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PACBRED

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Has anyone had a C & P exam with a nurse practitioner that wasn't interested in your disability but was looking for ways to state that your condition has improved? I've always had chronic lower back pain and was recently awarded 40% in 2016. After receiving that rating I then pursued IU and of course they set me up for a C&P exam. So after spending the morning with the nurse practitioner the exam lasted less than 30 minutes. So she had asked me to do certain movements which I was unable to perform and she did not measure or use any device to conclude her decision. So after weeks of waiting for the results I receive a letter stating that I had a normal range of motion. I was highly upset and was furious with the outcome. I then submitted evidence that my condition has not improved. I am also collecting Social Security disability due to my lower back and I sent them proof that I am no longer employed since 11/2016 and they sent me a form to give to my employer?? Go figure.... So they proposed to reduce my lower back % from 40 to 0. It is now a year and they have not reduced my lower back rating. So just recently I receive a call from the C&P clinic to have another examination for my lower back. So I asked the receptionist the same question is it a doctor that will be performing the examination? She stated no it will be a nurse practitioner. I informed the receptionist that I do not wish to have a nurse practitioner give her medical opinion due to the previous np and her medical opinion. So she told me to contact the Regional office to schedule me another C&P exam with a non va medical facility for this lower back C&P exam. So I receive an email from VES Services stating that I have a c&p exam with one of their medical providers at this facility. So it happens to be my old VA primary care Doctor who is no longer practicing at the VA clinic but with this VES Services agency. My concern is if I know this Doctor isn't a specialist for  my lower back why bother going through with this examination knowing that she was a primary care physician and not a back specialist ? I tried calling several chiropractors to see whether they can perform my C&P exam on my behave rather than the VES Services and they all seem to say that they don't do that examination. So now I'm concerned that they are really trying to reduce my 40% to 0. Does anyone have any suggestion or advice to this matter or have gone through with this process??? I have until next week to find a back specialist who is willing to perform the C&P exam before attending this VES Service examination. Anyone help.

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Seems like you have to get an independent medical opinion, or exam, from your own specialist which can show how bad your back really is. You had one c&P and they knocked you down, you asked for a re-schedule because they were going to give you an exam by another nurse which they have agreed to, and now they want you to get an exam from another non-specialist. They don't have to go along with another request for change. They have built a case that you just complain on the exam, who, by the way, they can have anyone do it they wish. I don't see anything else you can do. If you get a favorable exam from your own expert, you should win on approval. Find someone ASAP, and bring it with you when you go for your C&P. If you had a reasonable relationship with you old doc, maybe he can give you a favorable with your new evidence. If not, you appeal again.

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@GBArmy is right on about what you need to do.  One thing though do not miss a C&P exam!  They will reduce you if you do not show.  So you have an opportunity to see a doctor you saw prior?  This could work for you.

https://www.vba.va.gov/pubs/forms/VBA-21-0960M-14-ARE.pdf

here is the form they will use to rate you!  Be your own advocate in the room understand what they should be doing to confirm you back condition.  If they are not doing something on the DBQ ask about it and see if they just missed it.  Also bring your doctors notes!  I assume you go to the VA?  If so you can go to blue-button and print all of your back conditions to show them as they have no idea, but don't print out everything, just what is pertinent to your back.  

I just had my C&P Monday and the NP tried the oh you are already service connected, and I stated yes, but the RO did not code my disability correctly.  Then I went on to show her the remand and the new code and what was stated under the new code, and what the judge was looking for.  She stated everything and I was satisfied when I left, but this could have gone very poorly if I was not prepared.  

Two more pieces of advice.  Remember when doing you ROM and flex it is when you start to feel pain you tell them, and not suck it up.

Last you do have the option to go see you C&P officer at the VA hospital, it is their job to make sure you are satisfied with your C&P.  They can get you a different provider for a new C&P(I know I just did this on my last one).  

Edited by shrekthetank1 (see edit history)
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@GBArmy and @shrekthetank1 bring evidence to your exam. When I go for my back I bring a copy of my MRI and copies of x-rays, I just tell them in case they want to see them. All but one of them have been happy that I brought them along.

When I am called by QTC/LHI/VES and I don't like the doctor or NP that they want to schedule me for I ask is it possible to be seen by someone else, they have always said yes and it does not count as a re-schedule. I am just very friendly with them when I ask.

