hypertension Six Comp And Pen Exams Coming Up

[martin]

hey everyone, i got notification that i have my C&P's coming up. 2 on april 6th, and 4 on april 10th. hopefully this is about to come to a head. do i need to bring any documentation with me? the V.A. should have all of my documents obviously from the V.A. Dr's, as well as from my civilian Dr's. also, while being examined, can i bring up the fact that I have Hypertension as a compensable condition eventhough i didnt actually claim it on the initial claim form? it showed up on my over 40 physical for the Army.i so far have filed for PTSD, anxiety disorder, IBS, numbness in fingers and neck,(from IED explosion), i also had sinus surgery a few months after discharge which was a pre existing condition that was aggravated by the desert sand. i think their gonna check me for a brain injury as i had a blow to the head at a combat outpost, but no documentation made as all we had were SF medics. i blew it off. got stitched up on the spot, and went back to work.(accidental injury) but got the scar to prove it. anything that would be helpful on the C&P would be appreciated. thats all for now, best regards...Martin

[spike]

i will say this in my previous evaluation i brought a letter or two to the examiner and she reviewed it and also included it in my file and REFERENCED it that she agreed. Now, I think if you go in there and you bring a ream of paper, well....your going to look over eager and over proving your case. Plus the Doctor only wants to see you for about 10 minutes or so, so i would recommend that you probably bring it to the NSO to send to the C-file at the time of rating. Your NSO should have discussed this with you before you go to your exam. The doctor's job is only to answer the questions given by the RO, so if you didnt claim it, unless it has direct connection with something that they are already evaluating (i.e. eval right knee and left knee also has something wrong)

When you go to the Eval it probably should be Yes or No answers.....keep it simple. Also remember that your PTSD exam has to be seperate from the other comp exam. I believe you probably could get the rest of them consolidated.

Hope this helps. Just speaking from experience.

[Guest jangrin]

Martin,

When my husband got his C&P notices , we thought he had notices for 3 exams. It turned out that he actually had notice for two exams and one of the papers was for a "pre-exam" that is done prior to the actual C&P. The "pre-exam" was for taking BP and weighing by the nurse 30 to 45 minutes prior to the scheduled C&P.

You can call the telephone number on your paperwork and they can tell you for sure what each notice is for, exam or ?. Then you will also know exactly what C&Ps your having. The paperwork does not always specify the exact exam.

Hope this helps.

Jangrin

[betrayed]

When you are scheduled for a C&P examination they usually send you questionnaires, if they did not send them call the phone number in the scheduling letter that you received, tell them you have memory problems and would like the questionnaires so you may fill them out while not feeling rushed and forgetting important information. My other advice would be go to the schedule of ratings and use that as a guideline when answering the questions.

We have had many discussions on handing papers over to the doctor at C&P Physicals and whether or not the doctors must make them part of the record. An even better idea is if they send you questionnaires note on the questionnaire please see back. I just finished the one for Heart and Hypertension, now there is no question of whether or not it will be made part of the record. Below is what I am printing on the backside of their questionnaire.

Continuation of Heart and Hypertension questionnaire

ICO James M XXXXXXX, VA File XXXXXXXXX

1. At present time I am prescribed the following medications for Heart Disease and Hypertension: Imdur 30 mg once daily, Nitroglycerin .4 mg as needed, Zocor 20 mg once daily, Plavix 75mg once daily, aspirin 325 mg once daily, and Metoprolol 12.5 mg twice daily. Since my stent placement on 6/1/06 my medications have been constantly changed because of hypotension and bradycardia. I have been taken of Lisinopril, and Atenolol due to the hypotension and bradycardia. The side effects from the medications are hypotension and bradycardia, as well as constant fatigue; lightheadedness; headache, and dizziness.

