Just had C&P exam

[Charlieg]

After a year of waiting finally had c&p exam for shoulder impingment, rash on lower legs, and IBS.  Had a nexus letter from doctor for shoulder, and IBS and rash were diagnosed by VA.  The doctor did not seem to impressed and thought I had way to little testing for these and was shocked I had been diagnosed.  Guess I just have to wait and see.  The IBS and rash should be presumtive.  He said he doesnt make the decision.  Whats next?  How do I hear whats next?  He said I would get a letter, is this true?

[Vync]

Hiya CharlieG,
Some C&P examiners have the personality of a stale cracker and wrongly make veterans feel bad.

Keep in mind that there are three things required for initial service connection (SC)
1. Event/injury in service
2. Current diagnosis
3. Doc or C&P examiner connecting 1 and 2

The doc telling you he doesn't make the decision is partially right and wrong. For regular SC, the above three is normal and the doc does make a decision. For presumptive, it is supposed to work differently. The "presumptive" is usually something like you have to have paperwork showing you were in a certain location (i.e. Iraq, Afghanistan, Vietnam) during a certain date range and you came down with a presumptive illness. Example from Gulf War presumptive list is here: http://www.benefits.va.gov/COMPENSATION/claims-postservice-gulfwar.asp  For presumptives, the doc should just confirm the diagnosis and the VA regional office handles the paperwork.

 

If you have not signed up already, look into signing up for a VA Ebenefits account to check status online: http://ebenefits.va.gov  Just remember that the claim status might change at any time, like from preparing to notify back to gathering evidence.

You will get a letter from the at some point in the future. We have all been there waiting for hopefully good news to arrive in the mailbox. Try to keep your mind off it by yourself busy with hobbies like family, TV, fishing, video games, crafting, etc...

The first letter you get will probably be a generic form letter stating they received the C&P results, but due to a large number of claims they can't provide you with an ETA, blah, blah, blah... If they grant your claims, you'll get an award letter, a.k.a. a Big Brown Envelope (BBE), but it can be any color. If they do not grant them (or delay/defer some of them), you'll get a supplemental statement of claim (SSOC). Sometimes you might both in the same envelope if they grant some but defer or deny other issues.

My recommendation would be to try and obtain a copy of the C&P exam. By having the C&P exam findings, you can find out what the doctor determined and compare the findings to the rating tables. Until you get the BBE in the mail, everything is speculative.

If it was done at a VAMC, you should be able to get a copy via the Release of Information Office. Sometimes they can print the copy right away. If you just had the exam today, it might be a few days to a week before the doc has everything filled out. If the exam was done by QTC or another contractor, there is no telling how long it might take.

 

Below is a link for VA disability questionnaire worksheets which should give you a good idea of the type of questions you were asked and the examination performed:

http://www.benefits.va.gov/compensation/dbq_listbydbqformname.asp

There should be an examiner's statement in there somewhere where they make their nexus statement about SC status. If they said "as likely as not" (50%/50%), "more likely than not" (75%), or "is due to" (100%), then that means that you are service connected. Sometimes the examiners might state something like "must resort to mere speculation", which may go either way depending on the circumstances.

 

After you have your C&P exam findings, go over here to compare them to the rating criteria. If you end up being granted SC status, this will help you identify what rating percentages could receive.

http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5

 

Once on that page, search for "schedule of ratings" followed by your conditions.

Shoulder is under §4.71a   Schedule of ratings—musculoskeletal system
http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5#se38.1.4_171a

Rash is under §4.118   Schedule of ratings—skin
http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5#se38.1.4_1118

§4.114   Schedule of ratings—digestive system
http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5#se38.1.4_1114

 

Under each link, find tables for each diagnosis and look at the criteria for each rating %. For example, if your rash was diagnosed as dermatitis or eczema, you would use this sub-table. The criteria is on the left. Notice there are a lot of "or's" in there. You might qualify for more than one reason for a certain percentage shown on the right.

