Statement from my PCP overturned by C&P Doc?

[silverdollar22]

Had my C&P and found out today that I was denied even though my primary care doctor said that it “was more likely than not “ attributed to my auto accident while I was in the Army. My SMR states from the emergency room that my entire left side had a contusion from the accident. The C&P doctor apparently disregarded both pieces of evidence in her decision. The man I spoke to said he thought that my best bet would be to appeal the decision through the new appeal program. He said that 60% of the appeals were positive. Do I have to wait for the decision letter before I file an appeal? 

                 Thanks,

[vetquest]

Can you get an IMO?  In my case three C&P's were used to overturn a neurologists opinion and an IMO carried the day.  Buddy statements are also weighed by BVA.  I do not know how local boards weigh buddy statements but BVA chastised the local VA for not noting my buddy statements and included them in my decision.  Good luck.

[broncovet]

There are several ways to beat a bad c and p exam.  Chose one or more.

1.  Challenge the compentency of the examiner.  To do this, you need to find out the credentials of the examiner (hopefully, you got the examiner name on the exam report).  If the examiner:

a) is experienced in your field through training or experience

b) stated they "reviewed your file"

c)  provided an explanation of the reasoning for the conclusions (that is, why they concluded your condition was less likely than not due t military service, when the other doctor opined differently)

   ....then challenging the compentency of the examiner wont go anywhere.  However, if the examiner failed to do any of the above, then you may challenge.  

2.  Get an IMO/IME to refute the bad c and p exam.  

3.  Do nothing, but appeal anyway. (This is probably your worst choice).   This may work, however,  as the benefit of the doubt should accrue to the vet if there is a balance of evidence for and against the claim.  However, the board can elect to find one of the exams more probative, but they must give a reason why they did so.  (Example:  one doctor knew you longer, and had a more complete history).  

[Gastone]

Did you get a copy of the C & P DBQ? If not, do so ASAP. If the C & P was completed at your VMC, a copy of the DBQ should be in your MHV Clinician Treatment Notes within a week or two of the C & P.

I can't say I've ever seen a VA PCP that was  Board certified in any specialty. When it comes to a C & P Exam, other than an MH/PTSD exam or an Appeal Remand, it's not unusual for the examiner to be a PCP.

Did your VMC PCP opine in his Clinician Treatment notes or the DBQ you requested, as to the why's of his nexus opinion? Just saying he thinks it is, isn't adequate when going up against a C & P Examiner. The C&P Examiner must discuss his nexus theory, good or bad.

[Buck52]

I've Always had success on challenging a C&P Examiner that was not qualified to render his medical opinion or never mention the proper evidence that would help substantiate  my claim in his report  =  by getting an IMO using a specialist that abide by the VA Guidelines as set forth for the condition being claimed.

  I ask the New Private Dr to read my medical records that pertains to the claim and read the C&P Examiners report and ask the New Dr to examine me and go into a better detail explanation with his opinion...when the New private Dr (IMO) Does all this  you have about a 95%chance winning your claim and the VA will over turn the C&P Examiner.

When you see a private specialist  just be open and honest with them and let them know what your doing what you're claiming  and tell this new Dr if he is New to the VA compensation claims World, then  just let this New Dr know a little about the VA  and how to use wording like   '' in my opinion it is likely as not''  this Veteran condition was caused by or related to what he experience in the military  or go into more detail about it if he prefers too...going into more detail about your medical health is a good thing with the VA Raters and  they will usually over turn a C&P Examiner that was not qualified to render a medical opinion.

Some Specialist are Veteran Friendly and will help  I had a SPECIALIST I seen from urology I never met him before in my life  I got an appointment to see him and told him up front in his examining room what I needed  and how to word things the VA likes to see   about the '' is least likely as not'' and what all I needed from him  about examining me and his opinion .

I took my military records and medical records from VA and he read in part the things he needed to know & after his examination   I ask him if he can go into detail about what he has seen and read and give his honest opinion.

I told this Dr I need that to show the VA for my medical evidence in a claim I am trying to get  to get my benefits,  this Dr did just that  and it only took a day for that and a about a week later I got his letter in the mail and it was perfect....the VA went with his opinion and I won my claim.

Never hew-haw AROUND THE BUSH WITH THESE SPECIALIST always be open and honest with these guys   if they can't help you then find a Dr that will.

[silverdollar22]

First of all thanks to all who took the time to answer my post. I did look at my C&P results on ebennies and did some research on the examiner. She is the director at large what ever that means. She has a pretty big list of credentials so I’m not sure that route will work. Here is her opinion!

  MEDICAL OPINION REQUEST
TYPE OF MEDICAL OPINION REQUESTED: Direct service connection OPINION: Direct service connection
Does the Veteran have a diagnosis of (a) degenerative arthritis (DJD) left hip that is at least as likely as not (50 percent or greater probability) incurred in or caused by (the) motorcycle accident and MVA with left flank pain during service?
Medical Opinion:
Records reviewed. In review of the Veterans STR it is noted that he was involved in a MVA and motorcycle accident. In 6/20/1984 (p.g37; 1st STR tab dated 09/23/1995) he was involved in a motorcycle accident. The note
indicates that the Veteran c/o right side hip and shoulder pain. XRAY was NEGATIVE. The only noted documented issue was for bruises from the incident. Also in review of his STR it is noted that in 04/27/1984 (P.11; 3rd STR tab
dated 09/23/1995) he had a MVA. From that incident he had c/o right flank pain. Please note that this document appears to have been altered from the location of the condition from "R" I am assuming meaning right to
an "L" I am
assuming to mean left. However because the author of the note did not
initial
or sign next to the changes it is unclear who made the changes to the document. Nevertheless, it is also documented in this note from 1984 that
the
Veteran was dx'd with a contusion of his back. In review of the Veterans
MTR
it is noted that he was dx'd with DJD of his left hip in 2015 which is
almost
20 years after he exited service. There are NO not noted issues with his right hip to date. In review of his records there were no prior issues with is left hip since the 1984 incident and the Veterans issues with his left
hip
appear to have been intermittent since the dx's of DJD in 2015. Taking
the
above into consideration it is therefore LESS LIKELY that he has a dx's
of
(a) degenerative arthritis (DJD) left hip that was incurred in or caused by (the) motorcycle accident and MVA with left flank pain during service. It is also LESS LIKELY that this Veteran has a right hip condition that was incurred in or caused by service.

 I can add more information if necessary 

Edited February 17, 2018 by silverdollar22

[silverdollar22]

So what do you think?