The Realities Of Claims Round #2

[rootbeer22]

Folks:

I've learned three important lessons from the VA Disabilities Claims System recently. One is that even with the best preparation, you can get tripped up by the complexities of the rules. Today, I looked at one of my deferred claims that I thought was solid for round 2 and realized that the APRN that did the CP Exam did a "guesstimate" on the Shoulder ROM Measurements and they were way off? I actually spoke to another Vet last week that had a similar problem and realized that it was that same APRN that I had? So despite talking to her boss and making a complaint, it made little difference to make a change? Secondly, is that I've started to learn better patience and that something will happen when and if it's going to happen...and worry does not change that one bit? Thirdly, that many of us have been down this road before and it's important to learn from each other so we don't repeat the same mistakes over and over again in pursuit of service connections for disabilities. My goal now is 100% but I realized that when you climb a mountain, the last 10 feet is the hardest part of the climb. So, going from 80% or 90% to 100% is going to be much harder than most of us originally would think? But in the end, I'm much better prepared than I was 3 years ago because I know, I can now come to this board for help and advice...and that was not the case originally....take care...and Godspeed....rootbeer22

Edited July 29, 2015 by rootbeer22

[Buck52]

rootbeer,

Please write out your post in Paragraphs, it makes so much easier for the forum members to read.

all bunch up together like that above makes it hard to read, and some get confused.

Thanks

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

[Chuck75]

It's true that the VA often makes things difficult. Even after you have an SC'd 100% P&T single disability. They are still

in the low ball mode for everything else. Incontestable IMO's and treatment notes from qualified doctors are a way to effectively

fight back. Who knows, you might even get a C&P from a sympathetic C&P examiner once in a while!

[Carl the Engineer]

Yep, going from 70 to 80 is hard, and 80 to 90 is real hard and 90 to 100, nearly impossible.

I'm at 72 raw score, so a 10 will help me. However, that will be a 75 rounded up, and a long way from 90.

I have a senerio for 90, but it will be a couple years work.

Its either that, or complain,

Hamslice

[JR Reihs]

Folks:

I've learned three important lessons from the VA Disabilities Claims System recently. One is that even with the best preparation, you can get tripped up by the complexities of the rules. Today, I looked at one of my deferred claims that I thought was solid for round 2 and realized that the APRN that did the CP Exam did a "guesstimate" on the Shoulder ROM Measurements and they were way off? I actually spoke to another Vet last week that had a similar problem and realized that it was that same APRN that I had? So despite talking to her boss and making a complaint, it made little difference to make a change? Secondly, is that I've started to learn better patience and that something will happen when and if it's going to happen...and worry does not change that one bit? Thirdly, that many of us have been down this road before and it's important to learn from each other so we don't repeat the same mistakes over and over again in pursuit of service connections for disabilities. My goal now is 100% but I realized that when you climb a mountain, the last 10 feet is the hardest part of the climb. So, going from 80% or 90% to 100% is going to be much harder than most of us originally would think? But in the end, I'm much better prepared than I was 3 years ago because I know, I can now come to this board for help and advice...and that was not the case originally....take care...and Godspeed....rootbeer22

When you find yourself taking a non doctors opinion from a VA C&P exam, one must step back and ponder the thought of an IMO from a qualified ortho or a real doctor qualified to actually preform such exam.........In order to further yourself up the mountain, you must be willing to be proactive to remove the resistance. In your case, an IMO would be your next best step to counter the APRN guess.

[rootbeer22]

JR Reihs

You make a great point regarding the IMO/IMEs and at first I assumed that only qualified CP Examiners with the proper credentials would be conducting the CP exams? However, that's not the case always from what I've seen on hadit.com and from others experiences? Actually, the APRN's boss was very nice and advised me to just submit a "buddy statement" of what I had observed so the rater's could consider it? At least for my back injury CP Exam, I was able to do it again which later resulted in success, but not for my shoulders injuries? Yesterday, I loaded up my right shoulder MRI in ebenefits and plan to add a new buddy statement to explain what happened during the Shoulder ROM measurements? Basically this is an old story for many vets; the APRN pushed my arm up way past the point of pain and did not explain that she was supposed to stop the movement when my shoulder pain first starts during the measurements? Frankly, the MRI showed a 50% tear of the right shoulder rotator cuff, so for me pain starts at about 35 degrees but she stated that my right shoulder went to 90 degrees without pain? If anyone has had a 50% rotator cuff tear---that is just not possible to go 90 degrees without pain? Originally, she said that she reviewed the MRI and all of my smrs but I'm pretty sure she did not based upon her actions? Interestingly, she made a comment that Vets just now coming into the VA System were/are a "burden" to the system because so many Vets were seeking care these days? That attitude really surprised me and figured that she must have been just having a bad day when I showed up for my CP Exam.

I actually found the CP Examination Guide on the internet and read it before I went it to my own first CP exam. It stats that there should be no appearance of "bias" during the examination and that a measuring device should be used for ROM. Frankly, I felt that I did not get a fair unbiased assessment? Later, I got a copy of her credentials and she has no background in orthopedics?

Anyway, based upon the outcome of the next set of pending deferred contentions, I've done my research and selected a well-know IME/IMO Doctor to review my smrs--- as your suggest. For the most part, I'm happy with the outcome of the majority of my ratings but have a few that require better evidence via new IME/IMOs. Consequently, I spoke with a QTC rep yesterday about the current hold-up on my CP exams for a handful of deferred contentions? He said, they had to bring in another QTC specialist this week to review my case, but that final CP reports will be done in a couple of days or so? So, based upon the outcome of those exams and their ratings outcome, I plan to move forward with the new IME/IMOs as you suggest....thanks for your help....goodluck and godspeed..rootbeer22.

[Fat]

Rootbeer 22, hang in there buddy.

The ROM is supposed to be measured by a medical device.

An IME is probably the right step going forward.

A torn rotator cuff is supposed to be measured by ROM; however dont they also consider the pain element too?

Dont give in and refute the C&P with a IME.