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"REFUSED EXAM" bahahahahaha NOT!


blahsaysme2u

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im looking to those with experience with C&P exams and the raters....someone has royally messed up my claim and now i am starting from scratch for pain/loss of use in my left leg and foot. heres the story:

way back when- i put in a claim for bilateral knee/leg and feet. the VA couldnt find all my medical records...frustrating as it was they did eventually award my right leg based on some records they found. 

i found medical records to support the left leg and foot injuries(fractures that have since healed and now ache with arthritis like symptoms- tho i haven't been diagnosed with any arthritis yet) i reopened the claim going on 3 years ago with this new evidence(LOD and medical records showing removed from duty and put on profile for the fractures). the VA in all their wisdom saw this as a reopened claim for "bilateral knee/leg and fee" claim, even tho my right leg and feet/ankles are already SC. 

i have been to multiple C&P exams for this claim(and at least 5 have been scheduled in total) the first 2-3x the doctor evaluated my left leg and did the angles limited movement tests etc. the VA scheduled mayb 2-3x after those appointments to "evaluate the right leg and foot". i called PEGGY every time and confirmed what the c&P was for and explained i was not asking for increase in my right leg, my right leg is SC and i dont need any evaluation of that leg for this claim! they would cancel the appointment and reschedule and again it would be for my right leg. 

the last time i called they confirmed the appointment was only for left leg evaluation(saying that the previous C&P evals on the left leg are now out of date or invalid and i need a new one) so i go to the appointment. i get there and the doc starts evaluating my RIGHT LEG!!!! i flip. finally the doc says this is huge mistake bc he can see that the claim is for left leg but they ordered wrong thing and needs to be rescheduled. 

well the VA now denied my claim saying i refused the exam. 

WHAT DO I DO?!?!?!?!!? HELP PLEASE bc i am so done with this shite. this claim is not very much but it was one of the first claims i submitted in 2008 and i should get back pay for. also these 2 SC would give me 100% rating sooner than i was previous awarded and that would be extra back pay as well. i feel like i get 1 step forward in a win and 10 back in loses. 

@brokensoldier244th i know you have a lot of expertise in this. thoughts?

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  • HadIt.com Elder

What, exactly, did you claim, and on what form? If you originally had a bilateral claim that was partially denied then reopening  it would likely garner an increase exam for the right anyway since it's to your benefit - which won't hurt you- along with the re-examination of the left. That said, was the exam request created correctly or did the examiner screw up- without seeing the exam request there is no way to know.

You cant be penalized right now, ratings wise, for cancellations and no shows due to covid or fear of, and you get 1 "gimme" as of 1 Jan for exams that were originally scheduled on 1jan2022 or after and missed, before the exam request has to recreated vs just rescheduled so not going too it doesn't penalize you right now except for time. 

Did you file your reopening within a year of the original denial? if not then there is no contentition for back pay to 2008 for the left leg unless you have new or relevant evidence that they didn't see at the time that they should have seen. 

 

Send in a 4138 very specifically explaining why you refused the exam, because, if it wasn't completed, then you did, the examiner has "completed" (with notes on the diagnostic report)  or "not completed" as options from their end. 

 

Do you have a VSO? They can look this stuff up and see the actual notes and exam request- phone people aren't cleared for that.

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I KNEW YOU WOULD KNOW WHAT TO DO!  thanks my friend. 

just to answer some of your questons:

8 minutes ago, brokensoldier244th said:

What, exactly, did you claim, and on what form? If you originally had a bilateral claim that was partially denied then reopening  it would likely garner an increase exam for the right anyway since it's to your benefit - which won't hurt you- along with the re-examination of the left. That said, was the exam request created correctly or did the examiner screw up- without seeing the exam request there is no way to know.

it was a supplemental as i provided new medical records not used in my previous adjudication/denial. i didnt know i had it. and looking through the c-file and the denial written, it was not available(lod and treatment for fractured tibia and metatarsals in left) they said in their denial no record of any treatment for leg leg or feet. 

as far as the re-exam of my right leg, i was very frustrated bc i had sent many messages and explanations that this was not a claim for increase on my right leg and only for my left since that was the leg that was denied in 2008. 

11 minutes ago, brokensoldier244th said:

Did you file your reopening within a year of the original denial? if not then there is no contentition for back pay to 2008 for the left leg unless you have new or relevant evidence that they didn't see at the time that they should have seen.

no this reopened back in 2019 from the OG denial in 2008. again it was on form 20-0995 and we added a statement 4138 saying:

 

This 4138 accompanies the Supplemental Claim 20-0995 dated 12/19/2019. The Veteran would like to reopen the denial of a left foot
fracture and knee condition (arthritis). The Rating Decision dated 10/15/2008 denies on the basis of no access to the STRs;
attached please find STRs the Veteran was able to locate which show a left foot fracture on Active Duty, and a statement showing he was
removed from his duties. Please consider these documents as new and relevant evidence and reopen those issues.
 
