ptsd VA Requiring Second C&P Exams?!!!

[Mo]

Hello all. This is an update on my progress. 

10/23- Review of PTSD C&P Exam

10/31 - Lower Back C&P Exam

11/19 - Claim Submitted FDC on EBenny (all DBQs, Med Records, Forms,and Sworn Declarations uploaded)

11/23 - "Gathering Evidence" Status

12/1 - Spoke to RO and VA had submitted a 'medical opinon request from outside dr"

12/3 - Received call from "Veterans Evaluation Services" in MN stating the VA is requesting a local medical provider to conduct the same 2 C&P Exams!!!

Has this happening to anyone else? Could it be good or bad news?

I filed for Depression secondary to IVDS, Bilateral Radiculapathy of lower extremities secondary to IVDS, IU, and increase in PTSD. 

Any input would be greatly appreciated.

 

~Mo~

 

[broncovet]

It looks like you have 2 out of 3, then.  Current diagnosis, and "in service diagnosis of acute sciatica in 2004 and radical symptoms".  But, I dont like the word "acute".   Here is the definition of Acute:

Acute: Of abrupt onset, in reference to a disease. Acute often also connotes an illness that is of short duration, rapidly progressive, and in need of urgent care.

"Acute" is a measure of the time scale of a disease and is in contrast to "subacute" and "chronic." "Subacute" indicates longer duration or less rapid change. "Chronic" indicates indefinite duration or virtually no change.

end defination

To get VA benefits you need a "chronic" condition.  The VA wont pay you for back pain in the service which is short term and then goes away.  To get paid, you need a condition that continues to bother you now, not an old pain that went away. 

Remember that back pain you had in the service, they already said was short duration and went away.  So, did you have a car accident that caused this?  Did you lift something heavy?  Fall down the stairs or off a roof?  Get beat up by a jealous husband?  Any of these things COULD have caused your current diagnosis, but you have to have a doc say that your military service event
at least as likely as not" caused your condition. 

Do NOT count on the VA to connect the dots between  a "history of radiculapathy since 2004, "  AND  "the Veterans radiculapathy is at least as likely as not caused from an event in military service".  

I do see the connection, I really do. It does not matter what I think, tho.  It does not matter what you think either.  It matters what the doc writes in his report.   But you need a Doctor to state that it means the same thing.  The doc COULD say, "the MRI shows a history of radiculapathy since 2004, "   which means the Veteran's radiculapathy (here would be a good place for the doc to insert other related diagnosis such as IVDS/DEGENERATIVE DISC DISEASE (DDD), LUMBOSACRAL SPINE,) is at least as likely as not due to the Veterans in service injury. 

I believe you have great evidence for the doc to give you a nexus.  But, for whatever reason, the doc did not give you a nexus in the form VA requires.  IT HAS TO BE in the form of "at least as likely as not"  The rater probably has your file in electronic format and he can search for these terms and find the nexus pronto. 

 

 

Edited December 4, 2015 by broncovet

[broncovet]

Your exam is NOT "air tight".  Its missing the nexus.  Nowhere in it does it say, "diagnosis of IVDS/DDD of lumbar spine now inlcudes
bilateral lower extrmeity radiculopathy, is at least as likely as not due to xxx in military service." 

You wont win your claim without a nexus, and its good they sent it back.  YOU HAVE TO DOCUMENT YOUR DIAGNOSIS IS RELATED TO SERVICE. 

He documented symptoms.  Thats great.

You need the big 3..all of these:

1. Current diagnosis..you got that diagnosis of IVDS/DDD of lumbar spine now inlcudes
bilateral lower extrmeity radiculopathy,

2. In service event or aggravation (unknown if you have that from what you posted.)

3  Nexus.  No connection to military service was noted by doc. 

[broncovet]

Please remember:  I want you to get your benefits.  Im not trying to con you out of them.  Im just telling you what my experience shows that the VA will likely say. 

[GLW]

You should follow broncovet's advice. No nexus, they will deny. Remember, the VA looks for a reason to deny, not to approve.

[broncovet]

Yea, they can/do do just this.  It may be good for you!   Here is why:

Lets say you go to a C and P exam, and the doctor "forgets" something real important.  Oh, I dont know, say he forgets to write down some symptoms, or "forgot" to say, "the Vets  xxy condition is at least as likely as not due to zzz which happened in the military service". 

The Va COULD just deny you.  No nexus = no  benefits. 

Or, they could/should send you back to the doc for the required nexus.

