Did you get a flawed C & P exam-what you can do

[Berta]

You can immediately ask for a different doctor to do the exam.

When I say 'flawed', I mean the examiner did not have the expertise to opine on your claim, 

or the doctor did not have any of your medical  records, to include SMRs in many cases,

or the doctor failed to consider any other probative evidence that you moght have brought with you to the C & P yet the doctor didn't want to see it---

or the examiner LIED. There are probably many more reasons why an exam can be flawed.

This AM I received a call from OAWP-VA-DC, as to the ongoing investigation they are doing based on my other complaint .

I have more evidence to send to them-we went over some of the evidence they already have- it is solid to support my complaint-It is a different issue than this post is about-

But then I mentioned to the Triage manager the C & P situations I see so many of you here are dealing with.

I told him of 2 of my C & P exams (posthumously done on my husband) and am waiting until Jan 15, 2019 for a copy of one of them-to adequately prepare a OAWB complaint. on that matter, which affects so many veterans....and I am sure I am not the only survivor of a vet who has had this problem consistently with the RO I deal with.

He was shocked at what one SOC C & P examiner had stated..... I told him this was only one of many C & Ps they did- all wrong, to deny my claims. (all awarded since-yet not the point))

Would anyone here be willing to follow up my next complaint on the C& P problems many here have?

If it took a costly IMO/IME to get a full reading of your evidence, and then attain an award, tell them that.

If  your are in financial diffculties and cannot possibly afford an IMO/IME, tell them that.

If they lied about your condition , tell the OAWB that- and give evidence to show that they lied.

Be prepared to attach the C & P exam to the email you send to them, and attach any other evidence you feel they might need.

I told the OAWB Triage  manager I  have seen many C & Ps over the years that are highly erroneous and deny many valid claims . Claims that will add to the backlog and if they are valid they should never even be in the appeals process at all.

If you prepare a complaint, specific only to the C & P problem, you can refer OAWB  to my complaint ( Berta Simmons, NY ) that will be at OAWB on the 16th of this month.I am waiting until the 15th to see if VA will send me a C & P exam I requested.Whether I get it or not the complaint will still be filed on the 16th.

I do not really have a dog in this fight because so far I won any claim VA gave a lousy C & P on.I only needed the IMOs I have for one claim.

Something needs to be done about this situation.That wont happen with one complaint from a dead veteran's widow. The only evidence I have is my own personal

letters and C & P exams from the VA, And the info from NVLSP and GAO-which covers all veterans but  is general, and not specific to what many of you really go through with C & P exams,   that are geared to what the VAROs want-

                                                                     and that is - to deny the claim.

 

 

 

 

 

 

 

 

 

 

 

 

Edited January 8, 2019 by Berta

[Berta]

You can make an anonymous complaint by calling this number:

OAWP Anonymous Toll-Free Disclosure Hotline: (855) 429-6669

But it is best to file an email complaint here:

OAWP Email: vaaccountabilityteam@va.gov

They do not use snail mail.

I have sent them unredacted stuff I have received from the VA.

 

Edited January 8, 2019 by Berta

[Buck52]

Great Info Ms berta!!

[doc25]

9 hours ago, Berta said:

You can immediately ask for a different doctor to do the exam.

When I say 'flawed', I mean the examiner did not have the expertise to opine on your claim, 

or the doctor did not have any of your medical  records, to include SMRs in many cases,

or the doctor failed to consider any other probative evidence that you moght have brought with you to the C & P yet the doctor didn't want to see it---

or the examiner LIED. There are probably many more reasons why an exam can be flawed.

This AM I received a call from OAWP-VA-DC, as to the ongoing investigation they are doing based on my other complaint .

I have more evidence to send to them-we went over some of the evidence they already have- it is solid to support my complaint-It is a different issue than this post is about-

But then I mentioned to the Triage manager the C & P situations I see so many of you here are dealing with.