Like shrekthetank1 said when they use their tool you want to stop as soon as it hurts, only suck it up if you want a bad rating. Also as I have read on this site, you want to tell them about your worse day.

Good luck with your C&P.

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"I am also collecting Social Security disability due to my lower back and I sent them proof that I am no longer employed since 11/2016 and they sent me a form to give to my employer?? "

If you are sure they have notice of the SSDI award, it looks like they intend to reverse that proposal to reduce.

"I have until next week to find a back specialist who is willing to perform the C&P exam before attending this VES Service examination"

You might not need a specialist----why not wait for the decision-but make sure the C & P doc knows of the SSDI award.

"So I receive an email from VES Services stating that I have a c&p exam with one of their medical providers at this facility. So it happens to be my old VA primary care Doctor who is no longer practicing at the VA clinic but with this VES Services agency."

You just confirmed info I have been trying to find-are VA doctors becoming contractors?

The VA is putting contractors into every VAMC. I have been trying to find out if QTC,VES, and LHI hires former VA medical professionals. Loma Linda has 442 health care providers currently who are from contractors, and who work at the Loma Linda VAMC but are not VA employees.

The VA is doing this, in my opinion, to reduce their malpractice statistics. Their true statistics are not public, and higher than what the public knows.

This means that a veteran, or their survivor , if their medical care involves proven malpractice, cannot use Section 1151/and/or FTCA to be properly compensated for any injury or death the VA has caused, via negligence and malpractice, if the medical errors were done by contractors who work for the VA.

I say do NOT miss the C & P exam.It might go better than you think.

You can file a Provider complaint at the White House Hot Line 

1-855-948-2311 on the first examiner, who caused the proposed reduction.

Also you can file a complaint with the Office of Accountability-I will find their email addy and post.

"Does anyone have any suggestion or advice to this matter or have gone through with this process???"

Yes- the VA performed posthumous C & P exams on my dead husband many times.When a veteran is dead they have to review their entire medical records.And in my case a 6 page autopsy.

Every one of those denials  was wrong and a foolish  attempt to overcome their malpractice , 

They failed.

C & P exams are set up to deny claims. VA pays for them, so it is quite clear no Contracting firm will bite the hand that feeds them.

I filed a provider complaint with the White House last week. 

 

They failed. 

 

 

 

 

 

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

OAWP Email: vaaccountabilityteam@va.gov

When Veterans start making a big stink about these lousy C & P exams, something might be done.

 

 

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15 hours ago, PACBRED said:

Has anyone had a C & P exam with a nurse practitioner that wasn't interested in your disability but was looking for ways to state that your condition has improved? I've always had chronic lower back pain and was recently awarded 40% in 2016. After receiving that rating I then pursued IU and of course they set me up for a C&P exam. So after spending the morning with the nurse practitioner the exam lasted less than 30 minutes. So she had asked me to do certain movements which I was unable to perform and she did not measure or use any device to conclude her decision. So after weeks of waiting for the results I receive a letter stating that I had a normal range of motion. I was highly upset and was furious with the outcome. I then submitted evidence that my condition has not improved. I am also collecting Social Security disability due to my lower back and I sent them proof that I am no longer employed since 11/2016 and they sent me a form to give to my employer?? Go figure.... So they proposed to reduce my lower back % from 40 to 0. It is now a year and they have not reduced my lower back rating. So just recently I receive a call from the C&P clinic to have another examination for my lower back. So I asked the receptionist the same question is it a doctor that will be performing the examination? She stated no it will be a nurse practitioner. I informed the receptionist that I do not wish to have a nurse practitioner give her medical opinion due to the previous np and her medical opinion. So she told me to contact the Regional office to schedule me another C&P exam with a non va medical facility for this lower back C&P exam. So I receive an email from VES Services stating that I have a c&p exam with one of their medical providers at this facility. So it happens to be my old VA primary care Doctor who is no longer practicing at the VA clinic but with this VES Services agency. My concern is if I know this Doctor isn't a specialist for  my lower back why bother going through with this examination knowing that she was a primary care physician and not a back specialist ? I tried calling several chiropractors to see whether they can perform my C&P exam on my behave rather than the VES Services and they all seem to say that they don't do that examination. So now I'm concerned that they are really trying to reduce my 40% to 0. Does anyone have any suggestion or advice to this matter or have gone through with this process??? I have until next week to find a back specialist who is willing to perform the C&P exam before attending this VES Service examination. Anyone help.

yes I have had that experience. I went to a board certified surgeon with the DBQ. Probative value wiped out the ridiculous VA determination. 

