Upcoming C&p Exams

[snoopy4666]

I just found your board today and have been reading for hours....

I have 2 upcoming c&p exams on 03/29 and have a few questions.

I am 40y.o., currently 10% SC for a foot injury since 1988. I've had severe pain over the years and I have had 6 surgeries since 2004 at a VAMC to try and repair my great toe joint. After surgery #4 (07/06) I contracted a staph infection and was treated with 6 months of various kinds of antibiotics and vicodin.

- I lost my job 09/06 because my company wouldn't keep me on light duty and I wasn't qualified for FMLA,

- Surgery #5 (11/06) to remove infection, - Surgery #6 (12/06) to remove artificial joint hardware, Infection returned (01/07) and I was hospitalized and diagnosed/treated for osteomylitis (6 wks IV antibiotics), I also contracted a VRE infection which I am still testing positive.

I submitted a claim on (10/06) for MDD, IU, infection and reevaluation of current SC, and am receiving temp 100%, but I'm not sure how long this will last.

I cannot currently work due to the depression (over 3 yrs being treated/meds), severe pain, anemia, cellulitis of foot, and major symptoms from VRE and meds.

Med list ~ Morphine sulfate SR 30mg, morphine sulfate IR 15mg, neuroton, celexa, meds for knee effusion, stomach issues.

Does anyone have any tips to help me prepare for next weeks, back to back, C&P exams?

Would it be helpful to bring in photos documenting the infection?

Also, I'm also CH 31 but have had to take a few semesters off because of my medical problems. I am extremely depressed and want to get off the pain meds (I nearly ran out a few weeks ago and experienced withdrawal symptoms which scared the heck out of me)... I am talking with SATP, I'm not sure if this pain will ever leave. I am scheduled to see the pain management clinic but haven't gotten an appt yet.

Any info would be helpful.

Terry

Semper Fi

[Vike17]

Snoopy,

Your 100% temporary evaluation is assigned under §4.30 and there it stipulates how long that evaluation can be retained. Off the top of my head, I think it depends on how long your doctor states you'll be recovering from the surgeries.

As far as your MDD (Major Depressive Disaorder), are you claiming this as secondary to your already service-connected disabilities, or are you claiming this as a direct result of your military service? If its the first one, you'll need a statement froma shrink making the nexus or "connection" between your disabilities and your current diagnoses. If its the later, your SMR's will need to show signs symptoms of depression that manifested itself while you were on active duty.

As far as your foot, it's hard to say without knowing what diagnostic code it's rated under to determine what percentages could be awarded based on an increase after the temp 100% evluation is reduced.

With regard to your IU claim, in order to have a chance with it, you'll need to have one disability rated at 60%, or if multiple disabilities are present, one will need to be at least 40% with the others combining to an over all rate of 70%.

When yo go to your C&P exam, you should take all of your private treatment records of all of your claimed disabilities with you so the examiner can take a look at them and evaluate them. Then make sure the regional office has a copy of those records too.

I hope this helps!

Vike 17

[jbasser]

Being the problem is with a toe, you may have to ask for an extra schedular considerations based on the fact that the surguries and infections are keepong you from obtaining employment.

[Berta]

MARINE-

Can you possibly continue your education on line instead of traditional classroom-the net is full of colleges on line that are fully VA approved.But be a lot easier than getting to a campus in pain.Can you drive at all? What foot is it?

Have you formally applied for TDIU yet? The meds you take might well have side affects that would render one unemployable.

If Chap 31 (Voc Rehab) tells you that it is not feasible for you to continue due to SC disability-this documentation will help yor TDIU claim.

"Does anyone have any tips to help me prepare for next weeks, back to back, C&P exams?

Would it be helpful to bring in photos documenting the infection?

Also, I'm also CH 31 but have had to take a few semesters off because of my medical problems. I am extremely depressed and want to get off the pain meds (I nearly ran out a few weeks ago and experienced withdrawal symptoms which scared the heck out of me)... I am talking with SATP, I'm not sure if this pain will ever leave. I am scheduled to see the pain management clinic but haven't gotten an appt yet."

All of the blank C & Ps should have a link here at hadit- that shows you what to expect on the C & P exams.

Photos- Worth a thousand words- or more-

I made a template for a vets claim and for anything else he need to send-by using a very gorey color photo of an infection on his stomach that VA caused -giving him more disability (Sec 1151 claim)

Surgical screw up-it took me 3 days but I found a VA doc had even admitted to the screw up in his med recs.

It was gruesome but the Vet loved it and made sure he attached this template as a cover letter to each submission of evidence he made-like the med rec with the docs statement.

Do they expect this problem to heal?

Are you asking for higher SC rating for the MDD too?

- "I lost my job 09/06 because my company wouldn't keep me on light duty and I wasn't qualified for FMLA"

Do you have documented proof of that in your personnel record at this place?