2. Have you ever had a heart attack, No. Have you had a stroke, it is possible that I have had a TIA or CVA which was noted by Dr Lucian Maiden on 6/4/03 which he states “ Decreased fine motor movements of the right upper extremity which may be due to a left upper motor neuron lesion” also H. Marx Sacks, DO, LCDR, MC, USNR, Flight Surgeon noted on my retirement physical “Lacunar Disease or possible CVA” and also noted on my Report of Medical Assessment “may have had a TIA or CVA”. Have you had stent placement, catherization, angioplasty, a stress test? Yes I had a stent placement of the LAD with a J&J Cypher Stent done on 6/1/06 at providence hospital. I had three blockages one at 100%, and two at 80%. Please refer to the attached documents. Yes I had catherization done on 6/1/06 at providence hospital and catherization done at Huron Valley Hospital on 10/6/06. Yes I had a angioplasty done on 6/1/06 at providence hospital. Yes I had a Nuc Stress test done at the Ann Arbor VAMC on 4/6/06 which was abnormal and showed an Ejection fraction of 48%.

3. Do you have chest pain? Describe pain? Intensity of pain? How long does pain last? Do you take nitroglycerin pills for this? Do they help? How often? Are you short of breath? Do you have fatigue? Do you have dizziness? Do you pass out?

Yes I have chest pain I have been hospitalized 3 times for chest pain since September, SEP21-22, OCT 4-6, and OCT31 - NOV01. Crushing pressure in the center of my chest. The pain lasted until the administration of Nitroglycerin pills or paste. I am prescribed Nitroglycerin pills and Imdur for the chest pain. It was explained to me the Imdur is the same thing as Nitroglycerin pills but it was time release. I have not had chest pains since I started taking Imdur November 1st on a daily basis. I am short of breath after doing simple task as walking up a flight of stairs, I am constantly fatigued and have been told that is a result of the bradycardia and hypotension. I have dizziness and light-headedness, I have never passed out but have come close on several occasions. I was seen in the emergency room at the Ann Arbor VAMC on 12/14/06 for renal colic and also mentioned to the doctor about the dizziness.

4. What medication do you take for your heart? See paragraph 1.

6. What is your occupation? I am unemployable; the Veterans Administration has determined that I have a serious employment handicap. I applied for Vocational Rehabilitation with the Veterans Administration. The Veterans Administration denied my application for vocational rehabilitation on 6/1/06. In their letter dated 6/1/06 they state “ It does not appear feasible for you to obtain suitable employment through your Vocational Rehabilitation benefits at this point in time because of the severity of your disability.” “After carefully reviewing the evidence I have determined that it is not reasonable to expect you to be able to train for or get a suitable job at this time”. “In reaching my decision I considered the following evidence: Medical records from VAMC and private physicians: independent living evaluation: vocational and independent living interviews, rating decisions, personal documentation”.

My former occupation was police officer. When did you last work? My last job was delivering pizza; I did this for approximately four hours a night, three nights a week. I left this job in May of 2006 because of the stress of it. How does this condition affect your daily activities and your recreational activities?

I am only able to do light activities around the house a simple task as vacuuming leaves me short of breath and fatigued. I have no recreational activities. As of today Dec 21st 2006 I have had 105 medical appointments in 2006 and this appointment makes number 106.

They sent me 5 questionnaires

Heart and Hypertension

Respiratory

Diabetes

Genitourinary

Neurological Conditions

I plan to answer as few as possible questions on each questionnaire and have written see back. I plan to type up my history and everything I can and print it on the back of these forms.

Below is what is going to be printed on the back of the genitourinary questionnaire

Any input is appreciated.

4. Have you had urinary tract infections in the past year?

Yes Chronic Non Bacterial Prostatitis, I have been diagnosed with Chronic Prostatitis. 6/12/2002 Dr Stephen Rostand Professor of Medicine “H/O Prostatitis treated off and on with levaquin or bactrim” and “the patient has chronic Prostatitis”. 5/16/2002 Dr Stanley Wade “he has calculus Prostatitis” “He will also be put on bactrim DS one b.i.d. #60 with five refills” 5/1/2002 Dr Beland “acute clinical prostates” The term Chronic Prostatitis is listed on my physical (12/08/03) it is also listed on a Report of Medical Assessment. November 2001, Kartik Boorgo MD, “prosthetic calcification” September 13, 2000. Donald Olofsson MD “Prostatic calcifications” 1997, Scott Bildstein MD “findings consistent with chronic Prostatitis”

How many infections in the last year? Three or four.