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So the saga continues. So prior to this C&P I have tomorrow with the VES contractors I had a MRI appt. So I go and pickup my report from release of information at the clinic. I was so upset with the report. The report nearly stated that my back healed itself overnight. The report states no herniated disc or bulging disc. The opening statement of report states 5 lumbar type vertebral bodies. No vertebral body fracture, suspicious lesion or spondylolisthesis/spondylolysis. No foci of abnormal bone marrow signal intensity. So throughout the report they mention no disc herniation or bulge. Mild degenerative facet arthrosis. Mild disc space narrowing; no disc herniation/bulge. Degenerative facet arthrosis with ligamentum flavum thickening. Mild central canal stenosis. Mild right neural foraminal narrowing. Minimal posterior disc bulge with tiny posterior annular fissure.  So this same clinic I was complaining about my left hip and so they did MRI and it came back normal??? What the f. I have 5 years of MRI and cat scan from other clinics that states other wise. So now I'm pist and confused. I'm taking 1800 mg of gabapentin for pain because my primary care doctor doesn't know what to give me for the pain she did prescribe me with methocarbamol and naproxen . I had an allergic reaction that I ended getting an epi pen. So my doctor checked my list of meds and put me back on gabapentin  due to my allergic reaction to the previous meds she prescribed me. All the MRI from the other VA clinics and University of Pennsylvania Spine institute states herniated and bulging disc. These Mri that I have dates back to 2014-2018 stating all of the above then the 2019 MRI states normal finding with degenerative changes maybe spondylolisthesis/spondylolysis. Anyone ever experience this type of overnight miracle of the back? SMDH 

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"Has anyone had a C & P exam with a nurse practitioner that wasn't interested in your disability but was looking for ways to state that your condition has improved?"

 

I think the better question would be who has not had this problem.  Three years ago I had a NP who did a c/p exam on my left knee,  she decided it was not as likely stating it was a slop in my back yard that caused my left knee injury ( my claim was the service connected right knee buckled and I fell tearing  the meniscus of the left knee) ..  then 32 days later she went back and added a new statement citing part of a line from a document stating that an injury in one leg does not cause an injury in the other leg... the problem was that no such line existed in the document,  and the document was dealing with people who had a limp not knee problems. I  appealed the denial, and in the process made the examiner look like she was stuck on stupid. I  was afforded a new c/p exam from another N/P who also was a licensed chiropractor,. This guy spent 5 minutes looking at my knees, and 30 minutes talking with me,  the end result  was it was more likely than not that the right knee caused the left knee injury. I was finally serviced connected for the left knee secondary to the right knee.  Literally, tomorrow I have another c/p exam for my right knee, the last time it was rated for it was in 1986. I have two separate ratings on the right knee, one for instability , and one for limitation of movement with a torn meniscus.  I am attempting  to get an increased rating for both conditions  I hope to go from  two 10% ratings to two 30% ratings.  

As to your back injury, I am rated 60% for my back injury, backs do not just heal and even with surgery they are never right again. If I were you I would seriously question the latest MRI and produce copies of the former medical evidence, requesting a new MRI and Xrays. Its more likely that somehow someone mixed up your medical results with someone else. 

 

By the way my exam tomorrow is with another NP, who is 45 miles from my home and who does nothing but va c/p exams. I have always complained that C/p exams should not be done by a NP in fact they should only be done by a doctor that is qualified in  a specific field. ( that is asthma- a pulmonary doctor, or knees and back orthopedic  doctors...)  A N/P or a family med doctor are not qualified to perform specialist exams and then answer the question as to service connected or not... But lets face it the VA does not give a damn about the qualifications of an examiner, they just want to save money on the cost of the exam, so basically allow anyone in medicine to perform these exams.