I told him of 2 of my C & P exams (posthumously done on my husband) and am waiting until Jan 15, 2019 for a copy of one of them-to adequately prepare a OAWB complaint. on that matter, which affects so many veterans....and I am sure I am not the only survivor of a vet who has had this problem consistently with the RO I deal with.

He was shocked at what one SOC C & P examiner had stated..... I told him this was only one of many C & Ps they did- all wrong, to deny my claims. (all awarded since-yet not the point))

Would anyone here be willing to follow up my next complaint on the C& P problems many here have?

If it took a costly IMO/IME to get a full reading of your evidence, and then attain an award, tell them that.

If  your are in financial diffculties and cannot possibly afford an IMO/IME, tell them that.

If they lied about your condition , tell the OAWB that- and give evidence to show that they lied.

Be prepared to attach the C & P exam to the email you send to them, and attach any other evidence you feel they might need.

I told the OAWB Triage  manager I  have seen many C & Ps over the years that are highly erroneous and deny many valid claims . Claims that will add to the backlog and if they are valid they should never even be in the appeals process at all.

If you prepare a complaint, specific only to the C & P problem, you can refer OAWB  to my complaint ( Berta Simmons, NY ) that will be at OAWB on the 16th of this month.I am waiting until the 15th to see if VA will send me a C & P exam I requested.Whether I get it or not the complaint will still be filed on the 16th.

I do not really have a dog in this fight because so far I won any claim VA gave a lousy C & P on.I only needed the IMOs I have for one claim.

Something needs to be done about this situation.That wont happen with one complaint from a dead veteran's widow. The only evidence I have is my own personal

letters and C & P exams from the VA, And the info from NVLSP and GAO-which covers all veterans but  is general, and not specific to what many of you really go through with C & P exams,   that are geared to what the VAROs want-

                                                                     and that is - to deny the claim.

 

 

 

 

 

 

 

 

 

 

 

 

In 2007, I received a C&P exam for bilateral flat feet(in-service diagnosis) that was done by a Physician Assistant and in the exam results it appears pure speculation was used for congenital flat feet (I entered service with normal archs).

Would this be a flawed C&P exam?

[Berta]

With the inservice diagnosis, and some VA  idea that this was congenital, (VA has to prove congenital findings)

I feel the exam was flawed and the decision might well contain a CUE- not sure-

Did you appeal this? Has the VA subsequently awarded for this condition?

There are many good PAs out there, however- I have a severe pronation foot problem (I am a civilian) and my PCP doctor refered me to a Podiatrist who is also a surgeon. PA's  not have the expertise of a real podiatrist, someone who is a doctor and who also had specialized training in conditions of the foot.

If this was due to a VA remand, I already mentioned how remands MUST follow with what the BVA wants.

I rebutted a PA C & P and sent my rebuttal to the VA , stating it was too speculative, and why.

I also stated that the BVA remand specifically called for a cardio opinion, not a PA opinon.

I had 3 IMOs for the claims, VA had two against the claim and BVA wanted another one against it- it still would have put the claim in relative equipoise- but after I rebutted it the BVA gave the PA opinion no value at all and they awarded.

I found a case once at the BVA, whereby the veteran had SC flat feet- I guess the VA did nothing much to help him , and he ended up having consecutive ratings of secondary problems with his knees, hips and back, due directly to the flat feet and the BVA awarded him 100% or TDIU forget- long ago-

Foot conditions can end up affecting many joints of the body.

 I had a chronic back ache for decades and attributed it to hard work-tests revealed nothing wrong with my back or spine.

I got orthnics the podiatrist ordered ,telling me not to wear then longer than a hour or two a day for the first week-my daugther came home on leave from the Mil the same day and I stayed up longer than usual, cooking lots of food and standing a lot. The very next morning I wpke up with the chronic backache- it has never returned.  Foot conditions affect the biomechanical structure of the entire spine and bones.

