Esophagus C&P thoughts.

[sanktuary]

Hey everyone love the site.  I was just looking over the C&P exams that came back in through the blue button.  While my knee C&P exam was terrible ( Doctor laid me on my back and pushed all of his weight down on my knee, pushing it into my chest) hurt like hell, i even told him it was hurting.  But that one looks like he just did not care.  No tool used to measure anything, said I had no complaints since the service, even though my VA records shows imaging, offering of knee replacements and braces... but I digress.

The tinnitus one they gave me ( MOS 11B ) said  
Does the Veteran report recurrent tinnitus: Yes      
Date and circumstances of onset of tinnitus: He reported constant ringing  since 1996-97.
Circumstances of onset related to weapon training without hearing protection. The tinnitus is described as a loud whine or buzz sound. It is more noticeable in a quiet area, at night in bed.          
2. Etiology of tinnitus    ----------------------    At least as likely as not (50% probability or greater) caused by or a result of military noise exposure. 

My bigger issue is I can not make this out regarding the stomach disorder and espohagus issue i am having.  They have diagnosed me with Eosonophil Esophagitis.  They told me it was caused from silent reflux due from stomach issues.  But where as the exam for tinnutis stated At Least as Likely As NOT.   This one doesn't say that.  Can you guys give me your thoughts on what this looks like?

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Esophageal Conditions        (Including gastroesophageal reflux disease (GERD), hiatal hernia and other esophageal disorders)    
Disability Benefits Questionnaire
     Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination    Request?    [X] Yes   [ ] No    
    ACE and Evidence Review    ----------------------    Indicate method used to obtain medical information to complete this document:        [X] In-person examination    
    Evidence Review    --------------    

Evidence reviewed (check all that apply):        [X] VA e-folder (VBMS or Virtual VA)    [X] CPRS
    Diagnosis    --------    

Does the Veteran now have or has he/she ever been diagnosed with an    esophageal condition? Yes      

Other esophageal condition (such as eosinophilic esophagitis, Barrett's esophagus, etc.)      
Other diagnosis #1:  mallory weiss tear (esophogus)/healed 1995                ICD code:  000      
Date of diagnosis:  1995/during military service       
    Medical history    --------------    
Description of the history (including onset and course) of the Veteran's    esophageal conditions: 
42-year-old male here with a history of a Mallory  Weiss tear* of the esophagus during military service (1995) here in C&P to be  considered for residual GI problems. Since military service, he never sought  medical care, always being told his dysphasia (difficulty in swallowing) is  due to anxiety.  Vet states he has PTSD, VA records stat he has panic attacks with anxiety.  Had a gastroscopy (considering the stomach with a camera)    5/2/2018 at Wake Forest/NCBH that VA records state he had an esophageal dilatation. "

        * "Severe and prolonged vomiting can result in tears in the lining of the  esophagus. The esophagus is the tube that connects your throat to your    stomach. Mallory-Weiss syndrome (MWS) is a condition marked by a tear in the    mucous membrane, or inner lining, where the esophagus meets the stomach. Most    tears heal within 7 to 10 days without treatment, but Mallory-Weiss tears can    cause significant bleeding. Depending on the severity of the tear, surgery    may be necessary to repair the damage."
*********************************************************        
Does the Veteran's treatment plan include taking continuous medication for    the diagnosed condition? Yes      

Medications used for the diagnosed condition: pantoprazole 40 mg bid          

Does the Veteran have an esophageal stricture, spasm of esophagus    (cardiospasm or achalasia), or an acquired diverticulum of the esophagus? Yes      
Severity of condition:        Amenable to dilation        Moderate        Permitting liquids only
    Does the Veteran have any other pertinent physical findings, complications,    conditions, signs or symptoms related to any conditions listed in the    Diagnosis Section above? No
    Does the Veteran have any scars (surgical or otherwise) related to any    conditions or to the treatment of any conditions listed in the Diagnosis    Section above? No
Have diagnostic imaging studies or other diagnostic procedures been    performed? Yes      
Diagnostic Testing Preformed:        Upper endoscopy                 Date: 5/02/2018     
Results: esophogeal stricture/ esophogitis
Are there any other significant diagnostic test findings and/or results? No        

Do any of the Veteran's esophageal conditions impact on his or her ability to    work? No                

Remarks, if any:    ------------------       

Esophogeal problems (esophogitis and esophogeal stricture documented in       5/02/2018 study). 

[Berta]

I do not believe you got a C & P doctor with any expertise in the field of your disability-

If they had expertise they would not have gone to Google,like  I just did, 

 to find this  information they put in the C & P exam,.

