Can You Bring Your Spouse & Tape/video Recorder To A C&p Exam?

[tssnave]

Does anyone know if there is a regulation, training letter, SOP, or other documentation that either allows or prohibits a veteran from having another person such as a spouse present during a C&P exam?

Are there exceptions in the case where the disability (like a mental condition or physically incapacitating illness) makes it difficult for the veteran to advocate for themselves?

Is there a regulation, training letter, SOP, or other documentation that either allows or prohibits a veteran from tape recording or video recording a C&P exam?

I thought about calling and asking the patient advocate at the outpatient clinic that did my C&P exam but given some of what I’ve read on hadit I thought I’d run it past the members here first to see if anyone could give me the straight skinny along with what and where I could find the governing regulation.

As always, thanks for your assistance.

ts

Edited April 19, 2007 by tssnave

[betrayed]

"Medical Power of Attorney" means that whomever has this "Power of Attorney" has the legal authority to make decisions concerning your health care if you are unable to do so.

I disagree with your statement in part, depending on your condition, lets say your like me, you have severe depression and PTSD, the depression causes a lack of memory and thats a medical fact, then you take narcotics and tranqualizers well that kind of destroys your memory also.

concerning your health care if you are unable to do so

Due to my mental condition I am unable to speak for myself at times, like when under stress ie a C&P Exam.

In my case it is imperative that my wife accompany me and help me out during these times. My wife has been allowed in every C&P I have had.

Like I said the other day it helps quite a bit to grease the skids, call the C&P office talk to them explain your situation and the fact that your spouse has a medical power of attorney on file at the VAMC, and you expect them to accompany you inside for the C&P. Then ask is that going to be a problem, if they say I dont know, say will you please find out I will call you back in 3 days. Make sure you write down their name. This has worked for me every time, including my initial PTSD screening (4 hours) in the mental health clinic. This way there is no surprise for the doctor, nor one for you when they say she cant come in.

My other advice to you (I assume you have C&P's coming up) 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!!!!

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 April 21, 2007 by BETRAYED

[LarryJ]

I don't know what part of my statement you are disagreeing with.

I stated that if you are unable to make decisions concerning your health care that the person with your POA has the legal authority to do so. If you are incapacitated, either physically or mentally, then I would think that that would be enough to allow them (the person with your POA) to help you make those decisions.

Does this POA gain entrance to your physical or mental exams? No, not unless you are bad off enough to require the above mentioned assistance.

Does this POA gain this person the right to your medical records? No.

Does this POA gain this person the right to make medical decisions in your stead? No. Not until you are unable to make these decisions for yourself.

And, as far as someone has stated that his wife and his children all have his POA....I find that that could be very counterproductive and, in case of disagreement between the wife and the kids, could actually interfere with your care until a legal decision could be reached. Of course, we all know that that would never happen..................

[tssnave]

Thanks, everyone, for your feedback. There were some great points made.

I can see where having someone in the room could keep the veteran from fully disclosing their condition depending on the stability and quality of the relationship (and I'm blessed to have a good marriage and like other soldiers, my spouse has had POA for other legal/financial matters for years).

However, in the case of a VA C&P exam, especially if it is a second exam ordered after sending in an IMO, then I definitely think having a spouse in the room, and I liked the idea of them having a notebook, would be in the veteran's interst. I find it interesting that apparently different VA medical centers have different approaches to this issue. Some have had no problem, some have had to hold their ground to get the spouse in there, and some have been denied. So much for a central, governing VA policy that everyone follows.

I plan to call the outpatient clinic next week. I'm interested to hear what they have to say. I'll keep everyone posted on what they tell me and what plays out if I do get called for a second C&P exam.

Has anyone ever gotten a questionairre for mental disorders (NOT for PTSD) prior to a C&P exam? I agree with Betrayed that it sure would be nice to be able to write everything down beforehand on a form they had to accept and place in your file.

I have mentioned on other posts that I tried to give the C&P examiner documentation that showed my unemployability but she refused to take it because her report was sent electronicly to the VA and she said she had no way to give them papers so even if there is a mental disorder questionairre I doubt she would take it and enter it into evidence.

Thanks again for the feedback,

ts

[Testvet]

the rules say they are supposed to have your C File in order to do a proper C&P exam, without it how can they do the records and treatment records they are supposed to read prior or during the C&P, if the C File isn't present it isn't a proper exam. I have had to do more than one C&P over because they didn't have it and I made sure the Doctor noted it on the C&P paperwork he was filling out. Normally they rescheduled the new exam within 2 weeks and they always seemed to have the C File there for the new exam.

[allan]

>This way there is no surprise for the doctor, nor one for you when they say she cant come in.

I didn't realize it was a privalage at the examiners discression?

I was under the impression it was a RIGHT of all veterans to be attended to by their spouce.

Guess wen the examiner yelled my name & saw my wife of 33 yrs walk up with me he yelled again. "you can just have your lady friend sit down"

I walked straight to him & said,"my wife acompanies me, or I leave. It's your choice"? I didn't have any more disrespect after that.

Maybe the examiners need to get their crap together & learn a law governing, VETERANS RIGHTS. One of them says, that at "ALL" examinations, Veterans have the right to be accompanied by their spouce.

Maybe the examiner could learn to respect that right & extend a hand & introduce themselves. If they lack manners, maybe examining our dsabled vets isn't for them. Maybe washing dishes in some dive bar for minamum wage would be better?

Just a thought!

[tssnave]

Allan,

Do you have a link to the Veteran's Rights that you mentioned stating that veterans have a right to have their spouse attend ALL examinations? That would really be helpful. It amazes me that he would call your wife your lady friend. I agree with you - no manners whatsoever.

TestVet,

I asked if the doc reviewed my C-file during the C&P exam. She pointed to it on a chair and said she'd read it and spoke to some things in the file. It didn't strike me until later that they had to send the physical C-file back to the VA so why couldn't they send the paperwork I wanted to give them? I figured it doesn't really matter since I send everything through the DAV to make sure there's a record of me sending it and the VA getting it.