoactive

2+ Normal

3+ Hyperactive without clonus

4+ Hyperactive with clonus

Biceps:

Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+

Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+

Triceps:

Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+

Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+

Brachioradialis:

Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+

Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+

Knee:

Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+

Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+

Ankle:

Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+

Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+

6. Sensory exam

--------------

Indicate results for sensation testing for light touch:

Shoulder area (C5):

Right: [X] Normal [ ] Decreased [ ] Absent

Left: [X] Normal [ ] Decreased [ ] Absent

Inner/outer forearm (C6/T1):

Right: [X] Normal [ ] Decreased [ ] Absent

Left: [X] Normal [ ] Decreased [ ] Absent

Hand/fingers (C6-8):

Right: [X] Normal [ ] Decreased [ ] Absent

Left: [X] Normal [ ] Decreased [ ] Absent

Upper anterior thigh (L2):

Right: [X] Normal [ ] Decreased [ ] Absent

Left: [X] Normal [ ] Decreased [ ] Absent

Thigh/knee (L3/4):

Right: [X] Normal [ ]

Decreased [ ] Absent

Left: [X] Normal [ ] Decreased [ ] Absent

Lower leg/ankle (L4/L5/S1):

Right: [X] Normal [ ] Decreased [ ] Absent

Left: [X] Normal [ ] Decreased [ ] Absent

Foot/toes (L5):

Right: [X] Normal [ ] Decreased [ ] Absent

Left: [X] Normal [ ] Decreased [ ] Absent

7. Trophic changes

-----------------

Does the Veteran have trophic changes (characterized by loss of extremity

hair, smooth, shiny skin, etc.) attributable to peripheral neuropathy?

[ ] Yes [X] No

8. Gait

------

Is the Veteran's gait normal?

[X] Yes [ ] No

9. Special tests for median nerve

--------------------------------

Were special tests indicated and performed for median nerve evaluation?

[ ] Yes [X] No

10. Nerves Affected: Severity evaluation for upper extremity nerves and

radicular groups

----------------------------------------------------------------------

a. Radial nerve (musculospiral nerve)

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

b. Median nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

c. Ulnar nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

d. Musculocutaneous nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

e. Circumflex nerve

No response provided.

f. Long thoracic nerve

No response provided.

g. Upper radicular group (5th & 6th cervicals)

No response provided.

h. Middle radicular group

No response provided.

i. Lower radicular group

No response provided.

11. Nerves Affected: Severity evaluation for lower extremity nerves

------------------------------------------------------------------

Sciatic nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

b. External popliteal (common peroneal) nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

c. Musculocutaneous (superficial peroneal) nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

d. Anterior tibial (deep peroneal) nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

e. Internal popliteal (tibial) nerve

No response provided.

f. Posterior tibial nerve

No response provided.

g. Anterior crural (femoral) nerve

No response provided.

h. Internal saphenous nerve

No response provided.

i. Obturator nerve

No response provided.

j. External cutaneous nerve of the thigh

No response provided.

k. Ilio-inguinal nerve

No response provided.

12. Assistive devices

--------------------

a. Does the Veteran use any assistive devices as a normal mode of

locomotion, although occasional locomotion by other methods may be possible?

[ ] Yes [X] No

13. Remaining effective function of the extremities

--------------------------------------------------

Due to peripheral nerve conditions, is there functional impairment of an

extremity such that no effective function remains other than that which

would be equally well served by an amputation with prosthesis? (Functions of the

upper extremity include grasping, manipulation, etc., while functions for

the lower extremity include balance and propulsion, etc.)

[ ] Yes, functioning is so diminished that amputation with prosthesis would

equally serve the Veteran.

[X] No

14. Other pertinent physical findings, complications, conditions, signs

and/or symptoms

----------------------------------------------------------------------

a. Does the Veteran have any scars (surgical or otherwise) related to any

conditions or to the treatment of any conditions listed in the Diagnosis

section above?

[X] Yes [ ] No

b. Does the Veteran have any other pertinent physical findings,

complications, conditions, signs or symptoms?