This is just ONE example, but you benefit (likely) because your claim does not sit in appeals for 4 more years.  You should at least not get a remand for a defective C and P exam.    That is a good thing! 

Its also possible they are "doctor shopping" for a doc who will help VA deny you.  If this is the case, then your representative should get on this as soon as you get the decision and your cfile. 

A few months ago the VA was in some trouble because they sent Vets to C and P exams where the examiner was not competent/qualified.  They did that to me!!!!   I think they have admitted to this mistake. 

Edited December 3, 2015 by broncovet

[Mo]

Yea, they can/do do just this.  It may be good for you!   Here is why:

Lets say you go to a C and P exam, and the doctor "forgets" something real important.  Oh, I dont know, say he forgets to write down some symptoms, or "forgot" to say, "the Vets  xxy condition is at least as likely as not due to zzz which happened in the military service". 

The Va COULD just deny you.  No nexus = no  benefits. 

Or, they could/should send you back to the doc for the required nexus.

This is just ONE example, but you benefit (likely) because your claim does not sit in appeals for 4 more years.  You should at least not get a remand for a defective C and P exam.    That is a good thing! 

Its also possible they are "doctor shopping" for a doc who will help VA deny you.  If this is the case, then your representative should get on this as soon as you get the decision and your cfile. 

A few months ago the VA was in some trouble because they sent Vets to C and P exams where the examiner was not competent/qualified.  They did that to me!!!!   I think they have admitted to this mistake. 

Well I am representing myself but will get a rep after my decision if not happy. My C&P for my lower back was excellent I though. Here it is:

 

1. Diagnosis
------------
Does the Veteran now have or has he/she ever been diagnosed with a
thoracolumbar spine (back) condition?
[X] Yes [ ] No
[X] Other Diagnosis
Diagnosis #1: IVDS/DEGENERATIVE DISC DISEASE (DDD), LUMBOSACRAL SPINE,
L4-
L5, L5-S1
ICD code: M51
Date of diagnosis: SC
Diagnosis #2: Bilateral lower extremity radiculopathy due to IVDS/DDD
of
lumbar spine
ICD code: M54
Date of diagnosis: 2004 by hx

2. Medical history
------------------
a. Describe the history (including onset and course) of the Veteran's
thoracolumbar spine (back) condition (brief summary):
Veteran is being seen at his request in the DBQ referral clinic for the
SC
condition of DEGENERATIVE DISC DISEASE, LUMBOSACRAL SPINE, L5-S1.
Veteran relates his condition is worse, and he is awaiting a pain clinic
evaluation, however it is currently scheduled in December. Veteran
relates that he had similar presenting symptoms when the condition
occurred in 2004. Has had pain and radiation os symptoms since 2004 for
short periods of time-a few days or weeks.
He indicates that around May of this year had a worsening of low back
pain
with radiation into the legs (currently right > left), at time has
body
shaking as a response, numbness and tingling that begins in the lumbar
spine, radiates to bilateral buttocks and continues along lateral
hip/thigh area then to anterior calf down to great toe when sitting or
standing, and pain and burning sensation of posterior thigh and calf when
lying down. He indicates that it is just not getting better despite
taking
pain medications, having had steroid taper doses, and muscle relaxers. No
loss of bowel control, urinary retention, or saddle anesthesia.
Due to worsening symptoms, he underwent an MRI in Aug 2015 that revealed
Degenerative changes at L4-5 and L5-S1 with right-sided discal cyst at
L5-S1 resulting in moderate right lateral recess stenosis and impingement
of the right S1 nerve root.
Veteran is very tearful, has difficulty sitting still in the exam room,
has "jerking" almost bouncing movements associated with his
reported
severe pain symptoms, or with various movements of legs or back.

b. Does the Veteran report flare-ups of the thoracolumbar spine (back)?
[X] Yes [ ] No
If yes, document the Veteran's description of the flare-ups in his
or her
own words:
Veteran reports an inability to walk or stand during flares
c. Does the Veteran report having any functional loss or functional
impairment of the thoracolumbar spine (back) (regardless of repetitive use)?
[X] Yes [ ] No
If yes, document the Veteran's description of functional loss or
functional impairment in his or her own words.
cannot stand, walk, run, climb stairs, etc
3. Range of motion (ROM) and functional limitation
--------------------------------------------------
a. Initial range of motion
[ ] All normal
[X] Abnormal or outside of normal range
[ ] Unable to test (please explain)
[ ] Not indicated (please explain)
Right Lateral Flexion (0 to 30): 0 to 5 degrees
Left Lateral Flexion (0 to 30): 0 to 20 degrees
Right Lateral Rotation (0 to 30): 0 to 15 degrees
Left Lateral Rotation (0 to 30): 0 to 10 degrees

