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Is it Odd for a C&P Examiner to say he can't do an eval on my back because I am having a flair-up?


Joep

Question

I had a C&P exam today and the doctor started to do measurments on bending angles but since I was unable to move much as all becuase of a flair-up, he felt he could not do the exam.  Am I missing something?  This back flair-up also prevented him from being able to fully review my knee claim.

This is the second time I am seeing this doctor and the last time there were MANY discrepancies from what was observed, discussed, and what was documented on the DBQ.   I honestly felt he mixed me up with someone else.

I expected to see him for 2 issues but we went over 4.  I wonder if he will do a DBQ on all conditions or not and if not, will I be rescuheduled? 

I worry he will simply not address the issues he felt he could not measure due to my flair-up rather than documenting my movement (or lack there of) today which may appear I was fine. 

So stressed

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  • HadIt.com Elder

@JoepWait, what? That sounds very sketchy, even for a VA C&P examiner... They should have completed the exam anyway. For musculoskeletal disabilities, flare ups are considered functional loss per 38 CFR 4.40 and 4.45 (see quotes below). If you have had repeated issues with this examiner, consider reporting what happened and perhaps request a different examiner so you have objective findings. Keep in mind that once you are SC, you can always submit for an increase if that examiner low-balled your rating...

 

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§ 4.40 Functional loss.

Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like.

Quote
§ 4.45 The joints.

As regards the joints the factors of disability reside in reductions of their normal excursion of movements in different planes. Inquiry will be directed to these considerations:

(a) Less movement than normal (due to ankylosis, limitation or blocking, adhesions, tendon-tie-up, contracted scars, etc.).

(b) More movement than normal (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.).

(c) Weakened movement (due to muscle injury, disease or injury of peripheral nerves, divided or lengthened tendons, etc.).

(d) Excess fatigability.

(e) Incoordination, impaired ability to execute skilled movements smoothly.

(f) Pain on movement, swelling, deformity or atrophy of disuse. Instability of station, disturbance of locomotion, interference with sitting, standing and weight-bearing are related considerations. For the purpose of rating disability from arthritis, the shoulder, elbow, wrist, hip, knee, and ankle are considered major joints; multiple involvements of the interphalangeal, metacarpal and carpal joints of the upper extremities, the interphalangeal, metatarsal and tarsal joints of the lower extremities, the cervical vertebrae, the dorsal vertebrae, and the lumbar vertebrae, are considered groups of minor joints, ratable on a parity with major joints. The lumbosacral articulation and both sacroiliac joints are considered to be a group of minor joints, ratable on disturbance of lumbar spine functions.

 

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I had a lower back C&P during a flare up.  It's debilitating.  Her opinion, questioned my effort during the exam.  Guess she's never dealt with back spasms and not being able to tie your own shoes for weeks at a time.  I got denied.

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  • HadIt.com Elder

@El TrainI thought some of my ROM C&P exams were bad enough while not experiencing a flare up... Glad we can appeal bad decisions.

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  • HadIt.com Elder

I don't know is these C&P doctors are stupid, incompetent or just whores.  I have had docs just like you describe who have said the most outrageous things to me.  One said I was faking because I had a degree in psychology.

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I may be able to help, here.  

There are 2 types of back issues:

1.  Acute.  https://medlineplus.gov/ency/imagepages/18126.htm. Acute back pain, for example, suggests its temporary and gets resolved over time.  

2. Chronic.  Chronic conditions occur over time.  

    For benefits, we have to demonstrate chronicity, and continuity.  We "wont" be compensated for a back sprain that hurt like heck in service, but it went away and you have no omre issues from it.  We dont get paid for "pain and suffering".  

      A "flare up" suggests its acute, and will resolve over time.  Now, in the example of headaches, flare ups are taken into account.  In other words, the "frequency of flare ups".  In migraines they call them "prostrating flare ups".  This means your headache flare up is so bad, you cant get out of bed.  Then you need documentation of "how often" the flare ups" (migraine headaches) occur, such as once a month, 2x, 10 x, etc.  

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7 minutes ago, broncovet said:

For benefits, we have to demonstrate chronicity, and continuity.  We "wont" be compensated for a back sprain that hurt like heck in service, but it went away and you have no omre issues from it.  We dont get paid for "pain and suffering".  

I was watching one of those YouTube videos about C&Ps for back issues and there is an additional difference in a 'flare-up" that can interfere with a C&P for a service-connected back problem.  Like, arthritis is a good example of how an arthritic flare-up can interfere with painful range of motion evaluations concerning service-connected Disc Degenerative Disease (DDD).

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