[X] Yes [ ] No

If yes, describe (brief summary):

Gen: well dressed, well groomed

MS: AAOx3

Lang: no dysarthria, no aphasia

CN: pupils midline, EOMI, weakness of eye closure blt; states he

has

diplopia with both eyes open as well as with each eye covered (?);

facial sensation intact to LT blt, no facial asymmetry, weakness

when pt puffs out cheeks; tongue midline

Motor strength: 5/5 in blt UE except R triceps 4-/5 and L Triceps

is

4/5; blt deltoids 4/5; blt LE 5/5

DTRs: symmetric 2+ blt UE and LE except triceps 1+ blt

Coordinato: no dysmetria with FTN

Sensory: grossly intact to LT blt

Gait: steady

15. Diagnostic testing

---------------------

a. Have EMG studies been performed?

No response provided.

b. Are there any other significant diagnostic test findings and/or results?

No response provided.

16. Functional impact

--------------------

Does the Veteran's peripheral nerve condition and/or peripheral

Neuropathy impact his or her ability to work?

[ ] Yes [X] No

17. Remarks, if any:

-------------------

No remarks provided.

****************************************************************************

Medical Opinion

Disability Benefits Questionnaire

Name of patient/Veteran:

Indicate method used to obtain medical information to complete this

document:

[ ] Review of available records (without in-person or video telehealth

examination) using the Acceptable Clinical Evidence (ACE) process

because the existing medical evidence provided sufficient information on which

to prepare the DBQ and such an examination will likely provide no

additional relevant evidence.

[ ] Review of available records in conjunction with a telephone interview

with the Veteran (without in-person or telehealth examination) using the

ACE process because the existing medical evidence supplemented with a

telephone interview provided sufficient information on which to prepare

the DBQ and such an examination would likely provide no additional

relevant evidence.

[ ] Examination via approved video telehealth

[X] In-person examination

Evidence review

--------------

Was the Veteran's VA claims file reviewed? Yes

If yes, list any records that were reviewed but were not included in the

Veteran's VA claims file:

records

MEDICAL OPINION SUMMARY

-----------------------

RESTATEMENT OF REQUESTED OPINION:

a. Opinion from general remarks: Is the veteran able to maintain substantial

gainful employment based only on his service connected myasthenia gravis.

b. Indicate type of exam for which opinion has been requested: Neurology

peripheral nerves.

TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE

CONNECTION ]

It is at least as likely as not that veteran is able to maintain substantial

gainful employment based only on his service connected myasthenia gravis.

Vet has complaints about primarily ocular and mild generalized weakness. He

currently has a part time job.

[Navy04]

I have had a couple of Docs, where they performed the same C&P more than once within a year. It got to where I recognized their name.

[magnolia_318]

Just finished my second C&P exam. Same doctor, same questions, same exam. Do you guys think this second C&P had anything to do with the fact that my case was remanded back to the regional off by the BVA or that my case has been going on for over 10 years? BTW, this is the second C&P since the remand and not the second C&P overall.

Edited April 7, 2015 by magnolia_318

[63SIERRA]

I have had 3 CP exams for the same condition,.. 1st CP doc made major mistake, and I reported it,,, 2nd CP doc was favorable, and then they scheduled me for CP at VAMC and they checked the wrong box, , which I reported and contested,, ,,, the elementary errors that were made make me VERY suspicious.. the rating in question is only 10 percent, but they seem to be hell bent on not granting it.

[magnolia_318]

Thats kinda what I am thinking. The first C&P was favorable so they will probably send me back until I get an unfavorable exam. I have a couple of question. Being that my claim is over 10 years old, are they basing the decision solely on the results of the C&P or are they going to review my record and take into account my hospitalizations and crisis episodes that I have experienced over the past 10 years? Also, being that I was involuntarily medically discharged from the military, shouldn't I have been given a higher rating than the minimum rating of 30%, being that my condition was severe enough to discharge me from active duty?

Edited April 7, 2015 by magnolia_318