Unable to test forward flexion and extension formally due to veteran
not being able to stand without risk of fall, due to his repeated
jerking movements
If abnormal, does the range of motion itself contribute to a
functional loss? [X] Yes (please explain) [ ] No
If yes, please explain:
unable to twist or bend adequately; although veteran cannot
undergo
formal testing of forward flexion, it is clear he cannot apply his
own shoes, etc. due to low back pain and readicular pain
Description of pain (select best response):
Pain noted on exam on rest/non-movement
If noted on exam, which ROM exhibited pain (select all that apply)?
Forward Flexion, Extension, Right Lateral Flexion, Left Lateral
Flexion, Right Lateral Rotation, Left Lateral Rotation
Is there evidence of pain with weight bearing? [X] Yes [ ] No
Is there objective evidence of localized tenderness or pain on palpation
of the joints or associated soft tissue of the thoracolumbar spine
(back)?
[X] Yes [ ] No
If yes, describe including location, severity and relationship to
condition(s):
caused by SC DDD causing muscle spasms due to resisting movement

b. Observed repetitive use
Is the Veteran able to perfor
m repetitive use testing with at least three
repetitions? [ ] Yes [X] No
If no, please provide reason:
severe pain reported
c. Repeated use over time
Is the Veteran being examined immediately after repetitive use over time?
[ ] Yes [X] No
If the examination is not being conducted immediately after
repetitive
use over time:
[X] The examination is medically consistent with the Veteran's
statements describing functional loss with repetitive use over
time.

Does pain, weakness, fatigability or incoordination significantly limit
functional ability with repeated use over a period of time?
[X] Yes [ ] No [ ] Unable to say w/o mere speculation
Select all factors that cause this functional loss:
Pain
Able to describe in terms of range of motion: [ ] Yes [X] No
If no, please describe:
veteran is unable to complete movements after repeated movement
over time due to severe pain, limitation cannot be described in
degrees of motion, but would be severe in all planes of motion
based on todays limited exam,
d. Flare-ups
Is the exam being conducted during a flare-up? [ ] Yes [X] No
If the examination is not being conducted during a flare-up:
[X] The examination is medically consistent with the Veteran's
statements describing functional loss during flare-ups.
[ ] The examination is medically inconsistent with the Veteran's
statements describing functional loss during flare-ups. Please
explain.
[ ] The examination is neither medically consistent or inconsistent
with the Veteran's statements describing functional loss
during
flare-ups.
Does pain, weakness, fatigability or incoordination significantly limit
functional ability with flare-ups?
[X] Yes [ ] No [ ] Unable to say w/o mere speculation
Select all factors that cause this functional loss:
Pain
Able to describe in terms of range of motion: [ ] Yes [X] No

If no, please describe:
Veteran is not being examined during a flare, limitation cannot be
described in degrees of motion, but would be severe in all planes
of motion based on todays limited exam
e. Guarding and muscle spasm
Does the Veteran have guarding or muscle spasm of the thoracolumbar spine
(back)? [X] Yes [ ] No
Muscle spasm:
[ ] None
[X] Resulting in abnormal gait or abnormal spinal contour

Provide description and/or etiology:
tenderness with light touch in anticipation of pain due to DDD of
lumbar spine
Localized tenderness:
[ ] None
[X] Resulting in abnormal gait or abnormal spinal contour

Provide description and/or etiology:
veteran is resistent to allow examination and if the wheelchair he is
sitting in is going to hit a bump preparing for anticipated pain due
to
DDD of lumbar spine
f. Additional factors contributing to disability
In addition to those addressed above, are there additional contributing
factors of disability? Please select all that apply and describe:
Instability of station, Disturbance of locomotion, Interference with
sitting, Interference with standing

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
Ankle plantar flexion:
Right: [ ] 5/5 [X] 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: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Great toe extension:
Right: [ ] 5/5 [X] 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
--------------
No response provided
6. Sensory exam
---------------
Provide results for sensation to light touch (dermatome) testing:
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: [ ] Normal [X] Decreased [ ] Absent
Left: [ ] Normal [X] Decreased [ ] Absent
Foot/toes (L5):
Right: [ ] Normal [X] Decreased [ ] Absent
Left: [ ] Normal [X] Decreased [ ] Absent
7. Straight leg raising test
----------------------------
Provide straight leg raising test results:
Right: [ ] Negative [ ] Positive [X] Unable to perform
Left: [ ] Negative [ ] Positive [X] Unable to perform
8. Radiculopathy
----------------
Does the Veteran have radicular pain or any other signs or symptoms due to
radiculopathy?
[X] Yes [ ] No
a. Indicate symptoms' location and severity (check all that apply):
Constant pain (may be excruciating at times)

