Comp & Pen Exam

[theo]

Berta.. I recently had my C&P examination in December 06 just before Christmas.

Type : Respiratory (obstructive, Restrictive and Interstitial)

Pulmonary Tubersulosis and Mycobacterial Diseases

Compensation and pension examination

Instructions from the AMC to the examiner: "In particular, the examiner should discuss the manifestations of associated with the veteran's service-connected emphysema and allergic rhinitis and, to the extent possible, render an opinion as to the level of impairment caused by these disorders. The examiner is specifically asked to render an opinion as to the effect of the service-connected disabilities on the veteran's ability to procure, and to maintain, gainful employment (in rendering this opinion, the examiner should, to the extent possible, distinguish between the manifestation of the veteran's service-connected emphysema and service-connected allergic rhinitis and the manifestations of any non-service connected respiratory disorders."

The examiner's opinion:

1. Inactive tuberculosis

2. Bronchial asthma

3. Allergic rhinitis

OPINION:

1. The level of impairment caused by the veteran's allergic rhinitis is mild to moderate.

2. the level of impairment caused by the veteran's bronchial asthma is moderate. The veteran has been engaged in vocational rehabilitation in computer work. If he Veteran is able to be trained and to perform this work, he should be able to do this kind of work without too much interference due to the above service-connected conditions.

"While it should be granted that the allergic rhinitis and bronchial asthma are somewhat disabling, they should not severely impair the ability of the veteran to perform sedentary work. That being said, should the veteran be obliged to do a lot of talking on his job, he might find it more difficult to main employment due to shortness of breath, and chronic allergic rhinitis.

If there is a primary reason that the veteran would have great difficulty in obtaining and maintaining gainful employment, it is secondary to the nonservice-connected problems, such as chronic back pain, depression, and left flank pain secondary to incisional hernia."

The examiner's opinion regarding his C&P statement stated: "The veteran has been engaged in vocational rehabilitation in computer work. If the veteran is able to be trained and to perform this work, he should be able to do this kind of work without too much interference due to the above service-connected conditions."

My concern about this statement in that the examiner did not read the file / Vocational Rehabilitation Report. Which stated that the veteran was placed in the Independent Living Program, a computer was purchased from him communicate with family. And the report has stated that the veteran is unable to vocational rehabilitation.

REHABILATION CLOSURE STATEMENT. I won't go into specific information. "The Veteran completed an initial orientation and intial vocational interview on date indicated. The Veteran has a services connected disability combined rating of 60% for Pulmonary issue and other zero percent issue that are service connected. The veteran has an imparment to employability. He has not worked for the past five years, he is 60 years old and hs multiple medical problems with regards to his pulmonary condition. Furtermore, he has difficulties in terms of depression and is being treadted for this condition. Moveover, the Veteran has not overcome the effects of impairments to employability. The veteran was determined to have an employment handicap. Conditions for a serious employment handicap were also identified. The vertan is being treated for multiple condition and taking several medications. His Dr.indicated that the veteran was entitled to the Chapter 31 vocational rehabilitation benefits. However, he determined that the veteran was not feasible for competitive employment and would benefit from and Independent Living Plan."The Independent was written and since... I went through, now I have the file. The document is closes with comments of case managers closing statement."

Question, is the C&P examiner trumping the VOC Rehab people with his what if statement about being trained on computers and sedentary work? And do doctors statement's really matter anymore?

All of the Doctors letters included in the file and some referenced in the C&P

I'm trying to get a read on this comp and pen...

Your opinion please

Theo

[Dale Jr. 8]

Sounds like the C&P doc is trying to override the Vov Rehab. Some C&P docs try to pass the buck on a firm opinion to someone else. They like to use the term "without resorting to speculation". The whole key to this is your non-service connected issues. If those are the primary reasons that the Voc Rehab people said what they did you have an uphill climb. Either way if you get shot down at the VARO you can use the Voc Rehab paperwork as new evidence. Dale Jr.8

[john999]

Theo

Get a private IMO from a board certified specialist to rebut the C&P. As it stands the balance is in the VA's favor. The C&P doctor is basically turning the facts inside out to paint a picture of someone who can do computer work at some level. You want to rebut that with medical evidence.

[Berta]

I agree - this is VA double talk and it shows that Voc Rehab is often a two edged sword-

you can certainly point out that the C & P doctor did not have the Voc expert report- as that is definitely clear as to the fact that you have employment handicaps-

I feel Theo -that the Voc Rehab report should out -weight the C & P report but the VA weighs with a tilted scale-

Can you obtain an IMO? How about one from a Voc Rehab specialist who doesnt work for the VA-

Another thing about Voc Rehab-

I suggest that vets in this program ask for accommodations to their disability and get this documented.

My husband did as it was difficult for him to go back to school and these accommodations were significant to

their attempt to drop his SC award.

He had note takers and also special exams- what I mean is the exam clock seemed to tick like a bomb and it caused him great anxiety so they monitored him in a room alone for exams-

A vet might tire easily or need to move around during classes-it all depends on their disability- maybe they get anxious if asked questions in front of others- things like that-

Theo is your depression at all related to your SC problems and have you claimed it as secondary?

