Secondary claim & increase timeline w/ service connection? C&P?

[FlyboyLeRoy]

I am already service connected for meniers disease, among many other ear problems. Yesterday my doctor filled out a dbq and it supports my meniers disease increase and secondary migraines to meniers. My question is, being already service for meniers and having attached dbqs, will I still have a va c&p exam? Also, per the paperwork, what would you say my rating should be?

[ShrekTheTank]

who know what they will do.  I have seen it go both ways.  be ready for both.   They will probably do a C&P to see a current opinion

[brokensoldier244th]

It depends on alot of things. What is your doctors area of practice? What year are the dbq forms (it’s on the bottom)? Where is the rest of it? Headaches are their own dbq.
 

Are you SC for migraines already or just meniers? If headaches is a new claim you will need your doctor to write up a summary opinion of the headaches dbq where they explain their opinion of why it’s connected to your meniers with relevant supporting findings including any literature or other things that support that funding, along with a statement of some kind of statement that says what degree of sure they are coming that your headaches are related.  “At least as likely as not”, less likely than not, more likely than not, etc. 

 

You can look at the symptoms and ratings percentages  for migraines and menieres online on the ratings schedule, it’s all online already. Google 38 CFR 4.71a and find headaches on it. 
 

https://benefits.va.gov/WARMS/bookc.asp

Edited August 6, 2021 by brokensoldier244th

[FlyboyLeRoy]

10 minutes ago, brokensoldier244th said:

It depends on alot of things. What is your doctors area of practice? What year are the dbq forms (it’s on the bottom)? Where is the rest of it? Headaches are their own dbq.
 

Are you SC for migraines already or just meniers? If headaches is a new claim you will need your doctor to write up a summary opinion of the headaches dbq where they explain their opinion of why it’s connected to your meniers with relevant supporting findings including any literature or other things that support that funding, along with a statement of some kind of statement that says what degree of sure they are coming that your headaches are related.  “At least as likely as not”, less likely than not, more likely than not, etc. 

 

You can look at the symptoms and ratings percentages  for migraines and menieres online on the ratings schedule, it’s all online already. Google 38 CFR 4.71a and find headaches on it. 
 

https://benefits.va.gov/WARMS/bookc.asp

The forms say 2020 on them. There are much more forms but I only posted the ones that had the symptoms. Both dbqs are filled out and states his opinion in favor and that migraines are secondary to meniers, too. He is an otologist/neurologist, so he is the most quailed to discuss this topic. Currently I am only connected for The meniers  

[brokensoldier244th]

Okay, then you should be fine. It’s not a guarantee that you won’t have a c and p but it may only be another doctor reviewing your file and your doctors write up, meaning you won’t even have to go anywhere. It could be over video, too, depends in your Local covid situation.

I’m not a rater so I don’t interpret dbqs nearly as much as I do medical notes themselves, and that’s only to find evidences of conditions existing to justify an exam and the elements of service connection.
 

Have you uploaded your treatment notes from your doctor too, or filled out and sent in a 21-4142/4142a that gives us permission to request them? 

[FlyboyLeRoy]

49 minutes ago, brokensoldier244th said:

Okay, then you should be fine. It’s not a guarantee that you won’t have a c and p but it may only be another doctor reviewing your file and your doctors write up, meaning you won’t even have to go anywhere. It could be over video, too, depends in your Local covid situation.

I’m not a rater so I don’t interpret dbqs nearly as much as I do medical notes themselves, and that’s only to find evidences of conditions existing to justify an exam and the elements of service connection.
 

Have you uploaded your treatment notes from your doctor too, or filled out and sent in a 21-4142/4142a that gives us permission to request them? 

52 minutes ago, brokensoldier244th said:

Okay, then you should be fine. It’s not a guarantee that you won’t have a c and p but it may only be another doctor reviewing your file and your doctors write up, meaning you won’t even have to go anywhere. It could be over video, too, depends in your Local covid situation.

I’m not a rater so I don’t interpret dbqs nearly as much as I do medical notes themselves, and that’s only to find evidences of conditions existing to justify an exam and the elements of service connection.
 

Have you uploaded your treatment notes from your doctor too, or filled out and sent in a 21-4142/4142a that gives us permission to request them? 

Thanks for your response. My treatment notes are uploaded as far as new medications prescribed. Even with my dbq &  doctor exam, they still go off of my doctors notes right? I recall something about probative value or tie goes to the vet? I could be wrong, though  

 

[brokensoldier244th]

Yes, tie is supposed to go to the veteran but sometimes private doctors write the equivalent of a sick note for work as an opinion and it’s over ruled by the examination of the medical file. They don’t always know how to write a medical opinion- I see this a lot more with gp/ family practitioners trying to diagnose specialized stuff like fibromyalgia, tbi, or mh issues as examples.

 

 You also have to remember that your doctor is working off whatever they observe and what you tell them unless you have STRs and or myhealthvet or releases of information notes from VAMC visits. C&p doctors have access to your actual str service treatment notes and Vamc treatment.

This is a bigger deal in service connection because part of the three things needed for service connection is documentation of a service event or history or exposure-most outside docs can’t or won’t see that because they can’t just log in and see it, so unless you give it to them  they are writing an opinion that already doesn’t meet one of the necessary criteria (by law, we didn’t write it). They can’t say with a strong opinion that it’s connected to service if they haven’t seen your service records/and or Vamc You saying you were a scout sniper in the Gulf and were exposed to x,y,z is a subjective statement- subject to verification. Doctors observed conditions and statements are supposed to be objective- based on the what they have seen or actually read in your prior history. 
 

That hangs up a lot of people because a lot of gp/family doctors don’t write up medical opinions very often. VA raters can’t diagnose, they compare the opinion to the available notes to make sure it lines up factually and then they apply the ratings chart of symptoms and percentages to the symptoms you have (the cfr I posted). If you tell your doctor you are feeling ok, when you aren’t- that hangs you later.
 

When discussing service connected issues describe your symptoms in your worst day, not necessarily how you are on the day you are actually there, or at least get it in there that while you are feeling ok today last week you had a dizzy and almost stepped off the curb and fell or something (hypothetically). Otherwise you just have a lot of subjective statements about how bad you feel and no objective history of the the days when you don’t feel great. 

Edited August 6, 2021 by brokensoldier244th