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60 Second Exam, Rude Doctor, Total Denial Despite 20+ Years Of Civilian Doctor Visits


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#1 skydealer

 
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Posted 27 April 2012 - 01:42 PM

This past August I filed a VA claim. The issues were on items that I occurred while I was in the Air Force back in the early 1980s. These are not just things that were in my military records – the items I claimed were for chronic issues that I have spent thousands and thousands of dollars on medical bills over the past 30 years on. I never knew about being able to get the VA to take care of problems that arose while I was on active duty until recently or else I would have filed a long time ago.

I received a head trauma back in ’83 and have been seeing doctors and neurologists for constant headaches, memory loss and insomnia since the injury occurred. While I was in the service I was seen for chronic headaches after the trauma and the military records also reflect this. I also had pneumonia and developed a chronic cough. These are items that I have seen doctor after doctor about. The problem is that, even though I have over 100 pages of medical visits, they could never nail down a clear diagnosis… one doc said chronic sinusitis, another said it was chronic bronchitis, etc etc.

So, last summer I filed a compensation claim on these issues, along with a few others that were in my records that I have had to see civilian doctors on.

I truly had the CP doctor sent from Satan himself. At the beginning of the visit, Dr. Ngwa introduced himself and we shook hands. He sat down and started reading that I am being seen for chronic cough, chronic headaches, chronic bronchitis, etc., and the more he read the mode upset he became. I then received a five minute lecture on how this was a legal procedure and how dare I file something like this.

I had also sent in a copy of my civilian records as well as authorizations for the VA to retrieve any medical records directly. Dr. Ngwa said these did not exist (despite the fact that I did send them in over a month prior) and refused to acknowledge any existence of civilian records. He got even angrier when, after he accused me of hiring someone to fill out the claim form (of which I did NOT), I told him the phrases I had used, such as “chronic lung condition” and “bilateral knee pain” was straight out of my civilian records. He spoke with a heavy accent and I had to have him repeat things so I could understand, this also made him more hostile as we spoke.

The next 20 minutes were spent with me just sitting there while he typed away on the computer. From what I saw he was actually typing up the denial while I was sitting there and before he actually did any exams or any test results came in.

Eventually, he finally did get around to an actual physical exam – spending less than 60 seconds to exam my feet, legs, hands, and everything else.

A few months ago I asked the VA for what Ngwa reported. It turns out he shot down everything saying there were no issues. He answered questions on the report that he never asked me, such as items regarding my headaches, and on other incidents he did not actually report what I told him. I mentioned that I was on antibiotics 5 or 6 times for bouts of bronchitis and pneumonia in 2011 – he stated that I said I was sick twice last year.

So, everything was denied with the reason of “The evidence does not show a current diagnosed disability” with the exception of the chronic sinusitis, which stated there was no event in service. I had been in sick call at least 5 times for cough/fever/sinus problems.

I did not argue back during the exam and I kept my cool. He was insulting, even congratulated me on creating a whole new disease called chronic left leg syndrome (he was being sarcastic) and when we walked out to the receptionist to set up a breathing test I thanked him for his time and put out my hand. He looked down at it and turned his back and walked away. The receptionist and I just looked at each other in disbelief.

So, how does one appeal a mess such as this? A total “hands on” exam of less than 60 seconds? After getting a denial letter I went to the DAV, who told me that I needed to get letters from my doctors before they could do anything. You know how hard it is to get a NEXUS letter? Cripes, it was hard enough in the past to get them to do FMLA paperwork for my civilian job.

I did talk to the VA Patient Advocate and I stated that I wanted to file a complaint with the IG on the issue, but other people told me that if I did so I would be screwed for years on the claim.

How should one repeal something like this crap?? Should I just ask for a whole new CP exam? Should I get a lawyer?

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#2 Pete53

 
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Posted 27 April 2012 - 04:42 PM

First welcome to Hadit and thank you for serving. A bad C&P can be overcome. You will need to appeal the decision and if it was me ask for a hearing. Take the decision and go through the reasons you were denied.A current diagnosis is required. It should be a medical opinion that you have for the diagnosis and hopefully the Doc will link it to your service.

#3 john999

 
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Posted 27 April 2012 - 05:00 PM

What Pete says and you need an indpendent medical opionion of your own to rebutt what this witch doctor has said about you.

#4 sharon

 
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Posted 27 April 2012 - 07:55 PM

If at all possible, you need to post the Reason for Decision in order for us to look at the whole picture.

#5 Teac

 
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Posted 27 April 2012 - 11:17 PM

Your mistake was not obtaining a independant medical opinion.... claims for service connection are often very hard to prove... in your case your service was 30 years ago and that itself makes the claim harder to prove.

