Preparation for Decision without C&P appt

[Gunny Motto]

Question here, I had a claim in for bilateral bursitis(knees) and subluxation in left knee. This claim was initially denied because they said that I did not have a diagnosis for bursitis in my medical records. I have since then informed my doc of the apparent oversight as she has indeed been treating me for bursitis, however she stated "knee pain" in my record. Now, I have resubmitted my claim, and I also provided them my doc medical notes from my records which states the bursitis diagnosis, as well as medical record notes from an Orthopaedic doc siting the same as well as siting subluxation, and I also submitted the medical notes from my Physical Therapist. I also included a statement from my wife explaining how these issues have affected my daily activity. I look on ebenefits today, and my claim has moved from Gather Evidence straight to Preparation for Decision. Question, how can be preparing for decision when I have not been scheduled for a C&P exam yet? I mean, I know that I submitted a lot of evidence and all,,, but shouldn't they send me in for an exam?? Does this mean I'm on the brink of denial??

[broncovet]

No, it does not mean you are on the brink of a denial.  It means that C and P exams are discretionary, that VA may or may not provide a c and p exam.  It could mean you have enough evidence without a c and p exam to go ahead.  

I telll Vets this all the time, but we have Vets that try to show off their knowledge and it usually backfires.  You dont need to apply for "bursitis" of the knee.  Instead, apply for disabilities of the knee.  You probably dont know the difference between bursitis, arthritis, or some of the other knee disorders...you should let the doctor diagnose and treat you.  

When you apply for "bursitis" this suggests you are excluding symptoms of say, arthritis.  Maybe you have both..one in the patella-femoral jointt and another in the femoral tibia joint.  Just say your knee hurts and let the doc decide if its arthritis, bursitis, or something else, such as a torn ligament.  

[Gunny Motto]

Now that is very good and sound advice and it makes all the sense in the world to me! But when my claim was denied the 1st time, it stated " knee pain is not a diagnosis and just pain alone doesn't qualify for c&p". Which I thought was odd because I know people that has been approved for "chronic back pain ".Weird....

[anxiousinMD]

I also moved from Gathering of Evidence to Prep for Decision without a C&P, and I also have thorough treatment records from the VA and an IMO in favor of an increase. But I also wondered the same about if I was on fast track for denial...from what I understand they can still order you a C&P at this stage and move you back to Gathering of Evidence and it's not uncommon. Who knows. But yeah, like broncovet says, let them dx you. I'm hoping for the best but preparing for the worst. Good luck to you.

[broncovet]

Hopefully, you appealed the decision that stated "knee pain is not a diagnosis".  The court has ruled the Veteran can "identify the benefit sought" by pointing to the applicable body part.  There is no requirement that Veterans have an intimate knowledge of anatomy or medical diagnosis in order to receive benefits.   That is why they have doctors and c and P exams.   Not all Vets can even read.   The Veteran need not understand, nor be able to name the applicable joint to get benefits.   

 

Edited August 25, 2016 by broncovet

[saxman]

Thanks broncovet for posting your last comment because it hits on one of contentions I am appealing..

[saxman]

I file a claim for bilateral hip condition ( arthritis) and they didn't order a c and p exam.  I'm waiting to see the outcome of the claim, I feel it's in my favor because I sent in all the evidence showing I have arthritis of the hips.  This claim is secondary to an already SC condition.  Good Luck Gunny Motto!