5. Have you had Kidney stones? Describe Treatment. Yes I have chronic kidney stones, I began passing kidney stones at the age of 21 and continue through today. Dr Peter Fisher (ANN ARBOR VAMC Urologist) stated on August 4th 2005 “he has a vile of >1000 pale CaPO4 stones from <1mm to 3mm.” These are the stones I have caught there have been twice as many lost in public restrooms when I have not had a strainer with me. This condition causes me pain 24/7. I have had over seventeen Electro Shock Wave Lithotripsies (ESWL) as well as numerous basket retrievals on my left kidney. On 10/31/06 I had a KUB, which showed multiple large stones in my left kidney. On 11/16/2006 I had a renal scan conducted at the Ann Arbor VAMC which showed that my right kidney is filtering 68% of the blood and my left is filtering 32% of the blood. On 12/4/06 I had a renal ultrasound which I am unaware of the results. On 12/5/06 I had a appointment with DR Kim in the urology clinic where we discussed Percutaneous Nephrolithotomy and the removal of all stones from my left kidney. On 12/6/06 DR Kim called me and told me he couldn’t do the Percutaneous Nephrolithotomy stone removal, as it was too dangerous. He suggested Laser Lithotripsie, I asked him was there any urgency and he said yes my kidney function was sub optimal at best. I told him I had a appointment with the renal clinic on 12/21/06 and we would see what they say. The Indiana University-Purdue University Indianapolis has been conducting a research program on The Pathology of SWL Injury http://anatomy.iupui.edu/lithotripsy/swlpath.html the opening statement states “SWL has been widely viewed as one of the most effective means of removing kidney stones since it was introduced in the early 1980's. In contrast, views on the safety of SWL have changed as clinical experience with it has increased. One of the first clinical reports on SWL expressed the view that shock waves "do not cause damage in passing through body tissue,” but less than a year later another reported that renal damage occurred in 63-85% of all SWL patients and that 30% of SWL patients experienced immediate post-SWL reductions of effective renal plasma flow. Since then, there have been many reports of SWL-induced renal injury and impaired function in human patients and experimental animals. The more current view on SWL-induced renal injury is summed up in the lead sentence of a 1992 Journal of Urology editorial that referred to SWL as "a form of renal trauma, and went on to assert that "some degree of renal injury occurs with virtually every SWL treatment ”. A recent Mayo Clinic study which appears in the May 2006 issue of the Journal of Urology states that Nearly 4 Times Higher Diabetes Risk After Shock Wave Treatment For Kidney Stones. http://www.cbsnews.com/stories/2006/04/10/...in1487112.shtml it’s a well known fact the scarring causes hypertension. Its my belief that my kidney disease has caused my hypertension, my heart disease and now I have to worry about diabetes.

8. Erectile Dysfunction Date this began: DR Berry started treating me for ED on 2/28/05 with Viagra. Dave Bialy from the Ann Arbor VAMC started treating me with Viagra around July 05. On 1/25/2006 during a C&P Exam I was diagnosed with ED. I continued to use Viagra until recently when I was prescribed Nitroglycerin and Imdur. My prescription for Celexa has pretty much chemically neutered me.

10. What is your occupation? I am unemployable; the Veterans Administration has determined that I have a serious employment handicap. I applied for Vocational Rehabilitation with the Veterans Administration. The Veterans Administration denied my application for vocational rehabilitation on 6/1/06. In their letter dated 6/1/06 they state “ It does not appear feasible for you to obtain suitable employment through your Vocational Rehabilitation benefits at this point in time because of the severity of your disability.” “After carefully reviewing the evidence I have determined that it is not reasonable to expect you to be able to train for or get a suitable job at this time”. “In reaching my decision I considered the following evidence: Medical records from VAMC and private physicians: independent living evaluation: vocational and independent living interviews, rating decisions, personal documentation”. My former occupation was police officer. When did you last work? My last job was delivering pizza, I did this for approximately four hours a night, three nights a week. I left this job in May of 2006 because of the stress of it.

How does this condition affect your daily activities and your recreational activities?

I am only able to do light activities around the house a simple task as vacuuming leaves me short of breath and fatigued. I have no recreational activities due to my depression I don’t leave my house. As of today Dec 21st 2006 I have had 105 medical appointments in 2006 and this appointment makes number 106.

I think you get the picture!!!!

I had my C&P's yesterday..........