Edited by Richard1954 (see edit history)
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7 hours ago, PACBRED said:

So the saga continues. So prior to this C&P I have tomorrow with the VES contractors I had a MRI appt. So I go and pickup my report from release of information at the clinic. I was so upset with the report. The report nearly stated that my back healed itself overnight. The report states no herniated disc or bulging disc. The opening statement of report states 5 lumbar type vertebral bodies. No vertebral body fracture, suspicious lesion or spondylolisthesis/spondylolysis. No foci of abnormal bone marrow signal intensity. So throughout the report they mention no disc herniation or bulge. Mild degenerative facet arthrosis. Mild disc space narrowing; no disc herniation/bulge. Degenerative facet arthrosis with ligamentum flavum thickening. Mild central canal stenosis. Mild right neural foraminal narrowing. Minimal posterior disc bulge with tiny posterior annular fissure.  So this same clinic I was complaining about my left hip and so they did MRI and it came back normal??? What the f. I have 5 years of MRI and cat scan from other clinics that states other wise. So now I'm pist and confused. I'm taking 1800 mg of gabapentin for pain because my primary care doctor doesn't know what to give me for the pain she did prescribe me with methocarbamol and naproxen . I had an allergic reaction that I ended getting an epi pen. So my doctor checked my list of meds and put me back on gabapentin  due to my allergic reaction to the previous meds she prescribed me. All the MRI from the other VA clinics and University of Pennsylvania Spine institute states herniated and bulging disc. These Mri that I have dates back to 2014-2018 stating all of the above then the 2019 MRI states normal finding with degenerative changes maybe spondylolisthesis/spondylolysis. Anyone ever experience this type of overnight miracle of the back? SMDH 

Did they give you a copy of the MRI?  I know a couple of things about backs and that many problems never go away.  I would talk to them, but tell them you feel the MRI report is incorrect.  List all of the issues with you back and ask how all of those conditions from the 2018 MRI can miraculously disappear?  I would then ask for another MRI from another clinic and request a copy of the MRI.  I would then explain all of your pain and where and how it affects you.  Then explain all of the pain medication you are on.  

If this does not work I would then go to/call the Medical officer at the VA hospital in charge of C&P.  Appraise them of the situation and let them know you feel the MRI is not correct as none of you pain has gone away.  You also have the choice to call the Whitehouse Hotline and I have heard they can help also.

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The VARO direct  tried to tell me my husband's 6 areas of significant brain damage, due to proven VA malpractice were somehow 'cured' at death. Her point was he was 100% Total for the stroke but not Permanent.

My medical evidence (most of it from the VA itself) revealed his brain damage was certainly Permanent when he died- it is even in the autopsy, and contributed to his death per my FTCA/1151 awards.

A former VA doctor told me (I had to pressure her to even give him a CT  scan) that the doctors at Syracuse read the Scan over the phone to her and then she told the veteran, (hospitalized for weeks by then with totally wrong diagnosis) that the scan revealed he had a brain tumor and they were prepping him to go to Syracuse for brain surgery-my husband was alarmed at first but suddenly said maybe the surgery will cure my PTSD-

I immediately went to the nurses station to get a hold of the Neuro doctor at Syracuse- and when he got on the phone, I told him what she said and that I am familiar with brain tumor, as my Army husband had one. I know neurology-He said he did not say the veteran had a brain tumor-but they would do an MRI to find out what is wrong  and he read  the whole scan report to me.I said right away- no, this is not a tumor, it sounds like an ischemic stroke-----he agreed and that is what it was. 

You have to fight this MRI report-we deal with idiots at every level of the VA.

Google the person who prepared the result narrative.

Dont forget there are possibly 12 dead veterans or more and an undetermined number of living veterans, whose pathology reports were all wrong and caused the Fayetteville AR  VAMC to contact over 33,000 vets who had gotten wrong  reports from him. He was actually a VA employee and not a contractor, so the lawyers lined up at their public meetings, and the VA had to advise many of their 1151 and FTCA rights.

When the direct said this was a "local incident' at the televised Town Hall I called thr WH Hot line immediately- I guess they didnt want the Secretary or even most of the public to know about it.

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I was once evaluated at the UCSF thermoregulatory lab and they put me in a heating and cooling blanket and tested my reaction to heat and cold.  They noted that they had never previously seen such low readings of sweat production and noted the mental disability that occurs when I was heated.  A evaluator for the VA put me under heat lamps and used litmus paper to determine if I was sweating and tried to invalidate the previous testing.  An accredited lab got positive results and an inexperienced doctor invalidated the results in slipshod testing.  Guess who won at the BVA though. 

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