Will A Detailed Letter From My Doctor Carry More Weight Than A C&p Exam?

[magnolia_318]

I have had 2 C&P exams in the past 9 months. The first was somewhat in my favor but the second basically stated that every issue the examiner found in the first exam was now miraculously fine. After seeing this second exam, I went through my record and found that the examiner, who never actually performed an exam, was just copying and pasting notes from my VA medical record and using this as a basis for their findings. I also found that my condition was not being properly documented in my record. Verbally, my doc would tell me my condition was "moderate to severe" but in my record it was being notated as "mild". I addressed this issue with my doctor, who was kind enough to pen me a detailed letter describing the "true" nature of my illness and supporting my claim. So my question is, does this copy paste job of the C&P examiner carry more weight than a letter from my doctor who has treated me for the past 6 years? Their findings are in total contrast of each other. C&P examiner states my condition is "mild" and my doctors letter states it is "severe". He also goes in to more detail as to my limitations and how the frequency of my required treatments creates great limitations on my life. Let me know your thoughts.

[Berta]

"I addressed this issue with my doctor, who was kind enough to pen me a detailed letter describing the "true" nature of my illness and supporting my claim."

Was this a VA or non VA doctor?

Did he give a full medical rationale .based on your treatments records, for his opinion?

Did he state his credentials as to how his opinion is valid due to his expertise?

How do you know the VA 'examiner' was even a Doctor?

What is the disability and have you gone to the VA Schedule of Ratings here, and been able to isolate documented medical evidence that you fit into a higher rating?

If this is a non VA doctor, was VA fully aware of medical records he had about your disability and did the VA obtain those records and list them as Evidence in the decision?

I got a C & P result that was so ridiculous, that I have asked someone at VACO to tell me who prepared it, and what credentials they had.

The VA reversed the denial on that claim when I raised a ruckus , as I had an expert opinion

(from VACO long ago) as evidence that they had ignored.

I guess VA thinks I am dropping my complaint on this lousy C & P because they awarded that claim...

But I am going to use it against them, unless they do my next claim correctly.

A Real doctor outweighs any PA, RN, or even any VA doctor who does not have expertise in the field of disability.

Years ago I had a AO DMII death claim.

My dead husband's DMII had never been diagnosed or treated in his lifetime.

It was part of a malpractice FTCA wrongful death issues BUT I could not file for the same death under 1151

or FTCA because this was now a direct SC death issue.

VA had a Endocrinologist go against my claim (twice)

I found at healthegrades she didnt have any special expertise in the field, as to having any significant

publications except for articles on diets or something.

Dr. Bash, a Neuroradiologist did 2 excellent IMOs for me, knocking her opinion down and I also got a freebee IMO from a former VA doctor...the only doctor in 6 years who understood my husband's condition, and was apparently overruled as the other doctors almost successfully covered up years of VA malpractice.

I had 3 for ,they had 2 against, and the BVA remanded for a "cardio" opinion.

I got a PA opinion and knocked it down myself as being too speculate (which was easy because the PA didnt have a clue on cardio DMII stuff and could not interpret the autopsy

and the BVA agreed and awarded the claim.

How did you get 2 C & Ps? You must have challenged the first one like I did???.

I have had many decision from VA over the past 20 years.

In some they named the opiner and even added their specialy but these days it looks like they dont want us to even know who is opining against us and what expertise they have.

I think the "examiner" I had for the claim they reversed the denial on ,is employed to fill the paper cup dispenser at their RO water cooler. They definitely could not have been a real doctor....

I won't rest until the VA proves to me that is not true.

Or gives me the proper accrued cash for their recent CUE award.

Edited April 23, 2015 by Berta

[magnolia_318]

Was this a VA or non VA doctor?

This was a VA doctor, a neurologist that specializes in my disorder. He is also a doctor at a very prestigious hospital in the area. He also has numerous publications and has piloted numerous clinical trials and research into this specific disorder as well as codeveloping the medication, mestinon, that is a standard treatment for this disorder. So I am going to assume his credentials are a little

How do you know the VA 'examiner' was even a Doctor?

I checked him out, he is a doctor, just an unethical one

What is the disability and have you gone to the VA Schedule of Ratings here, and been able to isolate documented medical evidence that you fit into a higher rating?

Myasthenia gravis is the disablilty. I havent gone through the schedule of ratings. With this disorder, it affects numerous areas of your body so they are rating each area individually i.e. arms, legs, speech, eyes.

How did you get 2 C & Ps? You must have challenged the first one like I did???.

I didnt challenge anything. I was given 2 C&P exams by the same doctor. On the first exam, his write up was somewhat in my favor. I guess the RO had a talk with him and scheduled me for a second C&P 9 months later. On the second exam he said I was fine. Total 180 from the first C&P.

After that second exam is when I reviewed my record and saw all that erroneous "mild" stuff. Being that my VA doctor pioneered the modern day treatment for this disorder, I am hoping his write up trumps this examiners "findings". So I have 1 good write up from the examiner and 1 good letter from my doctor and 1 bad write up from the same examiner.

[Berta]

Myasthenia gravis is presumptive as a chronic disability, if symtomatic to at least 10% within one year after discharge>.

https://www.law.cornell.edu/cfr/text/38/3.309

"I was given 2 C&P exams by the same doctor. On the first exam, his write up was somewhat in my favor. I guess the RO had a talk with him and scheduled me for a second C&P 9 months later. On the second exam he said I was fine. Total 180 from the first C&P."

yeah... I guess they didnt like the "somewhat" favorable part.

But "somewhat in you favor" is not enough to succeed.

In the "detailed" letter your doctor wrote, did he understand the need to search through your SMRs to see if the above reg could be applied? And if not applicable, did he establish an inservice nexus via the SMRs?

Did he have the C & P results so he could medically rebutt them?

Did he follow the critical IMO wording here in our IMO forum?

[Buck52]

I agree with Ms Berta!

I would get a private specialist IME, & take all your medical records with you any smr's as evidence to rebutt the VA Doc Opine...it is costly but well worth it.

ask the private Doc to look at both of your C&P exams and address what is in question.

using VA guide lines & give his impression/opinion

I would think that being this is the same Dr that did both C&Ps and he contradicted himself is in your favor.

Yes the VA will take another Dr opinion.

jmo

....................Buck

[free_spirit_etc]

But that is offset a bit by the fact that the VA doctor treating him states his condition is severe, but notes in the medical record that it is mild.

I think the doctor's letter will help, but what will really help is if he correctly documents your condition in the medical records. If the second C&P just copied and pasted notes your treating physician noted in your medical record, in order to deny the claim -- the treating physician has brought his own credibility into question if he is stating your condition is different than what he is documenting in your medical records.

The letter can still help, but it sounds like he is contradicting his own treatment notes.

I would think that being this is the same Dr that did both C&Ps and he contradicted himself is in your favor.

[Buck52]

Yes I agree free-spirit

If there's not a Dr to rebut the VA Dr the VA rater will probably make his/her decision on the last Medical report. which seems to be not in favor of the veteran.