Private Doctor Nexus Statement

[deedub75]

Hello All,

I'm new to the forum although I've been on the site to read comments in the past.  

 

 

I've been battling the VA for years trying to get SC for my knees and my back.  I am claiming bilateral knee tendinitis and and bulging disc in my lower back secondary to my service connected right ankle injury and bilateral pes planus.  Every time I appealed, the VA kept sending my claim back to the same NP that keeps denying me over and over.  Every time new information was presented she would come up with a different reason to deny me.  She just keeps doubling down on false information.  First, she said I had a normal gait.  I provided a copy of my exit exam stating I had an abnormal gait.  She then said my gait wasn't bad enough.  My case ended up at BVA where the judge remanded it basically saying that the examiner was ignoring my abnormal gait and other issues.  She then denied it again saying that my age and weight was the cause of my knee and back issues.  I have put on weight but when I originally filed these claims and attended exams I was around 170 pounds or so.  

A couple of months ago, I decided to ask my orthopedic surgeon if he'd be willing to write a nexus statement for me.  I asked him if it was possible that pes planus and a bad ankle could cause knee and back issues and he said it absolutely can.  He couldn't believe that the VA would say it was impossible.  I found a nexus statement online and actually wrote it for him.  I gave him a handful of my records to review showing that the VA had diagnosed me with knee and back issues so he was comfortable saying that he revived my VA records.  I sent this in as a supplemental claim and got a call today from a contract company for a C&P exam.  I was kind of surprised that exams were ordered but I figured that maybe they want to find out the current severity of my conditions.  The person did mention medical opinions which have me a bit worried now.  

I believe I am seeing a general practice nurse practitioner.  If this NP says my knee and back issues are less likely than not caused by my SC pes planus and right ankle, could she really override what my board certified orthopedic surgeon says?

 

[deedub75]

On 2/29/2020 at 8:18 PM, ruby said:

They ignored my VA doctored and private MDs IMOs unti it went to the DRO but I also stated in my appeal that my medical va doctors and private IMOs  experience equaled 150yrs of experience to 1 DO with 15 yrs.  Plus I included every rule or regs that applied to a equal or greater than evidence.  I also complained that the examiner was not aware of my condition and refused to accept additional medical treatise to education himself on my condition or review the IMO or VA specialist statements.

complain about it being the same examiner (np) who has less knowledge and expertise then a specialist.  Put in in writing!

I think I originally filed this claim in 2010 and I've been keeping it open since then.  It ended up going to a DRO and then to BVA.  The judge remanded it questioning what the NP's logic and the fact that she seemed to ignore evidence of me having an abnormal gait.  Instead of waiting another 3-4 years for BVA, I jumped into the new RAMP lanes. They sent it back to the same NP and she denied again then saying that my bad gait wasn't bad enough.  I complained in writing about this NP but it did not good.  She's infamous around here with other vets I know.  I asked DAV how to get my claim away from her and they said I either needed a nexus statement from an outside doctor or just let it go back to BVA.  The nexus statement worked in that my claim will not be going back to that VA NP.  They are sending me to have a contract exam and from what I can tell, it appears to be another NP.  VA seems to be doing away with MD or DO exams to cut costs.  So, I can't imagine a scenario where a general practice NP should override a board certified orthopedic surgeon who has been my doctor for the last 5 years and has operated on my fee twice but I've seen it happen before.    

[deedub75]

2 hours ago, Berta said:

A properly written IMO/IME that follows the IMO/IME criteria here at hadit, 

even if it costs you $$$$, will be the best investment you might ever make.

Pes Planus is well known to cause back, knee and hip problems.*

I know that because I have pes planus.

* and  that is-it is well known in the field of podiatry as well as by orthopedic doctors.

I have custom orthos ,redone every few years. My neighbor was given cheap inserts because his SC knee replacements had made one leg longer than the other one.

His VA Dr said everybody has one leg longer than the other.That is technically true but not everybody had the knee surgery he has had.

I showed him my orthos and he was shocked at the difference between the cheap insoles the VA gave him so he raised a little hell with them and now has better orthos, but I dont know if the VA supplied them or he got them himself at a podiatrist's office.

They say one out of every 3 seniors falls every year.

If they require good orthotics,because foot problems can affect  one's balance, neither Medicare or CHAMPVA will pay for them - I have paid from 350 to 540 bucks for them.

M daughter was due  home from the Mil when my first pair was ready many years ago ( it takes 4-6 weeks).

