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C&P and Meds


SPO

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So after months of IT and other issues with the VA, they went from working strictly off medical opinion to asking for physical exam.  The exam has been sent out to QTC.  Since this is for Arthritis I know they will be doing range of motion.  The problem is I just took my latest dose of meds to control this condition (I take it once every three months), and the meds do a pretty good job of controlling symptoms.  So basically this C&P will not go well for me since my symptoms aren't going to be as bad.  I don't believe for a second that they will take in to account what I say my worst day is like vs the day of exam.  How am I supposed to handle this without getting screwed? Or am I going to have to go without meds and be miserable just to show them how bad it can be?

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Good that your case is now moving again.  Tell the examiner that you are on x medication and then explain what your worst day is.  They will take this into consideration if they are a good doctor.  Cross each bridge as you come to it and relax a little bit.  It takes a long time to move a claim through the VA and without some time off from your case you will wind up a basket case. 

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When they send these cases out to contractors you can request a  reschedule one time ..... if this were me I would get the c/p exam rescheduled for the next month....... They are going to try too push you into an exam as soon as one is available, but you really can schedule it for the day and time you want it... Been there done this just last January.....

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Even pushing out 1 month won't help since my med cycle last for 3 months,  I would have to push out to July to catch the end of the cycle.  

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I would suggest 2 things. Call your Patient Advocate at the VA hospital you go to and ask them what the rules are for rescheduling. They may say it's possible to re-schedule a few months out. If you can get a letter from your doctor about how the meds mask your symptoms, that might also be of help when you go for the C&P. Most importantly, whatever you do, do not skip the exam. You will be denied based on that alone.

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So I got scheduled for tomorrow morning with a QTC doctor for my exam.  QTC sent me an email with the DBQs they are sending to the doctor, however, there is no mention of Range of motion test.  The DBQ for all the different joints stops right before that point.  So is the doctor supposed to know to test range of motion based on what I say, or am I set up for failure?

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From what I understand, if your disability requires that you be checked for range of motion and the C&P examiner doesn't do it, you don't tell him what to do. If the decision comes back and is favorable to you, you win. If it comes back negative or reduces your rating, you file a NOD. More than likely, you would have to get another C&P exam to include the range of motion stuff. That may be at a more favorable time relative to your medications. Anyway, I doubt that if you have to tell the examiner how he should do his job that it would go over very well with him/her. Just go with the flow.

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So, how did it go?  Did the doctor test ROM?  Do you have your results back?

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I think it went pretty well. I went to a contact nurse practitioner through qtc.  She did measure some ROM with the tool (shoulders and forward flexion on my back.). I think she eyeballed the other joints which makes me nervous.  I did ask if we needed to measure and she said she got it.  All in all the doc was very nice, listened and had about 2-3 pages of notes by the end.   I wasn’t having a great day but not a bad day either and I explained that. I also submitted my prescription history with a letter from my treating doctor to let them know what I was on and for how long (over 2 years).  Qtc says they are still waiting for her to submit and they should have it by today.   I also got a call from the va regional office and the guy says he thinks it will be done within a month. Fingers crossed.

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So it took QTC almost a month to get the info back to the VA.  Now I'm not sure how long the VA will sit on the info before they move forward.  I have a hardship in, but it doesn't seem to make a difference to them.  Any suspense date that has been mentioned to me has been blown past.  

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Call IRIS and ask to check on this that you have a hardship case  and you truly need assistance.  thay may speed it up.

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13 hours ago, SPO said:

I have a hardship in, but it doesn't seem to make a difference to them

@SPO

Besides "about to die" , "about to be homeless" is the highest flag they have to push things faster. You don't have to say why you may be losing your home, just that you are on the edge of it.. Of course that has to be true in context of your hardship, and it usually is for veterans these days.

If you can get to your RO go there and submit a FOIA for the DBQ, Letter to QTC and the Codesheet if any for this exam. If they cannot do it at the front desk, ask for the Release of Information Officer.

That will at least tell you what the C&P says and what the rater is working with including any conclusion she made or failed to make.

