I am puzzled why I may have to do a 2nd C&P on a very defined and obvious claim.

[Steve C]

My claim is pretty definitive. I had a surgery in service for a kidney issue. For 39 years, I thought all was good from the surgery until during a cancer CT anual exam, I find out that that kidney had "died" through the years as a result of a bad procedure/bad technique/ or inept surgeon. I did my itent to file in 2020 and filed in 2021 and thanks to the COVID government shutdown, had to wait. On 1 June 2022 I was able to finally do a C&P (LHI) that I actually left feeling fairly comfortable with. On 6 June 2022, I get an email alledgely from VBA saying that I needed a C&P to support my claim and it listed Veteran Evaluation Service (with contact information) and stated I would be contacted. I immediately called VES who wasw absolutely no help because they had not received my records/information and had not assigned my case to a scheduler. I was basically told I had to wait to hear from them. 

Okay, I am the type who likes to research things that involve me. When looking into VES, I found that there is very little information on them and that they only have 25 locations nationwide listed under their name. I also found that yelp ratings were extremely poor. So yesterday, 9 June 2022, I called VES back to inquire and learn a bit more about them and ask why I was possibly going to have to have a 2nd C&P. Imagine my frustration when I learn they still do not have any information on me and still have not assigned a scheduler. But more than that, I would have been better off talking to a wall. She could not provide me any useful information; including where I may have to go for said C&P, only that they would pay for my travel or provide transportation. Mind you, out of the listed 25 locations, the closest is Cleveland OH and I live in Lexington KY which I seriously doubt they are going to transport me to.

With that said, has anyone had to deal with this fiasco? My claim is finite. I submitted a fully developed claim with indesputable VA records to back it up. Per my LHI NP who did my C&P 1 June, my military medical records support my claim. (she would not give me any more information than that). While supposedly VES is in good standing with VA, they don't seem very transparent or above board to me and I spent 17 years working on surgical teams as a surgical technician and surgical assistant (independent provider) with a pretty good working knowledge of history and physicals. I am interested with anyone's experiences with VES, for one. And can anyone explain the need for a 2nd exam on a defined case. I mean really, other than opening me up again to look and see that the kidney is no longer there, what could they possibly be looking for? The real proble lies in the fact that now, I am dealing with some issues with the remaining kidney that my VA doctors tell me has diminshed function. Thanks to cancer lung damage, I am not a candidate for transplant. This makes no sense to me.

[Vync]

Keep in mind the VA OIG recently released a scathing report on how C&P contractors and the quality review teams are screwing up. This secondary request might be a part of that, but no idea though...

The VA can request re-examination or clarification if the C&P findings are found to be inadequate. I do not know if they would t doesn't necessarily need to send a re-exam request back out to the same contracted vendor though.

[Carl the Engineer]

Two of my conditions on my last set of claims which were denied, were done by LHI were re-done by VES.

Both LHI and VES have online portals where you can see you appointments and who the doctor is.

If they have not recieved what they need from the VA, you would be hard pressed to get them to tell what their plan is for you.  And, I believe VES is just an administrative organization and they farm out the exams and labs to third parties, etc. 

I have come to believe, that the VA uses LHI first, and then VES if it is too complicated or a higher level of knowledge.  As LHI was a NP, and VES was a DR for my cases.

But, I could be all wrong,

Carl

My VES C&P exams were records only, not in person.

 

 

 

Edited June 10, 2022 by Carl Bacon
cause

[Vync]

1 hour ago, Carl Bacon said:

Both LHI and VES have online portals where you can see you appointments and who the doctor is.

Makes me wonder if VES checked the site when @Steve Ccalled...

[broncovet]

As of July, 2020, there are 412,892 people who work for VA.  

And, if these people are like other people in other walks of life, they have a wide variety of opinions on EVERYTHING, including how they do their job, when they schedule appointments, etc. etc.  

So, to predict how "your decision maker" will react, when we dont know that person at all, is extremely challenging. 

Yes, its fun to think, "when abc happens VA will respond with xyz", but that is not the reality.  

So, I try to stay away from questions like "why does VA do ______?" because its largely a meaningless guess.  

VA is generally not a  unified body.  Employee A, may well tell you something very different than Employee B, who disputes Employee C's views.  

Its not McDonalds where French Fries are fried 56 seconds in vegetable oil at 180 degrees or whatever, in all McDonalds in the country.  So, the results you get from VA are widely varied. 

But that is not always bad.  For example, if you dont like Employee A's response to your problem call back when he is off, and maybe Employee B will be much more favorable.  

[Richard1954]

They may have requested a new C/P exam because the first exam left some unanswered questions. Its also possible that the first exam you had by the contractor may be one of the thousands conducted that someone has identified as having a problem.  I am sorry to hear of your Kidney problems.

My oldest friend has faced the same problems with his kidneys and he undergoes dialysis 2 or 3 times a week.  I wish you the best, and hope you claim is decided in your favor.

Edited June 11, 2022 by Richard1954

[Steve C]

The primary reason that I am puzzled is that the VES email was sent the same day LHI posted their report to VA. As of yet, it has still not been reviewed or adjudicated. Ultimately, my records and documentation are cut and dry. The only thing additionally that could possibly be done in further exam is to open me back up to see the kidney isn't there (as far as the surgical mistake goes) and problems with the remaining kidney have been documented over the years.