Just haphazard, bewildering C&P exam. What happened? What can I do?

[aoneinsun]

Hi,

I had an interesting and bewildering C&P exam with a Dr. covering three items of evaluation; lower extremity varicose veins, piriformis syndrome (left hip), and lumbar condition with herniation (for a disc bulging 5 mm to the left at L4-L5).

 

Here is about how it went…

Firstly, I had filled out the summarized history questions for each of the three items. The papers I had diligently filled out simply laid on his desk the entire exam though, and he simply asked me questions as he went through his DBQs. I was very well versed in my medical record and could tell him the brief history (or development) of each condition (along with my medications) in a quick, concise fashion. He was reasonably personable, and he seemed to be pretty pleased with my being quick and to the point (it was towards the end of the day and he was delayed in getting to me). And he seemed to whip through the DBQs with speed. He did inspect my legs for varicose veins (which are really obvious). I was surprised that he didn’t ask if I had aching and fatigue in my legs after prolonged standing or walking or if the compression hosiery I was wearing was helping. He could have found out the answers to those questions if he had read the packet I filled out (he didn’t bother to read that it seemed, nor did I get sense that he read my medical record). I had to specifically say that I had aching while standing for long periods of time, and I didn’t realize I had varicose veins for years until recently. I think he should have asked me that when filling out the Artery & Vein Conditions DBQ at 3B. And I hope he filled that part out…

I also explained how I had hip/low back issues after some long runs and landing weirdly on my left leg while playing volleyball. He had me walk (which is in my case limp, barely putting my left foot forward to step) to the office door and back to see my gait. He had me try to lean backwards, forwards, side-to-side, and twist. I could do all pretty well except the leaning forward to touch toes. I could only lean forward maybe 15-20 degrees. I glanced at his notes, and they almost all looked like they said 30 degrees (normal) except I don’t know what he put for forward flexion (I saw nothing but 30 degrees on the sheet, and I don’t know if he put something down later to give an accurate reflection of my forward flexion). I’m wondering about this because the Back (Thoracolumbar spine) conditions DBQ specifically says in Section III (before 3A) to “Measure ROM with a goniometer.” In fact it says 3 repetitions of ROM (at a minimum) are needed. I only did forward flexion twice, and that was because the first time I leaned over he didn’t seem to like it that I couldn’t lean down very far, and so he stood up and showed me how to lean down to touch one’s toes to demonstrate what he was looking for from me. Again I leaned down about as far as I could without pain (which was not much). I don’t know what he wrote down, and I never saw a goniometer once in the exam. Should he have used a goniometer?

He didn’t examine me at all, as in seating me on the table, having me attempt to perform straight leg raise tests (which is required at step 12) or palpating for tenderness, etc. It was most like a reporter’s interview (aside from him observing me having trouble touching my toes and him encouraging me to try to do it). One thing he did do that I thought was indeed good was to run a pointy object up and down my legs while I was seated. Interestingly, I had slightly less sensation on the left leg, and I told him this.

He also didn’t test my hip flexion, or ankle flexion/dorsiflexion, great toe extension, etc, which is required per the DBQ at step 8A. That seems like that would have been a pertinent thing to assess, especially after observing how small of a step I took with my left foot while demonstrating walking for him. And he was supposed to test for piriformis syndrome (left hip) during this exam, and I even told him that just last week I was also diagnosed by the VA Pain Mgt clinic with IT band syndrome of the left hip for my tension and pain along the outside of the left hip. I have no idea what he put for ROM for my left hip...

He got to the end of the last DBQ form that he whipped through (after skipping what I think are essential parts), and then he finished the exam abruptly saying, “Well, that’s it. That’s all. We are done.” When I asked if there was anything else, he was like “No. That’ll do.”

At the end of the exam, he seem to notice the envelope full of the papers I had filled out along with my medication list I had diligently prepared. He was like, “What’s this”? I was like, “That is for you, which my medication list and everything.” He acted like “Oh,” and seemed to grab it and take it somewhere. I wonder what he did if anything with that. He seemed to be completely done with me at that point.

