How to handle the Veterans Affairs C&P Physical

By the Major

Before a veteran can be rated for a disability, he must be given a C&P physical examination.

This exam has a big effect on the overall rating a veteran receives. Many veterans organizations suggest the veteran gets a an alternative physical exam from a physician who is both licensed in a particular state state and is also board certified.

Your private physician can be used to refute the VA physicians' physical examination because the VA medical staff tend to damn the veteran they are examining “with faint praise and errors of omission.”

In fact, The VA has a Physicians Guide which defines how the VA doctor is supposed to conduct the physical: see http://www.hadit.com/forums/index.php?showtopic=3757. This guide includes work sheets for specific medical conditions.

However, The Major has yet to see a VA medical person who follows this guide or the attached worksheets. The C&P physical is important because the VARO staff uses it when they make the rate the claim.

What is you doctor's credentials? 

Many of the VA C&P medical staff are not doctors, but are internists who are unlicensed in the state that they work in.

Those who are doctors are usually primary care and have have specialties that may be irrelevant to the medical condition that you are being examined for.

One of the doctor's who examined The Major was not licensed in the state of Florida or board certified; and the two other medical staff that he is scheduled to see for physicals are Physician Assistants (PA).  The doctor who recently examined me has a specialty in Adolescent Medicine.

Accordingly an exam by a private physician who is state-licensed and board certified should carry more weight with with the local VA Regional Office (VARO) and the Board of veteran Appeals (BVA) than the physical performed by a VA internist or a PA.

This will certainly be the case if you appeal to and administrative law judge on the Board of Veteran Appeals. Most of the judges understand the difference between the opinion of a VA medical person with limited credentials and a board certified physician who is licensed in a state.

In my last physical examination, the VA doctor forgot to take my pulse, stated that I had “retired form my last job” which was false, said my abdomen exam was normal although I have an abdominal hernia, didn't list the medications I take for my medical condition, and didn't mention my recent ER hospitalization for my medical condition.

The internist also failed to list the side effects of the medication I take. He also suggested I was ambulatory although I reported to his room using a walker.

Fortunately I got an endocrine physical from a Florida licensed and board certified endocrinologist that I have sent to the local VARO to correct the record on the C&P physical exam.

Where is the c-file?

Under current regulations, C&P examiners are required to read your VA claims file (c-file) before conducting the exam. Your VA c- file should be in the examining room when the exam is conducted.

Failure of the doctor to review the claims file can be grounds for you to claim that the examination was unsuitable for rating purposes. See The National Veterans Organization of America. SELF HELP GUIDE (2003) www.nvo.org/vainfo/selfhelpguide_claims.pdf

Ask your VA medical staffer if the c-file is in the examination room? Or you can call your Representative in the Disabled Americans Veterans, American Legion or other non-governmental Veterans organization where you c-file is on the day before the physical. After the physical, visit you veteran representative in the VARO and verify the location of the c-file. If the c-file in not in the room, the C&P physical exam can be invalidated.

Also, call your state department of health (DOH) or Department of Professional Regulation (DPR) and check out the VA medical persons credentials. Find out of the physician is licensed in the state, whether they are board certified, and what their specialty is. If they are not licensed in the state, have the wrong specialization, or are not board certified, it will be easy to discredit their opinions in front of a BVA administrative law judge.

After the VA loving on the C&P is over 

After the VA Medical Center (VAMC) medical staffer has completed the physical, check with the closest VA clinic to see if the C&P physical is in your c-file. You will need to file a Freedom of Information Act (FOIA) Request to get a copy of the physical and may have to travel to a regional center to file the FOIA request.

Also, be aware an FOIA request is different than a Privacy Act request. The privacy act office is usually in the VARO while the FOIA office is usually in the VAMC.

To see the details on your disability such as percentages and the diagnostic codes (DC), you need a special report called a 'Rating Decision.' The rating decision lists all of your DCs that are service connected and the percentages awarded for a disability. You have to request this report through the Privacy Office. Rightardia recommends that veterans request this report every year or after a disability rating changes.

Even more important, review the VA C&P Progress notes from the medical person who performed the physical exam. You can counter any errors of omission or factual errors in this document and send this to the VARO so the rating officer sees your concerns.

You can also have your private physician review the VA C&P Progress notes for comment. This may take time because most physicians will take two to four weeks or more to respond with a letter.

Selecting a doctor

Find a cooperative private doctor who follows the Hippocratic oath.

I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement: 

To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art. I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone. 

I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion. But I will preserve the purity of my life and my arts. I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art. In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves. 

All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal. If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot. 

There are also some ideological doctors who are conservative and believe if you are applying for a VA or Social security Disability, that you are probably a welfare cheater. Find out if the doctor will help you during the first appointment. If he or she won't, find a doctor who will consider the facts of your case and who has a blind eye to conservative ideology. Find a progressive mensh rather than a conservative nebbish.

Rightardia makes no secret of the fact that we are a progressive blog. We suggest you also use Democratic congresspersons and Senators to help you with the claim. The Major had little success with the first Republican congressman. The second GOP congressman was better and at least filed congressional inquiries and provided responses.

The Major now has a Democratic senator helping him with his claim and he is a lot happier with the efforts of the Democratic staffers of Senator Bill Nelson.

Again Democrats are usually been more helpful with constituent needs than Republicans who like to kowtow to the affluent and the corporations.

Addenda: Two heads are better than one during a C&P physical. Bring your spouse or significant other along as long as you have sent a letter to the VA doctor prior to the physical. See the sample letter that follows:

Under the Title 2 of the Americans with Disabilities Act and Section 504 of the Rehabilitation Act (1973), I request the following accommodation(s) during my C&P physical exam on :

that my wife/spouse, significant other, _______________ shall accompany me to your examination room and assist me during the physical exam in your room. I have disabilities and his/her presence is essential for me to be able to properly complete the examination and to communicate with you.

I will assume that you are granting this request unless you contact me otherwise with a letter or email. 

C&P advised me that I needed to contact you directly on this matter prior to my appointment. It is my express hope that that you will favorably consider this request.

Sincerely,

veteran's name

Subscribe to the Rightardia feed: feeds.feedburner.com/blogspot/IGiu Netcraft rank: 13506 http://toolbar.netcraft.com/site_report?url=http://rightardia.blogspot.com