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New C/P exam


Richard1954

Question

I received a letter yesterday Dated 14 June. It reads;

We have requested an examination through a private medical facility in order to determine the current level of your disability. This private facility will soon advise you of the date, time and place of the examination. This notification will be in writing, by telephone or perhaps both. If you can't keep the ap[pointment or want to re-rescheduled, contact the medical faculity on the appointment noiice as soon as possible.

When a claimant, withour good cause, fails to report for an examination or reexamination, the claim shall be rated based on the evidence of record, or even denied. Examples of good cause include, but are not limited to, illness or hospitalization, death of a family member, etc. 

Ok so I have 4 claims in the system. My appeal on the left knee ( already had 2 exams), my claim concerning blood cloths in my lungs secondary to my COPD, and my claim for Venous Insufficiency,Chronic, and Peripheral secondary to COPd, the last two claim have ratings 60 to 100% ratings.  And a claim for Gerd secondary to COPD, and COPD medications to include steriods.

These genius that sent the letter did not tell me which claim they are talking about. 

In all my 35 years in dealing with the VA ,  I have never received such a letter.  I am befuddled . This letter is dated 14 June it is now 23 June and no private medical faculity has contacted me.  I wonder if this will be one of the known contractors, or if this will be done by a real private medical faculity.. Gee Dorthy ,  i'm gonna follow the yellow brick road with ya and together we will see were it goes. Do you think the Wizzard will get me a good exam and a better rating or will the wicked witch of the west spoil everything?   To be continued.

 

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  • Content Curator/HadIt.com Elder

This is not unusual. I had it happen to me several times back when I had claims in the system and before they were outsourcing to third party contractors. The exams would usually just state I had to report to the VAMC and go to the C&P clinic. However, a couple of years ago, I got a letter similar to the one you got. Not long after, I got a letter from LHI with was suprisingly detailed. It told me all about the exam from what the VA requested to the name and credentials of the examiner, the kind of DBQ, and included info on how to contact them. Of course, once I had the exam, the NP hosed up the report by opining on something I never claimed and I got a denial that was overturned on appeal.

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Same with me Vync

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Come to think about it, I did have an exam for Parkinson's Disease a couple of years ago. I did not even claim it. I don't have P D that I know of. But yes that was denied too. 

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7 hours ago, Whodat said:

Come to think about it, I did have an exam for Parkinson's Disease a couple of years ago. I did not even claim it. I don't have P D that I know of. But yes that was denied too. 

If you have a VSO where you granted them power of attorney, they can actually file claims on your behalf. I hear it is rare, but you never know...

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Thanks guys, I know they do exams using contractors but I have just never seen such a letter. I am still waiting for someone to contact me. Usually, I will get a phone call and they identify theirselves as contractors for the va ready to do an exam. I hate dealing with these contractors because you can never get a copy of the writen report, well almost never, but myself I have never had the luck of getting a copy of a c/p exam from a contractor.  Anyway  Dorothy and Toto are good company here in va nevr never land within the wizard of oz.

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From my understanding, this is normal. In fact, I had one in person C&P with LHI and have since had two records reviews by VES (the first because an MD stated "pre-existing condition") and the VA caught the misstatement  when the record clearly shows that not to be true). My 2nd records review was completed today and am now awaiting the decision.

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Hi Richard1954,

I'm not sure if you are aware, but you are allowed to tell VA that you prefer to have exams at the VAMC.  The ideal way to do that is on/with your application form.  For example, "increased evaluation for lumbar spine condition - please schedule my exam at the closest VAMC."  There may be issues with requesting the exam though.  VA uses your zip code and software spits out the 10 closest treatment facilities.  However, VAMCs regularly don't have personnel/staffing for certain exams.  If you want them done by VA examiners, you need to make it clear that you'll travel to the closest VAMC that can perform the exam - they're gonna pay you mileage and (depending on distance) lodging.  Here is the Manual citation addressing that:  M21-1 IV.i.2.A.2.b. ERRA Tool.  There are arguments for and against using VA versus contract examiners.  Personally, I prefer VA, but I have a good relationship with my PCM and I think I could get her to fill out a DBQ if I needed that.......