 

My Questions:

How can I get record of his notes and when might they become available? 

Is this super relaxed approach, and skipping through what I think are required sections normal? Is this anything like how a C&P exam should go?

Is this lack of use of an accurate measuring device going to lend itself to an accurate rating? Should I document that he did not use any accurate measuring device and have my own physician measure my ROM with a goniometer (or would that come later with a VA attorney after the VA denies my claim)?

 

 

What just happened? Was I supposed to be somehow more demanding during the exam, and if so how could I have done so appropriately?

 

 

Any advice appreciated!

[TALON II FE]

On ‎3‎/‎15‎/‎2016 at 1:30 PM, Vync said:

It is not unusual for some C&P examiners to leave your records untouched while you are in there. The time with you is supposed to be focused on the actual exam/DBQ and they probably will read the documents later. I have actually had a couple of examiners tell me they never received my c-file.

You mentioned not being able to move very much due to pain. This is very important for exams which have rating criteria based on range of motion (ROM). There should be two sets of numbers. One is the maximum possible ROM and the other is where pain begins.

For example, you bend to 10 degrees and pain begins, but can continue to bend to a max of 25 degrees. Some examiners and raters have no clue what they are doing and might try to rate that axis of ROM at 25 degrees, but it should really have been 10 degrees.

When you get your results, see if painful motion was factored in. If it wasn't, then you have another reason to request a new exam.

 

ALL of my ROMS say "With Pain", no annotation of where there wasn't pain, just as Vync mentions.  He never even asked, he tried 'distracting me' verbally while doing the ROM, he heard me 'grunting', breath catching, etc. which led him to add that, otherwise...well, who knows.  That means mine were done incorrectly, so it does happen way TOO MUCH, really.  Once I get my C-file, I will dispute ROMS most likely, along with some other big issues that are incorrect.

[aoneinsun]

I have the distinct feeling that I will end up needing to dispute the ROMs that my examiner will list for me too. Is that best done by asking for another C&P exam (if the examiner did not perform the exam properly / did not properly measure with a goniometer, etc). And/or would this entail contacting a VA attorney who would bring in the appropriate medical personnel to perform an independent exam?

[Vync]

Talon's right. This happens way too much. I don't know if the problem is lack of proper training on how to perform an exam or just a lazy examiner.

My BVA remand from the late 1990's specifically instructs the examiners to factor in painful motion.

Once you get the official C&P exam results, you'll be able to determine if they really screwed up. The best time to challenge something like this is while your claim is still alive. I honestly do not know if you would need to contact the C&P clinic or the VARO about this. However, it would not hurt to try to head it off at the pass. If they can get you back in for a re-eval before they render a decision, then hopefully you will not need to hop on the appeals train.

Regarding hiring an attorney, check out this topic:

 

[iceturkee]

11 hours ago, aoneinsun said:

I have the distinct feeling that I will end up needing to dispute the ROMs that my examiner will list for me too. Is that best done by asking for another C&P exam (if the examiner did not perform the exam properly / did not properly measure with a goniometer, etc). And/or would this entail contacting a VA attorney who would bring in the appropriate medical personnel to perform an independent exam?

i once had a vso tell me not to request anything until after adjudication. because, in reality, you aren't suppose to have your c&p exam until a decision is made. if you request now, i believe you will do yourself more harm than good.

Edited March 18, 2016 by iceturkee

[Vync]

5 hours ago, iceturkee said:

i once had a vso tell me not to request anything until after adjudication. because, in reality, you aren't suppose to have your c&p exam until a decision is made. if you request now, i believe you will do yourself more harm than good.

Wow, that's a horrible VSO!

You win the Internet today with that comment!

[iceturkee]

15 hours ago, Vync said:

Wow, that's a horrible VSO!

You win the Internet today with that comment!

actually, she was better than most. not saying much.