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I think I broke the record for fastest C&P exam

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JKWilliamsSr

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I had a C&P exam for Lumbosacral Strain.   I think I may have been in an out in less than 5 minutes.   Here is how the appointment went in order.

1.  I go in the doctors office and he says to me "tell me about your back"

2. I explain the issues about my back and how my recent flare up lasted almost three months.  It was so bad that my wife had to assist me with getting dressed and that I could not even put on my own sock or tie my shoes.  I tell the doctor I cannot recall the last time I had a day without any back pain.

3.  He has me stand up and bend over from the waist three times. He does not like how far I bent and asks me to bend more and I tell him it hurts to do so.   He did not take a measurement with a goniometer

4.  He has me lean three times too the right side and three times from the left side.

6.  He has me rotate 3 times

7.   He copies and pastes a few things on his computer.  I could not see what it was but I can say this much he barely typed any words.

8.  End of appointment.

My appointment was at 1:00  I was back in my car at 1:15.   I looked at the clock. This was at the Houston Regional VA Office.

 

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I had one where the neurologist said "I thought I took care of you last time" even before I got into the room.  He was rude and disrespectful and lectured me about how his time was being wasted.  In and out in several minutes and he wrote a scathing C&P that the BVA hammered.

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That is the SOP for doing a C&P Spine, except for the lack of goniometer. I went through the same thing, except I couldn't stand on one leg. And if you have spinal scoliosis its automatically 20%. For me that is low and had a private orthopedic surgeon rate my spine as 10* (since he saw my xrays/mri and how terrible the VA is) and that will bring me up to the proper level of 30%.  

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I remember my first C&P for my back. The doc was really quick and did them exam while periodically taking bites from a very large submarine sandwich. The results were really wonky. On one point, he noted ROM that should have granted me a %, stated movement stops where pain begins, but on the other he said he didn't find any clinical diagnosis. I got denied, but years later got SC from a doc who knew what they were doing.

The goinometer is a must. Some examiners are self-proclaimed experts and claim they done need to do not even bother to use one. That's a big no-no, especially if you get a lowball rating.

Per 4.40, 4.45, and DeLuca, they are supposed to take two sets of measurements. First, where painful movement was observed. Second, maximim ROM on the axis. If painful movement was observed, the VA is supposed to use that measurement.

Some VARO's work directly with adjacent VAMC's, like Montgomery AL. If that's the case, you should be able to get your C&P results online. Give it a few days and check online to see if it shows up in your progress notes.

 

Here is info about what is supposed to happen during a C&P
https://www.benefits.va.gov/compensation/dbq_listbydbqformname.asp

Here is a link to the current rating criteria. Just scroll down to "the spine":
§4.71a   Schedule of ratings—musculoskeletal system.

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