No veteran should ever go to a C/P exam or submit a claim without already having a nexus from their own doctor. When a veteran fails to provide an opinion they are leaving it up to a va hired examiner to decide their status. Now you would not expect a va lawyer to fight for you.. so why would you trust a va examiner to take your side.

Another problem that is very common and you pointed out was dealing with a foreign born doctor who spoke English so poorly or with such a thick accent that you had to ask him to repeat what he was saying over and over again. Couple the language barrier with only having a 5 or 10 minute exam and no medical records to review ... well the outcome was predictable.....

You can overcome this by filing a request for a decison review officer.... indicate that the exam was inadaquate and request a new exam, also indicate that the doctor did not have the medical records to review. And more inportant than anything else get a independant medical opinion that clealy shows the conditions you claims begain on active duty. Unless you get a opinion you are just wasting your time. Remember not only do you now have to prove service connection, but you have to overcome the denial based on the inadquate exam and the only way to overcome the examiners opinion is to create doubt by providing a statement that indicates otherwise.

Keep in mind the statement must state that the doctor reviewed your active duty medical records, and that you are now receiving treatment for the conditions claimed. It must state that it is at least as likey as not that the
conditions you have now are related to problems you had on active duty. Also the medical opinion must be justified by the medical record.

Welcome to hadit, and the best of luck...

#6 Berta

 
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Posted 28 April 2012 - 07:45 AM

You got good advise here but it would help to see the actual Reasons and Bases as well as the evidence list.
(Cover any personal stuff)as you have a lot of private medical evidence that VA might have acknowledged they got, but did not use in the decision.

"After getting a denial letter I went to the DAV, who told me that I needed to get letters from my doctors before they could do anything."
Yes and that is the general consensus here too.

"You know how hard it is to get a NEXUS letter?" IMOs doctors do that all the time with the veteran's SMRs and enough in the SMRs to warrant the "at least as likely or not "statement.

One of your private docs, with the IMO criteria that is here in the IMO forum , and a cover letter explaining to them what type of IMO you are seeking, might be willing for a small fee to prepare a letter for you since they treated you in the past. I know vets who even got freeby IMOs from their private docs and I go a freeby IMO from a former VA doc who treated my husband. It was only 2-3 sentences but the VA gave it as much weight as the 4 thousand worth of additional IMOs I had.


"I did talk to the VA Patient Advocate and I stated that I wanted to file a complaint with the IG on the issue, but other people told me that if I did so I would be screwed for years on the claim."

I have filed many complaints with the IG but as far as my claims went, VA managed to screw them up prior to and regardless of my IG complaints.

"How should one repeal something like this crap?? Should I just ask for a whole new CP exam? Should I get a lawyer? "

As others said, a strong IMO will help you.
A lawyer would probably suggest getting one too.You can sure push for a new C & P exam but the results of that one might not help you either. Hard to say.....

There are many private docs willing to prepare an IMO but don't have a clue on what the VA really needs.
If your private docs are unwilling to consider the IMO criteria the VA needs followed, in the IMO forum here, best to google for a good IMO doctor who is familiar with the VA.

My IMOs in addition to the freeby ,came from Dr. Craig C Bash,who used to work for the VA.

Although his field of expertise is NeuroRadiology, and not diabetes (Endocrinology)-the basis of that claim- he opined with a complete medical rationale on my husband's undiagnosed and untreated DMII from AO and overcame a VA Endocrinologist's opinion. I knocked down a subsequent PA opinion from VA .

The award was due in part to Dr Bash's statement to VA that he had seen similar multiple brain trauma as revealed in my husband's MRIs as in "thousands" of diabetics ,whose X Rays and MRIs he had studied and then supported that further with references to my husband's MRI and autopsy results.

Are you claiming TBI as brain trauma from closed head injury?

Do your SMRs reveal not only the cause of the injury but subsequent treatment for it?

Edited by Berta, 28 April 2012 - 07:51 AM.


#7 skydealer

 
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Posted 28 April 2012 - 12:14 PM

My thanks for everyone here for all the information and guidance.

I didn’t claim TBI specifically, I wrote down chronic headaches because that’s what I have been seeing civilian doctors for. There is also mention of short-term memory loss, also known as altered memory. I only used lingo that was spelled out in my civilian records. The problem that I have run into over and over with civilian doctors is, while they acknowledge that I have a constant cough and develop annual sinus infections to pneumonia, none of them can say why for sure… just that it has been present for decades.

