Some serious iconsistencies on two C&P Exams - zero probative weight?

[75HotelCalifornia]

So I did two C&P's down at Lee County, my dental went okay though I don't know if this dude copy and pasted my shit in.. These two facts have never happened that day (My blood pressure has never been near what he states, and if I had some shit in my mouth other than that little pokey thingy I would remember rinsing)

Right now the claim is in Pending Decision I may get sleep disturbances, but obviously not apnea. Though if I can prove these have zero probative weight due to inaccuracies, should I start uploading some stuff right now that would point these facts out? Cause I'll get their attention if I have to upload 100 copies before they close it out lol (I'd think one would be sufficient, I think it won't let them close it until they review this fact). Should I let it close out and file a Notice of disagreement? Halpppp!!

Two items - NEVER happened. (Doesn't matter they don't rate bruxism) See below.
Preprocedural antibacterial rinse of 0.5 ounces Chlorhexidine Gluconate
for 30 seconds was done. Patient reports no previous adverse reactions to
Chlorhexidine Gluconate or other antiseptics.
Vitals: Blood Pressure=134/96, Pulse=98/minute

PEr my records, my pulse is RARELY under 110-100 BPM and that blood pressure is INSANE again nowhere any range I have ever had. 

Second issue -  The heck? I never put anything in my mouth or rinsed. Most likely if you see his past C&P it will be the same BPM and same or similar numbers. I am concerned as I know this did not happen.


Now sleep *Disturbances* and *Sleep Apnea*
So, in the beginning, the doctor states: "A sleep study is already on record in the Veteran's claims folder." I had a sleep consult

Further down the following checkbox is marked: 5. Diagnostic testing
---------------------
a. Has a sleep study been performed?
[ ] Yes [X] No

I raised a lot of hell for my initial claim about Ebenefits as an IT person I pointed out a lot of stuff and made my technical argument. I even received a response from the Director of the VA at the time.

I emailed a contact I know works as a supervisor appeals, but kind wondering if I can wack these two C&Ps both less than likely due to inaccuracies. If you think I can, I'm super persistent, and a bit annoyed so I can be quite loud and cause a little ruckus. They usually well fix it quickly so I shut the hell up :).

Anyways.. thoughts?

[vetquest]

Once you have the SOC or SSOC, if it is unfavorable, you need to point out these inconsistences in your appeal of the C&P's.  I had a doctor once destroy my credibility in a C&P.  On appeal the BVA noted that I was a credible historian and used an IMO to decide directly opposite of the doctor's C&P claims.  This also begs the question of whether you will need an IMO if you go to the BVA.  If the inconsistences are apparent you should be able to get by without an IMO, just use your civilian records.  IMO's are expensive and you usually need a lawyer to get one.

Also let me point out that there are ladies present.  We try not to use military language that begins with an s or f and others. 

Edited August 6, 2018 by vetquest

[kanewnut]

9 hours ago, vetquest said:

IMO's are expensive and you usually need a lawyer to get one.

Are you sure about that?

 

9 hours ago, vetquest said:

Also let me point out that there are ladies present.  We try not to use military language that begins with an s or f and others.

If they were in the military, they heard it all!

[FMFDOC25]

On 8/5/2018 at 10:27 PM, 75HotelCalifornia said:

So I did two C&P's down at Lee County, my dental went okay though I don't know if this dude copy and pasted my shit in.. These two facts have never happened that day (My blood pressure has never been near what he states, and if I had some shit in my mouth other than that little pokey thingy I would remember rinsing)

Right now the claim is in Pending Decision I may get sleep disturbances, but obviously not apnea. Though if I can prove these have zero probative weight due to inaccuracies, should I start uploading some stuff right now that would point these facts out? Cause I'll get their attention if I have to upload 100 copies before they close it out lol (I'd think one would be sufficient, I think it won't let them close it until they review this fact). Should I let it close out and file a Notice of disagreement? Halpppp!!

Two items - NEVER happened. (Doesn't matter they don't rate bruxism) See below.
Preprocedural antibacterial rinse of 0.5 ounces Chlorhexidine Gluconate
for 30 seconds was done. Patient reports no previous adverse reactions to
Chlorhexidine Gluconate or other antiseptics.
Vitals: Blood Pressure=134/96, Pulse=98/minute

PEr my records, my pulse is RARELY under 110-100 BPM and that blood pressure is INSANE again nowhere any range I have ever had. 

Second issue -  The heck? I never put anything in my mouth or rinsed. Most likely if you see his past C&P it will be the same BPM and same or similar numbers. I am concerned as I know this did not happen.


Now sleep *Disturbances* and *Sleep Apnea*
So, in the beginning, the doctor states: "A sleep study is already on record in the Veteran's claims folder." I had a sleep consult

Further down the following checkbox is marked: 5. Diagnostic testing
---------------------
a. Has a sleep study been performed?
[ ] Yes [X] No

I raised a lot of hell for my initial claim about Ebenefits as an IT person I pointed out a lot of stuff and made my technical argument. I even received a response from the Director of the VA at the time.

