Analysis of Deferred Contentions--What I Found Today

[rootbeer22]

Folks:

Today I did a sort of "after action" review of my FDC claim. By trade, I'm a business and management  analyst that looks at organizational processes and procedures. So, I figure that I would analyze part of the  results of my initial FDC claims results and then the deferred contentions that  followed and became the phase II - up of my claim. Anyway, Originally,  I did 13 DBQ's  at a VA facility to speed up my claim  but the nurse who did them, did not follow the VA Exam Manual properly? In particular, she did not follow the procedures correctly to the ROM Measurements and guesstimated about half of them without a measuring device? So, I complained and was able to take  two of the most important exams over? As a matter of fact, the rater later commented that there was a big difference between the DBQ and the second CP Exam with a doctor doing the examination? Of course, the second time, a measuring device was used and the point of pain was considered--as it should have been originally. Frankly, I'm not sure I would have done the DBQ's again now based upon the bias that I saw with that nurse? She essentially told me when we first met that she was too busy to do the DBQ's and that her boss was making her do them due to a new policy? She also made a point to let me know that older vets coming into the system just now, were taking up resources? So, I think that clouded her measurements and my particular readings during the exams? I still got most of the sc for the initial contentions but most of them were in the 10% range and I'll have to go for increases via the NOD Process.

Anyway what I learned today, concerning my deferred part of my claims, was that most of the evidence that is "supposedly missing"  was on/in my handwritten smrs anyway that the VBA already has? On the deferred claims, I only went 1 for 7 and knew something was wrong then? So, when the A8 says, "no record of "groin injury" in service",  but it was right their black & white in the records, then I guess handwritten records don't go thru the word search parameters of the VBMS system very well? The good news is that I found it (the missing evidence), easily but the bad news is that the rater did not, so  it's going to be a couple of more years before I see the  results or a service connection now for these contentions? When I first reviewed the VBMS and how it works, I knew that from the Desert Storm Generation  back,  that hand \written records are going to be a major problem to contend with in terms of claims accuracy and getting the correct results. Frankly, unless the records are typewritten, there's a very  good chance that they may just be overlooked and not considered at all --like mine this time? Unfortunately, my current  civilian PCP does all of his notes handwritten and not one can hardly read them, but he's a great doctor?

 

Take Care..Rootbeer22

[rootbeer22]

Vync:

 

According to the VA Examination manual, examiners are not supposed to show any bias at all towards a patient...both positive or negative. From what I've seen so far is that there's a great deal of miscommunication when it comes to the ROM measurements in particular? I think some of it is techniques, as an example, raising a  shoulder until the patience winces or shows pain? However , what about the patient/Vat whom is on very heavy pain meds when that is done and how does that effect the measurement. Frankly, I think the Vet should talk to the examiner first about it before the exam starts.  I read the VA Exam manual before I took my CP exams and there were several violations of the protocol. However, if you call out the examiner, it should be counterproductive for your case. For instance, there is no way that examiner reviewed all of my records before the exam but she stated that she reviewed all of them. So, Vets have to find a way to be diplomatic during the exam...even if you know they are doing the procedures incorrectly.  Rootbeer22

[Vync]

You make a good point about bias, but we all know that even though there are rules, they are frequently not followed.

The pain on movement is tricky. I personally skipped my pain meds for a couple of days prior to my C&P exam because I needed an objective assessment, not one masked by the pain meds. I remember telling the doc that he needed to use the goinometer and I'll tell him when it hurts. The guy was a jerk and told me he has been doing it long enough to not need the tool and he could tell when someone is in pain. I asked him to document the exact statement immediately, but then he suddenly changed his tune. There is no excuse for laziness. You're right. The doc shafted me on the exam, but I had a private specialty doc's write up that trumped it.

I learned later that by providing the C&P doc a separate summary write up showing instances of treatment/therapy over the years, medication, a "pain diary", MRI's results, buddy letters, and highlighted specific instances, they were able to accurately assess my problems. Not all C&P docs will accept them. I had one who happily reviewed it. I had another who refused completely stating that they can only review what's in the file (which is a lie).

When a VA neurologist gave me a C&P exam while eating a hoagie sandwich, that really said a lot about his priorities.