What the heck just happened??

[Sgt. Wilky]

I posted last week that I was summoned for an RFE C&P exam. I went to the exam and the Nurse Practitioner saw me. It was probably the worst C&P exam I ever had. I logged in to my VA and went to the Blue Button and printed off my exam notes and I've since been furiously wearing out my highlighter on these papers. 

First of all, this nurse practitioner was very impersonal. He told me we were there to satisfy the bean counters in D.C. and that this was a legal exam, not necessarily a medical exam. I knew right then I was in trouble.

Second, during the course of the exam, numerous times he told me "push through the pain, push through the pain" numerous times. He never asked if I was in pain and the times I told him it WAS painful, he quipped, "I didn't ask you that." During the range of motion for my upper and lower back he told me to reach down and touch my toes and told me to bend my knees to do so if I couldn't bend over, which I promptly did bend my knees. He said "you need to touch  your toes." I felt like a freshman football player getting chastised by the coach. He noted in section 3 of my DBQ that "no pain noted on exam" which is a flat out lie. I told him several times throughout the exam that I was in pain, and that it was painful, and told me again, that he didn't ask me if I was.

Thirdly, I've been comparing the medical exam notes carefully, and while the sections are numbered correctly in his notes, entire sections of the DBQ were not included in his report. Coincidentally, sections 4 (ROM measurements after repetitive use testing) which were the same before and after the repetitive use and section 5, which address pain, are non-existent in his medical examiners notes. Section 7 dealing with functional loss was not in his medical notes. These points all would have been in my favor and helped. He obviously only covered and inserted information on those points that would benefit the VA reducing my rates (I'm only at 10% and not asking for anymore).

There are just so many other things wrong with this exam and his notes, he makes me look like a liar, and that's what makes me the most angry. This was purely adversarial and I have no idea what or why he felt that I deserved that kind of treatment. There's no doubt they're going to either reduce me to 0% on this.

I'm basically going to copy and paste and email it to my VSO here in Fort Collins and see what they say about it, but I'm trying to figure out what my next steps should be after I finish documenting my experience with the guy in my notes. Any ideas would be appreciated.

Semper Fi,

Sgt. Wilky

[Jeromy]

You should get a questionnaire giving feedback for your exam either by email or regular mail.  I did on mine about a month ago, can't wait to my next one on the current exam I had last week so I can tell my side of the story.  I'd definitely get the ducks in a row and provide any new medical reports between now and the outcome of your claim.  Then request a "reconsideration" based on "XYZ" evidence the examiner missed and new material associated with claim.  It beats doing a full appeal.

[Holllie Greene]

Hi Sgt. Wilky,

That sounds like a horrible experience.  I wonder how these people are hired.  Anyway, when all is said and done, perhaps meeting with your VSO and exploring the possibility of a NOD.

Just my thoughts.

H

[Buck52]

go to your C&P Chief  tell him/her what you just told us about your  ROM motion and pain  about the examiner saying'' I didn't ask you if you was''

when you were in pain  they do not have the right to treat you like that. This examiner had no right to put you in pain and when you mention to him you were having pain and  he says I never ask you if you were having pain. the examiner is there to examine you  he filed to do that.   also they are suppose to use a goniomenter

Using a goniometer, measure and report the range of motion in degrees of forward flexion, extension, left lateral flexion, right lateral flexion, left lateral rotation and right lateral rotation. Generally, the normal ranges of motion for the cervical spine are as follows: • Forward flexion: 0 to 45 degrees • Extension: 0 to 45 degrees • Left Lateral Flexion: 0 to 45 degrees

 

Request another exam with a Different examiner.

[Sgt. Wilky]

Thank you guys! I will contact the Cheyenne VA Medical Center C&P Office and talk to the lady there. I may even ask to have it done somewhere else, maybe Denver if they'll let me do that. If I call and complain, I don't believe I'm going to get fair treatment from that place again.

[Guest L]

As a sidebar - the goniometer is not "required" for measurements, due to the professional credentialing and experience of the person rating.

It states no where in the criteria they must use it but rather list/ document  the range of motion.  It is not fair since this is subjective ( based on the person's opinion) 

In a true "therapeutic " environment of range of motion testing the person is held to a high standard, goniometer is often not used. ......but at the VA this could be a way to get around a true measurement. 

In any exam and Life... the rule of thumb is stay below your pain level - never push through the pain. Pain is a warning sign....to stop! 

I would complain as @Buck52 states. 

Edited May 22, 2018 by L
added info

[Buck52]

38 C.F.R.4.46 -

§ 4.46 Accurate measurement.

Accurate measurement of the length of stumps, excursion of joints, dimensions and location of scars with respect to landmarks, should be insisted on. The use of a goniometer in the measurement of limitation of motion is indispensable in examinations conducted within the Department of Veterans Affairs. Muscle atrophy must also be accurately measured and reported.

On DBQ's (VA FORM 21-0960M-14) it states the following for Measuring Range of Motions:

NOTE: Measure ROM with a goniometer, rounding each measurement to the nearest 5 degrees. During the measurements, document the point at which painful motion begins, evidenced by visible behavior such as facial expression, wincing, etc. Report initial measurements below.

Following the initial assessment of ROM, perform repetitive use testing. For VA purposes, repetitive use testing must be included in all joint exams. The VA has determined that 3 repetitions of ROM (at a minimum) can serve as a representative test of the effect of repetitive use. After the initial measurement, reassess ROM after 3 repetitions. Report post-test measurements in Section 5.

C&P Service Clinicians Guide.htm

17. Musculoskeletal

a. For all joint or muscle disorders, state each muscle and joint affected.

b. Separately examine and describe in detail each affected joint.

Measure active and passive range of motion in degrees using a goniometer.

In addition, provide an assessment of the effect on range of motion and joint function of pain, weakness, fatigue, or incoordination following repetitive use or during flare-ups. (See the appropriate musculoskeletal worksheet for more detail.) NOTE: The diagnosis of

degenerative or traumatic arthritis of any joint requires X-ray confirmation

 but once confirmed by X-ray, either in service or after service, no further X-rays of that joint are required for disability evaluation purposes.

When an examiner in this case a C&P Examiner is used for  medical opinion  and reports his clinical findings accordingly  the exam should be conducted appropriately   and speculation or guessing about ROM is just that speculation. therefor  the exam should be classified as  inadequate. re exam should be scheduled.