ACE C&P Exam for migraines

[Rallen]

The Veterans Board of Appeals granted me service connection for migraines. The claim was sent to the regional office for rating and I was granted a rating of Zero. A NOD was filed within days of the decision with a selection of Decision Review Officer review appeal under the legacy appeal system. The appeals management center requested a opinion from the regional office and one day I looked on Ebenefits and saw a C&P exam scheduled on July 1, 2019 at 13:00. I was looking at this on Ebenefits at around 17:00 and was amazed to see that I showed up and completed the exam! I was totally confused, and around three days later the ACE C&P exam showed up in Ebenefits and here are the results:

 

Jul 01, 2019, 01:00 PM	OFFICE CONSULTATION	GENERAL INTERNAL MEDICINE	Encounter for other administrative examinations ICD10 Z02.89 with Provider Comments: MEDICAL C&P ACE CHART REVIEW		OLD EAST POINT VA CLINIC
	Encounter Notes The included Outpatient Encounter Notes are available 3 calendar days after completion and include a maximum of the 5 most recent notes associated with the Outpatient Encounter. The data comes from all VA treatment facilities. ·           Date/Time Encounter Note Provider Jul 01, 2019, 03:09 PM C & P EXAMINATION NOTE :  LOCAL TITLE: C&P EXAM  STANDARD TITLE: C & P EXAMINATION NOTE  DATE OF NOTE: JUL 01, 2019@15:09 ENTRY DATE: JUL 01, 2019@15:09:12  AUTHOR:  URGENCY: STATUS: COMPLETED  See CAPRI for ACE completion. NURSE PRACTITIONER Signed: 07/01/2019 15:09   Jul 01, 2019, 01:00 PM C & P EXAMINATION NOTE :  LOCAL TITLE: C&P EXAM  STANDARD TITLE: C & P EXAMINATION NOTE  DATE OF NOTE: JUL 01, 2019@13:00 ENTRY DATE: JUL 01, 2019@15:08:26  AUTHOR:   URGENCY: STATUS: COMPLETED  Headaches (including Migraine Headaches) Disability Benefits Questionnaire Name of patient/Veteran: Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] Review of available records (without in-person or video telehealth examination) using the Acceptable Clinical Evidence (ACE) process because the existing medical evidence provided sufficient information on which to prepare the DBQ and such an examination will likely provide no additional relevant evidence. Evidence Review --------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with a headache condition? [X] Yes [ ] No [X] Migraine including migraine variants ICD code: G 43.9 Date of diagnosis: established 2. Medical History ------------------ a. Describe the history (including onset and course) of the Veteran's headache conditions (brief summary): The following contentions need to be examined: Migraine headache b. Does the Veteran's treatment plan include taking medication for the diagnosed condition? [ ] Yes [X] No 3. Symptoms ----------- a. Does the Veteran experience headache pain? [ ] Yes [X] No b. Does the Veteran experience non-headache symptoms associated with headaches? (including symptoms associated with an aura prior to headache pain) [ ] Yes [X] No 4. Prostrating attacks of headache pain --------------------------------------- a. Migraine / Non-Migraine- Does the Veteran have characteristic prostrating attacks of migraine / non-migraine headache pain? [ ] Yes [X] No 5. Other pertinent physical findings, complications, conditions, signs, symptoms and scars ----------------------------------------------------------------------- a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? [ ] Yes [X] No b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above? [ ] Yes [X] No c. Comments, if any: No response provided. 6. Diagnostic testing Are there any other significant diagnostic test findings and/or results? [ ] Yes [X] No 7. Functional impact -------------------- Does the Veteran's headache condition impact his or her ability to work? [ ] Yes [X] No 8. Remarks, if any: ------------------- CPRS/medical records are silent for any c/o of headaches for past 2 years. NURSE PRACTITIONER Signed: 07/01/2019 15:08 SELYN

 

I have been under care by a board certified neurologist for close to the last 40 years for migraines. I requested my neurologist to complete the DBQ for migraines, which was faxed to the intake center in WI. The appeal has been running for over 2 years for the rate increase and a earlier date. Two questions: 1. Does the neurologist DBQ carry more weight than the DBQ completed by the nurse practitioner ? The DBQ completed by the neurologist is impossible to post because of technical problems.  2. Embarrassing  question! My phone broke and I lost my contacts-Does anyone have the number for the appeals management center?  

[Patton]

Welcome to Hadit Rallen!

