Rationale Question

[AllTheWay]

Greetings to my Hadit family.

I am not the sharpest tool in the shed but the tools that I do have can still accomplish the mission. Someone out there please make me smart and help me understand. Why does the VA require a C&P examiner provide and rationale but the doesn't really consider the rationale especially if it is a rationale in favor for the VET.

I will give an example.

In the past, I have been filing for cervical and lumbar strain due to an incident that happened while in service. (Motor Vehicle Rollover). I have filed for this claim for a total of 4 times. The last denial, I did actually did a NOD which was issued a soc. Yes I lawyered up and its on appeal at the BVA level. All is annotated in SMR's as well as VMR's. The C&P examiner which is a Nurse, basically opined less then likely incurred or caused by the claimed in-service injury, event or illness.   (denial from 21 jump street), then her rationale: although STR notes was treated for an acute neck strain after a MVA,  it is the opinion that the veterans neck pain/ was treated in service  had resolved as there is a pattern of lack of evidence of a continuum of a chronic neck disability in military service and in time immediately after service and that the veterans complaints of neck pain, spondylosis with foraminal stenosis is a separate and distinct process not related to military services.) How does she know that. There were no x-rays or MRI's ordered while I was in the emergency room after the accident. The decision letter stated just that verbatim. I did have my PCP at the VAMC do a IMO and she did put as least as likely but still denied do to no strong rational. I had no further injuries post military for my neck. I even submitted my entry exam. Had multiple injuries in that vehicle rollover, (shoulders and knees). Shoulder just got granted at 20%. Knees got denied.

 

I had reopened claim for knees. which was injured during the same MV rollover. But by getting denied several times, I took a different avenue of approach and filed it secondary to pos planus. The VA examiner had given me that warm feeling that it was going to work but I guess the warm feeling was just gas. That did not go well at all even though she said that she was helping me. She opined that my bilateral knee condition is least as likely no related to pes planus. The rationale was: (The veteran has specific diagnosis for the left knee, as mentioned above(DBQ), and the right knee has a dx of recurrent strain. From the history, these are related to specific injuries in the service and not by the pes plans). Now whats ironic about this is that previous denial  decision letter for the cervical spine stated the the rational but the decision letter for the knee did not.

Isn't this kind of crazy that our VA system is against our vets or am I just crazy. I feel bamboozled.

Like bronco vet all all others had stated do not give up, keep all decision letters and never quit. The VA is looking for any loop hole to deny a claim, esp if you are very close to that 100.

[Buck52]

I believe they do because they can and get away with it.

Most of us that have had C&P Examiners like you described here to let us think their on our side get our hopes up high only to be shot down later..

These examiners are chicken shit*** That the reason they do it  or they just want to power to say who gets what.

The Cure for this is  go to a private Dr preferably a specialist and ask for his  rational  opinion   if your condition could be related to military service. and go in detail that he has read your medical records and exam you  and this is his professional opinion.   ect,,,ect,,,

 

[brokensoldier244th]

Spondylosis is an immune condition not caused by trauma. I doubt that there were no x-rays after a car Accident- that flies in the face of most any standard of care. Your lawyer should know, it would come out as part of Discovery for your appeal.

Good luck, but just know that an Nurse practitioner is a doctor in everything but name- same training, just less residency and a different licence board, and they often pick up that two extra years in practice and are usually more up to date on changes than doctors are. Two of my best friends are nurse practitioners. They aren't slouches, and an np opinion can outweigh a doctor if the evidence is there. 

[Berta]

I suggest you go to the BVA web site, www.bva.gov and read some of the decisions with this term in them:

' spondylosis with foraminal stenosis '- there are plenty.

Then use the same term and add Motor Vehicle Accident

Has the VA ever given you an MRI that would reveal this type of injury?

 

[Richard1954]