This is excellent evidence of unemployability.

Chap 31- dont turn into a brain surgeon-it might make VA think you are fuly employable when the reality is- from what I see here-you should be 100%.

I mean it is sure OK to continue your education- but with the level of pain you have-I would not want VA to mess with your comp because they think you would become employable.

Then again-the foot problem could be temorary TDIU? With more treatment? But the MDD is another story-

CAn you tell us what VRE means?

Edited March 22, 2007 by Berta (see edit history)

[snoopy4666]

Can you possibly continue your education on line instead of traditional classroom-the net is full of colleges on line that are fully VA approved.But be a lot easier than getting to a campus in pain.Can you drive at all? What foot is it?

I did try to take a few online courses last year, but wasn't able to focus. The pain meds pretty much put me in a zone. Yes, I can drive, but the pain can be excruiating.

After reading my rating decision, (which I understand more thanks you awesome vets!) I will have my SC reviewed after the temp 100% ends.

"Do they expect this problem to heal?

Are you asking for higher SC rating for the MDD too?"

My joint is no longer and has been fused, so its permanent. My Dr. told me last week that I could have the main nerve injected with something to stop the pain, but the deformity isn't going away.

The MDD will be secondary to my SC residuals of GSW to R 1st metatarsal phalangeal joint (it was an accident!)

"I lost my job 09/06 because my company wouldn't keep me on light duty and I wasn't qualified for FMLA"

Do you have documented proof of that in your personnel record at this place?

Yes, I have proof from an unemployment claim that I submitted, also emails from when I worked there and have completed the 21-8940

Then again-the foot problem could be temorary TDIU? With more treatment? But the MDD is another story-

TDIU would be fine, I want to work, I'm a single parent (daughter leaves for AirForce B.C. on June 12th) and only want to get my life back together. Hopefully the pain clinic can solve my pain... but the depression is aweful. Just sucks me down into a crappy dark spot...

CAn you tell us what VRE means?

VRE stands for Vancomycin-resistant enterococci .. everyone has it, but from what I understand it can be transmitted just by touching things (everyone.. please wash your hands good if you go to VAMC or any other medical facility).

It can cause serious complications in persons who have low immune system.. I would say that it's a step below MSRA infection.

I was treated for it while inpatient, but I'm very resistant to most antibiotics, I just had another test on tues. so we shall see!

http://www.cdc.gov/ncidod/dhqp/ar_vre.html

[Berta]

I feel you have excellent evidence-

did you tell them of the affect of those meds for SC that prevent employment?

like Do not take and drive, causes confusion ,drowsiness. etc-

GSW-I assume the GS passed through a muscular group? As well as bone structure?

Is there painful scarring?

Did they SC and rate the GSW already?

[Berta]

forgot-

Is the 10% SC for the GSW?

[snoopy4666]

Yes, the 10% is for the SC GSW. The main surgery of 07/06 was for a scar revision, but after all the infections/surgeries, the scar is pretty bad.

The GS went through my r great toe joint, and clipped off half of the joint bone (it was a .45 cal) 1986 - Please don't ask how this happened.. it WAS an accident.

After reading my rating decision, it is showing that they will rate my SC after the temp 100% ends?? which I am not sure when this will be.

[Berta]

Veteran- I dont need to know a thing-

I do not doubt you at all.

I am GLAD the GSW is already SC- I began to worry about that-didnt know if that was awarded yet or not- Good-

Also the Temp 100% can be continued up to a year of the medical evidence supports that-you have to apply for extentions- however- seems to me they would make a TDIU decision and it should be P & T-based on the info here here and that it cannot be fixed-

and the TDIU hopefully could come to coincide with the end of the 100% temp comp-

hard to say what the VA will do at all veteran-

Lets hope it all goes OK- when they consider TDIU.

Thank you for your service!

[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

[snoopy4666]

So then, I am supposed to call and get the questionairres?

Also, when I'm asked an occupation, are they referring to the present or past employment occupations?

Do they have different questionairres for each ailment?

[betrayed]

So then, I am supposed to call and get the questionairres?

Also, when I'm asked an occupation, are they referring to the present or past employment occupations?

Do they have different questionairres for each ailment?

Do they have different questionairres for each ailment? yes pretty much

when I'm asked an occupation, are they referring to the present or past employment occupations? current is what I would do

So then, I am supposed to call and get the questionairres? If you want to follow my advice yes call or drive to the VAMC Where your gonna get the C&P and pick them up, I know this seems like a pain in the rear but the outcome will be worth it

[snoopy4666]

Are these standard forms? Can I find them somewhere online?

[betrayed]

Are these standard forms? Can I find them somewhere online?

not they I have ever found.

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.

http://ecfr.gpoaccess.gov/cgi/t/text/text-....1.1.5.2.109.72