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Latest Compensation & Pension (C&P) Clinicians Guide as of 2020

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marathonjon

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This is the latest Compensation & Pension (C&P) Clinicians Guide dated 20180719. The only other one I've seen is dated 2002, including the one on this website and the VA website. I got this from my claims agent, who got it from the VA.

VA Compensation & Pension (C&P) Clinicians Guide 2 Final Corrected 20180719.pdf

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3 hours ago, Phury & Rhage said:

1) Is your wrist service-connected?  If it is, consider getting your own evaluation done.  My understanding is that some VA medical centers offer "DBQ clinics".  Get another doctor to fill one out.  Conflicting medical evidence is a solid basis for appeal.  If it's not service-connected, STILL get another evaluation of the severity of your condition.  Severity is separate from the medical opinion about nexus.  Try to make sure that any separate evaluation you get is in your record before the rating decision is issued.  

2) Examiners refusing to do something associated with the exam is unacceptable.  If they do that, document it on a VA Form 21-4138 and submit it BEFORE the examiner even submits the report to VA.  You can also call the contract vendor (QTC, VES, etc) and complain that the doctor refused to examine something.  Also, most DBQs are available publicly.  Get a copy and look at what they are supposed to be measuring/commenting on for that exam.  They can't refuse to do something that's on that DBQ (of course they can, but that's your basis for appeal). 

3) Unless your issue is on appeal and the exam was directed by a reviewer (rater or DRO), your exam is supposed to include EVERYTHING on that DBQ.  ROs don't order specialized exams that look at only SOME things on the DBQ.

4) Same as #1, but you can also tell the examiner that you'd like them to note what you said in their report.  Then YOU make a note of it.

5) "Rating Officer"s don't order exams except in very defined circumstances - as part of an appeal/review; or if the exam is deficient and they want it clarified or if there is conflicting evidence and they want a new examiner to reconcile the evidence.  Initially, exams are ordered by a VSR on the pre-development team and they are very generic requests.  We aren't usually personalizing an examination request (I've worked Pre-D) unless there is a reason i.e. verify a Veteran's stressor for PTSD, confirm a particular type of exposure.

6)  It's possible that the guidance attached in this thread says something about not deviating, but if the condition is related to the one we ordered an exam for, the examiner is REQUIRED to address it even if it means using additional DBQs to do so.  For instance, an exam for diabetes mellitus could also reveal diabetic neuropathy.  Those conditions would require 2 separate DBQs.  If we ordered the exam for diabetes and the examiner diagnoses diabetic neuropathy, they are required to do both DBQs.  Our contract vendors know how to bill VA for extra DBQs when the examiner says they are necessary.  It's possible that doctors aren't real clear on that process - I don't know.

Be your own advocate.  If you think the examiner is ignoring what you say, make your own record (or get a doctor to make one) and send it to VA ASAP.  The new appeals process can really work with that evidence.  Get it in your record.

Good luck,

Phury  

Phury,

Well into that.  Problem is doing face to face exams.  But going ahead, with an attorney,  in the appeal without additional examinations focusing on 38 CFR 4.42 injury examination requirements.  Trying to get the directives C&P examiners function under that seem to be non compliant with 4.42.  Really don't need an outside examiner.  Have the 1969 Naval Hospital, Oakland, CA surgery report from the IPTR.  Surgically fused bones don't become free of ankylosis.  They become more arthritic.  All that is needed is an orthopedic pathology text book.  (Thanks for the post.  Triggered a decision to do a thorough look up on the injury I have.  It is not all that uncommon.)

This has been a long standing minimalization effort by the military and VA since before the VA existed.  As an activist, I am trying to get C&P examinations to be compliant with the regulation.  We will see if the Court agrees once we get it there.  The Executive Director, Compensation Services, Beth Murphy may correct the situation before it gets there.

 

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On 8/1/2020 at 5:01 PM, marathonjon said:

This is the latest Compensation & Pension (C&P) Clinicians Guide dated 20180719. The only other one I've seen is dated 2002, including the one on this website and the VA website. I got this from my claims agent, who got it from the VA.

VA Compensation & Pension (C&P) Clinicians Guide 2 Final Corrected 20180719.pdf 277.86 kB · 754 downloads

your link doesn't work for me

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26 minutes ago, Tbird said:

your link doesn't work for me

It's not a link; it's an attachment to the forum post. When I click on it, Firefox asks me if I want to open it in Firefox or download it. Both options still work for me. Your popup or ad blocker may be preventing it from opening or downloading. As the site admin, you should be able to figure out what the issue is.

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On 8/1/2020 at 6:01 PM, marathonjon said:

This is the latest Compensation & Pension (C&P) Clinicians Guide dated 20180719. The only other one I've seen is dated 2002, including the one on this website and the VA website. I got this from my claims agent, who got it from the VA.

VA Compensation & Pension (C&P) Clinicians Guide 2 Final Corrected 20180719.pdf 277.86 kB · 782 downloads

Thank you for posting this! Solid info!

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