As far as the head injury and chronic headaches: I never even put two and two together until I had asked for copies of all of my medical records going all the way back to the military. It flat out mentions in there that I started going to sick call for constant headaches a month or who after head trauma. I’m seeing a neurologist now and have updated him on what I found out about my medical history.

So my Service Medical Records do show the incident where I was hit in the back of the head and also shows a couple of visits to sick call.

17 Sep 83 – SMO states incident where I was struck on back of the head and was knocked out.
15 Nov 83 – SMO shows me complaining of 3-4 weeks of headaches. Lights and noises make it worse. Fiorinal (used to relieve tension headaches) was prescribed.
30 Nov 83 – SMO says follow-up on headaches. “Better but still has occasional dull headaches”. Looks like I had a CT and it was normal. Odd how I still don't remember any of that.


Unfortunately, I could not get any of my civilian records prior to the early 1990s, but I do have a long history of seeing many doctors for the headaches (and cough). Unfortunately, none of them could nail down just why I was having the constant problem. Which is why it’s been so difficulty to provide a civilian diagnosis. I have tons of paperwork showing I’ve been complaining of these issues – it’s just that no one has been able to nail down exactly why they are happening.

The bottom line appears to be getting an IMO, of which I have requested from one doctor so far and will be asking the neurologist as well as I see him next week. Seeing the VA is so backlogged on claims, should I submit the appeal now or wait a few months once I get an IMO? Also, it better to appeal everything en masse or separately? I.e – file an appeal just on the headache issue and another on the lung/sinus?

#8 carlie

 
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Posted 28 April 2012 - 03:32 PM

If at all possible, you need to post the Reason for Decision in order for us to look at the whole picture.


Ditto -

Without knowing the VBA's exact wording - anything is just a guess.

#9 skydealer

 
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Posted 28 April 2012 - 11:21 PM

Ditto -

Without knowing the VBA's exact wording - anything is just a guess.


Pretty much all of the denials shows the denial reasons of "The evidence does not show a current diagnosed disability". This was in the letter I received. I also obtained the blue sheets signed by the ratings rep., this is what the DAV received. The blue sheets are all marked NODX - not service connected, no diagnosed.

I just noticed all of those - not service connected? That's not what my service records show.

There's a line in the evidence which says "Your service treatment records are incomplete for review". This falls back to a letter I got last fall from the VA which said that my service medical records were missing but they had them during the CP exam and I had sent them an additional copy as well. This is turning into a real paperwork snafu.

#10 carlie

 
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Posted 29 April 2012 - 11:41 AM

Pretty much all of the denials shows the denial reasons of "The evidence does not show a current diagnosed disability". This was in the letter I received. I also obtained the blue sheets signed by the ratings rep., this is what the DAV received. The blue sheets are all marked NODX - not service connected, no diagnosed.

I just noticed all of those - not service connected? That's not what my service records show.

There's a line in the evidence which says "Your service treatment records are incomplete for review". This falls back to a letter I got last fall from the VA which said that my service medical records were missing but they had them during the CP exam and I had sent them an additional copy as well. This is turning into a real paperwork snafu.


Well, there does have to be a currently diagnosed disability to get it SC'd.
What conditions did you file a claim for SC ?

If these conditions are SC'd at a later date due to newly found/discovered SMR's,
then you can get an earlier effective date per 38 CFR 3.156c.

#11 carlie

 
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Posted 29 April 2012 - 11:46 AM

So my Service Medical Records do show the incident where I was hit in the back of the head and also shows a couple of visits to sick call.

17 Sep 83 – SMO states incident where I was struck on back of the head and was knocked out.
15 Nov 83 – SMO shows me complaining of 3-4 weeks of headaches. Lights and noises make it worse. Fiorinal (used to relieve tension headaches) was prescribed.
30 Nov 83 – SMO says follow-up on headaches. “Better but still has occasional dull headaches”. Looks like I had a CT and it was normal. Odd how I still don't remember any of that.



Unfortunately, I could not get any of my civilian records prior to the early 1990s, but I do have a long history of seeing many doctors for the headaches (and cough). Unfortunately, none of them could nail down just why I was having the constant problem. Which is why it’s been so difficulty to provide a civilian diagnosis. I have tons of paperwork showing I’ve been complaining of these issues – it’s just that no one has been able to nail down exactly why they are happening.

The bottom line appears to be getting an IMO, of which I have requested from one doctor so far and will be asking the neurologist as well as I see him next week.


The doc that does your IMO needs to be able to review these SMR's and support their link
of their the current diagnosis (with full medical rationale) to what is in your SMR's.
JMHO




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