My neighbor ( USAF SC knee replacements) showed me what the VA gave him as orthonics.

I showed him mine and he was surprised at how different they were than his-he would have done better if the VA sent him to Walmart to use the Dr Scholl orthonic thing, or gone to a real foot doctor.

If your entrasnce exam and/or your SMRs showed no condition like this when you enlisted, and if the condition was at a ratable level ( via evidence the VA had when they denied) than I suggest you go over the CUE forum and

prepare a CUE claim -there are templates there-

 

 

 

 

 

 

Edited January 9, 2019 by Berta
corrected something

[Berta]

Is anyone here willing to actually contact the OAWB and send them a copy of your flawed C & P exam?

 

[wirat]

Hi, I'm new to this board and the C&P exam process. I was injured many decades ago and was treated in military hospitals, I kept every record I could. I was initially given 10% for arthritis in my right shoulder although my entire shoulder was broken apart on active duty. Funny, I never questioned what the VA gave and assumed (I was young) that they were acting in good faith.

Fast forward to today and now I have issues with range of motion, scaring pain, etc. I have filed a claim for an increase. Went to a C&P exam with an LHI contract "provider". Everything went well during exam, friendly, he measured scar, I told him how it was painful, he acknowledged it TWICE and looked at it, etc.

Two months go by and I get the results. He says service it's connected (of course) but on his exam he checks NOT painful. Confused, I try to get in touch with him via LHI and cannot. I tell LHI it must be an admin error since there is only a YES or NO box he checks off. He must have made a mistake. LHI calls me back and states they contacted the provider and he swears there was no mention of any pain during the exam! 

Well, if painful YES or NO is on his exam checklist, what do they think I would have said if he even covered that part during the exam? He never asked nor had to because I brought it up.

So I look in to this "provider" and it turns out he is a nurse. He was wearing a frock that had "Dr." stitched on it when he did the exam. The exam was conducted at a clinic near me.  I called the clinic and they said he did not work there, only used an exam room there. So I checked the Internet for this guy and every clinic I found he was associated with I called and they said he did not work there and they did not know who he was!

When I called LHI a service rep there told me they used contract providers to be "fair and unbiased" for the veteran!

I then checked his state license and he has a nursing license, but the address listed is like a shell of an office at some strange store location. Basically a PO box service for mobile physicians.

From what I can see, this nurse is just a shill for the VA, has no means of contact, no regular office location, goes around wearing a doctors gown and then when he does the exam and you disagree there is no recourse?

I currently have another exam scheduled for next week. Now I have my guard up from the 1st experience. This time it is with a physician through VES. I checked that Dr.s' name and same thing, no office, no contact number, and only her history is in Indiana while I am in Florida and the exam will be here in Florida. I checked the Florida Department of Health for a physician's license and she is not listed as having one in Florida. 

You need to check up on these "practitioners" they are scheduling you with. I think you might be surprised to see these flags;

1) No regular office or contact information.

2) Listed at several clinics or locations on the Internet.

3) Not licensed to practice medicine in your state. (Not sure yet, but I think Florida may allow this if only for a consultation)

4) Using a leased or rented exam room to do C&P exams at a clinic where they don't have a regular office.

5) Their sole source of income, primarily all they do is C&P exams as contractors for medical service companies.

My finding is that this is all put on by the VA under the guise to make the C&P exams appear to be "fair and impartial" when basically you are being seen by a contract practitioner who is really nothing more than a straw man (or woman) VA employee.

That way, they can meet you for the exam, send in the results, and when you finally see it two months later and it is not favorable or is deficient, you have no means to contact them to correct it. Then the VA can turn a blind eye and say they are only going off medical information provided to them by an independent medical practitioner, when they know very well it was essentially a VA paid agent who did the exam under these circumstances. 

What is the recourse under these circumstances? Can you request another exam? It seems you can file a NOD but then you are burning up an appeal when you should not have to appeal it in the first place.