Right lower extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe
Left lower extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe
Intermittent pain (usually dull)
Right lower extremity: [ ] None [ ] Mild [ ] Moderate [X] Severe
Left lower extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe
Paresthesias and/or dysesthesias
Right lower extremity: [ ] None [ ] Mild [ ] Moderate [X] Severe
Left lower extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe
Numbness
Right lower extremity: [ ] None [ ] Mild [ ] Moderate [X] Severe
Left lower extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe
b. Does the Veteran have any other signs or symptoms of radiculopathy?
[ ] Yes [X] No
c. Indicate nerve roots involved: (check all that apply)
[X] Involvement of L4/L5/S1/S2/S3 nerve roots (sciatic nerve)
If checked, indicate: [ ] Right [ ] Left [X] Both
d. Indicate severity of radiculopathy and side affected:
Right: [ ] Not affected [ ] Mild [ ] Moderate [X] Severe
Left: [ ] Not affected [X] Mild [ ] Moderate [ ] Severe
9. Ankylosis
------------
Is there ankylosis of the spine? [ ] Yes [X] No

12. Assistive devices
---------------------
a. Does the Veteran use any assistive device(s) as a normal mode of
locomotion, although occasional locomotion by other methods may be
possible?
[X] Yes [ ] No
If yes, identify assistive device(s) used (check all that apply and
indicate frequency):
Assistive Device: Frequency of use:
----------------- -----------------
[X] Cane(s) [ ] Occasional [ ] Regular [X] Constant
b. If the Veteran uses any assistive devices, specify the condition and
identify the assistive device used for each condition:
single cane used for DDD of lumbar spine
13. Remaining effective function of the extremities
---------------------------------------------------
Due to a thoracolumbar spine (back) condition, 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.; functions of the
lower extremity include balance and propulsion, etc.)
[X] No
14. Other pertinent physical findings, complications, conditions, signs,
symptoms and scars
-----------------------------------------------------------------------
a. Does the Veteran have any other pertinent physical findings,
complications, conditions, signs or symptoms related to any conditions
listed in the Diagnosis Section above?
[X] Yes [ ] No
If yes, describe (brief summary):
Reflexes and strength of hips and knees were NOT tested due to
veteran's guarding on exam and jerking motions with any sort
of
spikes in pain. Minimal movements of veteran's lower
extremities
casued significant pain;

15. Diagnostic testing
----------------------
a. Have imaging studies of the thoracolumbar spine been performed and are
the
results available?
[X] Yes [ ] No
If yes, is arthritis documented?
[ ] Yes [X] No
b. Does the Veteran have a thoracic vertebral fracture with loss of 50
percent or more of height?
[ ] Yes [X] No
c. Are there any other significant diagnostic test findings and/or results?
[X] Yes [ ] No
If yes, provide type of test or procedure, date and results (brief
summary):
MRI Lumbar spine 08/13/2015
Impression:
1. Negative for spinal canal stenosis. 2. Degenerative changes at
L4-5 and L5-S1 with right-sided discal cyst at L5-S1 resulting in
moderate right lateral recess stenosis and impingement of the
right
S1 nerve root.
16. Functional impact
---------------------
Does the Veteran's thoracolumbar spine (back) condition impact on his or
her
ability to work?
[X] Yes [ ] No
If yes describe the impact of each of the Veteran's
thoracolumbar
spine (back) conditions providing one or more examples:
Veteran has difficulty walking at this time, cannot stand for more
than a few moments, needs to use a cane when ambulating, cannot
walk more than a few feet, cannot sit for more than 10 minutes
without needing to move.

17. Remarks, if any:
--------------------
Veteran's condition is currently in the process of additional treatment
with
pain clinic evaluation scheduled in December 2015, possibly sooner; it is
possible that this treatment could improve his overall physical functioning
and symptoms related to the lumbar spine condition;
Veteran's upadted diagnosis of IVDS/DDD of lumbar spine now inlcudes
bilateral lower extrmeity radiculopathy, Right worse than left, as evidenced
by physical examination and history; the updated diagnosis includes the
findings due to progression of the condition over time

Edited December 7, 2015 by Mo