HLR or Board

[SPO]

This might get a little long winded but please stick with me.  I just had my supplemental claim for arthritis closed.  I was awarded 2 out of about 15 affected joints, and suprise, suprise it seems that the reason the others were denied was because of the C&P examiner not doing a thorough exam and incorrect reporting on the paperwork.  The reason for denial on all of them was no diagnosis.  Now the problem with this was that she was provided with a letter and medical records from my rhuematologist (an M.D.) stating specifically which joints are diagnosed and affected, and the letter is  from May 2020, so it is current information (she is a nurse practitioner, and best I can tell specializing in family medicine).  She decided she didn't believe me when I told her joints hurt during the exam so basically said nothing was wrong, thus no diagnosis.  In particular I know she lied about the range of motion of my shoulders.  I have a difficult time getting to 90 degrees on either arm, but her range of motion says 120 degrees.  she did actually measure this, but I know where my arms were and it was less than 90.  She did measure my back (which was approved) but nothing else.  She didn't even actually examine my hands or feet.  She "examined my elbows and knee from across the room.  Also, she stated I have no flare ups, but I know for a fact the QTC questionairre I submitted to her stated that I do, as well as my statement I filed with the claim to the VA.

I called DAV as soon as I left the exam and asked them what to do and they said, just wait for the exams to come in and see what they say.  When the exams came in I couldn't get anyone at DAV to actually look through them all, so they said just wait for the decision.  I finally got someone to look through a few of them (after the decision was made) and from what the DAV is telling me, many of the joints don't look like the reach the compensable level based on her C&P. 

Now I am at a crossroads.  I can either Higher level review and see if maybe they will give me 0% service connection because my doc's diagnosis should outweigh her 10 minute "exam"(maybe a couple 10% ratings if I'm lucky), or get in line at the the BVA.  I'm not sure what to do next and I've heard advice to go both ways from the DAV.  They say I can't fight the bad C&P through HLR.  Any thoughts or advice?

[Berta]

." My left and right shoulders and left ankle were diagnosed with a chronic strain by the c&p doc.  What grounds does she have to outweigh my docs diagnosis of psoriatic arthritis, especially when evidence of an issue was found in the exam.

That diagnosis appears to be in the Doctor's IME but his IME does not conform to the IMO/IME format that is in our IMO/IME forum.

The IMO/IME is lacking in a medical rationale , supported by abstracts or treatises, that the right and left shoulder psoriatic arthritis  is due to the service connected  psoriatic arthritis.

It is possible that they did not consider the IMO, as it is not specifically listed on the evidence list, but then again, 

it was not prepared in the IMO.IME,  format which the VA is familiar with.

Can you scan and attach here a redacted copy of the C & P exam they used for this decision?

 

 

 

 

[SPO]

I don’t have to c&p’s yet.  I requested them and according to the va they should be on the way

can you point me to the format for the letter.  It was like pulling teeth to get that one (which was a format DAV gave me).  I tired to get him to give a better rationale it’s supporting literature but he acted like I was trying to pull a scam asking him to rewrite. He just couldn’t wrap his head around the whole va process and requirements.

Edited August 14, 2020 by SPO

[Berta]

https://community.hadit.com/topic/53826-read-first-if-getting-an-imo/page/3/

Many private doctors don''t have a clue on preparing an IMO/IME.

If a vet is paying for one,( and they can be costly) they need to  make sure the doctor follows the proper criteria.

I had no problem with getting 2 superb IMOs years ago- but the IMO doc was a former VA doctor and he knew just how to prepare a strong and valid IMO. ( Dr.Bash) 

He started off one of them stating the most recent posthumous C & P exam was "medically inaccurate."and told them why .

It sure was. I caught a very significant error in the exam myself.

We have more posts here on IMO/IMEs but I prepared this by following all the points Dr. Bash had made in the 2 IMOs I got from him.