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Could my C&P examiner be disqualified?

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Justaskpat

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I had a C&P exam for anxiety at retirement in 2010. it was denied SC. I did not appeal because I was basically overwhelmed by the whole process. I recently found out the psychiatrist who did my C&P had been convicted of 2 federal crimes (medicare improper billing and mail fraud), punishment = suspended medical license 1993-96 and 3yrs 6months active supervised probation. CHAMPUS, Medicare and Medicaid revoked his providership status in 1994 due to these federal convictions. medical licenses for MA, NY,CA surrendered due to these federal convictions. At some point after his Virginia medical license was reinstated in 1996, QTC hired this doctor as a C&P examiner.

December 2018 I resubmitted for Anxiety with "new evidence" and was seen by VA C&P psych doc (LHI). This time they found the Anxiety was SC. The 2010 convict psychiatrist said, "single episode, severe", not SC. I'm going to do a CUE based on my medical record which shows treatment for anxiety for the last 12 years I was active. I'm wondering if I should also include the above information about the C&P doctor being a convicted felon. In my mind, C&P examiners are basically diagnosing medical problems, so how could he be allowed to diagnose a Federal employee for a C&P contractor when he is permanently prohibited from diagnosing or treating that Federal employee's family covered by CHAMPUS/TRICARE? I hope this makes sense.

19July2019 Addendum:  I just obtained the C&P notes from both the 2010 and 2019 Psych C&P's. I uploaded 2010.

There is an issue with the 2019: LHI did the exam, but the person signing as the psy doc who did my exam is not the doc who did the exam. Also, and this is the biggest problem, even though I told the doctor I contemplated suicide, the box next to "suicidal idealization" is not checked. I'm not sure how to get this rectified. I don't think I can contact LHI directly.

2010 VA Disability Rating Decision.pdf 2019 VA Disability Rating Decision.pdf

2010 Psych C&P.pdf

Edited by Justaskpat
Uploaded NOD/CUE COVER LTR, NOD 2019 ANXIETY, CUE 2011 ANXIETY
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You can add to the CUE  I wrote, or you can ask- as the March 2019 decision says, ask for a reconsideration on the percentage-which I advise doing, instead of adding to the CUE claims,  and you also have time to properly prepare a NOD. on each denial you feel should be service connected.

 

Your decision had 26 issues.

You can file a NOD on any of them with evidence that they should be service connected.

You can, from what I saw in the downloads,-file a valid CUE on the TMJ, and add some good internet printouts of the well known fact that any MH can cause Bruxism ( TMJ). We have TMJ vets here as well if you use the search feature, to see how they handled those claims.

"I had had a suicide screening at the VA in January that showed results "revealed suicidal ideation over the last 2 weeks, which indicates a POSITIVE primary screen for Risk of Suicide.".   I would like to think this is just an error that LHI did not check the box. I don't think they will talk to me directly about this. I think my rating would be increased from the 50% they gave me if LHI had completed the form properly. What should I do about the person signing not being the person who did my exam? The exam doctor was a fully certified and licensed psychologist. Thankful I had written her information down."

You can call LHI- their contact info is here under a search, or you can google them for it.

I lost a more detailed response to you minutes ago because the weather affects my satellite- I am in a cloud.

Others will chime in. And I suggest that you go over some of the posts here regarding Reconsideration, and filing a NOD, etc etc.

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You can add to the CUE I wrote-but I feel, since you had 26 issues, and have until March 2020 to file a NOD, these issues can be covered in the NOD.

Also the decision ( March 2019) does state they would reconsider the decision if you prove you developed any psychosis or active mental condition during or within 2 years of your separation.

You could also ask for a reconsideration on that basis.That would extend the NOD deadline.

The M21-1MR revision of that is here under a search. It resulted from a letter I sent to former Secretary Shulkin, who also used my CUE suggestion as well in M 21-1MR.

 " I would like to think this is just an error that LHI did not check the box. I don't think they will talk to me directly about this. I think my rating would be increased from the 50% they gave me if LHI had completed the form properly. What should I do about the person signing not being the person who did my exam? The exam doctor was a fully certified and licensed psychologist. Thankful I had written her information down."

There is contact info here for LHI. Many veterans have contacted them directly due to problems in a C & P exam.

Make this point to them:

I had had a suicide screening at the VA in January that showed results "revealed suicidal ideation over the last 2 weeks, which indicates a POSITIVE primary screen for Risk of Suicide."

https://logisticshealth.com/provider-network.aspx

 

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  • HadIt.com Elder
On 7/8/2019 at 7:36 AM, Buck52 said:

yes I understand  but  veteran has only 10 days to make/request the amendment . my statment was further away from the 10 days.

Once a record or notes are entered into the veterans C-file  it can not be taken out, the veteran as 10 days to request =the amendment to his record  if not and the record is entered into the Veterans C-file  the records can't be taken out what so ever  its there the remainder of his life time.   EVEN IF THE VETERAN IS ADJUDICATED TO A RATING AT A LATER DATE...  IF THE BAD RECORD IS IN HIS//HER C-FILE its there to stay.

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double posts------ sorry-----this is the New Reconsideration regulation:

This is what former Secretary  Shulkin changed based on my suggestion- I hope this is the right one- the search feature here takes so long ----- the point is that the NOD time frame can now be extended , due to a valid reconsideration request.

We actually had a lawyer here argue with me that there was no such thing as Reconsideration (he knows better now) and a vet rep who thought, prior to this change, years ago -that a Recon Request would stop the NOD clock.It didn't until the most recent change and I wonder how many vets lost their claims due to his negligent advice.I hope they sued him.

Buck I might not be here much for a few days.not only weather problems affecting my internet but also many other issues taking up my time......maybe you can  add some more advice for this member....

 

 

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  • HadIt.com Elder

If you want to win your claim within your life time get a IMP to refute the C&P exam.  I have had numerous bad C&P exams and the fastest and best way to prevail is to get a strong C&P from an specialist to rebuke the original C&P.  I have challenged bad C&P exams and it takes years to even get a new exam and then you will probably get another bad exam since you have no control of a VA exam. One you get your positive IMO you appeal or reopen your claim with "new evidence".  As long as you can get new IMO's you can appeal.  I got three IMO's on a claim for TDIU. I did not stop appealing and getting IMO's until I got TDIU P&T. It took a couple of years, but a lot faster than depending on VA exams.  You just cannot depend on VA exams.

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On 7/20/2019 at 7:28 AM, Berta said:

There is contact info here for LHI. Many veterans have contacted them directly due to problems in a C & P exam.

Make this point to them:

I had had a suicide screening at the VA in January that showed results "revealed suicidal ideation over the last 2 weeks, which indicates a POSITIVE primary screen for Risk of Suicide."

thanks for everything Berta. I will contact LHI next week. I will be working on compiling everything for the CUEs etc and working on them. Will read about NODs as well. Have a lot to learn! Hope your storms let up soon!!

Edited by Justaskpat
spelled Berta's name correctly
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