First C/P examiners.... there are only two areas when I think the VA requires someone who practices in the area of the exam, to do the C/P exam, that being the eyes, and  TBI issues there might be more that I am not aware of.  The va allows almost anyone to do C/P exams. I don't like it when I draw a NP or an older doctor ( a doctor who is retired and doing C/P exams on the side).  It has been my experience that NP will screw the veteran every time. I even had one NP stated that my left knee injury was not caused by my right knee injury, instead claiming that it was the slop that I was on that caused the injury. She then went back 22 days later and changed her reason for denial citing a research paper concerning gaits. She actually cited a line from this paper that did not exist in the research paper, as the rational for denial of the claim.  In the end I was afforded a new C/p examiner,  this time from a NP chiropractor in private practice. He opined it was at least as likey than not, and I won the claim.  But when it came to the arthritis of the knee, he opined that it existed prior to the knee injury which made no logical sense, especially since I had never been treated for the left knee prior to my claimed injury.  And it was six months before the va would actually treat the knee pain, and another 18 months before the 2nd NP would do the exam.  So there is no way he could know when the arthritis was caused, and there was no way to separate the pain from th arthritis from the pain of the torn meniscus. Needless to say,  this is on appeal.  Older doctors,  are scatter brained, and say and do things at the exam but in reality have nothing to do with  the actual issues and most of the time you feel comfortable with the older examiner, only to find out he writes not likely on the exam..... 

There is no law or regulation that requires any veteran to seek continued  treatment for any  injury or disease after a diagnoses and initial treatment.  The raters will cite lack of medical care more often than not as a reason to deny, but the BVA and the Court have held that lack of medical care is not a valid reason for denial. Especially in cases where continued treatment would do not good.  A lot of times I see on this and other boards that you must have continued medical care while in service and post service, and while this improves your chance of getting an approved rating, it still is not required. Take sinusitis for example, who is going to the doctors each time they get a sinus  headache?  Or knee pain... sure you might get some pain pills, but how often since most of us know they do not help.... No continued medical treatment is not required to get a claim approved.

I have a neck, and back, and TBI that occurred in 1974 when I was thrown from a moving jeep. When I retired from the service,  I was rated only for my back injury. It was 30 years before I claimed the TBI and was awarded 40%,  I have never claimed the neck injury, but have received treatment since the accident and one va doctor about 2 years ago opined that the neck injury was caused by the same accident  but I just have not filed for it.  My point here is to show that you do not need medical evidence after an injury to get a claim approved, While I did have headaches, after the TBI and still get some bad ones today,  I never got treatment for the head injury after I got out of the hospital except twice while I was still in service.  Although there is evidence on CT scan and xray of damage to my front left frontal lobe. 

More recently, when I reopened my claim for my right knee injury after 33 years, the claim was denied saying my knee condition had not worsened. Yet , the medical evidence for the left knee  showed that my right knee gave out and caused me to fall to the ground twisting the knee and  tearing my left knee meniscus resulted in my left knee being service connected secondary to the right knee. I have yet to see the C/P exam for this claim, and it has been 9 months since I requested the c/p exam leaving me only 3 more months to appeal the decision.  In this instant the rater did not review the entire record, or he would have seen that I have a history of the right knee giving out. 

Under the older claim system I used to think that the raters where in a world of their own,. now I just think that they are not qualified or smart enough to rate claims properly. Under the new system it is very true that claims are decided under a year,  and one personal claim  this included the initial claim., a supplemental claim and a higher lever review all for the same claim.  Factually,  they seem to deny claims faster than they ever did, which doesn't do anyone any good, and I think they do it this way to manipulate  the numbers to look better. 

So your not the only veteran who feels NP should not be doing C/P exams... and your not the first veteran who feels that your getting screwed... at one time or another we have all been screwed and all we can do it to keep fighting for  rating that we deserve....

Appeal appeal appeal.. but along the way you should consider a private medical opinion because it seems that is the only way you will finally win your claim.

Best of Luck

[brokensoldier244th]

always make sure the rationale supports what you are contending. Stenosis and spondylosis are caused by age as much as anything, unless your doctor specifically says its due to a trauma then your claim will more than likely be denied. I have a lower back rating, and sorting out what is due to age and what is due to the fall I had in service was the hardest part, and I did have to appeal once, but some of my back issues are due to age and not trauma, and not secondary to my existing injury. If your doctor says its tied to your accident they have to state why, and rule out age related and other factors. If they can't do that, or don't, then its possible that your issues aren't all tied to service issues, not that the VA is trying to lowball you. 

[brokensoldier244th]

NPs are not any less competent. There are a lot of NPs that practice in the US that were doctors in their own countries but aren't licensed in the US as an MD. It doesn't discount their education or experience. There are a lot of NPs that are content to be NPs so they don't have to carry millions in malpractice insurance- that doesn't make them any less competent, just smart. 

 

Just saying that just because you have an NP doesn't mean you are getting less care. Lots of NPs are more up to date than doctors are on issues because they are required to attend more continuous schooling to maintain their license. Doctors do CE also, but the requirements are less. In many cases id rather have an NP than a doctor, unless I need a specific specialty.