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kelsa2828

Knee Claim - No C&P Exam?

Question

Hi All,

I filed my first/only VA claim just about a month ago. Included is a claim for my right knee. I've had problems with it for a few years now and it pretty much hurts all the time. I've done a number of physical therapy sessions with my private health care, and have requested an MRI a couple times to no avail. My physical therapist is pretty confident that it's patellofemoral pain syndrome and apparently there wouldn't be much they could do even with an MRI? That's about as far as I've gotten medically.

Anyway, when I made my claim, I sent the VA the records of my PT sessions and my visits with my doctor, but I only see "chronic right knee pain" as her diagnosis, and I don't see any causation verbiage anywhere in the records I have (No idea if VA got additional records from my health care). So I was surprised when they scheduled 3 C&Ps for other body parts, but none for my knee. Now it is in the Preparation for Decision phase, and no C&P for the knee still. I did read that "chronic pain" is now rateable, but would they assume it's service connected without any medical rhetoric stating that? (It definitely is - and I would have zero problems with proving that nexus). Anyone had a claim like this or have any insight?

For reference, I served from 2010-2014, OEF, M249 gunner (for some reason), was active Army so obviously tons and tons of running/ruck marches, and did plenty of dismounted patrols in AFG. So perhaps they get it?🤷‍♀️

Thanks in advance! And if you have any questions about the rest of my claim don't hesitate to ask. 

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Of course, I have not read your records.  However, a nexus statement is one of the 3 required Caluza elements for service connection.  

The VA does not order a c and p exam for every condition.  Its a judgement call from them as to whether a c and p exam is warranted.  

Of course, there are at least 2 possibilities as to why you did not get a c and p exam.

1.  You already have everything documented, so a c and p exam is not needed. 

2.  A VA decision maker decided that a c and p exam would "not" result in you being awarded benefits.  An examplewould be if you did not have an "in service event" documented

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.I have been told  a C/p is not always requested, now  in my case they actually requested 2 c/p exams for my left knee

 

But...  I never heard of a c/p exam not being requested because a decision maker made the decision that a c/p would not result to your being award benefits...simply because many times the va will ask an examiner for their opinion concerning service connection. You do not have to have show a service connection when you submit a claim,  the question of service connection will come later... 

I have many issues that were directly service connected 15 + years after retiring from the Army without a proven  in service event ( for example sleep apnea, eppidmittis and a some other issues)  all it takes is a medical opinion,  indicating  it is more likely than not that the issue was a result of military service, and how the doctor came to the conclusion after reviewing the active medical records. 

Its more than likely that they think they have enough information to make the decision so don't need a C/P exam.

 

 

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Thank you both for the feedback! Obviously I am hopeful that it's because they see a nexus somewhere, and not because they are going to deny it. I guess I'll just have to see. Mostly just curious if anyone has had a similar situation where there was no C&P and no clearly stated nexus (that I can see at least), yet the claim was accepted. Just a little nervous because I don't feel like I've even had the opportunity to explain to anyone the knee claim. There is no event in my military record that would show a knee injury, and I never saw a doctor for it until a couple years ago, it's just from overuse. Fingers crossed 🤞😬

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Welcome aboard and glad you made it thru your first initial claim process. As far as C&Ps, I have had multiple conditions granted without exams, in fact a few that I did not even ask for. I tell Vets all the time the VA, Military or SSDI can not argue or deny a condition when the Veteran Submits Hard Core medical evidence like X Rays, MRIs, Cat Scans etc. At that point it is Law and Policy not a Raters opinion of your condition. Good luck and keep us posted. God Bless

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On 1/19/2019 at 9:11 AM, Navy04 said:

Welcome aboard and glad you made it thru your first initial claim process. As far as C&Ps, I have had multiple conditions granted without exams, in fact a few that I did not even ask for. I tell Vets all the time the VA, Military or SSDI can not argue or deny a condition when the Veteran Submits Hard Core medical evidence like X Rays, MRIs, Cat Scans etc. At that point it is Law and Policy not a Raters opinion of your condition. Good luck and keep us posted. God Bless

Thanks for the info! Will keep you guys updated!

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