They doctor came out and introduced herself and said did you complete the questionnaires and I said yes. I gave them to her. She said ok sit her it will be a half hour before I talk to you (this was a two hour scheduled appt). She came out and sent me here and there about the hospital, back to the lab three times, up for a pulmonary function test and plus I had two other appointments that I missed because of the pulmonary function test that I didn’t know I was getting. Anyway 4 hours later I am sitting out side her office and she hands me the C&P report and says proof read this. It was nine pages long, I found two mistakes. The report was fukcing awesome! I couldn’t of hoped for a better report unless I wrote it my self.

Diagnosis

Vestibular Disequilibrium

Carpal Tunnel Syndrome

ED

Hypertension

Coronary Artery Disease

Nephrolithiasis

Chronic Prostatitis

Sleep apnea

Deviated septum

Right upper extremity Incoordination

[betrayed]

so i would recommend that you probably bring it to the NSO to send to the C-file at the time of rating.

Hope this helps. Just speaking from experience.

My experience and that of others on this board you can not trust a NSO to do anything, some are good, most are not, A VSO once told me you get what you pay for, I later fired him because I paid him nothing and in return I got nothing from him, think about that

[martin]

thanks for the great advice ,and response. WOW!!.i'll call for the questionaire. i get the picture. i hope it all turns out to my benefit after all this time. i guess i better get hot...martin

[betrayed]

Also

1.) Index to Disability Examination Worksheets

These 57 Disability Examination Worksheets are in use both by the doctors of VHA (Veterans Health Administration) who do the disability examinations and by the rating specialists, hearing officers, and Decision Review Officers of VBA (Veterans Benefits Administration) who do the disability evaluations. Found at

http://www.vba.va.gov/bln/21/Benefits/exams/index.htm#bm01 get the worksheets that apply to your conditions and study them.

2.) My other advice would be go to the schedule of ratings and use that as a guideline when answering the questions.

Edited March 23, 2007 by BETRAYED (see edit history)

[Pete53]

I had a C&P Feb 20, 2007 and was not given a sheet of questions but I was asked questions from a list. My exam was thorough and the C&P was done fairly in my opinion.

Probably the most important thing you can take with you to the C&P is that you need to answer the questions like how you feel most of the time at home. Most of us will save we feel ok when it took a giant effort just to get there.

Good Luck

[carlie]

Martin,

Any objective medical evidence you have that refers to your disabilities -- take it with you.

Just the main stuff! Don't walk in there with 50 pages. If you can, make copies of the most important evidence you have (that supports you claim) to leave with the C&P examiner.

"so far have filed for PTSD, anxiety disorder,

You can only be compensated for 1 mental disorder.

IBS - what is the IBS from - do you have a medical diagnosis and papers where a medical doc has provided a nexus (connection) from injury or illness to military service or secondary nexus to meds?

numbness in fingers and neck,(from IED explosion) - need medical diagnosis and nexus from doc.

Do you have any muscle spasms, or loss of range of motion?

i also had sinus surgery a few months after discharge which was a pre existing condition that was aggravated by the desert sand - need medical diagnosis and nexus from doc.

i think their gonna check me for a brain injury as i had a blow to the head at a combat outpost, but no documentation made as all we had were SF medics. " - same thing here - this you will

probably file on down the road but don't wait too long.

carlie

Edited March 24, 2007 by carlie (see edit history)

[tssnave]

Here's my experience with my C&P exam for a mental disorder and taking documentation with me to support my claims that was not already in my C-file:

My DAV rep told me to take the documentation I had to my C&P exam and give them to the doc about my losing jobs due to excessive absences that were brought on my sc mental disorder.

However, she would not take the papers because she said the way the system works is she types her answers to the C&P questions into a computer and the report goes straight to the VA electronically and there's no way she can include hard copies of any other evidence. She did review it and made a note in the report about what she read that supported my claims about losing jobs. She told me to send the information to the VA so they would get in my C-file, but she did not have the ability to accept any hard copy evidence from me.

The upside of the electronic C&P report is my exam was on a Wednesday and they had a favorable, written decision that my DAV rep faxed me days later on Friday!! After almost 3 years of waiting for the whole deny, appeal, DRO, C&P exam process to play out, having a decision within 3 days was amazing.

So, don't be surprised if your C&P examiner cannot accept any papers in support of your claim. Do ask him/her to make a note of what you’ve brought that they've read.