i currently have a lawyer but he was hired for my OSA EED claim and i dont believe he will assist with other claims without charging me. so i guess i will submit this on my own on 4138 and just say something to the affect:
 
this is in regards to denail dated xx/xx/xx for not attending c&P. i did attend this exam and it was scheduled for the wrong leg and foot and the doctor dismissed me without doing the exam. 
 
or something like that and see where i get. i dont know why they even need an exam when i clearly am showing medical evidence of SC. now its 2022 and still farting around with this claim. 
thanks again for your input.
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Well no matter what anyone tells you. The VA will send you to more than one C & P Exam trying to get one they want that will denies your claim or down grade your %.  I recently experienced it in my PTSD claim. They sent me to a PHD to decided if I was "insane" at the time of my discharge. He gave a favorable saying I was insane and was sulfuring from PTSD. They than tried to to send my to a second PHD to determine if I had PTSD due to MST. I called up Betty and told her that I would do another C & P bout only would see the 1st PHD. (I didn't refuse the exam) So I go to the Exam and the same PHD says the same thing that I had PTSD due to MST. So the VA wanted an IMO to decide I guess if I was UI. I called them up and said I wanted it done my the same PHD. He does the IMO in my favor.  

I file for another claim for my right knee and secondary left knee an bilateral hips. So the VA tries to send me to LHI for a C & P. When LHI calls for the Exam they try to schedule me with a NP. I tell them because this is a complex orthopedics exam I want them to send me to a MD no NP's. Well the person on the phone puts me on hold ang goes talks to a supervisor or some one and comes back and tells me that they do not have any MD's in my area only NP's. So I call the VHS the one's who did my PTSD C & P and asks them if the had MD to do this type of exam and they say yes. So I call the VA up (800 you know who) and tell them LHI said they did not have any MD's to do a complex orthopedics exam and I am requesting an MD because of the complex orthopedics exam. So they have QTC they and setup an exam with a NP. So I explain to them that they had to send me to a MD because it was a a complex orthopedics exam. So they search and find one 100 miles away. Well that Doc was a VA hack who did not read the medical records (From 2008 to present) she low balled me at 10%. The VA requested a IMO to back up that doc that wrote.

"One's R knee and L knee are anatomically discontinuous and physiologically unrelated. An injury to one's knee will not result in any chronic pathology of the contralateral
joint."

He went on to say. "As also noted in ortho TRs from 12/1/2004, pt's work setting entailed frequent walking up and down stairs, as there was no elevator. His treating orthopedist felt this
repetitive use of stairs was the etiology of aggravation of his symptoms."


"Thus, based on the evidence of record, there is insufficient evidence to establish a nexus, with greater than 50% probability, that this pt's current L knee Condition is at
least as likely as not proximately due to and/or the result of his R knee condition."

The treating orthopedic surgeon who has seen me from 2008 to the present and became my Community Care Doc in December 2021 made the statement no. 2 above. The PHD only used half of that statement. The now Community Care Doc has schedule a right knee replacement surgery for March 14, 2022. that means the VA will have to rate me at 100% for 13 Mo. and reduce it to 50% after that. The Community Care Doc has agreed to do a IMO and the DBQ's on the 24 of this Mo.

I have said all the above to this end. There is a way to refuse there C & P Exam's and if you don't think you need one you can tell them that you want them to decide you claim "on the evidence in the record".

broncovet  or some of the others can quote the REG's for the above.

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Rattler this what I am I have been say.

You had comp exam you feel was favorable and was enough evidence to granted your claim.

The va has to much power with the comp exam thing.

They can order as many exams as they want until they find the one to not grant a veteran benfits.

If a veteran refuse or ask for a decision on there record or ask for a md.

They denied veterans and don't even address your evidence.

An say you refuse a exams they never state you had 7 6 10 comp exams.

And no one see a problem with this.

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  • HadIt.com Elder

No, YOU just say that. Many people see a problem with it. Just because it hasn't changed fast enough for you doesn't = it not being a problem. That being said, if you want claims decided based on DBQs that don't address all the issues adequately just because reexams make it take longer, well....

 

That's why there are reexams. We can't just schedule them arbitrarily. You make these sweeping assumptions about how you think it works that are not always correct and then get upset about it. 

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Ok did the va keep order exam in his case.

Ok did they try and keep ordering exams in my case.

And there are many more veterans going through the same thing

I think you are the one assuming because you work for them that us veterans can't understand the process or don't no it.

Some of us have been fight the va with the law longer than u working there.

They ain't train you on the law they train you on process things and if they didn't volate the law.

There would be no bva or remand

The va manual tell y'all how to handle things as many of us veterans on here can tell you they don't follow it

 

It seem to me you are really try to stop ppl from see the wrong with the va not haven't no rules on how many comp exam they can order.

Not once have you show me a number that say that it's to many.

The CFR  does address it the CFR give to Much lead way for the va to keep ordering them

An yes I will bring up everything and error that I feel is hold veterans up.

We debated this on another thread for a whole day.

My stand aint going to change.

It should be a law on how many comp exam the va can order.

A veteran should be able to say he has and feel the comp exam he had should be used for rating.

 

Just like the va can say this exam is inadequate to keep ordering exams until they find one that unfavorable.

 

 

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