I emailed a contact I know works as a supervisor appeals, but kind wondering if I can wack these two C&Ps both less than likely due to inaccuracies. If you think I can, I'm super persistent, and a bit annoyed so I can be quite loud and cause a little ruckus. They usually well fix it quickly so I shut the hell up :).

Anyways.. thoughts?

On the dental C&P what does the C&P examiner's nexus state? You only need the examiner to state "at least as likely as not" (equal to or greater than 50% probability) was due to service. If it's a direct-service connection claim. On the other hand, if it's a secondary condition being claimed did the examiner state "at least as likely as not" (equal to or greater than 50% probability) was due to service connected disability? Also look for "If you see that and a rationale substantiatiating the claim. You're good.

Now, if the examiner did not provide a rationale with an unfavorable nexus such as "not at least as likely as not" (less than 50% probability) or "not due to" (0% probability). Point that out  there was no rationale provided by the examiner on your exam for your appeal because that would make that C&P Exam inadequate, resulting in a remand . The same could be said if a rationale is not provided for a favorable nexus, it'll result in a remand, which delays the appeal process, but instead the court details instructions of what needs to happen to proceed with your case at a later date. This gives you some time to find more inaccuracies or obtain a favorable nexus of opinion from another physician, if you haven't already obtained one. (An unfavorable nexus and poorly provided rationale vs a favorable nexus with a well-written rationale=a tie...and a tie goes to the veteran.)

You're not wrong if you know what happened or didn't happen during your C&P Exam....YOU WERE THERE!! Whatever inaccuracies you witnessed have it documented in your notes and question the competency of the examiner. It's not going to hurt you because if the exam is ruled to be inadequate, another C&P exam will need to be done or the court will instruct the examiner to provide their rationale and if it's still not adequate enough? Then I have no idea WTF they're doing. lol.

I'm confused about the Sleep issue. Was a sleep study done? I mean were you actually hooked up to the sleep study wires and had you sleep without a cpap and then had you sleep with a cpap? Yes or no? If so, what does the report say towards the end of the sleep study and what was the recommended diagnosis and treatment?

Now if you just had a sleep consult, yet the examiner stated that a sleep study was already on record?then that would raise concern, because the examiner sounds like he or she was lying. I think that would be a reason of a doubt, to conclude that exam would be deemed inadequate. 

Call out mistakes out, if you feel their necessary, but be prepared  with clear and unmistakable medical evidence. The ratings scheduler has to use any medical evidence pertaining to your claim or claims.

Hope this helps explain some things. Best wishes on your claim.

[broncovet]

I agree with Vetquest, and he gave good advice.  I will add this, however.   Dont even try to "prove" a doctor wrong...their testimony will be accepted as credible over your's every single time.  DO use the following regulations, however, already in place, for such an event:

1.  

 

Quote

 

38 cfr 1.579 Amendment of records.

(a) Any individual may request amendment of any Department of Veterans Affairs record pertaining to him or her. Not later than 10 days (excluding Saturdays, Sundays, and legal public holidays) after the date or receipt of such request, the Department of Veterans Affairs will acknowledge in writing such receipt. The Department of Veterans Affairs will complete the review to amend or correct a record as soon as reasonably possible, normally within 30 days from the receipt of the request (excluding Saturdays, Sundays, and legal public holidays) unless unusual circumstances preclude completing action within that time. The Department of Veterans Affairs will promptly either:

(1) Correct any part thereof which the individual believes is not accurate, relevant, timely or complete; or

(2) Inform the individual of the Department of Veterans Affairs refusal to amend the record in accordance with his or her request, the reason for the refusal, the procedures by which theindividual may request a review of that refusal by the Secretary or designee, and the name and address of such official.

(Authority: 5 U.S.C. 552a(d)(2))

 

Next, if you can not get your (medical records corrected), you can "refute" the doctors findings but only with another doctor's findings.  That is, another doctor can write an opinion disputing the findings of Doc 1.  Generally, the VA has to give the Veteran the benefit of the doubt, that is, if doc a says "yea" and doc b says "nay", they have to give it to you.  However, the BVA CAN choose one doc's opinion over another provided that they give a reasons and bases for doing so.  Example:  While doc a says "yea" and doc b says "nay", doc b is board certified and more competent and did a more thorough exam, therefore, the answer is nay.  

However, if you hire doc c to do an even more thorough exam and he is an even more competent medical expert, it can sway the opinion in your favor.  

By the way, "just because" someone has heard profanity in the past, does not necessarily mean they will "not" be offended by its presence.  Pretty much "everyone" has heard profanity from others, even a child.  Mostly, that is how children learn to utter profanity, is by listening to adults.  

Example:  If you were a minority, you may have been subject to racial slurs in the past.  This does not excuse someone using a racial slur in the present tense.  

Edited September 20, 2018 by broncovet
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