C&P and Meds

[SPO]

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?

[GeekySquid]

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?

 

[SPO]

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.

[GeekySquid]

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.

[SPO]

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.

[GeekySquid]

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.