My biggest concern during my C&P exam was that she noted the nexus between my active duty treatment and my current treatment. At the conclusion of the exam, I asked her about the nexus and she offered to read what she had written in that regard. It was a relief to hear her say that she'd written a resounding yes on the nexus.

In hindsight, there were other things I should have been concerned about that I just didn't key into. Moral of the story: talk to your DAV or other SO rep or post your questions here at hadit with enough time for folks to advise you and ask those questions if there's anything in particular you need to make sure gets in your report. Also ask the examiner if it has been addressed and ask if they'll read what they wrote so you’ll have a clue about what the rater will be reading.

I hope this helps. Good luck.

ts

[spike]

When was this electronic and what RO are you located near because I actually was able to see my 10 inch C-file on his desk. He go from a script like Q/A. He also asked me to elaborate so that he could make sure as he said "Have all the evidence and statements correctly so that the RO can not say they were missing anything. I kind of feel relieved in a sense, the examiner indicated he was a recovering alcoholic and knew what it is like for someone to judge someone on the basis of not understanding what a person of a mental illness goes through. He said he felt the need to make sure that we (veterans) get the benefits we deserve and the treatment. He indicated if I received a denial to come back to his office and he was willing to do whatever it took to help me get the treatment, as he was ignored for treatment himself. The examiner indicated that he felt mental illness was worse than physical in the sense its a lot easier to mend a physical wound, but doctors are still trying to find ways of treating mental illnesses like PTSD.

[tssnave]

My C&P was done a month ago in the Winston Salem, NC outpatient clinic. The psychologist had my physical C-file there and it was obvious she had read it (remembered my history, made comments about my drug treatment). Like yours, my C&P exam followed a list of questions (which Vike17 has posted earlier in this thread but I hadn't seen before my exam). She typed my answers (well, I assume she typed my answers, I haven't gotten a copy of the C&P exam itself - the outpatient clinic said I had to get it from the VA RO because they don't have a copy of it) into her computer and said the report would be at the VA RO later that day electronically which it must have been because they made a decision by the end of the week.

The problem at the C&P exam was I didn't realize I needed to expound on close-ended questions to tell her how my sc mental illness affected those areas of my life she queried me on. Example: she asked if I had graduated high school. Yep. Did I have any education beyond high school and if so, what? Yep. I have a BS in Business Administration. On she goes to the next question. It wasn't until later that I found out that "occupational impairment" with "school" was one of the things they were looking for. Had I realized that I would have told her it took me 7 years to complete the last 3 years of college because of my sc disability.

Another thing that amazes me, if you look at the mental illness C&P exam questions, they ask if you have any panic attacks. She asked me this, I said no, and on she went to the next question. Well, if you look at the actual rating chart it is "near continuous panic attacks or depression affecting your ability to live independently." Since I said no to panic attacks we did not discuss my ability to live independently whatsoever. This is part of why I was rated 50% and not 70% where my symptoms truly fall out. Why? Because the examiner asked the question on the exam which was limited to panic attacks which I don't have when the rating is actually supposed to be based on panic attacks and depression, which I do have. ARRGGGG!!!

I could go on with several more examples but I'll spare you my rant and myself the irritation. Plus, in the interest of fair reporting, I wasn't functioning well that day to begin with and that combined with a list of exam questions that were often closed ended and didn't even cover what they rate you on just sunk my rating. The good news is they did rate me 50%, I found this board, and with my back pay I can now afford to go to a civilian shrink and get a more comprehensive report to cover all the areas that we didn't adequately cover during the C&P exam.

I am glad you had a good experience with your examiner. Sounds like he had a great deal of empathy which can go a long way. I thought my examiner was very kind. By the end of the exam I was all washed up and if she asked me if there was anything else I had to add I don't remember the question and I certainly didn't answer it, hence, my lower rating and subsequent appointments with a private shrink to get it all out and on paper to give to the VA.

At this point I know what I need to cover with the private doc that I didn't cover during the C&P exam. What I'm trying to understand is if I need to request a reconsideration of new and material evidence or just request an increase in rating.

Thanks,

ts

[tssnave]

Betrayed,

Just realized it was you, not Vike17, who posted the C&P exam link and schedule of ratings. I must have gotten the two of you confused because I have learned so much from both of you on various topics. Sorry for the mix-up.

Thanks for all your help,

ts