Gulf War Illness C&p Exam Question?

[lmorris08]

I recently under went a Gulf War Illness C & P Exam. I filed the claim based on the impressions that a VA Examiner found on a Gulf War Registry Examination. The impressions were:

1. Irritable Bowel Syndrome- Condition currently diagnosed treated by private doctor.

2. Cervical Degenerative Disk Disease with radiculopathy

3. Thoracic Outlet Syndrome

4. Sacroilac Pain/lower back

Medical evidence was submitted with the claim ie. MRI demonstrating herniated disc at C5-C6.

In addition the C6-C7 levels are fairly degenerated with mild to moderate bilateral narrowing, noted by Neurosurgeon.

My question is if the if the C and P Examiner writes such comments as this under diagnosis what is the likelihood of a favorable rating...I ask because I have the diagnosis and treatment.

"Cervical spondylosis with myelopathy (Icd9 code: 721.1) claimed as Cercical degenerative disk disease with radiculopathy. Veteran has a claimed disability pattern related to (neck pain in bilateral upper extremities that meets the criteria for a disease with a clear and specific etiology and diagnosis. Not caused by service or related to GW environmental exposure. Not caused by service or service connected conditions. As per medical literature, condition is the inevitable result of aging regardless of race, professional background, military service or history of trauma."

This claimed was based on diagnosis, MRIs and treatment by pain management. These conditions were claimed on a presumptive basis.

Your comments and input is appreciated...

Edited July 29, 2015 by lmorris08

[Guest]

Veteran has a claimed disability pattern related to (neck pain in bilateral upper extremities that meets the criteria for a disease with a clear and specific etiology and diagnosis. Not caused by service or related to GW environmental exposure. Not caused by service or service connected conditions. As per medical literature, condition is the inevitable result of aging regardless of race, professional background, military service or history of trauma."

With this remark I doubt very seriously that VA would grant any type of claim for neck/CDDD or any back condition. It does not specifically address your IBS condition. Only time will tell.

Edited July 29, 2015 by pete992

[lmorris08]

Pete992,

Thank for your response. I could tell from the tone of the C & P Exam that the results probably would not be favorable. The Examiner rarely made eye contact. He asked questions and typed mostly until near the end when he conducted the physical part of the exam. He seemed agitated especially when I responded a certain way. He did not noted some of my responses the way I answered.

It seemed like his goal was to refute the medical evidence that he had in front of him. He asked me if I lifted weights? I told him that I had not in year. He noted that my upper body was musclular abdomen area round..What does that have to do with a back condition or injury?

I hope the Rater looks at the diagnosis and history of treatment. I just have to wait and see I suppose. Again thanks for your response.

[USMC_VET]

Go and get a IME to refute it

Edited July 29, 2015 by USMC_VET

[lmorris08]

USMC_VET,

Thanks for the response. If this claim is denied I plan on appealing. I will pursue the IMO while waiting on the appeal. I have experienced a great degree of difficulty in getting an IMO in the past. I will not give up..Again thanks.

Edited July 29, 2015 by lmorris08

[Keidan]

Just a thought was your examiner a PA,NP or MD this has everything to do with your exam and remember if it was a MD go and get a second opinion and the tie goes to the veteran!

[pwrslm]

" He did not noted some of my responses the way I answered."

Go to your privacy office, the ROI guy that give you copies of your records at your local clinic. Correction of your medical file is covered under HIPPA (sp?) privacy act.

Request that your medical file be corrected. Cite the exact nature of what the examiner put down, what it was that you told him, and that you want the record to correctly reflect what you reported in the examination. He should have a form for you to fill out. They will approach him, ask his opinion, he will probably deny it all. They will review the info, if its is justified and evidence in your medical file back you up, they can amend your health record. If the don't, they must give you the opportunity to put in a statement to rebut the examiners statements.

This is law, they MUST follow this process. If the examiner corrects the statement, or they agree to amend it in spite of his denial, its a simple CUE.

The HIPAA Privacy Rule:
Patients' Rights

4. The right to request an amendment to medical records

When patients access a medical record and find information they believe is inaccurate, they may file a written request that the record be corrected. The covered entity must respond to the request within 60 days. It may decide to take an additional 30 days, but must provide the individual with a written explanation for the delay and a date by which it will complete the action.

If the covered entity denies the request, it must provide the patient with the following information in writing:

• the basis for the denial (for example, the covered entity did not create the record, the information is not part of the designated record set, the individual is not allowed to access the record under another HIPAA provision, or the record is accurate and complete);
• that the individual has a right to submit a written statement disagreeing with the denial;
• that the individual may request that the covered entity provide the request for amendment and the denial with any future disclosures that pertain to the request; and
• how the individual may complain.

For more information see 45 CFR §164.526.

(THE MORE PEOPLE WHO DO THIS THE BETTER)

If thousands and thousands of these start showing up, it will be like a bright like blinking on a problem that will have to be addressed. Falsification of medical records is a Felony.

Edited July 29, 2015 by pwrslm