The podiatrist told me to only start out by using them for a few hours a day. With my baby service woman home, on leave, I forgot what the Dr said and was on my feet for hours cooking and showing her my garden , a new roof I had  , my new PC, and all that stuff, with the orthos still in my shoes.

I woke up the next morning without a chronic back ache I had had  every morning for years.The back ache never came back and all my bone scans over the years had revealed there is nothing wrong with my spine.

Maybe the VA does a better job with foot problems these days, that does not mean however, that some C & P doctor would have a single clue on this type of disability.

These claims can be bolstered by good podiatric internet print outs , that a IMO/IME doctor could use as well, to support their opinions.

 

Well, at first they denied my knee and back issues because they denied my pes planus.  Once I got the pes planus denial overturned by the DRO, they again denied my knee and back issues because they said I had a normal gait.  I have no idea how I had a normal gait with SC right ankle and bilateral pes planus.  Anyone who watched me walk could clearly see I had a permanent limp.  I even claimed my left ankle secondary to my SC right ankle but they denied it for the same reason as the knee and back.  When I sent it to the BVA, I pointed out that my exit exam clearly said I had an abnormal gait.  How could I go from having an abnormal gain when I left service, then get SC for pes planus, get an increase in my right ankle disability, and then magically develop a normal gait? The judge pretty much agreed but remained it anyway tell the examiner not ignore the evidence.  The same examiner (NP) then decided that my gait wasn't bad enough to cause knee and back issues then she threw in my age and weight was the likely cause.  I was only like 34 years old and about 170 pounds at the time I filed the original claim.  I get to see an outside contract examiner this time but from what I can tell this examiner is not an MD or DO.  When the contact company called to schedule they said DBQs for back, neck and ankle as well as medical opinions.  I think I will call back and ask what medical opinions they are requiring.  My nexus letter only mentioned knee and back issues secondary to pes planus.  I didn't even ask hime to comment on the left ankle as secondary to pes planus and right ankle.  It could be possible that they are only requiring a medical opinion for the left ankle claim.  My doctor said it's crazy that the VA is denying me because it's well know that pes planus causes knee and back issues.  

[JKWilliamsSr]

Even with a good IMO/IME the rater will still ignore the evidence you submit.  This is something I am repeatedly learning.  For lack of a better word and I hate to say things like this but I think they are just lazy.  There could be an argument that they are short staffed and undermanned and when you add that to the pressure of needing to quickly complete claims things could be missed.  The problem here is that the errors should be made in favor of the veteran and not against.  My claims have an IME that was for every disability that was claimed. 

My recent Supplemental claims was closed this weekend and I was only awarded 10% for Bilateral Pes Planus.  There were 10 claims on this supplemental including "Bilateral Pes Planus with Plantar Fasciitis" which was diagnosed in service.  They gave me Pes Planus and completely ignored the Plantar Fasciitis and on top of that I submitted Private Medical Records showing cortisone shots for treatment of my Plantar Fasciitis.  So  a clear error was they did not adjudicate the Plantar Fasciitis.....that is just one of many I am sure. 

My C&P exam for feet was bad and they completed the supplemental claim before I could challenge the exam.   I think this was intentional because early on they gave me a C&P exam for my back and 30 days later I was able to review the results.  The examiner did everything wrong and made things up that I never said.  This is contradicted by the lay statements I submitted when I filed my claim so it is proof that the examiner never reviewed it.  Hell he did not even use a goniometer.   Well I challenged this exam submitting a memorandum to the VA and it was completely ignore.  Nothing was done about it.   It will come to bite them in the ass because it was a matter of record and no matter what they still have to account for it. 

I am going the BVA route and I am hiring an attorney.  While I think my claim is a slam dunk I learned there is no such thing with the VA and I am going to have a qualified seasoned veteran take care of this for me even if I have to overpay.   Getting 70% to 80% of something is better than 100% of nothing. 

Edited March 2, 2020 by JKWilliamsSr

[ruby]

Going the BVA route to me is the way to go.   What happened to you is similar to my situation.  But I won on the DRO level.

[Fat]

DONT GIVE UP.

Maximize your appeal and send the information to the BVA..

[deedub75]

23 hours ago, Fat said:

DONT GIVE UP.

Maximize your appeal and send the information to the BVA..

If it's not approve through this supplemental claim, it will go back to the BVA.  It was there before and was remanded back to the same NP who was originally denying it.  The judge was skeptical of this NP's reasoning.  I wish the judge would have just granted it.  At least if it goes back to the BVA the judge will see my nexus statement from my board certified orthopedic surgeon who has been treating me for the last 6 years vs. this NP who keeps making up new reasons to deny me.