 

 

 

"Severe and prolonged vomiting can result in tears in the lining of the esophagus. The esophagus is the tube that connects your throat to your stomach. Mallory-Weiss syndrome (MWS) is a condition marked by a tear in the mucous membrane, or innerlining, where the esophagus meets the stomach.May 4, 2017"

Mallory-Weiss Syndrome - AARP's Health Tools

https://healthtools.aarp.org/learning-center/mallory-weiss-syndrome?lcStart=1

___________________________

"Vet states he has PTSD, VA records stat he has panic attacks with anxiety."

 

Is it possible that the meds you take for the Panic attacks or PTSD aggravate this condition?

 

Have you googled this doctor to see what background they have in GI conditions like yours?

 

". Since military service, he never sought  medical care, always being told his dysphasia (difficulty " etc

Is that a true statement- because the doc then states:

"Does the Veteran's treatment plan include taking continuous medication for    the diagnosed condition? Yes   "  

 

These are conflicting statements-

I think you should request a better C & P exam-

 

Others will chime in.

 

 

 

 

 

 

 

[sanktuary]

I agree that is why it is so confusing to me.  

I do take medications for the condition, due to an ER visit where food had gotten stuck in my esophagus.  Then they finally referred me to the VA GI Clinic and seen that they have been wrong all of these years.  The Weiss tear ( which I did not know i had, they told me in Seoul that I had a hole in my stomach and it would affect me for life) as it healed would cause scarring in the esophagus, which causes stricture.

He stated that I have not seen anyone for this issue but then the next sentence states that the doctors have always told me the swallowing issue was related to my panic and anxiety.  That in itself is contradictory.

The examiner states I have not had continuity of care, but everytime I had brought this up to the PCP they blew me off and just stated it was due to my MH issues.

Edited July 30, 2018 by sanktuary

[sanktuary]

I just looked the examiner up online, it gives his name and then states " MPH, PhD, PA-C "
He is listed as a Physicians Assistant on the VA website.  But told me he was in family practice .

[Berta]

I would, if I were you, make those points in an IRIS complaint and request an exam from a medical doctor qualified to opine on your disability. Ask IRIS for an email reply so that they cant make something up on the phone.

Tell them the PA used a Google site ( give them the link I posted here) because he didn't know what your disability entails and the exam results are too speculative.

[sanktuary]

Thanks for the help.

I just do not think this is right.  I mean why would they allow someone unqualified to do an exam?  Why would the person doing the exam evade the main question that the VA looks for in these cases " Is the injury related to a service connection with More So Likely Than Not" evidence?

All this is going to do now is drag me from the initial claim to now dealing with appeals for months if not years due to these examiners being unqualified or not caring if they answer the questions laid out beforehand.  This system needs overhauled.  

The directions in the heading of the C&P explicitly asks to do the following, and yet it was not done!

 MEDICAL OPINION REQUEST
    TYPE OF MEDICAL OPINION REQUESTED: Direct service connection
    OPINION: Direct service connection
    Does the Veteran have a diagnosis of (a) stomach condition that is at least as likely as not (50 percent or greater probability) incurred in or caused     by (the) stomach issues in service during service?
    Rationale must be provided in the appropriate section.
    DBQ GI Esophagus (including GERD & hiatal hernia)
    MEDICAL OPINION REQUEST
    TYPE OF MEDICAL OPINION REQUESTED: Direct service connection
    OPINION: Direct service connection
    Does the Veteran have a diagnosis of (a) stomach issues/vomiting blood that is at least as likely as not (50 percent or greater probability) incurred in or caused by (the) stomach issues in service during service?
    Rationale must be provided in the appropriate section.
 

[Berta]

20 hours ago, sanktuary said:

Why would the person doing the exam evade the main question that the VA looks for in these cases " Is the injury related to a service connection with More So Likely Than Not" evidence?

Because he did not know how to properly do a C & P exam.

"I mean why would they allow someone unqualified to do an exam?  " Because That makes it easy to deny the claim.

The VA has forced thousand of veterans to get IMO/IMEs ,( opinions from a real doctor,) to overcome lousy C & P exams.

We had a male vet here get a opinion on a leg condition from a Gynecologist!

Many of us here ( me included )have put up with this BS before. 

I hope you filed an IRIS complaint. You can complain to the White House Hot Line too.

1-855-948-2311

When every vet starts fighting back over these lousy C & P exams, with VACOcomplaints and/or WH Hot Line complaints- then maybe VA will be forced to do something about it-

I was on the old Prodigy Veterans BBS- early 1990s- pre internet- and one member was a former BVA attorney -William Smith- who always made this point-

if something is wrong with your C & P or any aspect of the way VA deals with your claim, you MUST rebutt it- otherwise, if you don't,

per the VA- you have accepted it.