Favorable C&P exam turned into unfavorable after addendum

[BlueBarracuda]

Greetings all,

This is my first post after looking for similar situations. My C&P exam for spine issues was in June and it seemed favorable until an addendum was made this month which turned everything around. They denied my claim for aggravated spine issues and had inaccurate information stating my condition didn't progress until after service. Is the best way to go about this by filing an appeal or by making a new claim for low back pain? 

[Vync]

Welcome to Hadit!

Was the addendum made by the C&P examiner, a non-C&P doctor, or possibly someone working at the VARO?

How long after service did they claim the condition progressed after service?

 

 

[BlueBarracuda]

Thank you Vync for the warm welcome and reply.

The addendum was made by the C & P examiner, but 10 weeks later. They are saying my progression is the typical rate of progression for my spine issues, therefore not related. That leaves me unsure if I should appeal this or claim it as chronic low back pain. I have several records to support as such. Also, when the examiner quoted my angles they were much lower than anything sound. A spinal curve doesn't shrink and then exaggerate again a few years later.  

56 minutes ago, Vync said:

Welcome to Hadit!

Was the addendum made by the C&P examiner, a non-C&P doctor, or possibly someone working at the VARO?

How long after service did they claim the condition progressed after service?

 

 

 

[Vync]

6 hours ago, BlueBarracuda said:

Thank you Vync for the warm welcome and reply.

The addendum was made by the C & P examiner, but 10 weeks later. They are saying my progression is the typical rate of progression for my spine issues, therefore not related. That leaves me unsure if I should appeal this or claim it as chronic low back pain. I have several records to support as such. Also, when the examiner quoted my angles they were much lower than anything sound. A spinal curve doesn't shrink and then exaggerate again a few years later. 

Do you happen to have copies of all of your service treatment records? If not, get them.

I ask because the entrance and exit exams, plus any back injury treatment will be important.

 

When you joined, you had the "presumption of regularity". This means that you are presumed to be healthy. The entrance exam is performed to identify any medical condition which could be exempt from this presumption. In my case, they noted I had eyeglasses which corrected my vision to 20/20. Aside from that, I was presumed to be healthy and normal.

When you left the service, the exit exam was performed for pretty much the same reason. In some cases, the examiners might be lazy how they handle it. For example, I left the service which chronic asthma. The doc noted I was treated for asthma, but said my lungs were normal. However, I fought it on appeal and won due to repeat treatment for it while I was in the service.

 

Be ready to fight back by using your treatment records against the VA. We all know that being in the military and seeking treatment for injuries may be frowned upon and often results in veterans who didn't get the treatment they needed while they were on active duty. For example, look for any treatment after having a fall, car accident, etc.. which caused your back to get this bad. That C&P doc might have tried to attribute the state of your back to natural aging, but if you can prove that they were too lazy to find your actual root cause injury event, that is ammo in your favor.

 

I would not recommend you open a new claim because all the VA will do is just continue with or reopen your existing claim. Read the SSOC letter and the appeal documentation you received with it. The SSOC should state exactly why they denied your claim. Fight them on each issue directly. I would recommend you consider filing a reconsideration. You have until the NOD clock runs out to have the VA look at your submission to see why you think the C&P doc was wrong. If they don't reply in time, be sure to file an official NOD/appeal before the NOD clock expires. If it expires, then they would consider any further action on your claim to be reopening it, but with a potential new effective date.

 

Question: Can you post the text of the denial letter section regarding your back? Be sure to omit any personal info or details which don't matter. It might help others here be able to offer an opinion.

 

 

[MarkInTexas]

Did the C&P examiner himself/herself actually do the addendum, or was it somebody else at QTC, VES, etc that just typed something in at the bottom of the DBQ?

That's been known to happen.  Some clerk gets word from the VA that the C&P was not to their liking and they ask for "clarification", which means, "change your story".  Only often it's not the actual Doctor that does the addendum.

Just wondering.  You might still be able to use it.

Good luck!

Mark

[BlueBarracuda]

On 9/10/2016 at 6:20 PM, MarkInTexas said:

Did the C&P examiner himself/herself actually do the addendum, or was it somebody else at QTC, VES, etc that just typed something in at the bottom of the DBQ?

That's been known to happen.  Some clerk gets word from the VA that the C&P was not to their liking and they ask for "clarification", which means, "change your story".  Only often it's not the actual Doctor that does the addendum.

Just wondering.  You might still be able to use it.

Good luck!

Mark

Mark,

 

Yes it was the same examiner. The thing is it is not likely for an adult spine to go from a higher degree of curve to a lower degree of curve back to an even higher degree of curve within 5 months. It is very confusing. It seems to be a long process to go through for someone to understand this fact. Thank you.