Your Neurologist DBQ should carry more weight. 

I have an appeal pending right now in which my Doctor wrote a Nexus Letter and a DBQ. Then the VA sent me to a Nurse Practitioner that more less stated the same as yours did. The RO (Regional Office) denied my claim but after an review (from the Board?) it was reopened. Calling the VA I found out that the Nurse Practitioner's DBQ was rejected because he did not collect the right information. So now I wait to see if they are going to use my Doctor's statement or if they are going to send me to another C&P Exam. At the end of the day, I will win this claim because of my Doctor's statement / DBQ. 

Hopefully somebody can give you the number for the appeals management center. The only number I have used is 1-800-827-1000.

[Rallen]

Just now, Patton said:

Welcome to Hadit Rallen!

Your Neurologist DBQ should carry more weight. 

I have an appeal pending right now in which my Doctor wrote a Nexus Letter and a DBQ. Then the VA sent me to a Nurse Practitioner that more less stated the same as yours did. The RO (Regional Office) denied my claim but after an review (from the Board?) it was reopened. Calling the VA I found out that the Nurse Practitioner's DBQ was rejected because he did not collect the right information. So now I wait to see if they are going to use my Doctor's statement or if they are going to send me to another C&P Exam. At the end of the day, I will win this claim because of my Doctor's statement / DBQ. 

Hopefully somebody can give you the number for the appeals management center. The only number I have used is 1-800-827-1000.

Thanks for the warm welcome Patton. Thanks  for sharing your claim information as well as your appeal. The paranoid feeling I had for the Atlanta Regional Office is gone in that I see it is a systemwide problem with the VA.

[Richard1954]

If This were my claim,  I would immediately file an appeal and discredit the ACE  C/P exam. First, they are supposed to call you and speak with you before they fill one of those things out. second, they based the ACE on you VA medical records. The exam is inadequate because they do not consider outside medical evidence before they fill the form out and many times they never even bother to look at the C/P exam. I have had two ACE exam in the last 3 years, and I beat both of them hands down, one for left knee, one for my TBI. In my cases I made the examiners look like 2nd graders and was able to get a hands on  face to face exam.  

ACE Directive.pdf ACE News Release.docx

Edited August 6, 2019 by Richard1954
uploaded files

[Rallen]

Just now, Richard1954 said:

If This were my claim,  I would immediately file an appeal and discredit the ACE  C/P exam. First, they are supposed to call you and speak with you before they fill one of those things out. second, they based the ACE on you VA medical records. The exam is inadequate because they do not consider outside medical evidence before they fill the form out and many times they never even bother to look at the C/P exam. I have had two ACE exam in the last 3 years, and I beat both of them hands down, one for left knee, one for my TBI. In my cases I made the examiners look like 2nd graders and was able to get a hands on  face to face exam.  

ACE Directive.pdf 55.37 kB · 0 downloads ACE News Release.docx 113.8 kB · 0 downloads

The appeal is still at the Appeals Management Center and had not been assigned to a DRO when the management center requested an opinion from the Atlanta Regional Office. The Service connection was granted by the Board of Appeals who sent it to the Atlanta Regional Office for rating which was zero. I had been denied service connection 30 years ago so I never bothered to mention the emergency room visits, the different medications and my long struggle with migraines. My treating neurologist completed a DBQ for migraines, which I would gladly post, But I can't copy the and paste the DBQ because it does not copy correctly. Both DBQ's should be before the DRO when the Appeals Management Center assigns this appeal. So I hope I get a DRO that will review the evidence and give me a fair shake. Still hoping to get that phone number for the Appeals Management Center. 

[Patton]

At least they Service Connected your migraines, that's half of the battle. Wait for the rating letter. If they rate it at 0%, then submit a Supplemental Claim. Include all new documentation (emergency room visits, etc...). 

The VA as a whole has made the claim process a lot more difficult than it needs to be. Many Veteran just give up and that is a win for the VA. Never give up! 

Doing a google search, I came up with this: 

Once the Board issues a decision (including a remand), we no longer have the authority to act on the appeal. Please review "Your Rights to Appeal Our Decision" included with your Board decision.  You may also contact the Appeals Management Office (AMO) via email or phone at 1-800-827-1000, your local RO or your representative (if you have one to advocate on your behalf). 

[Patton]

I should have included the website, which is: https://www.bva.va.gov/CustomerService.asp