I cannot see how the VA would take a doctor's opinion regarding Voc Rehab over a Voc Rehab specialist report-especially in your case-but it would help alot to get more support for the Voc Rehab report-

by the way- you dont have to answer but consider this-

your grades might be great or they might reflect that you are having difficulties-something the C & P doc did not consdier at all.

[theo]

I agree - this is VA double talk and it shows that Voc Rehab is often a two edged sword-

you can certainly point out that the C & P doctor did not have the Voc expert report- as that is definitely clear as to the fact that you have employment handicaps-

I feel Theo -that the Voc Rehab report should out -weight the C & P report but the VA weighs with a tilted scale-

Can you obtain an IMO? How about one from a Voc Rehab specialist who doesnt work for the VA-

----I took your advice and got an Independent Medical Opinion - Dr. Bash (www.veteransmedadvisor.com)

who wrote an opinion targeting the multiple types steriods for the pulmonary asthma condition, and the gradual increase in weight which has caused the sleep apnea. Also he indicated that there is clear hypertension issues as indicated by my medical records.

Another thing about Voc Rehab-

I suggest that vets in this program ask for accommodations to their disability and get this documented.

----I don't know what you mean. If it what I think it is, I addressed it below pertaining to the evaluation.

My husband did as it was difficult for him to go back to school and these accommodations were significant to

their attempt to drop his SC award.

He had note takers and also special exams- what I mean is the exam clock seemed to tick like a bomb and it caused him great anxiety so they monitored him in a room alone for exams-

A vet might tire easily or need to move around during classes-it all depends on their disability- maybe they get anxious if asked questions in front of others- things like that-

----I went through an evaluation through voc rehab which involved a battery of test and observation. I was not able to maintain or complete the 10 day evaluation and was placed on ILP (Independent Living Program).

Theo is your depression at all related to your SC problems and have you claimed it as secondary?

---Regarding the depression, the VA denied me a service connection for depression. I don't know how the depression got separated from the TDIU and the 1151 issue but it is not apart of the ongoing issue. It appears I'll have to re apply.

I cannot see how the VA would take a doctor's opinion regarding Voc Rehab over a Voc Rehab specialist report-especially in your case-but it would help alot to get more support for the Voc Rehab report-

by the way- you dont have to answer but consider this-

your grades might be great or they might reflect that you are having difficulties-something the C & P doc did not consdier at all.

---It is obvious that the examiner did not read the inch thick Voc Rehab Evaluation report that was put in my file. the file does indicate problems with the concentration and other. This is the report that was one of the reasons the BVA remanded it back to the AMC.

Theo

Edited January 1, 2007 by theo

[Berta]

"This is the report that was one of the reasons the BVA remanded it back to the AMC."

Absolutely-----I get the whole picture now- case of the VA ,as usual, not reading the evidence -

Theo-has the remand been posted yet at the BVA website?

This too is significant:

"I was not able to maintain or complete the 10 day evaluation and was placed on ILP (Independent Living Program"

The VA trys to think a Voc Rehab program can change a vet into a rocket scientist overnight- the truth is many many vets are sure smart and can do well in Voc Rehab but this does not mean in any way that they have been able to overcome their disabilities-nor does it mean they are employable.

Problems in concentration- right there that is something their examiner failed to consider-

this would be in a job setting as well as Voc rehab setting and this surely stems from your SC disabilities.

It really gets me when the VA highlights a Voc Rehab vet who is taking PC courses or who can use a computer because the VA itself would probably not find most PC literate vets as qualified for working for the VAR0s

or any other PC area of the VA.

[theo]

Berta, I went to the BVA's website and put in Docket NO and other info and nothing came back. It could be that I'm not inputting the correct information. The remand was sent to AMC in September with the instructions. Its funny how the 1151 2005 C&P last year was separate from this years 2006 TDIU C&P when the remand was for incomplete but they did not reexamine me for 1151 just Unemployability. The two issues was separate issue, however the BVA or AMC lumped both apeals together to make one decision. I feel its going to end up back at the Court of Appeals.

The BVA remanded this back to the AMC after they denied me, this prior to the Court of Appeals remanding it back to the BVA in 2004 for the 1151 and the TDIU. The BVA appeal was initiated back in 2002, so this has been going on for a while now. I went through the Voc Rehab Evaluation for only 6 days.

Dale Jr. 8 wrote this:

"The whole key to this is your non-service connected issues. If those are the primary reasons that the Voc Rehab people said what they did you have an uphill climb."

The rehab report is full of pain issue pertaining to the hernia pain. My concern is how high is the uphill climb.

Back then I was taking morphine sulfate, now that was a trip in itself. Trying to concentrate during testing... my God. Breathing is an issue when you are taking certain meds.

Anyway thanks for the reply.. if you can tell me how to access the BVA online I'll access and share with you.

Thank for Dr. Bash... He great.

Theo