Va provider did not give a medical opinion

[Supply Guy]

I went to C&P exams for sleep apnea,  GERD, erectile dysfunction secondary to service connected TBI with sleep paralysis and also for an increase to the TBI/Sleep paralysis.  It was suppose to be a 4 hour block of time and the VA provider rushed through it in an hour.  She had to Google Sleep paralysis lol because she never heard of it before.  She did not provide a medical opinion on sleep apnea or the increase and didn’t approve the gerd or erectile dysfunction.

The claim is in Preparation for Decision now.   My questions:  since she did not provide a medical opinion on sleep apnea even though the VSR asked for it, how will this impact the claim?

Also, since she is obviously not trained in sleep related conditions, if the claim is denied is this a good argument to get new C&P exams when I request higher level review?

My wife and I submitted lay statements as well several medical articles to support the claim.  I was diagnosed with sleep apnea at a VA sleep study in November.  I’ve been out of the Army since 1990.

 

[broncovet]

Well, we dont know what "other" medical evidence you have in your file, so we have to take a guesstimate.  However, I have seen VA to be very liberal and flexible about "bending the rules" on the Caluza element documentation..NOT!  

If you have the Caluza elements documented, including a current diagnosis, in service event and nexus, your chance are great at eventually getting awarded benefits.  

Absent one or more of those 3 elements, tho, your chances are very slim.  You can read your file, it does not have to be documented "in the C and P exam", but it has to be documented.  

[Carl the Engineer]

I can speak to the 4 hour block of time.  I am not sure where you got that 4 hours from, but I have in the past had two C&P exams in the same day, only to attend the first and then sent packing as the second was for the examiner to work on my case.

So, your examiner may have used the other time to do some work without you.

If you look at your past appointments on your Ebenefits calendar, you should see appointment kept.  Even if you were not there.

Not Kept, would be a whole different discussion,

Hamslice

 

[Richard1954]

The doctor does not have to be qualified in sleep apnea to render an opinion. Very few C/P examinations require a doctor to be qualified in a specific field.

 neither does a doctor have to give an opinion even if asked for one.,....but not providing an opinion may result in another c/p exam

[Supply Guy]

Update:  there was a Request 2 to VAMC on my claim. I called the C&P scheduler to be proactive and she told me the VSR was asking for an opinion on TBI increase, hiatal hernia, and sleep apnea.  She said she had to talk to her boss about how to staff the exams.  Then I saw request 2 completed and the claim is back preparation for decision.  Sounds like the VAMC just provided a medical opinion and felt they did not need to see me again.  Pretty sure this is a denial.  Who knows though lol.  I just won an appeal for my back which took almost exactly 3 years.

[broncovet]

Whenever the VA sends you to a c and p exam, the examiner is "presumed" competent, regardless of whether they "actually are" or not.  

Relying upon ebenefits/va.gov is a bad idea.  Generally, I dont specualte on "what ebenefits means when it says_________", because that assumes ebenefits is reliable, up to date and consistent.  

The only thing consistent about ebenfits is that you should never rely upon it.