Good luck,

Phury

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In addition to YOU filing directly, your representative with POA filing on your behalf, Inferred claims are a reality, but Vets often get mixed results with inferred claims.  

One example, is TDIU.  "If" you applied for benefits, prior to 2016, AND your doctor noted you are unemployed/unemployable, this is often an inferred claim for TDIU.  

Nowadays, you have to fill in a form for each claim, but that was not the case in the past.  

I actually got my tinitus claim awarded by contact with a VA employee ON THE PHONE, because it was a claim for increase, and, because the VA employee "documented" that I had applied by phone.  Remember, while claims do have to be applied "in writing", many Vets apply "online" digitally, and if you spoke to a VA employee telling them you want to apply for _________ this would suffice (prior to 2016) as long as the conversation was documented in your file.  The trouble is, we often dont know if it has been documented, until we review the file.  

Years ago, one VA employee told me "you could apply for benefits for increase  on a napkin and send it in".  Dont try that now, but, if your file did contain that napkin (applying for an increase of benefit "a").  and it was dated prior to 2016, you may get an earlier effective date.   The idea is, once you filed formally, you need not be redundant and tell the VA everything all over and over again such as name, dates of service, branch, exit service date, MOS, etc. etc, as many of these things just dont change.  

Also, no we dont always know the condition(s) claimed when VA calls us for a comp and pen exam.  We are required to attend the exam, however, or be denied.  Never miss a comp and pen exam.  The VA considers it like you have abandoned your claim and are no longer seeking benefits when you miss an exam.  "If" you have compelling reasons, you can reschedule the exam, such as if you were in the hospital, or otherwise could not attend the c and p exam, then you need to notify VA promptly, that you have to reschedule the c and p exam.  

I agree its frustrating to go to an exam, and not know what its about.  

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On 6/23/2022 at 11:57 PM, Richard1954 said:

 

These genius that sent the letter did not tell me which claim they are talking about. 

In all my 35 years in dealing with the VA ,  I have never received such a letter.  I am befuddled . This letter is dated 14 June it is now 23 June and no private medical faculity has contacted me.  I wonder if this will be one of the known contractors, or if this will be done by a real private medical faculity.. 

 

Hi Richard1954,

I get where you are coming from so I thought I'd give you a little more information about that letter.  When I first started (in 2018), we were trained to send an exam notification letter when we ordered an exam.  VBMS has a particular (and not super user-friendly) ability to generate letters, but the letter formats are pretty limited.  If the Manual had a requirement to send that letter, I couldn't find evidence of it now.  The Manual underwent a major reorganization last year and it's a complicated process to view the previous versions, where it used to be an easy thing to do.  Anyway, with most letters (but not all) created in VBMS, the processor can add extra text to the letter.  That function is really picky so required extra language may not always make it into the letter.  In the case of exam letters, I confess that it would never occur to me to include the specific issue(s) the exam request(s) concern.  If you claimed 8 issues and I ordered exams for 5 of them, I might send you a letter, but I wouldn't list each condition I ordered an exam for. 

If you get that letter, you can wait for the contract examiner to send you appointment notification (they don't always coordinate appointments; sometimes they just make them and notify you - primary reason I don't care for them).  If the appointment is with the VAMC, you can ask which issue is being addressed in the exam(s), when they call to schedule the appointment with you.

There are 2 options in VBMS for sending an exam request notification letter.  One of the options says that the notification should let the Vet know you've request an exam from "QTC" (a particular contract vendor).  The actual verbiage in the letter doesn't say which contract vendor (VES, QTC, etc.) the request went to.  The reason I mention this is a VSR selecting that letter might not do so if they aren't aware that the label isn't accurate.  Also, it appears that the notification letter is no longer required (if it ever was - again with the problems trying to look up previous versions of the Manual).  You could absolutely use your voice(s) to get that specific requirement added back into the Manual.  

Good luck to you,

Phury

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