7806   Dermatitis or eczema.
More than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period	60
20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period	30
At least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period	10
Less than 5 percent of the entire body or less than 5 percent of exposed areas affected, and; no more than topical therapy required during the past 12-month period	0
Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DC's 7801, 7802, 7803, 7804, or 7805), depending upon the predominant disability.

 

 

Now for the reality of the VA: I don's want to spook you, but the VA findings are not always correct. It is not unusual for the VA to deny a claim when it should have been approved. They often also issue low ball ratings of 0% or 10% when a higher rating is warranted. They also do not always get earliest effective dates (EED's) correct. When you get your BBE or SSOC in the mail, The first thing you want to do is check it against the C&P examiner report to make sure everything is correct. Sometimes they check the wrong box, typo the wrong range of motion (ROM) value, or just ignore sections. If they screwed up, it can be challenged via reconsideration or notice of disagreement (NOD)/appeals.

In addition, some conditions can be deemed as secondary claims. Let's use your shoulder for example. You might have impingement that limits your range of motion, but what about pain like burning, electricity, or numbness down your arm, elbow, wrist, or hand? Radiculopathy can be rated as a nerve claim secondary to an already SC claim. If the SC condition causes you to become depressed, that can be a secondary mental health claim. If the medication prescribed for treatment of a SC condition causes another disability, then that can be claimed also. For example, if they gave you prozac for treatment of depression and it caused your noodle to malfunction, that can be claimed as ED. Until someone has experienced the domino effect of secondary claims, they may not realize just how much impact it may have on their life. It's usually not their fault because it's all connected to their service.

 

Good luck! I hope this helps!

[Charlieg]

Also he had me get xrays for shoulder and stomach and blood work while I was there.  He specifically told me he does not  write " in my opinion, or as likely or not"  statements.  I have a password and username for ebenifits but have never been able to login.

[Charlieg]

I was finally able to access ebenifits but can't get a premium account because I can't get past the address part.  Cant figure out what address va has for me. Although everytime I go its verified.

 

[Gastone]

Next time your at your VMC, stop in at the Vet Learning Center. There should be (1) person, usually the Honcho, that takes care of MHV & E-Ben Authentication and Upgrades to E-Ben Premium Account.

Some Nam Vets still have to visit their RO to get the E-Ben up-grade, if they don't have a DOD ID card.

Never know, you may end up, having to visit your RO to get it straightened out.

You just had a C & P after a year? Your original claim wasn't an FDC (Fully Developed Claim), right?

Did you supply any or all of your Medical Evidence at the same time you filed the original Claim? Barring any recent submission by you, of New & Material Evidence, your probably looking at a wait-time of 9 - 12+ months for a Rating Decision Letter.

If Awarded SC, your Retro $$ Direct Deposit should hit your Bank/CU account WELL in advance our you receiving the Award/Denial Letter.

Consider, if you haven't already done so, setting your Bank/CU Direct Deposit Account notifications for all Transactions, to be Txt/E-Mail in real time. My Retro Deposits have hit ,anywhere from 3 weeks to 4 months before actual Award Letter arrived.

Semper Fi

[Charlieg]

I was turned down for IBS and Rashes for no clinical diagnosis and for shoulder impingment because he didnt agree with the nexus letter from my orthepedic surgeon.  Looking on healthevet i see where my problem code for IBS is k58.0 which when i look it up is a diagnosis for ibs but its not the 4 digit code for compensation.  The same for the shoulder..  How do i get the diagnosis codes for compensation on my records?  Im just confused

[Carl the Engineer]

I dont get that your C&P examiner won't opine "or as likely or not" etc.  In allmost all of my claims, the examiner opines or the RO sends it back for a statement. ??

Anyway, you need to get on myHealthyVet and use the "Blue Button" and download your "VA Notes".  They should show your C&P exams.

You have a year to appeal.  You may want to do some research and maybe get some outside help, whether thats a lawyer or doctor that does exams for veterans claims.

Sounds like your examiner was a duffus,

FWIW,

Hamslice