Painful motion rule

[SPO]

I'm looking at a copy of my last c&p exams for arthritis.  I was denied for no diagnosis, which is an issue I am appealing because I have more than one.  However, the examiner checked the block "Pain noted on exam but does not result in / cause functional loss" for many of my joints with varying Ranges of motions( such as flexion or exetension).  Would this qualify as the objective evidence of pain for the painful motion rule?

[Vync]

It is not unusual for the C&P examiners to miss evidence. For them to get dermatology mixed up with rheumatology could be either a typo or simply rushing through.

Level of expertise (specialist vs. NP) can matter, but it has to have legitimate justification/evidence backing it up. The VA NP examined my non-VA specialist MD's independent medical opinion and stated this in their notes. However, it wasn't a case of NP vs. MD. It was reversed because the NP failed to opine on my heart attack, instead opining on something completely different. Once my evidence was reviewed on the merits, the senior rater decided that my non-VA specialist MD's opinion was well grounded and covered all the bases. No follow up C&P was needed because the NP had recently done the rest of the heart eval. Mistakes like this make me and other vets wonder if it was just another case of someone hurrying to flip cases instead of going slower and being more thorough. I have been in the VA system since 1995 and stupid errors like this have occurred on 75% of my claims.

For direct SC, I have seen cases where the VA denies simply because the non-VA doc did not state they had examined the veteran's military records. However, for secondary SC, that is not necessarily required. There's a lot to it.

Lacking x-ray analysis on some joints sounds like the VA failed in their duty to assist...

[SPO]

In my case she listed the records she reviewed stating “dermatology” associates. She never opined about what my doctor said, just provided her own diagnosis or lack there of.  They weren’t lacking X-ray evidence as in it didn’t exist.  Lacking x-ray evidence as in it didn’t show on X-ray.  Inflammatory arthritis doesn’t always effect the bones right away, mostly soft tissue.

[Vync]

Definitely sounds like something you should bring up in your upcoming meeting. It never hurts to explain you submitted X evidence to support your claim and would like to ask if it was really examined.

It also helps to know if they actually received those records. I always mail a copy to Janesville WI intake center using certified/return receipt mail, so I have proof they received my submission. I also fax a copy, too.

We can get a limited amount of records from www.myhealth.va.gov, about two years for regular records and it varies for other types. You can go to the VAMC and submit a request for all of your VAMC records. However, those records will not contain non-VA records, like those you included with your claim. We as veterans cannot research them like the C&P examiners can, but we can request a copy of our claims folder. I did that back around 2012 and it took about nine months to receive it. However, I requested another copy in late 2019 and still have not received it. If I were to ask if the VA received something prior to the time they shipped, I would have no way to do that.

If you have an accredited VSO, they may have access to the internal VA system and could possibly check it. At minimum, that would answer the question as to whether or not they received your rheumatology records. 

Another thing I learned is the intake center doesn't necessarily keep your submission together in one piece. I had one claim where they scanned it in and misfiled some of it. The examiner never saw it because it was in the wrong place. The senior reviewer was on the phone with me and found the records filed differently and on a date a couple of years off from the one that mattered.

[SPO]

Here is a copy of one of the C&P's.  I'm curious if blocks checked will equal "objective evidence of painful motion" under 4.59.  Ignore the diagnosis part, that is the main part of my appeal, but I am trying to guess what I can expect if I am granted and they use the c&p already on file to rate severity.

Wrist C&P.pdf