 

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Closed today and they denied everything, not service connected.  I had diagnosis, my doctor had a statement saying more likely than not it’s connect to my primary psoriasis, and I believe the c&p went well.  Don’t know how to deal with this now

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3 minutes ago, SPO said:

Closed today and they denied everything

@SPO

I assume you mean that Ebenefits shows today's date.

At this point you cannot do much except wait for the decision letter and go to your RO and submit a foia for the DBQ.

I also suggest you FOIA the Letter sent to the contractor, the doctors notes and response letter and the code sheet. There may be clues in those documents.

If you can, others have suggested trying to go speak with the C&P doc again and see if she has a reaction expecting a different outcome. One recent post say their C&P wrote a Statement in Support of Claim for the veterans appeal.

Since we don't have your docs in this thread, it is difficult to say much more until you are able to upload them here. redacted of course.

You show a 70% rating in your profile. What are you rated for? I assume you are claiming the arthritis as secondary to something; which of your other rated conditions is the primary?

 

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I’m rated for psoriasis and I claimed psoriatic arthritis (which is medically linked and the result of the same underlying inflammatory autoimmune condition) I’d suggest googling if you’re interested for a better explanation than I can give. I had a diagnosis and supporting info from my doctor on my initial Dbq I submitted.  I’m really curious what was missing for the va to approve this.

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21 minutes ago, SPO said:

I’m really curious what was missing for the va to approve this

@SPO

sorry to say the only concrete thing I can say is what I already did. Get the DBQ's from the RO and the letters when they show up.

I will say that here on hadit is thread of others who have the same condition. Maybe you can reach out to them? it's an old thread but they may respond to a vet

https://community.hadit.com/topic/45215-psoratic-arthritis/

maybe tag  them in that thread and PM them.. who knows they might respond?

I wish I had more to offer you.

Let us know what you find out.

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I apologize in advance for the length of this, but here is an excerpt from my decision letter, I'll try to upload the whole thing later. Most of my contentions have an explanation just like this, or very similiar.

"Service connection for psoriatic arthritis of the left shoulder is not established. Service connection may only be granted for a chronic disability which began in military service or was caused by some event or experience in service.

The evidence does not show an event, disease or injury in service. (38 CFR 3.303, 38 CFR 3 .30~). Your service treatment records do not contain complaints, treatment, or diagnosis for this condition. The VA medical opinion found no persistent disability. 

The medical opinion we received from the VA contract examination was more persuasive than your private physician's opinion because it was based on an in-person examination and a thorough review of your relevant military and /or personal history and contained a more convincing rationale. (38 CFR 4.6) The evidence does not show that your condition resulted from, or was aggravated by, a service-connected disability. (38 CFR 3.303, 38 CFR 3.304) The evidence does not show that your disease developed to a compensable degree within the specified time period after release from service to qualify for the presumption of service connection. (38 CFR 3.307, 38 CFR 3.309)

 The VA contract medical opinion dated December 15, 2018, was not based on a review of your claims file or an in-person examination. 

Service connection for psoriatic arthritis of the left shoulder is denied because the medical evidence of record fails to show that this disability has been clinically diagnosed. (38 cfr 3.303)"

I can make sense of this.  I submitted a DBQ from my doctor with a diagnosis, but the say its not clinically diagnosed.  Also CFR 3.07 and 3.308 are presumptive conditions, I did not claim this as a presumptive condition, its a secondary to psoriasis.  I don't have the copies of the opinion and exam yet.  Also they say the medical opinion was not based on my claim file or an exam, how is that valid for anything?  I'll probably also create new thread with this info in another area of the forum.

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4 hours ago, SPO said:

I'll probably also create new thread with this info in another area of the forum.

@SPO

This is probably a good idea as it sounds like you have to craft a large and detailed response this result alone.

I don't remember if you have your C-File but I would order a new one, and I would head to the RO and request the DBQ and any communication between VA and the Provider and the notes of the DBQ.

keep us posted and put up that letter when you can, including the "Evidence" they used to deny.

 

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